Research Profile - The Rural Advantage

Because small town doctors, nurses and pharmacists often know each other outside their jobs, building teams to identify and treat chronic diseases early – before major problems develop – could be a key to better health.

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When it comes to having pharmacists play enhanced roles in chronic disease management, a small town may be the best place to think big.

"In rural communities, the physicians, pharmacists and nurses usually know each other," says Dr. Ross Tsuyuki of the University of Alberta. "They golf together or their kids go to school together, so you can take advantage of those established relationships."

With friendships already in place, building primary health-care teams in which pharmacists work alongside doctors and community nurses to identify patients with chronic and often undetected conditions such as high blood pressure (hypertension) presents fewer obstacles than it might in a metropolis, says Dr. Tsuyuki, who leads the Rural Alberta Clinical Trial in Optimizing Hypertension (Rural RxACTION).

"We're talking about a different way of working together, and the key is engaging pharmacists to help take care of patients. You want them to be doing that as part of a team and enhancing what everyone else is doing. It's doable in a big city, but it's a lot harder."

Funded by the Canadian Institutes of Health Research (CIHR), Rural RxACTION will evaluate changes in blood pressure among patients who are prescribed anti-hypertensive therapy by their pharmacists in 14 rural communities. It is fitting that the randomized controlled trial should be happening in Alberta.

"We have a unique situation here in Alberta," says Dr. Tsuyuki, "because the province was the first to give pharmacists the ability to prescribe. This will be the first randomized controlled trial of pharmacists' prescribing. Because this is new, we need to evaluate it to see if it improves patient outcomes."

Screening for high blood pressure and getting it under control are important in avoiding major cardiovascular problems such as heart disease and stroke, but because the condition has no symptoms, it often goes undetected and untreated. Hypertension is a problem in both urban and rural centres – about 4.6 million Canadians between the ages of 20 and 79 have high blood pressure – but dealing with it in smaller centres can present unique challenges.

"We know that family physicians in rural communities are really overworked because they have staffing issues, says Dr. Tsuyuki. "So it can be quite difficult to get in to see your family physician. We think having pharmacists practice to their fullest potential will offload some of the physicians' workload and that patients are going to be happier."

While the Rural RxACTION study is still in the recruiting stage – 110 participants of a total 340 have been signed up, along with 17 pharmacists – Dr. Tsuyuki expects enhancing the role of pharmacists will prove to be a win-win for doctors and their patients.

"Our feeling is by engaging people in the community who are really accessible, like pharmacists, you have a chance to do more prevention and public health programs. That's where we think this is going."

"We're talking about a different way of working together, and the key is engaging pharmacists to help take care of patients."
– Dr. Ross Tsuyuki, University of Alberta