title: Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. Economic impact of community pharmacist intervention in cholesterol risk management: an evaluation of the study of cardiovascular risk intervention by pharmacists. Pharmacist-Led Group Medical Appointment Model in Type 2 Diabetes Effects of the pharmacist's input on glycaemic control and cardiovascular risks in Muslim diabetes. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study. Physician and pharmacist collaboration to improve blood pressure control. Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. A Randomized Controlled Trial of Team-Based Care: Impact of Physician-Pharmacist Collaboration on Uncontrolled Hypertension A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: study of cardiovascular risk intervention by pharmacists-hypertension (SCRIP-HTN). 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 a two-part educational intervention to improve hypertension control: a cluster-randomized trial. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension Pharmacist recommendations to improve the quality of diabetes care: a randomized controlled trial. Pharmacist's contribution in a heart function clinic: patient perception and medication appropriateness. Comprehensive pharmaceutical care in the chain setting. The Physician and Pharmacist Team: An Effective Approach to Cholesterol Reduction Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Outcomes of patients discharged from pharmacy-managed cardiovascular disease management. Impact of a Pharmaceutical Care Program in a Community Pharmacy on Patients with Dyslipidemia A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. Pharmaceutical care of patients with heart failure. Types of interventions made by clinical pharmacists in the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacist collaborative management of poorly controlled diabetes mellitus: a randomized controlled trial. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial A randomized controlled trial of a smoking cessation intervention based in community pharmacies. Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. A Pharmacotherapy Follow-Up Program in Patients with Type-2 Diabetes in Community Pharmacies in Spain Experience-based group education in Type 2 diabetes: a randomised controlled trial. Clinical impact of a pharmacist-physician co-managed programme on hyperlipidaemia management in Hong Kong. Costs of a Community Pharmacist-Led Medicines Management Service for Patients with Coronary Heart Disease in England Impact of a pharmacist on drug costs in a coronary care unit. Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting. Impact of pharmacist-conducted home visits on the outcomes of lipid-lowering drug therapy. Outcomes of pharmacist-managed diabetes care services in a community health center. Community Pharmacist–Provided Extended Diabetes Care A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures. Physician-pharmacist cooperation program for blood pressure control in patients with hypertension: a randomized-controlled trial.
abstract: OBJECTIVE To compare the effectiveness of an evidence -based , systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension . METHODS Patients in a staff model medical group with uncontrolled hypertension were r and omized to either a usual care ( UC ) or a physician-pharmacist comanagement ( PPCM ) group . All physicians in the study received both group and individual education and participated in the development of an evidence -based hypertension treatment algorithm . Physicians were then given the names of their patients whose medical records documented elevated blood pressures ( defined as systolic > or = 140 mm Hg and /or diastolic > or = 90 mm Hg for patients aged < 65 yrs , and systolic > or = 160 mm Hg and /or diastolic > or = 90 mm Hg for those aged > or = 65 yrs ) . Patients r and omized to the UC group were managed by primary care physicians alone . Those r and omized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist , who provided patient education , made treatment recommendations , and provided follow-up .  Blood pressure measurements , antihypertensive drugs , and visit costs/patient were obtained from medical records . RESULTS One hundred ninety-seven patients with uncontrolled hypertension participated in the study . Both PPCM and UC groups experienced significant reductions in blood pressure ( systolic -22 and -11 mm Hg , respectively , p < 0.01 ; diastolic -7 and -8 mm Hg , respectively , p < 0.01 ) . The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups ( p < 0.01 ) . More patients achieved blood pressure control in the PPCM than in the UC group ( 60 % vs 43 % , p = 0.02 ) . Average provider visit costs/patient were higher in the UC than the PPCM group ( $ 195 vs $ 160 , p = 0.02 ) . CONCLUSIONS An evidence -based , systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension result ed in improved blood pressure control and reduced average visit costs/patient 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 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 Purpose The purpose of this study was to assess whether the VA-MEDIC ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction ) , a pharmacist-led group medical visit program , could improve achievement of target goals in hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to usual care . Methods This was a r and omized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors . VA-MEDIC consisted of a 40- to 60-minute educational component by nurse , nutritionist , physical therapist , or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions . Measures The attainment of target goals in hemoglobin A1C ( A1C ) , blood pressure , fasting lipids , and tobacco use recommended by the American Diabetes Association . Results Of 118 participants , 109 completed the study . VA-MEDIC ( n = 58 ) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors . After 4 months , a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7 % and a systolic blood pressure less than 130 mm Hg . No significant change was found in lipid control or tobacco use between the 2 study arms . Conclusion Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors AIMS To determine whether an extended pharmacy service would improve glycaemic control and cardiovascular risks in diabetic Muslims . METHODS Ambulatory literate adult diabetic Muslims with A1C > 7 % were r and omly assigned to either a study group ( usual care plus added pharmacist input , N=63 ) or a  control group ( usual care only , N=67 ) . On four consecutive visits , at 2-month intervals , the study group met a pharmacist who educated and discussed with each patient regarding medication uses and diabetic treatment . This was accompanied by providing a diabetic pamphlet .  Changes in A1C ( mg/dL ) , lipid parameters ( mg/dL ) , medication adherence ( % pill count ) and diabetic knowledge scores were measured . RESULTS There was no difference in A1C reduction between the study and the control groups ( -0.8 vs. -0.6 , p=0.56 ) . Total cholesterol and LDL-C improvements were greater in the study group than in the control group ( -31.6 vs. -1.2 , p=0.000 ; -15.0 vs. + 9.1 , p=0.002 , respectively ) . The percent pill count ( + 6.8 vs. -2.8 , p=0.004 ) and diabetic knowledge scores ( + 2.1 vs. + 0.6 , p=0.002 ) were increased in the study group but not in the control group . CONCLUSION The pharmacist ' s one-on-one education on diabetes accompanied by its pamphlet , in Muslim patients with diabetes did not affect glycaemic outcome but reduction in cardiovascular risks through lowering total cholesterol and LDL-C was found . The strategies may also improve diabetic knowledge and medication adherence CONTEXT Poor medication adherence diminishes the health benefits of pharmacotherapies . Elderly patients with coronary risk factors frequently require treatment with multiple medications , placing them at increased risk for nonadherence . OBJECTIVE To test the efficacy of a comprehensive pharmacy care program to improve medication adherence and its associated effects on blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) . DESIGN , SETTING , AND PATIENTS A multiphase , prospect i ve study with an observational phase and a r and omized controlled trial conducted at the Walter Reed Army Medical Center of 200 community-based patients aged 65 years or older taking at least 4 chronic medications . The study was conducted from June 2004 to August 2006 . INTERVENTION After a 2-month run-in phase ( measurement of baseline adherence , BP , and LDL-C ) , patients entered a 6-month intervention phase ( st and ardized medication education , regular follow-up by pharmacists , and medications dispensed in time-specific packs ) . Following the intervention phase , patients were r and omized to continued pharmacy care vs usual care for an additional 6 months . MAIN OUTCOME MEASURES Primary end point of the observation phase was change in the proportion of pills taken vs baseline ; secondary end points were the associated changes in BP and LDL-C. Primary end point of the r and omization phase was the between-group comparison of medication persistence . RESULTS A total of 200 elderly patients ( 77.1 % men ; mean [ SD ] age , 78 [ 8.3 ] years ) , taking a mean ( SD ) of 9 ( 3 ) chronic medications were enrolled . Coronary risk factors included drug-treated hypertension in 184 patients ( 91.5 % ) and drug-treated hyperlipidemia in 162 ( 80.6 % ) . Mean ( SD ) baseline medication adherence was 61.2 % ( 13.5 % ) . After 6 months of intervention , medication adherence increased to 96.9 % ( 5.2 % ; P<.001 ) and was associated with significant improvements in systolic BP ( 133.2 [ 14.9 ] to 129.9 [ 16.0 ] mm Hg ; P = .02 ) and LDL-C ( 91.7 [ 26.1 ] to 86.8 [ 23.4 ] mg/dL ; P = .001 ) . Six months after r and omization , the persistence of medication adherence decreased to 69.1 % ( 16.4 % ) among those patients assigned to usual care , whereas it was sustained at 95.5 % ( 7.7 % ) in pharmacy care ( P<.001 ) . This was associated with significant reductions in systolic BP in the pharmacy care group ( -6.9 mm Hg ; 95 % CI , -10.7 to -3.1 mm Hg ) vs the usual care group ( -1.0 mm Hg ; 95 % CI , -5.9 to 3.9 mm Hg ; P = .04 ) , but no significant between-group differences in LDL-C levels or reductions . CONCLUSIONS A pharmacy care program led to increases in medication adherence , medication persistence , and clinical ly meaningful reductions in BP , whereas discontinuation of the program was associated with decreased medication adherence and persistence . TRIAL REGISTRATION clinical trials.gov Identifier : BACKGROUND Noncompliance is a major factor in the morbidity and unnecessary hospital readmissions for patients with heart failure . Several studies have aim ed to reduce rehospitalizations in heart failure patients through a comprehensive , multidisciplinary approach . Medication compliance was rarely measured in these studies or , when it was measured , the method employed was seldom valid . We aim ed at determining the effect of a pharmacist-led intervention on medication compliance in patients with heart failure . METHODS We conducted a r and omized controlled trial into the effect of a