Development of a pharmacist-led cholesterol screening and lipid-lowering medication review service in coronary artery bypass graft patients

A community pharmacist delivered adherence support service for dyslipidaemia

BACKGROUND

Dyslipidaemia is a major risk factor for coronary heart disease. A key issue in management is adherence to therapy. Pharmacists are ideally situated to provide a service to increase medication adherence and optimize health outcomes. This study aimed to evaluate the impact of a community pharmacist-delivered adherence support service on patients' adherence and total cholesterol levels.

METHODS

A repeated measures [baseline (t = 1), post-intervention at 3-monthly intervals (t = 2,3,4)], randomized-controlled study in community pharmacies, with patients on chronic lipid-lowering therapy was conducted. Measures used were Brief Medication Questionnaire, Medication Adherence Report Scale, total cholesterol and pharmacist intervention data sheets. A baseline t-test of cholesterol levels between groups was conducted followed by a repeated-measures analysis of variance.

RESULTS

Seventeen pharmacists recruited 142 patients (97 completions: 49 control, 48 intervention). Most patients missed either the third or last visit, thus data at t = 3 and 4 were combined. Although the intervention group started with a higher cholesterol level (5.1 vs. 4.8 mmol/l), a difference was observed in the drop in cholesterol levels of the intervention group between t = 2 and 3 (F(1,95) = 8.85, P < 0.01), and between the two groups over the study period (F(2,190) = 4.89, P < 0.05). No changes in medicine adherence scores were observed though there was an improvement in participants' exercise and eating habits.

CONCLUSIONS

Patients significantly lowered their cholesterol levels probably as a result of the service delivered by their pharmacists within the short study time frame of ~9 months.

Sensitivity of Patient Outcomes to Pharmacist Interventions. Part III: Systematic Review and Meta-Analysis in Hyperlipidemia Management

Background

Hyperlipidemia increases the risk of cardiovascular diseases, and control is pivotal ror preventing disease complications. Multidisciplinary interventions, including those performed by pharmacists, are important for improving patients’ outcomes.

Objective:

To quantify the impact of pharmacist interventions in enhancing patients’ outcomes.

Methods

TWO reviewers searched International Pharmaceutical Abstracts, MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials. 3rd Quarter, and Cumulative Index to Nursing and Allied Health Literature (all from inception to July 2007) for pharmacist interventions in hyperlipidemia. Quality was assessed using the Downs-Black scale. Data extracted included the number of patients enrolled; study characteristics; intervention type; and pre- and postintervention measures for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol, adherence, and quality of life. A random effects meta-analysis combined data. Heterogeneity of effects was tested using χ5 analysis. Publication bias was assessed using funnel plots and the Begg-Mazumdar statistic.

Results:

Forty-eight studies were found; 23 met inclusion criteria. Study settings included medical clinic/center (n = 12), community pharmacy (n = 8), hospital (n = 2), and patient homes (n = 1). Article quality was good (71% ± 7.0%). Patient education (78%) and medication management (74%) were the most common interventions. Total cholesterol was significantly reduced from baseline (mean ± SD; 34.3 ± 10.3 mg/dL; p < 0.001) and above that for controls (22.0 ± 10.4 mg/dL: p = 0.034). LDL-C was reduced significantly from baseline (32.6 ± 11.3 mg/dL; p = 0.004), but not significantly more than controls (17.5 ± 10.9 mg/dL; p = 0.109). A clinically relevant but not statistically significant reduction in triglycerides was found. No impact on HDL-C levels was found. Patients’ adherence to pharmacotherapeutic regimens and quality of life were considered possibly not sensitive and possibly sensitive to pharmacist interventions, respectively.

Conclusions:

Total cholesterol is sensitive to pharmacist interventions, while LDL-C and triglyceride levels are possibly sensitive to those interventions. Further research is required for these outcomes.