A Pilot Collaborative Pharmacist-Physician Practice Improves Hypertension Outcomes in Rural India

Background

In rural India there is a significant shortage of healthcare professionals to address the healthcare needs of the population.

Objectives

This investigation examines whether pharmacists working under a collaborative practice agreement with physicians can improve healthcare outcomes in rural India in a cost-effective manner.

Materials and Methods

Nissi Joseph, a registered pharmacist and pastor, established a collaborative practice with physician Dr. Madhavi Nelluri to address hypertension within his congregation in rural India. Of 74 interested patients, monthly screenings over three months identified 18 as normotensive, 42 as pre-hypertensive, and 14 as hypertensive. Seventeen patients who were unable to afford their medications agreed to receive monthly counseling from the pharmacist in exchange for free antihypertensive medicines. Joseph met with these patients monthly to inform them about their hypertension status, discuss non-pharmacological management approaches and distribute the prescribed medications.

Results

Among 17 patients, mean SBP decreased over four visits from 165±5.9 to 132.6±1.6; DBP changed from 87.1±1.5 to 82.2±1.6, and both were statistically significant at p<0.005. Initially, only two patients had SBP/DBP below 140/90; by the fourth visit, only three patients remained above this level.

Discussion

The economic constraints faced by rural communities are considerable and physician visit expenses including medicine and diagnostics would consume a substantial portion of an individual's income. Follow-up visits are uncommon. The pharmacist collaborative model reported here would provide a cost-effective alternative.

Conclusion

This study shows that pharmacists, working with physicians, can effectively manage hypertension and improve healthcare access for India's rural population.