IMPROVING DYSLIPIDEMIA MANAGEMENT IN THE COMMUNITY: A RANDOMIZED TRIAL OF PHARMACIST PRESCRIBING, THE RxACT STUDY

Abstract

BackgroundDyslipidemia is an important modifiable risk factor for cardiovascular disease. Despite strong evidence and clear practice guidelines, it remains sub-optimally treated. Pharmacists are frontline primary care professionals, and, with expanded scopes of practice, could identify and treat patients with dyslipidemia. The objective of the RxACT study was to evaluate the effect of pharmacist prescribing and follow-up in patients with dyslipidemia not at recommended treatment targets.MethodsDesign: Randomized trial of pharmacist prescribing vs. usual care.SettingFourteen community pharmacies in Alberta.PopulationAdults with uncontrolled dyslipidemia (treated or untreated) as defined by the 2009 Canadian Dyslipidemia Guidelines.InterventionPharmacists assessed patients’ cardiovascular risk, reviewed LDL-c control, and developed treatment goals, including prescribing lipid-lowering medications. Follow-up was at 6, 12, 18 and 24 weeks.ControlPatients received usual pharmacist and physician care, a copy of their lab results and a pamphlet on cardiovascular disease. Follow-up was at 12 and 24 weeks.ResultsWe enrolled 99 patients with a mean (SD) age of 63 years (13), 49% male and mean baseline LDL-c 3.37 (0.98) mmol/L. The unadjusted proportion of patients achieving LDL-c target was 43% of intervention group, vs. 18% of controls (χ2 (1) = 7.24, p < 0.007). Intervention group subjects had a greater reduction in LDL-c (1.59 mmol/L, SE 0.15) vs. control (0.42 mmol/L, SE 0.10), p<0.0001.ConclusionPharmacist prescribing and follow-up in patients with dyslipidemia resulted in > 2-fold more patients achieving recommended target LDL-c levels. This could have major implications for prevention of cardiovascular disease in Canada.AstraZeneca BackgroundDyslipidemia is an important modifiable risk factor for cardiovascular disease. Despite strong evidence and clear practice guidelines, it remains sub-optimally treated. Pharmacists are frontline primary care professionals, and, with expanded scopes of practice, could identify and treat patients with dyslipidemia. The objective of the RxACT study was to evaluate the effect of pharmacist prescribing and follow-up in patients with dyslipidemia not at recommended treatment targets. Dyslipidemia is an important modifiable risk factor for cardiovascular disease. Despite strong evidence and clear practice guidelines, it remains sub-optimally treated. Pharmacists are frontline primary care professionals, and, with expanded scopes of practice, could identify and treat patients with dyslipidemia. The objective of the RxACT study was to evaluate the effect of pharmacist prescribing and follow-up in patients with dyslipidemia not at recommended treatment targets. MethodsDesign: Randomized trial of pharmacist prescribing vs. usual care. Design: Randomized trial of pharmacist prescribing vs. usual care. SettingFourteen community pharmacies in Alberta. Fourteen community pharmacies in Alberta. PopulationAdults with uncontrolled dyslipidemia (treated or untreated) as defined by the 2009 Canadian Dyslipidemia Guidelines. Adults with uncontrolled dyslipidemia (treated or untreated) as defined by the 2009 Canadian Dyslipidemia Guidelines. InterventionPharmacists assessed patients’ cardiovascular risk, reviewed LDL-c control, and developed treatment goals, including prescribing lipid-lowering medications. Follow-up was at 6, 12, 18 and 24 weeks. Pharmacists assessed patients’ cardiovascular risk, reviewed LDL-c control, and developed treatment goals, including prescribing lipid-lowering medications. Follow-up was at 6, 12, 18 and 24 weeks. ControlPatients received usual pharmacist and physician care, a copy of their lab results and a pamphlet on cardiovascular disease. Follow-up was at 12 and 24 weeks. Patients received usual pharmacist and physician care, a copy of their lab results and a pamphlet on cardiovascular disease. Follow-up was at 12 and 24 weeks. ResultsWe enrolled 99 patients with a mean (SD) age of 63 years (13), 49% male and mean baseline LDL-c 3.37 (0.98) mmol/L. The unadjusted proportion of patients achieving LDL-c target was 43% of intervention group, vs. 18% of controls (χ2 (1) = 7.24, p < 0.007). Intervention group subjects had a greater reduction in LDL-c (1.59 mmol/L, SE 0.15) vs. control (0.42 mmol/L, SE 0.10), p<0.0001. We enrolled 99 patients with a mean (SD) age of 63 years (13), 49% male and mean baseline LDL-c 3.37 (0.98) mmol/L. The unadjusted proportion of patients achieving LDL-c target was 43% of intervention group, vs. 18% of controls (χ2 (1) = 7.24, p < 0.007). Intervention group subjects had a greater reduction in LDL-c (1.59 mmol/L, SE 0.15) vs. control (0.42 mmol/L, SE 0.10), p<0.0001. ConclusionPharmacist prescribing and follow-up in patients with dyslipidemia resulted in > 2-fold more patients achieving recommended target LDL-c levels. This could have major implications for prevention of cardiovascular disease in Canada.AstraZeneca Pharmacist prescribing and follow-up in patients with dyslipidemia resulted in > 2-fold more patients achieving recommended target LDL-c levels. This could have major implications for prevention of cardiovascular disease in Canada.