pharmacist-led intervention on medication compliance in patients with heart failure ( predominantly New York Heart Association [ NYHA ] II and III ) treated with loop diuretics , presenting to a cardiology outpatient clinic or admitted to hospitals in The Netherl and s. Patients in the intervention group received monthly consultations from their community pharmacist during a 6-month period . Patients in the control group received usual care . Primary endpoint was medication compliance , assessed with a medication event monitoring system , an electronic pill bottle that registers time of opening . Secondary endpoints were the number of rehospitalizations , death , and quality of life . RESULTS A total of 152 patients were r and omized : 74 patients to the intervention arm and 78 patients to the usual care arm . Over the 6-month study period , patients in the intervention group had 140/7656 days without use of loop diuretics compared with 337/6196 days in the usual care group ( relative risk 0.33 [ confidence interval ( CI ) 95 % 0.24 - 0.38 ] ) . Two consecutive days of nondosing occurred on 18/7656 days in the intervention group compared with 46/6196 days in the usual care group ( relative risk 0.32 [ CI 95 % 0.19 - 0.55 ] ) . There were no significant differences in rehospitalizations , mortality , or disease-specific quality of life between groups . CONCLUSIONS A pharmacy-led intervention can improve medication compliance in patients with moderate to severe heart failure , even in those with relatively high compliance . Future interventions should also focus at less compliant patients BACKGROUND Studies have demonstrated that blood pressure ( BP ) control can be improved when clinical pharmacists assist with patient management . The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control . METHODS This was a prospect i ve , cluster r and omized , controlled clinical trial with clinics r and omized to a control group ( n = 3 ) or to an intervention group ( n = 3 ) . The study enrolled 402 patients ( mean age , 58.3 years ) with uncontrolled hypertension .  Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines . Research nurses performed BP measurements and 24-hour BP monitoring . RESULTS The mean ( SD ) guideline adherence scores increased from 49.4 ( 19.3 ) at baseline to 53.4 ( 18.1 ) at 6 months ( 8.1 % increase ) in the control group and from 40.4 ( 22.6 ) at baseline to 62.8 ( 13.5 ) at 6 months ( 55.4 % increase ) in the intervention group ( P = .09 for adjusted between-group comparison ) . The mean BP decreased 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group ( P < .05 for between-group systolic BP comparison ) . The adjusted difference in systolic BP was -12.0 ( 95 % confidence interval [ CI ] , -24.0 to 0.0 ) mm Hg , while the adjusted difference in diastolic BP was -1.8 ( 95 % CI , -11.9 to 8.3 ) mm Hg . The 24-hour BP levels showed similar effect sizes . Blood pressure was controlled in 29.9 % of patients in the control group and in 63.9 % of patients in the intervention group ( adjusted odds ratio , 3.2 ; 95 % CI , 2.0 - 5.1 ; P < .001 ) . CONCLUSIONS A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group . Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00201019 OBJECTIVE To examine the effect of a 12-month pharmaceutical care ( PC ) program on  vascular risk in type 2 diabetes . RESEARCH DESIGN AND METHODS We recruited 198 community-based patients r and omized to PC or usual care . PC patients had face-to-face goal -directed medication and lifestyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessment s and provision of other educational material . Clinical , biochemical , and medication-related data were sent regularly to each patient 's physician(s ) . The main outcome measure was change in HbA(1c ) . A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease ( CHD ) and stroke risk in patients without a history of cardiovascular disease . RESULTS At total of 180 patients ( 91 % ) completed the study .  Mean ( 95 % CI ) reductions were greater in PC case subjects ( n = 92 ) than control subjects ( n = 88 ) for HbA(1c ) ( -0.5 % [ 95 % CI -0.7 to -0.3 ] vs. 0 [ -0.2 to 0.2 ] ) and systolic ( -14 mmHg [ -19 to -9 ] vs. -7 [ -11 to -2 ] ) and diastolic ( -5 mmHg [ -8 to -3 ] vs. -2 [ -4 to 1 ] ) blood pressure ( P < or = 0.043 ) . The improvement in HbA(1c ) persisted after adjustment for baseline value and demographic and treatment-specific variables . The median ( interquartile range ) 10-year estimated risk of a first CHD event decreased in the PC case subjects ( 25.1 % [ 15.6 - 36.2 ] to 20.3 [ 14.6 - 30.2 ] ; n = 42 , P = 0.002 ) but not in the control subjects ( 26.1 % [ 17.2 - 39.4 ] vs. 26.4 [ 16.7 - 38.0 ] ; n = 52 , P = 0.17 ) . CONCLUSIONS A 12-month PC program in type 2 diabetes reduced glycemia and blood pressure . Pharmacist involvement contributed to improvement in HbA(1c ) independently of pharmacotherapeutic changes . PC could prove a valuable component of community-based multidisciplinary diabetes care ABSTRACT OBJECTIVE Evaluate the effectiveness of collaborative management of hypertension by primary care-pharmacist teams in community-based clinics . STUDY DESIGN A 12-month prospect i ve , single-blind , r and omized , controlled trial in the Providence Primary Care Research Network of patients with hypertension and uncontrolled blood pressure . METHODS As compared to usual primary care , intervention consisted of pharmacy practitioners participating in the active management of hypertension  in the primary care office according to established collaborative treatment protocol s. At baseline , there was no significant