05 Apr Risk For Cardiovascular Events Reduced With Addition of Pharmacists’ Care
MedicalResearch.com Interview with:
Dr. Ross Tsuyuki
Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC
Professor of Medicine (Cardiology) and Director, EPICORE Centre
Faculty of Medicine and Dentistry
University of Alberta
EPICORE CENTRE
Research Transition Facility
University of Alberta Edmonton, AB
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As you know, most cardiovascular disease is caused by modifiable risk factors. However, the identification and control of these risk factors continues to elude us.
Pharmacists in the community are the most accessible primary healthcare providers. That is being increasingly recognized and the scope of practice for pharmacists has been changing to meet these needs. In Alberta, Canada, pharmacists have one of the broadest scopes of practice – many can independently prescribe and order laboratory tests.
We sought to test the effect of a pharmacist-based prescribing and care program in patients at high risk for cardiovascular events.
We enrolled 723 patients at high risk for cardiovascular events (defined as those with diabetes, vascular disease (coronary, cerebrovascular, or peripheral arterial disease), chronic kidney disease, or high Framingham risk (>20%) primary prevention. All patients were recruited by their pharmacist and had to have at least one modifiable risk factor not well controlled.
Patients were randomized to receive pharmacist intervention or usual care.
Intervention patients received a Medication Therapy Management review, consisting of assessment of cardiovascular risk, patient education, and management of the patients’ risk factors, according to the latest Canadian guidelines. Pharmacists conducted follow-up visits monthly.
Usual care patients were the control (comparison) group and received usual pharmacist and physician care. Both groups were followed for 3 months.
The primary outcome measure was the difference in estimated cardiovascular risk at 3 months, as calculated using validated risk engines such as Framingham, the International Risk Score, and the UKPDS risk.
We found a 21% reduction in the risk for cardiovascular events in the pharmacist care group compared to control.
There was also significant reductions in blood pressure, LDL cholesterol, glycated hemoglobin in those with diabetes, and 21% fewer smokers in the pharmacist care group compared to control.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response:
- Community pharmacists can identify patients with poorly controlled risk factors
- They can take responsibility to help patients manage their risk factors
- Patients were very satisfied with the care they received from their pharmacist.
- For policymakers – if you are serious about reducing the burden of cardiovascular diseases, you could have 450,000 helping hands in the US and Canada if you take steps to engage pharmacists
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Our next steps are to “spread and scale up” this intervention. We will make all of the study materials available to pharmacists so that they can implement such a program. We will be posting these materials on our website later today: www.ualberta.ca/epicore/rxeach
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Effectiveness of Community Pharmacist Prescribing and Care on Cardiovascular Risk Reduction: Randomized Controlled RxEACH Trial
J Am Coll Cardiol. 2016;():. doi:10.1016/j.jacc.2016.03.528
Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC1; Yazid N. Al Hamarneh, BSc(Pharm), PhD1; Charlotte A. Jones, MD, PhD, FRCP(c)2; Brenda R. Hemmelgarn, MD, PhD, FRCP(c)3
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Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC (2016). Cardiovascular Events Reduced With Addition of Pharmacists’ Care MedicalResearch.com
Last Updated on April 5, 2016 by Marie Benz MD FAAD