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A project to regularly measure seniors' blood pressure – done in partnership with local pharmacies – is filling a gap in the health-care system. Early successes have led to CSN-sponsored follow-up programs in Ontario and Alberta.

Sometimes an idea makes so much good sense, you wonder why no one thought of it before.

Such is the case with the Cardiovascular Health Awareness Program (CHAP), the brainchild of Dr. Larry W. Chambers, President of the Élisabeth Bruyère Research Institute, a University of Ottawa and SCO Health Service partnership, and Dr. Janusz Kaczorowski, Research Director in the Department of Family Medicine at McMaster University in Hamilton.

Several years ago, the two researchers saw a disturbing gap in Canadian health care: One in three people over the age of 65 have high blood pressure, a precursor of stroke and heart disease. Few, however, seek help because they are unaware or are unwilling to go to their doctors' office just to have their blood pressure checked.

As a result, high blood pressure – which is largely treatable with diet, lifestyle changes, and inexpensive medication – frequently goes unchecked until it escalates to a life-threatening problem requiring intensive and expensive care.

Drs. Chambers and Kaczorowski wanted to find a way of reaching this at-risk population. The light-bulb moment came in at a local pharmacy, looking at the pharmacy's blood pressure machine.

"When we talked to the pharmacists, they told us they had the machines in the corner and that, yes, people used them. We asked if the people came to the counter after they'd taken their blood pressure. They said: 'We don't have time for that; it's a popular device and it brings people into the store. And that's it, full stop.'"

Where others might have seen a barrier, they saw an opportunity. The average Ontario senior has 24 prescriptions filled a year. That's two trips a month to the drug store. Many pharmacies already have Seniors Days, so why not build on the concept and put blood-pressure clinics right in the pharmacies?

They took the idea even further. What if family physicians were enlisted to encourage their senior patients to take part in the pharmacy sessions, where trained volunteers would assist them in taking their blood pressure readings? The results would then be relayed back to the doctors and the circle would be complete: at-risk patients would have their blood pressure checked routinely and their doctors would be alerted if they showed signs treatment was required.

What began as discussions with public health practitioners five years ago blossomed into trials in five Ontario cities, including a large-scale demonstration project in Brockville and Grimsby in 2003. Funding had to be applied for and co-ordinators hired. Drs. Chambers and Kaczorowski and their research team had to acquire marketing skills to successfully recruit and retain volunteers and to mobilize communities. They had to find local leaders in the community to support program and encourage others to join in.

"It has to be a community-driven exercise," says Dr. Chambers.

The Grimsby and Brockville results were encouraging. The seniors felt comfortable in the pharmacy sessions, which became something of a social event for them. There were fewer signs of "white-coat effect" in which a patient's blood pressure reading is artificially high because of anxiety of being in a clinic. Also, the readings were more accurate because the project used state-of-the-art Canadian-made machines. The results were relayed back to the family doctors with patients with the highest readings flagged for each physician.

And the pharmacists were glad to be partners in the project. "We held the sessions Friday mornings at the store," says John Taylor, pharmacist at a Brockville Pharmasave. "It was good for the store, good for the patients, and good for the doctors. It's a win-win."

A new CSN-sponsored project is now underway in 21 Ontario communities. As with the Brockville and Grimsby pilot project, doctors and volunteers and pharmacies are being brought on board. As well, 21 communities that are not part of the project will be used to provide a comprehensive comparison of the program on health and health care.

The program also is expanding into Western Canada. Dr. Charlotte Jones, associate professor of medicine at the University of Calgary, is leading a CHAP pilot project in Airdrie, Alberta.

"The CSN suggested that we see if it was feasible to do in communities outside of Ontario," says Dr. Chambers.

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