difference in blood pressure between groups . Primary outcome measures were the differences in mean systolic and diastolic blood pressures between arms at study end . Secondary measures included blood pressure goal attainment ( < 140/90 mmHg ) , hypertension-related knowledge , medication adherence , home blood pressure monitoring , re source utilization , quality of life , and satisfaction . RESULTS A total of 463 subjects were enrolled ( n = 233 control , n = 230 intervention ) . Subjects receiving the intervention achieved significantly lower systolic ( p = 0.007 ) and diastolic ( p = 0.002 ) blood pressures compared to control ( 137/75 mmHg vs. 143/78 mmHg ) . In addition , 62 % of intervention subjects achieved target blood pressure compared to 44 % of control subjects ( p = 0.003 ) . The intervention group received more total office visits ( 7.2 vs. 4.9 , p < 0.0001 ) , however had fewer physician visits ( 3.2 vs. 4.7 , p < 0.0001 ) compared to control . Intervention subjects were prescribed more antihypertensive medications ( 2.7 vs. 2.4 , p = 0.02 ) , but did not take more antihypertensive pills per day ( 2.4 vs. 2.5 , p = 0.87 ) . There were minimal differences between groups in hypertension-related knowledge , medication adherence , quality of life , or satisfaction . CONCLUSIONS Patients r and omized to collaborative primary care-pharmacist hypertension management achieved significantly better blood pressure control compared to usual care with no difference in quality of life or satisfaction BACKGROUND Blood pressure ( BP ) control in patients with diabetes mellitus is difficult to achieve and current patterns are suboptimal . Given increasing problems with access to primary care physicians , community pharmacists and nurses are well positioned to identify and observe these patients . This study aim ed to determine the efficacy of a community-based multidisciplinary intervention on BP control in patients with diabetes mellitus . METHODS We performed a r and omized controlled trial in 14 community pharmacies in Edmonton , Alberta , Canada , of patients with diabetes who had BPs higher than 130/80 mm Hg on 2 consecutive visits 2 weeks apart . Care from a pharmacist and nurse team included a wallet card with recorded BP measures , cardiovascular risk reduction education and counseling , a hypertension education pamphlet , referral to the patient 's primary care physician for further assessment or management , a 1-page local opinion leader-endorsed evidence summary sent to the physician reinforcing the guideline recommendations for the treatment of hypertension and diabetes , and 4 follow-up visits throughout 6 months .  Control-arm patients received a BP wallet card , a pamphlet on diabetes , general diabetes advice , and usual care by their physician . The primary outcome measure was the difference in change in systolic BP between the 2 groups at 6 months . RESULTS A total of 227 eligible patients were r and omized to intervention and control arms between May 5 , 2005 , and September 1 , 2006 . The mean ( SD ) patient age was 64.9 ( 12.1 ) years , 59.9 % were male , and the mean ( SD ) baseline systolic/diastolic BP was 141.2 (13.9)/77.3 ( 8.9 ) mm Hg at baseline . The intervention group had an adjusted mean ( SE ) greater reduction in systolic BP at 6 months of 5.6 ( 2.1 ) mm Hg compared with controls ( P = .008 ) . In the subgroup of patients with a systolic BP greater than 160 mm Hg at baseline , BP was reduced by an adjusted mean ( SE ) of 24.1 ( 1.9 ) mm Hg more in intervention patients than in controls ( P < .001 ) . CONCLUSION Even in patients who have diabetes and hypertension that are relatively well controlled , a pharmacist and nurse team-based intervention result ed in a clinical ly important improvement in BP . Trial Registration clinical trials.gov Identifier : NCT00374270 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 STUDY OBJECTIVE To measure the effectiveness of a multifaceted educational intervention to improve ambulatory hypertension control . DESIGN Cluster-r and omized trial . SETTING Academic health system using an ambulatory electronic medical record . SUBJECTS A total of 10,696 patients with a diagnosis of hypertension cared for by 93 primary care providers . INTERVENTION Academic detailing , provision of provider-specific data about hypertension control , provision of educational material s to the provider , and provision of educational and motivational material s to patients . MEASUREMENTS AND MAIN RESULTS The primary outcome was blood pressure control , defined as a blood pressure measurement below 140/90 mm Hg , and was ascertained from electronic medical records over 6 months of follow-up . We determined the adjusted odds ratio for the association between the intervention and the achievement of controlled blood pressure . When we accounted for clustering by provider , this adjusted odds ratio was 1.13 ( 95 % confidence interval 0.87 - 1.47 ) . Adjusted odds ratios were 1.03 ( 95 % confidence interval 0.78 - 1.36 ) in patients whose blood pressure was controlled at baseline and 1.25 ( 95 % confidence interval 0.94 - 1.65 ) in those whose blood pressure was not . These odds ratios were not significantly different ( p=0.11 ) . CONCLUSIONS These results were consistent with no effect or , at best , a relatively modest effect of the intervention among patients with hypertension . Had we not included a concurrent control group , the data would have provided an unduly optimistic view of the effectiveness of the program . The effectiveness of future interventions may be improved by focusing on patients whose blood pressure is uncontrolled