The Effectiveness of Pharmacist Interventions on Cardiovascular Risk: The Multicenter Randomized Controlled RxEACH Trial. A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway – a randomized controlled trial A Pharmacist Care Program A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): A Randomized Trial Design of the Effect of a Community Pharmacist Intervention Program on Serum Cholesterol Risk Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. Pharmacist-Led Shared Medical Appointments for Multiple Cardiovascular Risk Reduction in Patients With Type 2 Diabetes A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Effectiveness of Pharmacist Interventions on Cardiovascular Risk in Patients With CKD: A Subgroup Analysis of the Randomized Controlled RxEACH Trial. Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Greater effect of enhanced pharmacist care on cholesterol management in patients with diabetes mellitus: a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. Pharmacist intervention in the prevention of heart failure for high-risk elderly patients in the community Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. Enhancing diabetes care by adding a pharmacist to the primary care team. Economic impact of community pharmacist intervention in cholesterol risk management: an evaluation of the study of cardiovascular risk intervention by pharmacists.
BACKGROUND Despite the cardiovascular disease ( CVD ) risk associated with hypertension , diabetes , dyslipidemia , and smoking , these risk factors remain poorly identified and controlled . OBJECTIVES The study sought to evaluate the effectiveness of a community pharmacy-based case finding and intervention on cardiovascular risk . METHODS The RxEACH ( Alberta Vascular Risk Reduction Community Pharmacy Project ) study was a r and omized trial conducted in 56 community pharmacies . Participants were recruited by their pharmacist , who enrolled adults at high risk for CVD . Patients were r and omized to usual care ( usual pharmacist care with no specific intervention ) or intervention , comprising a Medication Therapy Management review from their pharmacist and CVD risk assessment and education . Pharmacists prescribed medications and ordered laboratory tests as per their scope of practice to achieve treatment targets . Subjects received monthly follow-up visits for 3 months . The primary outcome was difference in change in estimated CVD risk between groups at 3 months . CVD risk was estimated using the greater of the Framingham , International , or United Kingdom Prospect i ve Diabetes Study risk scores . RESULTS We enrolled 723 patients ( mean 62 years of age ; 58 % male , and 27 % smokers ) . After adjusting for baseline values and center effect , there was a 21 % difference in change in risk for CVD events ( p < 0.001 ) between the intervention and usual care groups . The intervention group had greater improvements in low-density lipoprotein cholesterol ( -0.2 mmol/l ; p < 0.001 ) , systolic blood pressure ( -9.37 mm Hg ; p < 0.001 ) , glycosylated hemoglobin ( -0.92 % ; p < 0.001 ) , and smoking cessation ( 20.2 % ; p = 0.002 ) . CONCLUSIONS The RxEACH study was the first large r and omized trial of CVD risk reduction by community pharmacists , demonstrating a significant reduction in risk for CVD events . Engagement of community pharmacists with an exp and ed scope of practice could have significant public health implication s. ( The Alberta Vascular Risk Reduction Community Pharmacy Project : RxEACH [ RxEACH ] ; NCT01979471 ) Objectives : The aim of the study was twofold ; 1 ) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease ( CHD ) discharged from the University Hospital of North Norway , and 2 ) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors . Methods : A total of 102 patients aged 18 - 82 years were enrolled in a non-blinded r and omized controlled trial with an intervention group and a control group . The intervention comprised medication reconciliation , medication review and patient education during three meetings ; at discharge , after three months and after twelve months . The control group received st and ard care from their general practitioner . Primary outcomes were adherence to clinical guideline recommendations concerning prescription , therapy goal achievement and lifestyle education  defined in the medication assessment tool for secondary prevention of CHD ( MAT-CHDSP ) . Secondary outcomes included changes in the biomedical risk factors cholesterol , blood pressure and blood glucose . Results : Ninety-four patients completed the trial , 48 intervention group patients and 46 controls . Appropriate prescribing was high , but therapy goal achievement was low in both groups . Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end , 78.4 % vs. 62.0 % , p<0.001 . The difference was statistically significant for the documented lifestyle advices in intervention group patients . No significant improvements in biomedical risk factors were observed in favor of the intervention group . Conclusions : The study showed an increased guideline adherence in both study groups . This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task . A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention . Amendments to the follow-up program are suggested before implementation in st and ard patient care can be recommended Objective : To investigate the effect of a pharmacist care program on cardiovascular risks in type 2 diabetic patients . Methods : A 9-month , prospect i ve , r and omized , controlled study was conducted in a public hospital in Hong Kong . Patients in the intervention group had regular drug-counseling sessions with pharmacists in addition to routine medical care , whereas patients in the control group received only routine medical care . The primary outcome was the change in coronary heart disease ( CHD ) risk . Results : A total of 105 patients completed the study . Patients in the intervention group had a statistically significant reduction in CHD risk compared to those in the control group ( −1.64 % ± 3.56 % ; n = 51 vs −0.01 % ± 3.08 % ; n = 54 , P = .013 ) . For stroke , a reduction in risk was noted in the intervention group , while an increased risk was noted in the control group ( −1.06 % ± 1.82 % vs 0.31 % ± 2.51 % , P = .002 ) . In addition , hemoglobin A1c levels were significantly reduced in the intervention group compared with the control group ( −1.57 % ± 1.50 % vs –0.40 % ± 1.19 % , P < .001 ) ; a similar profile was seen with low-density lipoprotein cholesterol ( −0.36 ± 0.76 vs −0.03 ± 0.74 , P = .026 ) . Furthermore , there were nonsignificant improvements in high-density lipoprotein cholesterol , triglyceride , and blood pressure in the intervention group . The increased level of underst and ing regarding medications in the intervention group was statistically significant ( P < .001 ) , yielding a better enhancement in compliance compared with patients in the control group ( 22.5 % ± 13.4 % vs 2.0 % ± 5.0 % , P < .001 ) . Conclusion : The pharmacist care program implemented in this study demonstrated a significant cardiovascular risk reduction in type 2 diabetic patients ; therefore such a program would be a valuable addition to a multidisciplinary care of diabetic patients BACKGROUND It has been demonstrated in previous studies that pharmacist management of patients with type 2 diabetes mellitus ( T2DM ) in the outpatient setting not only improves diabetes-related clinical outcomes such as hemoglobin A1c but also blood pressure ( BP ) , total cholesterol ( TC ) , and quality of life . Improved control of BP and TC has been shown to reduce the risks of cardiovascular disease ( CVD ) , which has placed a heavy economic burden on the health care system . However , no study has evaluated the cost-effectiveness of pharmacist intervention programs with respect to the long-term preventive effects on CVD outcomes among T2DM patients . OBJECTIVES To ( a ) quantify the long-term preventive effects of pharmacist intervention on CVD outcomes among T2DM patients using evidence from a matched cohort study in the outpatient primary care setting and ( b ) assess the relative cost-effectiveness of adding a clinical pharmacist to the primary care team for the management of patients with T2DM based on improvement in CVD risks with the aid of an economic model . METHODS Clinical data between the periods of June 2007 to February 2010 were collected from electronic medical records at 2 separate clinics at Kaiser Permanente ( KP ) Northern California , 1 with primary care physicians only ( control group ) and the other with the addition of a pharmacist ( enhanced care group ) . Patients in the enhanced care group were matched 1:1 with patients in the control group according to baseline characteristics that included age , gender , A1c , and Charlson comorbidity score . The estimated 10-year CVD risk for both groups was calculated by the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Risk Engine ( version 2 ) based on age , sex , race , smoking status , atrial fibrillation , duration of diabetes , levels of A1c , systolic BP ( SBP ) and TC , and high-density lipoprotein cholesterol ( HDL-C ) observed at 12 months . There was no statistical difference in the baseline clinical inputs to the Risk Engine ( A1c [ P=0.115 ] , SBP [ P=0.184 ] , TC [ P=0.055 ] , and HDL-C [ P=0.475 ] ) between the 2 groups . A Markov model was developed to simulate the estimated CVD outcomes over 10 years and to estimate cost-effectiveness . The final outcomes examined included