Cardiovascular risk reduction strategies in community pharmacy settings need real world angle

• Published in: Canadian pharmacists journal Vol. 140; no. 5; pp. 295 - 297
• Main Authors: Blackburn, David F., Evans, Charity, Lamb, Darcy A., Taylor, Jeffrey G., Skilton, Kevin
• Format: Journal Article
• Language: English
• Published: SAGE PUBLICATIONS, INC 01.09.2007
• Subjects: Cardiovascular disease; Disease management; Pharmacists; Pharmacology; Pharmacy; Physician patient relationships; Primary care; Canada
• ISSN: 1715-1635; 1913-701X
• DOI: 10.3821/1913-701X(2007)140[295:CRRSIC]2.0.CO;2

It has been shown that community pharmacists can influence adherence and/or utilization of recommended cardiovascular medications.5 8 However, protocols that have achieved success have been very labour intensive. For example, in a study by Chabot and colleagues,8 eligible subjects were identified through a scan of prescription records and then contacted by phone to request participation. Pharmacists measured each individual's blood pressure at every prescription refill, documented the encounter, and made individual recommendations based on their findings. In a descriptive evaluation of a lipid lowering program,' pharmacists spent an average of 30 to 60 minutes with each patient on the initial visit and 10 to 30 minutes on subsequent visits that occurred every 3 months. Each visit consisted of a point-of-care cholesterol test and communication of the results to the responsible physician. In a more recent example of a successful pharmacist intervention,5 pharmacists took blood pressure measurements, provided individualized education every 2 months, and blister-packed all medications for each eligible subject. Similar to the previous studies, the average time required for each patient at the initial visit was 60 minutes, while subsequent visits lasted approximately 30 minutes (every 2 months). Although these studies provide reproducible, high-quality protocols, the reason they have not been implemented into usual community pharmacy practice is most likely related to the time requirement. These strategies require pharmacists to provide rigorous and frequent care to individual patients in addition to their already full work day. In Saskatchewan, we have already observed the problems with asking pharmacists to perform strategic protocols on top of their existing duties. The recently published PIRR study invited all Saskatchewan pharmacists to take part in a highquality program to improve cardiovascular medication use.10 Out of 1 100 invitations sent, 61 pharmacists volunteered. Of the 61 volunteers, 20 did not enroll any patients over a period of 2 years. Published studies of community pharmacy interventions have demonstrated beneficial effects on cardiovascular risk reduction. However, these initiatives were generally restricted to small numbers of subjects. For example, excellent adherence was reported in an uncontrolled study reported by Bluml and colleagues, but the study population was restricted to approximately 15 patients per participating pharmacy.' Similarly, limited success in improving adherence was reported in 7 pharmacies throughout Quebec, with an average of only 13 patients per pharmacy.7 One of the largest community pharmacy studies on record, the SCRIP study, averaged only 6 subjects in the intervention arm per participating pharmacy.17