at baseline We evaluated blood pressure control , quality of life , quality of care , and satisfaction of patients who were monitored by specially trained community pharmacists in a group medical practice . After participating in an intensive skill development program , pharmacists performed in an interdisciplinary team in a rural clinic . The primary objective was assessed by evaluating outcome variables at 6 months compared with baseline in 25 patients r and omly assigned to a study group . A control group of 26 patients was also evaluated to determine if outcome variables remained constant from baseline to 6 months . Systolic blood pressure was reduced in the study group ( 151 mm Hg baseline , 140 mm Hg at 6 mo , p<0.001 ) and diastolic blood pressure was significantly lower at 2 , 4 , and 5 months compared with baseline . Ratings from a blinded peer review panel indicated significant improvement in the appropriateness of the blood pressure regimen , going from 8.7 + /- 4.7 to 10.9 + /- 4.5 in the study group ( p<0.01 ) , but they did not change in the control group . Several quality of life scores improved significantly in the study group after 6 months ( p<0.05 ) . These included physical functioning ( 61.6 vs 70.7 ) , physical role limitations ( 56.8 vs 72.8 ) , and bodily pain ( 60.0 vs 71.7 ) at baseline and 6 months , respectively . There were no significant changes in the control group . Patient satisfaction scores were consistently higher in the study group at the end of the study . Our results indicate that when community pharmacists in a clinic setting are trained and included as members of the primary care team , significant improvements in blood pressure control , quality of life , and patient satisfaction can be achieved OBJECTIVE : To assess the effect of a physician and pharmacist teamwork approach to uncontrolled hypertension in a medical resident teaching clinic , for patients who failed to meet the recommended goals of the fifth Joint National Commission on Detection , Evaluation and Treatment of High Blood Pressure . HYPOTHESIS : Physician and pharmacist teamwork can improve the rate of meeting national blood pressure goals in patients with previously uncontrolled hypertension . DESIGN : A single-blinded r and omized controlled trial lasting 6 months . SETTING : A primary care outpatient teaching clinic . PATIENTS : A sample of 95 adult hypertensive patients who failed to meet national blood pressure goals based on three consecutive visits over a 6-month period . INTERVENTION : Patients were r and omly assigned to a control arm of st and ard medical care or to an intervention arm in which a physician and pharmacist worked together as a team . MAIN RESULTS : At study completion , the percentage of patients achieving national goals due to intervention was more than double the percentage in the control arm ( 55 % vs 20 % , p < .001 ) . Systolic blood pressure declined 23 mm Hg in the intervention arm versus 11 mm Hg in the control arm ( p < .01 ) . Diastolic blood pressure declined 14 and 3 mm Hg in the intervention and control arms , respectively ( p < .001 ) . The intervention worked equally as well in men and women and demonstrated noticeable promise in a minority of mixed-ancestry Hawaiians in whom hypertension is of special concern . CONCLUSIONS : Patients who fail to achieve national blood pressure goals under st and ard outpatient medical care may benefit from a program that includes a physician and pharmacist teamwork approach BACKGROUND Diabetes mellitus continues to result in substantial morbidity and mortality despite receiving much attention from health care providers . Automated clinician reminder systems have been developed to improve adherence to diabetes care guidelines , but these reminder systems do not always provide actionable information and may be unable to detect relevant , subjective patient information that affects clinical decision making . Face-to-face visits with pharmacists , who have knowledge of care guidelines and medication management strategies , may assist in improving diabetes care . It is unknown if the combination of pharmacist chart review and clinician reminders could improve diabetes care without requiring face-to-face visits . OBJECTIVE To assess the effects of a comprehensive , pharmacistdelivered , primary care , physician-focused intervention in a large hospital based primary care practice to improve the quality of care for patients with diabetes including rates of semiannual hemoglobin A1c testing and other biomarker and process measures . METHODS This was a prospect i ve , r and omized , controlled study conducted in a hospital-based , primary care practice , composed of 37 faculty primary care physicians ( PCPs ) and 95 internal medicine residents . The initial sample included 346 patients with diabetes and 72 PCPs caring for them . PCPs were r and omized to receive either a personalized letter from a practicing pharmacist containing treatment recommendations for patients with upcoming primary care visits ( intervention , n = 33 ) or to usual care without the letters ( control , n = 39 ) . The letter included patient-specific recommendations regarding overdue testing as well as drug therapy to achieve diabetes-related treatment targets . The intervention included addition of the letter to the electronic medical record ( EMR ) and presentation of the letter to the PCP at the time of the index primary care visit that occurred between November 2003 and August 2004 . Follow-up chart review was performed after the primary care visit to determine changes in 5 process and 3 biomarker outcome measures of diabetes care within 30 days of the index visit . The primary study outcome was a process measure , change in rates of semiannual A1c testing from baseline to 30-day follow-up . Baseline differences were tested for statistical significance using Pearson chisquare . The statistical significance of the intervention 's effect was tested using logistic regression models predicting achievement of each study outcome , with r and omization status ( intervention vs. control ) as the predictor variable of interest , controlling for baseline performance for each measure . RESULTS 171 patients were in the 4 medical clinic suites with 33 PCPs who received the intervention , and 175 patients were in the 4 suites with 39 PCPs in usual care . 