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6/6/2002

Community Pharmacist Program Aids Cholesterol Management

Kate Traynor

A Canadian study finds that special care provided by community pharmacists can help people with a high risk of cardiovascular events improve their cholesterol risk management.

The intervention program consisted, in part, of a screening session during which a pharmacist identified the patient's cardiovascular risk factors and measured and interpreted the patient's total serum cholesterol levels.

According to the research team, the intervention program increased by 2.8 times the likelihood that a patient would undergo a cholesterol panel workup within 16 weeks of entering the study.In all, 53 percent of the 344 patients in the pharmacist intervention group and 29 percent of the 331 patients who received standard care had a cholesterol panel workup during the study.

The pharmacist intervention program increased by 2.5 times the odds that a study participant would receive a new prescription for a cholesterol-lowering drug. Ten percent of the patients in the intervention group received such a prescription, compared with 4 percent of the usual-care patients.

The study, which was described in the May 27 Archives of Internal Medicine, was conducted at 54 community pharmacies in the Canadian provinces of Alberta and Saskatchewan. Pharmacists recruited study participants on the basis of their medical histories or use of medications commonly taken by people at risk for cardiovascular disease. The average age of the study enrollees was 64 years.

In addition to checking the cholesterol levels and risk factors of people in the intervention group, pharmacists gave these patients an informational brochure and provided advice on cholesterol management. The pharmacists encouraged patients to talk to their physicians about cholesterol management. To reinforce the message, the pharmacists faxed to each patient's physician a form containing information obtained during the screening session.

Patients in the intervention group returned to the pharmacy or were contacted by telephone at 2, 4, 8, and 12 weeks after the initial session with the pharmacist. At the end of the 16-week study, the patients were evaluated and their blood pressure and serum cholesterol levels were measured.

People in the usual-care group received general advice from a pharmacist and were given the same patient-care brochure received by patients in the intervention group. A pharmacist contacted the usual care patients by telephone at week 8 and conducted a final visit at week 16.

Although both men and women benefited from the pharmacist intervention, the effect was strongest in women who had received special care from community pharmacists. Patients with diabetes mellitus likewise benefited more from the intervention than did people without the disease. Forty-three percent of the study participants had diabetes mellitus and 39 percent were women.

The research team speculated that pharmacist intervention programs that target women and patients with diabetes mellitus could be particularly useful for improving these patients' cholesterol risk management.

Despite its apparent positive effect on cholesterol management, the intervention program did not seem to increase patients' satisfaction with pharmacy services. Some 82 percent of the patients in both groups were satisfied with pharmacy services at the start of the study and remained equally satisfied 16 weeks later. The intervention had no effect on patients' satisfaction with pharmacist–physician interactions and did not alter patients' mental or physical health status, which were measured using standard survey instruments.