incremental cost and effectiveness measured by life years and per quality -adjusted life year gained . Both deterministic sensitivity analysis ( SA ) and probabilistic SA were conducted to examine the robustness of the results . RESULTS The estimated risks for coronary heart disease ( CHD ) and stroke ( both nonfatal and fatal ) at the end of the follow-up were consistently lower in the enhanced care group compared with the control group , even though baseline risks in both groups were similar . The absolute risk reduction ( ARR ) between the enhanced care and control groups increased over time . For example , the ARR for nonfatal CHD risk in year 1 was 0.5 % ( 1.2 % vs. 0.7 % ) , whereas the ARR increased to 5.5 % in year 10 ( 14.8 % vs. 9.3 % ) . Similarly , the ARR between the enhanced care and the control groups was calculated as 0.3 % for fatal CHD in year 1 and increased to 4.6 % in year 10 . Results from the Markov model suggest that the enhanced care group was shown to be a dominant strategy ( less expensive and more effective ) compared with the control group in the 10-year evaluation period in the base-case ( average or mean results ) scenario . Sensitivity analysis that took into account the uncertainty in all important variables , such as wage of pharmacists , utility weight ( the degree of preference individuals have for a particular health state or condition ) , response rate to pharmacists ' care , and uncertainty associated with the estimated 10 years of CVD risk , revealed that the relative value of enhanced care was robust to most of the variations in these parameters . Notably , the level of cost-effectiveness measured by net monetary value depends on the time horizon adopted by the payers and the magnitude of CVD risk reduction . The enhanced care group has a higher chance of being considered as a cost-effective strategy when a longer time horizon such as a minimum of 4 to 5 years is adopted . CONCLUSIONS Adding pharmacists to the health care management team for diabetic patients improves the long-term CVD risks . The longer-term CVD risk reductions were shown to be more dramatic than the short-term reduction . A longer time horizon adopted by health plans in managing T2DM patients has a higher probability of making the intervention cost-effective OBJECTIVE : To determine the efficacy of a program of intervention by pharmacists on lipid risk management in patients at high risk for cardiovascular events . METHODS : R and omized , multicenter ( 44 sites in Alberta and Saskatchewan ) study of community pharmacist intervention versus usual care in 1000 patients . Patients are those at high risk of vascular events ( existing atherosclerotic vascular disease , or diabetes with ≥1 other risk factor ) . After obtaining consent , the pharmacist calls the Project Office to r and omize . Patients allocated to intervention receive a brochure and education about cardiovascular risk factors . Pharmacists also complete a physician contact form , which lists the patient 's risk factors , medications , and any recommendations . A point-of-care cholesterol test is performed , the result is discussed with the patient , and it is entered on the contact form . If appropriate , the patient is asked to see his or her primary care physician for further assessment and /or treatment , and the form is faxed to the physician . Patients are followed up at two , four , eight , 12 , and 16 weeks . During follow-up visits , pharmacists provide educational reinforcement and check for primary end point occurrence . Patients allocated to usual care receive the brochure only , with minimal follow-up . The primary end point is a composite of measurement of a complete lipid panel by the physician , or addition or modification of lipid-lowering drug therapy . Sub studies will evaluate economics ( third-party payer and pharmacy manager perspective ) , patient satisfaction , and quality of life . CONCLUSIONS : SCRIP ( Study of Cardiovascular Risk Intervention by Pharmacists ) is a unique ongoing trial that is evaluating a community pharmacist intervention design ed to optimize cholesterol risk management in patients at high risk for cardiovascular events OBJECTIVES To demonstrate that pharmacists working with physicians and other providers in an ambulatory care setting can improve glucose , blood pressure , and lipid control for patients with type 2 diabetes and to report patient adherence to screening and general preventive measures . DESIGN Prospect i ve , r and omized , clinical practice study . SETTING Burlington , MA , between January 2001 and August 2003 . PATIENTS 164 patients patients with type 2 diabetes older than 18 years with glycosylated hemoglobin ( A1C ) greater than 8 % . INTERVENTION Pharmacist-patient clinic visits included obtaining a