30-day outcomes were analyzed for 301 patients ( 87.0 % ) who attended their scheduled index primary care visit . Of these 301 patients , 44.5 % were black , 65.8 % were female , and the mean age was 63 years . At baseline , there were no significant differences between the intervention group ( n = 150 ) and the usual care ( control ) group ( n = 151 ) in the 3 biomarker measures ( proportion with A1c less than 7 % , proportion with low-density lipoprotein cholesterol [ LDL-C ] less than 100 milligrams per deciliter [ mg per dL ] , or blood pressure less than 130/80 millimeters mercury [ mm Hg ] ) . There were no significant baseline differences in 4 of the 5 process measures ; however , the rate of annual LDL-C testing was significantly higher for the intervention than for the control group at baseline ( 86.0 % vs. 74.8 % , respectively , P = 0.015 ) . In logistic regression analysis , rates of semiannual A1c testing were not significantly different between the intervention and control groups , increasing from baseline to follow-up by 16 % in the intervention group and 9 % in the control group ( P = 0.146 ) . The proportion of patients with A1c less than 7 % at follow-up was 43.3 % in the intervention group versus 37.7 % in the control group ( intervention effect P = 0.099 ) . The only statistically significant difference between the 2 groups in the 8 outcome measures was a higher proportion with an annual eye exam at follow-up in the intervention group ( 60.0 % ) versus the usual care group ( 50.3 % , intervention effect P = 0.017 ) . CONCLUSIONS Pharmacist-generated recommendations delivered by letter to PCPs in an academic medical practice were not associated with statistically significant improvements in most quality measures for diabetes care assessed at 30 days following the intervention . Further research is needed with more patients and a longer follow-up time to determine how best to improve the quality of care of patients with diabetes using focused recommendations for therapy changes and reminder notices to clinicians BACKGROUND It has been cited that the management of congestive heart failure ( CHF ) requires a multidisciplinary approach ; however , the role of the pharmacist has not been extensively studied . The roles for pharmacists are changing to meet the long term needs of patients in the community setting , including patients with CHF . OBJECTIVES To evaluate the effect of a pharmacist on the appropriateness of medications taken by patients in the heart function clinic using the Medication Appropriateness Index ( MAI ) and to measure the effect of a pharmacist on the patients ' response to the pharmacist 's interventions using the Purdue Directive Guidance ( DG ) scale . METHODS Eighty patients attending the heart function clinic at The University Health Network , Toronto General Hospital Toronto , Ontario were r and omly assigned to an intervention group that received pharmacist services or a nonintervention group that received usual care from the clinic staff . Patients were assessed at baseline and at one-month follow-up . RESULTS The change in MAI score from baseline was 0.74 and 0.49 for the intervention and nonintervention groups , respectively ( P=0.605 ) . The change in DG survey results was 9.97 and 1.00 for the intervention and nonintervention groups , respectively ( P<0.001 ) . The intervention group improved significantly in all components of the DG survey , especially those pertaining to feedback and goal setting . CONCLUSIONS A benefit was demonstrated for ' directive guidance ' of patients , in the form of education and goal setting as shown by positive survey results A controlled , r and omized study was conducted in two chain pharmacies to determine the clinical value of comprehensive pharmacy services for hypertensive patients in a chain pharmacy setting . Twenty-seven patients were enrolled as intervention participants with 26 control subjects . Monthly services for the intervention group included blood pressure and heart rate assessment s and counseling on lifestyle modifications and drug therapy . Control patients received initial and final blood pressure measurements and minimal counseling . Both study and control groups completed quality -of-life question naires upon entering and completing the study . Results showed that blood pressure control was significantly improved in the study group . Compliance rates as well as energy/fatigue scores ( a quality -of-life scale ) improved in the study group compared with the control population . Community pharmacists in chain stores could have a beneficial effect on the health care of large numbers of patients if pharmaceutical care programs were developed OBJECTIVE : To assess the effect of a program that encourages teamwork between physicians and pharmacists on attempts to lower total cholesterol levels and to meet recommended goals proposed by the National Cholesterol