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document
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 . BACKGROUND Although some studies have demonstrated that pharmacist intervention can improve drug therapy among patients with cardiovascular disease ( CVD ) , more evidence derived from randomized 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 randomized 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 randomization . 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 infarction 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 .
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Intervention_Educational
Dader Method
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Intervention_Educational
pharmacist intervention
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Intervention_Educational
community pharmacist interventions
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Intervention_Educational
Dader Method for pharmaceutical care
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Intervention_Educational
intervention group that received pharmaceutical care , which was provided by specially trained pharmacists working in collaboration with physicians
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Intervention_Control
control group that received usual care (
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Intervention_Educational
routine dispensing counseling
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Intervention_Control
) and verbal and written counseling regarding CVD prevention
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Outcome_Physical
control of blood pressure
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Outcome_Physical
total cholesterol
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Outcome_Physical
blood pressure ( BP )
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Outcome_Physical
total cholesterol ( TC )
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Outcome_Physical
both BP
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Outcome_Physical
TC ( BP/TC )
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Outcome_Physical
proportions of patients achieving BP
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Outcome_Physical
TC
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Outcome_Physical
BP/TC therapeutic goals
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Outcome_Physical
mean BP
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Outcome_Physical
TC values
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Outcome_Physical
BP
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Outcome_Physical
TC
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Outcome_Physical
BP
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Outcome_Physical
TC
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Outcome_Physical
BP/TC
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Outcome_Physical
BP
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Outcome_Physical
TC
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Outcome_Physical
BP/TC
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Outcome_Physical
BP
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Outcome_Physical
TC
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Outcome_Physical
BP/TC
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Participant_Condition
cardiovascular disease
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Participant_Condition
cardiovascular risk
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Participant_Condition
cardiovascular disease ( CVD )
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Participant_Condition
CVD
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Participant_Condition
CVD
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Participant_Condition
high or intermediate cardiovascular ( CV ) risk
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Participant_Age
25 to 74 years
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Participant_Condition
CVD
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Participant_Condition
CV risk
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Participant_Sample-size
714
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Participant_Age
62.8 [ 8.1 ] years
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Participant_Condition
CVD
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Participant_Condition
high or intermediate CV risk