comprehensive medication review ; performing targeted physical assessment ; ordering laboratory tests ; review ing , modifying , and monitoring patients ' medication therapy and providing detailed counseling on all therapies ; facilitating self-monitoring of blood glucose ; and providing reinforcement of dietary guidelines and exercise . MAIN OUTCOME MEASURE Effect of clinical pharmacists working with physicians in an ambulatory setting on health measures ( e.g. , A1C , blood pressure , cholesterol ) of patients with diabetes . RESULTS Baseline characteristics were similar between the two groups . After 1 year , significant improvements occurred for A1C and low-density lipoprotein ( LDL ) cholesterol in the intervention group compared with the control group ( A1C , 7.7 % vs. 8.4 % ; LDL , 93.7 vs. 105.1 mg/dL ; P < 0.05 ) . Systolic blood pressure improved for all study patients without a difference between the two groups . Diastolic blood pressure improved significantly in the intervention group compared with the control group ( 73.4 mm Hg vs. 77.6 mm Hg , P < 0.05 ) . Significantly more intervention patients were screened for retinopathy , neuropathy , and microalbuminuria than control patients ( P < 0.05 ) . CONCLUSION For all indices measured , this study demonstrated that collaborative diabetes management with a clinical pharmacist can improve overall care Purpose To assess whether VA MEDIC-E ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH ] Extended for 6 months ) , a pharmacist-led shared medical appointments program , could improve attainment of target goals for hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to st and ard primary care after 6 months of intervention . Methods A r and omized , controlled trial of VA MEDIC-E ( n = 50 ) versus st and ard primary care ( n = 49 ) in veterans with type 2 diabetes , hemoglobin A1c ( A1C ) > 7 % , blood pressure ( BP ) > 130/80 mmHg , and low density lipoprotein cholesterol ( LDL-C ) > 100mg/dl ( 2.59 mmol/l ) in the previous 6 months was conducted . The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions . Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist . Evaluation measures included lab values of A1C , LDL cholesterol , BP , and goal attainment of these values , and diabetes self-care behavior question naires at 6 months . Results The r and omization groups were similar at baseline in all cardiovascular risk factors except for LDL , which was significantly lower in the MEDIC-E arm . At 6 months , significant improvements from baseline were found in the intervention arm for exercise , foot care , and goal attainment of A1C , LDL-C , and BP but not in the control arm . Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk BACKGROUND Despite clear evidence for the efficacy of lowering cholesterol levels , there is a deficiency in its real-world application . There is a need to explore alternative strategies to address this important public health problem . This study aim ed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events . METHODS A r and omized controlled trial conducted in 54 community pharmacies ( 1998 - 2000 ) included patients at high risk for cardiovascular events ( with atherosclerotic disease or diabetes mellitus with another risk factor ) . Patients r and omized to pharmacist intervention received education and a brochure on risk factors , point-of-care cholesterol measurement , referral to their physician , and regular follow-up for 16 weeks . Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions . Usual care patients received the same brochure and general advice only , with minimal follow-up . The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication . RESULTS The external monitoring committee recommended early study termination owing to benefit . Of the 675 patients enrolled , approximately 40 % were women , and the average age was 64 years . The primary end point was reached in 57 % of intervention patients vs 31 % in usual care ( odds ratio , 3.0 ; 95 % confidence interval , 2.2 - 4.1 ; P<.001 ) . CONCLUSIONS A community-based intervention program improved the process of cholesterol management in high-risk patients . This program demonstrates the value of community pharmacists working in collaboration with patients and physicians BACKGROUND Affecting a substantial proportion of adults , chronic kidney disease ( CKD ) is considered a major risk factor for cardiovascular ( CV ) events . It has been reported that patients with CKD are underserved when it comes to CV risk reduction efforts . STUDY DESIGN Prespecified subgroup analysis of a r and omized controlled trial . SETTING & PARTICIPANTS Adults with CKD and at least 1 uncontrolled CV risk factor were enrolled from 56 pharmacies across Alberta , Canada . INTERVENTION Patient , laboratory , and individualized CV risk assessment s ; treatment recommendations ; prescription adaptation(s ) and /or initiation as necessary ; and regular monthly follow-up for 3 months . OUTCOMES The primary outcome was change in estimated CV risk from baseline to 3 months after r and omization . Secondary outcomes were change between baseline and 3 months after r and omization in individual CV risk factors ( ie , low-density lipoprotein cholesterol , blood pressure , and hemoglobin A1c ) , risk for developing end-stage renal disease , and medication use and dosage ; tobacco cessation 3 months after r and omization for those who used tobacco at baseline ; and the impact of rural versus urban residence on the difference in change in estimated CV risk . MEASUREMENTS CV risk was estimated using the Framingham , UK Prospect i ve Diabetes Study , and international risk assessment equations depending on the patients ' comorbid conditions . RESULTS 290 of the 723 participants enrolled in RxEACH had CKD . After adjusting for baseline values , the difference in change in CV risk was 20 % ( P<0.001 ) . Changes of 0.2mmol/L in low-density lipoprotein cholesterol concentration ( P=0.004 ) , 10.5mmHg in systolic blood pressure ( P<0.001 ) , 0.7 % in hemoglobin A1c concentration ( P<0.001 ) , and 19.6 % in smoking cessation ( P=0.04 ) were observed when comparing the intervention and control groups . There was a larger reduction in CV risk in patients living in rural locations versus those living in urban areas . LIMITATIONS The 3-month follow-up period can be considered relatively short . It is possible that larger reduction in CV risk could have been observed with a longer follow up period . CONCLUSIONS This subgroup analysis demonstrated that a community pharmacy-based intervention program reduced CV risk and improved control of individual CV risk factors . This represents a promising approach to identifying and managing patients with CKD that could have important public health implication BACKGROUND Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease ( CVD ) , more evidence derived from r and omized controlled trials ( RCTs ) is needed , including assessment of the effect of community pharmacist interventions in patients with CVD . OBJECTIVE To assess the effectiveness of the Dader Method for pharmaceutical care on achieving therapeutic goals for blood pressure ( BP ) , total cholesterol ( TC ) , and both BP and TC ( BP/TC ) in patients with CVD and /or high or intermediate cardiovascular ( CV ) risk attending community pharmacies in Spain . METHODS Patients aged 25 to 74 years attending community pharmacies with a prescription for at least 1 drug indicated for CVD or CV risk factors were r and omized to 2 groups : an intervention group that received pharmaceutical care , which was provided by specially trained pharmacists working in collaboration with physicians , and a control group that received usual care ( routine dispensing counseling ) and verbal and written counseling regarding CVD prevention .  Patients were recruited from December 2005 to September 2006 , and both groups were followed for 8 months . Study outcomes were assessed at baseline and at 16 and 32 weeks after r and omization . The primary outcome measures were the proportions of patients achieving BP , TC , and BP/TC therapeutic goals ( BP lower than 140/90 mm Hg for patients with uncomplicated hypertension and lower than 130/80 mm Hg for patients with diabetes , chronic kidney disease , or history of myocardial infa rct ion or stroke ; TC lower than 200 mg per dL for patients without CVD and lower than 175 mg per dL for patients with CVD ) . Secondary outcomes were mean BP and TC values . BP was assessed manually by the pharmacist after a 10-minute rest in the supine position . This measurement was performed twice for every participant , and the average of the 2 measurements was calculated . TC was measured by the pharmacist during the study visit using the enzymatic dry method . Statistical analyses were performed using 2-tailed McNemar tests , Pearson chi-square tests , and Student 's t-tests ; P < 0.05 was considered statistically significant . RESULTS 714 patients were included in the study ( 356 intervention , 358 control ) , and the mean [ SD ] age was 62.8 [ 8.1 ] years . The 2 groups were similar at baseline in clinical and demographic characteristics , including the proportion of patients at therapeutic goals for BP , TC , and BP/TC . After 8 months of follow-up , there were statistically significant differences in favor of pharmaceutical care in the proportions of patients who achieved therapeutic goals for BP ( 52.5 % vs. 43.0 % , P=0.017 ) , TC ( 56.5 % vs. 44.1 % , P=0.001 ) , and BP/TC ( 37.1 % vs. 21.8 % , P < 0.001 ) . CONCLUSION Compared with usual care