Education Program ( NCEP ) . DESIGN A single-blind , r and omized , controlled trial lasting 6 months . SETTING : An ambulatory primary care center . PATIENTS : A sample of 94 patients with total cholesterol levels of 240 mg/dL ( 6.2 mmol/L ) or higher . INTERVENTION : Equal numbers of patients were r and omly assigned to a control arm in which st and ard medical care was received and an intervention arm which implemented close interaction between physicians and pharmacists . MEASUREMENTS AND MAIN RESULTS : Absolute change in total cholesterol levels from baseline values and the percentage of patients who achieved an NCEP goal after 6 months of intervention were determined . The rate of success in achieving NCEP goals in the intervention arm was double the rate in the control arm ( 43 % vs 21 % , p < .05 ) . Total cholesterol levels in the intervention arm declined 44 + /- 47 mg/dL ( 1.1 + /- 1.2 mmol/L ) versus 13 + /- 51 mg/dL ( 0.3 + /- 1.3 mmol/L ) in the control arm ( p < .01 ) . The effect of intervention on reducing total cholesterol levels was similar for men and women and did not appear to be altered by age . The effect of intervention was greatest in patients with coronary heart disease ( p < .01 ) followed by those without disease but with two or more coronary heart disease risk factors ( p < .05 ) . An effect of intervention was absent in patients without coronary heart disease and with fewer than two risk factors . CONCLUSIONS : Attempts to lower total cholesterol levels and achieve NCEP goals are likely to be more successful when combined with programs that include teamwork between physicians and pharmacists . Some programs , however , may be more successful for high-risk patients , for whom it is often easier to provide more aggressive therapies . Although altering adverse lipid profiles in lower-risk patients may be difficult , achieving optimal cholesterol levels could have an important impact on preventing movement to higher risk strata OBJECTIVE To evaluate the effect of case management by a clinical pharmacist on glycemic control and preventive measures in patients with type 2 diabetes mellitus . STUDY DESIGN R and omized controlled trial in a university-affiliated primary care internal medicine clinic . METHODS We recruited 80 patients with poorly controlled type 2 diabetes mellitus . A clinical pharmacist provided evaluation and modification of pharmacotherapy , self-management diabetes education , and reinforcement of diabetes complications screening processes through clinic visits and telephone follow-up . The main clinical outcome was hemoglobin A1C ( HbA1C ) level ; process measures included HbA1C and low-density lipoprotein measurement , retinal examination , urine microalbumin testing ( or use of angiotensin-converting enzyme inhibitors ) , and monofilament screening for diabetic neuropathy . RESULTS Patients in the intervention and control groups were similar in age , sex , mean HbA1C levels ( 10.1 % and 10.2 % , respectively ; P = .65 ) , and current treatment regimens at baseline . Patients who received case management by the clinical pharmacist achieved greater reduction in HbA1C levels than those in the control group ( 2.1 % vs 0.9 % , P = .03 ) . Three of the 5 process measures were conducted more frequently in the intervention group than the control group , including low-density lipoprotein measurement ( 100.0 % vs 85.7 % , P = .02 ) , retinal examination ( 97.3 % vs 74.3 % ) , and monofilament foot screening ( 92.3 % vs 62.9 % ) . CONCLUSIONS Proactive diabetes case management by a pharmacist substantially improved glycemic control and diabetes process-of-care measures . This approach , integrated with and based in the primary care setting , was an effective and efficient approach to improving care , especially for those with poor glycemic control at baseline OBJECTIVE To evaluate whether patients with coronary artery disease ( CAD ) discharged from the Clinical Pharmacy Cardiac Risk Service ( CPCRS )  would maintain their lipid goals with use of an electronic laboratory reminder system . STUDY DESIGN A 2-year , r and omized study at Kaiser Permanente Colorado . METHODS Patients with prior CAD ( acute myocardial infa rct ion , coronary artery bypass graft surgery , percutaneous coronary intervention ) who had been enrolled in the CPCRS for at least 1 year and who had 2 consecutive low-density lipoprotein cholesterol ( LDL-C ) , non-high-density lipoprotein cholesterol , and blood pressure readings at goal within 6 months before enrollment were r and omized to remain in the CPCRS ( CPCRS care ) or to receive usual care from primary care physicians plus laboratory reminder letters ( usual care ) . The primary outcome was maintenance of LDL-C goal at study end . The t test and chi(2 ) test of association were used to assess differences in mean and categorical values , respectively . RESULTS A total of 421 patients ( 214 CPCRS care , 207 usual care ) were r and omized . Their mean age was 72 years ; 74 % were male . After 1.7 years of follow-up , the proportions of patients maintaining their LDL-C goal of < 100 mg/dL were 91 % and 93.1 % in the CPCRS care and usual care groups , respectively ( P = .46 ) . The proportions maintaining their LDL-C goal of < 70 mg/dL were 68.6 % and 56.8 % in the CPCRS care and usual care groups , respectively ( P = .23 ) . CONCLUSION This study demonstrated that LDL-C measures can remain controlled in most patients discharged from a cardiac disease management program BACKGROUND : Inappropriate use of medications is a significant problem in health care today . A possible solution to this problem may be achieved through