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Effectiveness of a Pharmacy Care Management Program for Veterans with Dyslipidemia
Author(s) -
Smith Michael C.,
Boldt Amy S.,
Walston Cassandra M.,
Zillich Alan J.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1273
Subject(s) - dyslipidemia , medicine , national cholesterol education program , cohort , pharmacy , confidence interval , retrospective cohort study , veterans affairs , cohort study , clinical pharmacy , physical therapy , family medicine , metabolic syndrome , obesity
Objective To evaluate the effectiveness of a care management program provided by clinical pharmacists for veterans with dyslipidemia. Design Retrospective cohort design. Setting Two primary care clinics at a V eterans A ffairs M edical C enter. Patients An intervention ( IT ) cohort of 213 patients referred for management of dyslipidemia by clinical pharmacists and a control cohort of 219 patients with dyslipidemia receiving usual care ( UC ). Methods Data were obtained from electronic medical records regarding drug therapy, lipid levels, and patient characteristics. Using multivariable regression models to adjust for baseline characteristics, the primary analyses compared mean final measured values of low‐density lipoprotein (LDL) cholesterol, total cholesterol ( TC ), high‐density lipoprotein ( HDL ) cholesterol, and triglycerides ( TG s) among the IT and UC cohorts at the final follow‐up visits. Secondary analyses compared the proportion of patients achieving National Cholesterol Education Program/Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults ( NCEP / ATPIII) concordant LDL goals and the time to achieve LDL goals between the two groups. Results Compared with the UC cohort, the adjusted difference in the mean final measured LDL for the IT cohort was −10.4 mg/dl (95% confidence interval [ CI] −16.1 to −4.6, p < 0.001) and TC was −12.7 (95% CI −21.3 to −4.1, p=0.004). There were no significant differences in the adjusted mean final measured HDL or TG s between the two groups. The NCEP / ATPIII goal LDL was met in 80.3% of patients in the IT cohort and 65.3% of patients in the UC cohort (odds ratio [ OR] , 2.6; 95% CI 1.6–4.3, p<0.001). Time to achieve goal LDL was significantly shorter for the IT cohort compared with the UC cohort (risk ratio, 1.8; 95% CI 1.2–2.8, log‐rank p=0.002). Conclusion Veterans referred to a clinical pharmacist for treatment of dyslipidemia achieved significant reductions in TC and LDL . A greater proportion of patients achieved NCEP / ATPIII goal LDL , and the time to attainment of LDL goals was shorter in the pharmacist‐managed cohort, supporting a continued role for pharmacy care management in the treatment of patients with dyslipidemia.