plus written education , pharmaceutical care focused on patient evaluation and follow-up in collaboration with physicians improved the achievement of BP , TC , and BP/TC treatment goals in patients with CVD and /or high or intermediate CV risk attending community pharmacies in Spain BACKGROUND Adverse drug events and medication errors are threats to quality care . Inpatient studies suggest that a pharmacist may reduce these events , but outpatient studies have not been forthcoming . METHODS We conducted a pooled analysis of 2 r and omized controlled trials to determine the effect of pharmacist intervention on adverse drug events and medication errors . We studied 800 outpatient cases of hypertension stratified into complicated ( n = 535 ) and uncomplicated ( n = 265 ) . Patients in the complicated stratum had heart failure or other cardiovascular complication .  Computer programs examined 1-year electronic record data to identify events classified as adverse drug events and preventable or potential adverse drug events . Medication errors included preventable and potential adverse drug events . RESULTS Of the 800 participants ( mean [ SD ] age , 59 [ 10 ] years ) , 484 ( 90.5 % ) and 258 ( 97.4 % ) participants remained in the complicated and uncomplicated strata , respectively , at 12 months . Compared with the control group , the risk of any event was 34 % lower in the intervention group ( risk ratio , 0.66 ; 95 % confidence interval [ CI ] , 0.50 - 0.88 ) , including a lower risk of adverse drug events ( risk ratio , 0.65 ; 95 % CI , 0.47 - 0.90 ) , preventable adverse drug events ( risk ratio , 0.52 ; 95 % CI , 0.25 - 1.09 ) , potential adverse drug events ( risk ratio , 0.70 ; 95 % CI , 0.40 - 1.22 ) , and medication errors ( risk ratio , 0.63 ; 95 % CI , 0.40 - 0.98 ) . CONCLUSIONS This post hoc analysis suggests that pharmacist intervention to improve medication use in out patients with cardiovascular disease decreases the risk of adverse drug events and medication errors . Further studies are needed to confirm this finding STUDY OBJECTIVE To determine the effect of enhanced pharmacist care on cholesterol management in patients with and without diabetes mellitus . METHODS We conducted a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists ( SCRIP ) , a 54-center r and omized trial of pharmacist intervention compared with usual care in patients at high risk for cardiovascular events . The patients involved had atherosclerotic disease or diabetes . We compared the effect of pharmacist intervention in patients with and without diabetes . The primary end point was a composite of performing a fasting cholesterol profile , or adding or increasing the dosage of a cholesterol-lowering drug . Secondary end points were individual components of the primary end point and change in 10-year risk for cardiovascular events , using the Framingham risk equation . RESULTS Of the 675 patients enrolled in the SCRIP study , 294 ( 44 % ) had diabetes .  Enhanced pharmacist care had a more beneficial effect on cholesterol management in those with diabetes ( odds ratio [ OR ] 4.8 ) than without diabetes ( OR 2.1 ) , p=0.01 . Secondary end points showed similar trends , and reduction in Framingham risk was greater in patients with diabetes than without . CONCLUSION Pharmacist intervention for dyslipidemia appears to have a greater impact in patients with diabetes . Results of this sub study suggest that pharmacists should target this patient group for interventions in cholesterol risk management OBJECTIVES To identify patients at risk for coronary artery disease ( CAD ) through a search of a community pharmacy 's prescription data base , to screen and identify patients with elevated cholesterol and at risk for CAD , to enroll patients in a pharmacist-directed lipid management program , and to evaluate selected clinical and humanistic outcomes . DESIGN R and omized , pretest-posttest control groups . SETTING Independent community pharmacy in a suburban metropolitan area . PATIENTS 51 patients who were not at National Cholesterol Education Program low-density lipoprotein cholesterol ( LDL-C ) or defined triglyceride goals and who met inclusion criteria . INTERVENTION Pharmacist-directed lipid management program . MAIN OUTCOME MEASURES Clinical outcome measures included total cholesterol , LDL-C , high-density lipoprotein cholesterol ( HDL-C ) , and triglyceride levels ; achievement of LDL-C goal ; and risk factor prediction scores . Humanistic outcome measures included patient satisfaction with pharmaceutical care and patient knowledge of hyperlipidemia . RESULTS LDL-C was decreased in the pharmacist intervention group ( n = 25 ) , compared with an increase in the control group at study end . HDL-C levels increased and triglyceride levels decreased