LAUSR

Objective: Repeat prescribing(RP) for patients with well-controlled hypertension(HT) can be understood as repeating medication prescription to a patient without a direct doctor consultation taking place. RP is an uncommon practice in Hong Kong(HK). This study aimed to determine if RP by nurses could lead to non-inferior disease control in patients with well-controlled hypertension when compared with usual care, and if RP was acceptable and safe to these patients. Design and method: Patients with well-controlled hypertension, with no change of anti-hypertensive medication in the previous year, not being pregnant, and with no cardiovascular complications were recruited. Participants were randomized to intervention group, who received RP and brief meeting with nurse, or to usual care. Participants in both groups were scheduled for clinical follow-up visit at a 3–4 month interval till the end of study at 12-month. At each follow-up visit, a nurse in the intervention arm decide whether the patients were in satisfactory condition or needed to refer the patient back to the case doctor based on a pre-developed protocol on HT management. The primary outcome measures were systolic blood pressure (SBP) and diastolic blood pressure(DPB) as measured by automated blood measure monitoring in the clinic at month 12. Two-sample non-inferiority test was conducted to compare SBP and DBP between two groups. Intervention was considered non-inferior if difference of readings were within a pre-set margin of 6.57mmHg. Secondary outcome measures were patient's acceptability and medication compliance. Results: 197 patients were randomized to the intervention group and 203 patients to the control group. The SBP were not statistically different between the two groups (intervention 127.1 mmHg vs control 128.3 mmHg; p = 0.3) while the DBP was minimally lower in the interventional group (invention 73.1 mmHg vs control 74.9 mmg, p = 0.04). Only 3 out of 197 patients opted out of the intervention groups due to preference to assessment by case doctor. Medication compliance and adverse events were similar in both groups. Conclusions: Nurse-led RP was acceptable, safe, and non-inferior to usual care in hypertension management among controlled hypertensive patients. Multi-center randomized controlled study local study is needed to generalize this finding.