Theme | Subtheme | Quotation |
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Definition of high BP is not based on the BP value alone | Demographics | No value, background. There is a formula to screen for hypertension and pre-hypertension. Age, history but it is hard to do in retail 120/80 is the average but it fluctuates between gender, age, weight. Depends on the person |
Comorbidities | Depends if they don’t have any diabetes or kidney disease. If no diabetes 140/90 or if diabetic, have kidney disease or heart disease it needs to be under 130/80 | |
Guideline used | Depends on which guidelines you follow. ADA guidelines look at diabetes, age. They say 140/90 for diabetics. If not ASCVD risk, if healthy 150/90 but I don't go through everything. ASCVD, JNC7, could follow those too. Controversial topic, diabetes linked to hypertension | |
BP consistently elevated | Depends…if it is a first reading or if it is always above 140/90 | |
Pharmacists will converse with the patient and assess the situation prior to providing advice | Troubleshoot (encourage to relax and retake BP) | First I try and calm them down, try to retake their blood pressure in 5 min Sometimes I manually check, calm them down, retake it I tell them to relax and retake it. They could be sort of pacing, sit for 10 min then go to the machine Have another reading. Running around, stress makes it go up sometimes |
Review events prior to blood pressure taking | Did you walk? Have coffee? Did they just exercise or drink coffee? Because that will elevate it. The reading is just a snapshot of that moment | |
Discuss lifestyle (diet/exercise) | Before the readings I discuss their diet and lifestyle | |
Review medical history and medications/medication compliance | I go over their diagnosis, medications, their history Ask about medications, sometimes medications need to be added Some have high blood pressure medications, are they using any blood pressure medications? Are they taking medications as prescribed? | |
Assess symptoms | They have a headache sometimes. Go through all of that I ask about symptoms, headache, that is concerning | |
Advice is patient specific and dependent on various patient factors | BP reading/value | Changes with whatever reading they have. If above 170 to ER. If it is lower, I give them pharmacy and non-pharmacy advice Check with doctor unless it is really elevated then urgent care Depending on where they stand…If it is quite high, I advise them to see their family doctor or go to urgent care. If it's not that high, come back and retake it in the afternoon |
BP consistently elevated | He said 150/90 [BP reading], I said that's fine but if consistently high go to the doctor If it is high all the time, I tell them to go to their doctor | |
Symptoms | Check up with family doctor if they do not feel well, tired | |
Medications/history of HTN | Tell them to follow up with their doctor if medications need to be changed It depends [advice]. Are they on blood pressure medications? | |
Advice/interventions provided are multifaceted | Reassurance/education | A lot of times it is 130 or 120 and they freak out. That happens often…[I] provide hypertension education, what is high Tell them caffeine intake can increase blood pressure if they had it a half an hour before. A full bladder can raise it too Anything over 135 is high on the machine so they come running. “No man, it isn't high. You're fine” The machine is not as accurate as the doctor's office. The cuff size is standard here…Blood pressure is dynamic, not just one reading |
Monitor BP/keep logbook | Tell them to keep a log of their readings Record blood pressure a few times Monitor it | |
Lifestyle changes (diet/exercise) | I tell them what they can do to lower it, decrease salt, increase exercise I tell them about how to change their diet and exercise Do they eat salty food or any canned food? Tell them to avoid it | |
PRN medication administration | Some have blood pressure medications, fast acting that they take if their blood pressure is high. We tell them to take it | |
Seek medical attention | I advise them to see their family doctor or go to urgent care It is better to speak with a doctor to be monitored Make an appointment with your doctor | |
No store/governing body policy for pharmacists to follow when providing advice to patients with elevated in-store BP readings | Professional knowledge used to guide advice | No policy but what I know from my profession, my knowledge No [policy], just professional judgement and obligation. If they have an elevated reading and ran out of medications I have to record their blood pressure in record if refilling blood pressure medication and I have to call the prescriber |
Familiarity/comfort with patient guides advice | Regular patients, look at their history, medications. If not a regular patient [I] send them to urgent care to get a check up No [policy], individualized, how much I know them. How many times they have taken it in a row [BP]? Do they have high blood pressure? | |
Follow a HTN guideline | [I] follow current guidelines but there are 3. There is no in-store policy per se, they just want us to follow one of the guidelines No, not really [policy]. Guidelines you can follow though | |
Advice is pharmacist specific, have their own set of rules/guidelines | No, all pharmacists have their own. You may get different advice from different pharmacists No policy. Set of rules to follow. No exercise, sitting down, no speaking, rest, no caffeine for a half hour to 1 hour before taking blood pressure No policy. Just ask about any medications, conditions, allergies. Nothing specific [in terms of policy] | |
Referral process to the ED is dependent on several factors | Symptoms/presentation | Symptoms. Dizzy, not able to walk, tired, headache If they feel their heart beat higher, you have to consider heart attack. If they are tired or don’t feel well Someone grabbing their chest saying “I am having a stroke” I would think those patients go straight to the emergency department Experiencing any other symptoms, lightheaded and dizzy Symptoms, feel dizzy, feel like having a headache, tend to ask to go to emergency…have a buzzing in their ears Headache, vision change, I suggest to go to the emergency department. See a doctor right away |
Severity of BP value | One time it was 200/140 so I said “do you need me to call 911 for you?” Over 180 or 190 to emergency department or urgent care 180 plus or diastolic well over 100 [to ED] If really really elevated, stroke level…I don't know how much you know about hypertension but not everyone has symptoms when their reading is high so it depends. Someone with a high reading could be having a stroke Doctor's office unless it is over 180, then go to the hospital. That is an emergency Cut-off 200s. Straight to emergency, or maybe 190, close to 200. They need to see a doctor sooner than later | |
BP consistently elevated | If it is consistently high go to emerge, it is always there | |
Factors potentially contributing to elevated reading | Gather more information. They missed a dose [medication]? Had caffeine or walked far? Just talk to them | |
Access to/availability of a primary care practitioner | Urgent care or emergency department if they don't have a primary doctor Call their prescriber, their regular doctor and see if they can order a one-time dose of something. I've had that happen before too. But if not, and over 180 or 190 to emergency department or urgent care | |
Presence of comorbidities | Sometimes it is their blood glucose reading. Like if it is over 300, call 911 | |
No past medical history of HTN | If they don’t have a history [HTN] then definitely tell them they need to get it checked out now [urgent care or ED] | |
Weekday vs. weekend | One case around 180–190, called the ambulance, it was a weekend, I couldn't let her go | |
Familiarity with patient/access to drug profile | If I have their profile, I will change their medication dose [increase it] and tell them to see their doctor [as opposed to advising them to go to the ED] |