in both groups . Of treatment group patients , 32 % achieved their cholesterol goals , compared with 15 % of control group patients . Risk factor prediction scores improved in the treatment group and worsened in the control group . The treatment group 's hyperlipidemia knowledge scores improved significantly from pretest to posttest . Both treatment and control group patient satisfaction scores for the pharmacist investigator were favorable at study end . CONCLUSION Both treatment and control patients benefited from participating in this study . Patients enrolled in the lipid management program made greater improvements in their knowledge of hyperlipidemia , risk factor scores , and cholesterol levels Background Heart failure has become one of the major causes of hospitalization worldwide . Hypertension , diabetes mellitus and hyperlipidemia are the major causes of heart failure . In order to effectively prevent heart failure , blood pressure , blood glucose and cholesterol levels shall be closely monitored and controlled as well as medication adherence . This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in high risk elderly patients in the community of Hong Kong . Aim This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in highrisk elderly patients in the community of Hong Kong . Methods This prospect i ve uncontrolled study was conducted between July 2012 and April 2013 with two revisits every 3 to 4 months to review elderly patients ’ medication profiles as well as assess their blood pressure ( BP ) , r and om capillary blood glucose ( RCBG ) level , cholesterol levels , signs and symptoms of heart failure and the compliance level . The results collected at the baseline data were analyzed and compared with those collected at the last follow-up visit . Result A significant increase in number of subjects free of symptoms of heart failure ( 31.88 % , p < 0.001 ) was found . For chronic disease management , significant reduction in LDL-cholesterol level ( -0.86 ± 0.56mmol/L , p = 0.038 ) and triglyceride level ( -1.15 ± 1.09mmol/L , p < 0.001 ) was observed in overall participants . Yet , no significant reduction in BP level or RCBG level was observed in overall subjects . Significant reduction in mean Morisky Medication Adherence Score ( -0.54 ± 1.50 , p = 0.005 ) indicated improvement in medication compliance in participants . Conclusion The Pharmacy Outreach service has a significant role in prevention of heart failure , by means of minimizing heart failure symptoms , improving medication compliance and enhancing chronic disease management , particularly cholesterol management in community elderly patients . This study provided a reference for further investigation and evaluation of the role of pharmacists in preventing heart failure in the high-risk community elderly patients BACKGROUND Glycemic goals ( hemoglobin A1c < 7 % ) are often not achieved in patients with type 2 diabetes despite the availability of many effective treatments and the documented benefits of glycemic control in the reduction of long-term microvascular and macrovascular complications . Several studies have established the important positive effects of pharmacist-led management on achieving glycemic control and other clinical outcomes in patients with diabetes . Diabetes prevalence and mortality are increasing rapidly in Jordan . Nevertheless , clinical pharmacists in Jordan do not typically provide pharmaceutical care ; instead , the principal responsibilities of pharmacists in Jordan are dispensing and marketing of medical products to physicians . OBJECTIVE To assess the primary clinical outcome of glycemic control ( A1c ) and secondary outcomes , including blood pressure , lipid values , self-reported medication adherence , and self-care activities for patients with type 2 diabetes in an outpatient diabetes clinic r and omly assigned to either usual care or a pharmacist-led pharmaceutical care intervention program . METHODS Patients with type 2 diabetes attending an outpatient diabetes clinic of a large teaching hospital were recruited over a 4-month period from January through April 2011 and r and omly assigned to intervention and usual care groups using the Minim software technique . The intervention group at baseline received face-to-face objective -directed education from a clinical pharmacist about type 2 diabetes , prescription medications , and necessary lifestyle changes , followed by 8 weekly telephone follow-up calls to discuss and review the prescribed treatment plan and to resolve any patient concerns . The primary outcome measure was glycemic control ( A1c ) , and secondary measures included systolic and diastolic blood pressure , complete lipid profile ( i.e. , total cholesterol , low-density lipoprotein cholesterol [ LDL-C ] , high-density