Table 1.

Program evaluation framework for the pilot study of a pharmacist-led hypertension management service

Aspect of Evaluation	Pre-planning phase	Planning phase	Implementation phase	Impact and Outcomes
Recommended activities and actions	• Identify policies and resources • Ascertain community and epidemiological need • Engage relevant community / stakeholders	• Develop implementation plan • Describe outcome measures • Describe specific strategies	• Prepare timeline • Develop program components	• Assess short-term and medium long impact of program
Activities completed as part of this pilot study	• Hypertension management guidelines identified (i.e., National Heart Foundation) (20) • Health Collaboration Model (HCM) (26) utilised • Liaison with representative GP organisations (i.e., Medicare Locals) consulted • Consultation with advisory group (comprising GPs, pharmacists)	• Study protocol developed in accordance with hypertension management guidelines and HCM (Figures 1 and 2) • Outcome measures defined, including process, clinical, and humanistic measures • Participant feedback to be canvassed via semi-structured qualitative interviews • Pharmacist training program developed (9)	• Timeline for pilot study prepared (Figure 1) • Pharmacist training program delivered (9) • Service resources amassed (e.g., BP monitors) and/or developed (e.g., data recording forms) • Pharmacists supported by Project Officer and investigators with respect to provision of resources, access to information, and assistance with promotion of intervention	• Process measures  - # pharmacists participating in study  - # patients recruited  - uptake of therapeutic adjustment recommendations • Clinical outcomes  - change in systolic BP  - change in medication adherence (MMAS score) • Humanistic outcomes  - change in QoL •Participant feedback  - pharmacist feedback (qualitative interview)  - patient feedback (qualitative interview)
Challenges encountered in study	• Absence of need assessment to identify areas of need / service gaps; over-estimating potential impact of service • Limitation on pharmacists’ scope of practice - inability to independently manage patients or prescribe medication due to current Australian practice regulations • Not well established relationships with local GPs (limited inter-professional collaboration)	• Not conceptualising the initial ‘screening’ step of the study (the initial BP checking step, prior to patient enrolment) as a key part of the intervention • Underestimating the impact of the specific characteristics of hypertension (i.e., asymptomatic, variable), and it's responsiveness of changes in patient behaviour	• Complexity and comprehensiveness of study documents impacting on pharmacists ability to recruit patients and record outcome measures • Pharmacy support staff (e.g., pharmacy assistants) not included in training – unable to assist in patient recruitment	• Small sample size impacting on outcome measures • Challenges encountered in pre-planning, planning, and implementation phases reflected in outcome measures • Lack of feedback from GPs

GP = general practitioner; HCM = Health Collaboration Model; BP = blood pressure; MMAS= Morisky Medication Adherence Scale; QoL = quality of life; # = number of participants