lipoprotein cholesterol [ HDL-C ] , serum triglycerides ) , and self-reported medication adherence ( 4-item Morisky Scale ) and self-care activities ( Summary of Diabetes Self-Care Activities question naire ) . Data were collected at baseline and at 6 months follow-up . Changes from baseline to follow-up were calculated for biomarker values , and between-group differences in the change amounts were tested using the t test for independent sample s. A P value of < 0.05 was considered statistically significant . RESULTS A total of 77 of 85 patients ( 90.6 % ) r and omly assigned to the intervention group and 79 of 86 patients ( 91.9 % ) assigned to usual care had baseline and 6-month follow-up values . Compared with baseline values , patients in the intervention group had a mean reduction of 0.8 % in A1c versus a mean increase of 0.1 % from baseline in the usual care group ( P = 0.019 ) . The intervention group compared with the usual care group had small but statistically significant improvements in the secondary measures of fasting blood glucose , systolic and diastolic blood pressure , total cholesterol , LDL-C , serum triglycerides , self-reported medication adherence , and self-care activities . Between-group differences in changes in the secondary measures of HDL-C and body mass index were not significant . CONCLUSIONS Patients with type 2 diabetes who received pharmacist-led pharmaceutical care in an outpatient diabetes clinic experienced reduction in A1c at 6 months compared with essentially no change in the usual care group . Six of 8 secondary biomarkers were improved in the intervention group compared with usual care PURPOSE The impact of pharmacist interventions on short-term clinical markers and long-term cardiovascular risk in patients with type 2 diabetes is investigated . METHODS Selected health outcomes were retrospectively analyzed in 147 adults with type 2 diabetes whose care was managed by a team of providers including a pharmacist ( the enhanced care group ) and a matched sample of patients ( n = 147 ) managed by a primary care physician only ( the control group ) . All patients received services through the same health maintenance organization ( HMO ) . The primary study endpoints were ( 1 ) the changes from baseline to 12-month follow-up in glycosylated hemoglobin ( HbA(1c ) ) , low-density lipoprotein cholesterol ( LDL-C ) , and blood pressure ( BP ) values , ( 2 ) rates of attainment of HbA(1c ) , LDL-C and BP goals , and ( 3 ) changes from baseline in predicted 10-year risks of coronary heart disease ( CHD ) and stroke . RESULTS During the 12-month study period , the mean HbA(1c ) value was decreased from 9.5 % to 6.9 % in the enhanced care group and from 9.3 % to 8.4 % in the control group ( p < 0.001 ) ; patients in the enhanced care group were significantly more likely to attain goals for HbA(1c ) ( odds ratio [ OR ] , 3.9 ) , LDL-C ( OR , 2.0 ) , and BP reduction ( OR , 2.0 ) and three times more likely to attain all three goals ( OR , 3.2 ) . The estimated 10-year risk of CHD was decreased from 16.4 % to 9.3 % with enhanced care versus a reduction from 17.4 % to 14.8 % with usual care ( p < 0.001 ) . CONCLUSION The addition of a pharmacist to an HMO primary care team improved short-term surrogate markers as well as long-term cardiovascular risk in adult patients with type 2 diabetes The Study of Cardiovascular Risk Intervention by Pharmacists , a r and omized , controlled trial in over 50 community pharmacies in Alberta and Saskatchewan , Canada , demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease . In a sub study , costs and consequences were analyzed to describe the economic impact of the program . Two perspectives were taken : a government-funded health care system and a pharmacy manager . Costs were reported in 1999 Canadian dollars . Incremental costs to a government payor and community pharmacy manager were $ 6.40/patient and $ 21.76/patient , respectively , during the 4-month follow-up period . The community pharmacy manager had an initial investment of $ 683.50 . The change in Framingham risk function for the intervention group from baseline also was reported . The 10-year risk of cardiovascular disease decreased from 17.3 % to 16.4 % ( p<0.0001 ) during the 4 months . The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period . The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives . It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors
Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in out patients
BACKGROUND Pharmacists may improve the clinical management of major risk factors for cardiovascular disease ( CVD ) prevention .
A systematic review was conducted to determine the impact of pharmacist care on the management of  CVD risk factors among out patients .