better control of patients ' drug therapy . OBJECTIVE : To design a pharmaceutical care program for dyslipidemic patients within a community pharmacy setting that provides education in the areas of medication compliance and lifestyle modifications , while emphasizing the importance of achieving cholesterol goals to ensure improvement in quality of life . METHODS : Patients at an outpatient pharmacy volunteered to be surveyed for 16 weeks . Although both the intervention and control groups were surveyed , the r and omly selected intervention group was interviewed more frequently and more comprehensively . Cholesterol , triglycerides , glucose , weight , risk factors , drug-related problems ( DRPs ) , and quality of life were measured via a survey at the onset of the study and continually measured until the study 's conclusion . RESULTS : In the intervention group , 26 DRPs were detected , of which 24 were resolved ; in the control group , 26 DRPs were detected , of which 5 were resolved . When comparing initial and final blood cholesterol levels in the intervention group , the mean decrease was 27.0 ± 41.1 mg/dL ( p = 0.0266 ) ; in the control group , the average blood cholesterol level decreased by a mean of 1.4 ± 37.2 mg/dL ( p = 0.6624 ) . In the intervention group , the triglyceride level decreased an average of 50.5 ± 80.3 mg/dL ( p = 0.0169 ) , while the control group experienced a mean triglyceride level increase of 29.6 ± 118.5 mg/dL ( p = 0.1435 ) . As a result of the intervention , the quality of life in the intervention group was improved . CONCLUSIONS : Short-term pharmaceutical care plans developed in a retail pharmacy within the proper setting may contribute to improved blood lipid values , cardiovascular disease risk factors , and patients ' quality of life This was a prospect i ve , cluster r and omized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years ( mean , 61 years ) .  Pharmacists made recommendations to physicians for patients in the intervention clinics ( n=101 ) but not patients in the control clinics ( n=78 ) . The mean adjusted difference in systolic blood pressure ( BP ) between the control and intervention groups was 8.7 mm Hg ( 95 % confidence interval [ CI ] , 4.4 - 12.9 ) , while the difference in diastolic BP was 5.4 mm Hg ( CI , 2.8 - 8.0 ) at 9 months . The 24-hour BP levels showed similar effects , with a mean systolic BP level that was 8.8 mm Hg lower ( CI , 5.0 - 12.6 ) and a mean diastolic BP level that was 4.6 mm Hg ( CI , 2.4 - 6.8 ) lower in the intervention group . BP was controlled in 89.1 % of patients in the intervention group and 52.9 % in the control group ( adjusted odds ratio , 8.9 ; CI , 3.8 - 20.7 ; P<.001 ) . Physician/pharmacist collaboration achieved significantly better mean BP values and overall BP control rates , primarily by intensification of medication therapy and improving patient adherence AIM The aim of this study was to investigate the impact of a pharmacist-led pharmaceutical care programme , involving optimization of drug treatment and intensive education and self-monitoring of patients with heart failure ( HF ) within the United Arab Emirates ( UAE ) , on a range of clinical and humanistic outcome measures . METHODS The study was a r and omized , controlled , longitudinal , prospect i ve clinical trial at Al-Ain Hospital , Al-Ain , UAE . Patients were recruited from the general medical wards and from cardiology and medical outpatient clinics . HF patients who fulfilled the entrance criteria , and had no exclusion criteria present , were identified for inclusion in the study . After recruitment , patients were r and omly assigned to one of two groups : intervention group or control group . Intervention patients received a structured pharmaceutical care service while control patients received traditional services . Patient follow-up took place when patients attended scheduled outpatient clinics ( every 3 months ) . A total of 104 patients in each group completed the trial ( 12 months ) . The patients were generally suffering from mild to moderate HF ( NYHA Class 1 , 29.5 % ; Class 2 , 50.5 % ; Class 3 , 16 % ; and Class 4 , 4 % ) . RESULTS Over the study period , intervention patients showed significant ( P < 0.05 ) improvements in a range of summary outcome measures [ AUC ( 95 % confidence limits ) ] including exercise tolerance [ 2-min walk test : 1607.2 ( 1474.9 , 1739.5 ) m.month in intervention patients vs. 1403.3 ( 1256.5 , 1549.8 ) in control patients ] , forced vital capacity [ 31.6 ( 30.8 , 32.4 ) l.month in the intervention patients vs. 27.8 ( 26.8 , 28.9 ) in control patients ] , health-related quality of life , as measured by the Minnesota living with heart failure question naire [ 463.5 ( 433.2 , 493.9 ) unit.month in intervention patients vs. 637.5 ( 597.2 , 677.7 ) in control patients ; a lower score in this measure indicates better health-related quality of life ] . The number of individual patients who reported adherence to prescribed medications was higher ( P < 0.05 ) in the intervention group ( 85 vs. 35 ) , as was adherence to lifestyle advice ( 75 vs. 29 ) at the final assessment ( 12 months ) . There was a tendency to have a higher incidence of casualty department visits by intervention patients , but a lower rate of hospitalization . CONCLUSIONS The research provides clear evidence that the delivery of pharmaceutical care to patients with HF can lead to significant clinical and humanistic benefits The purpose of this study was to describe and evaluate the activities and interventions provided by ambulatory care clinical pharmacists during the IMPROVE ( Impact of Managed Pharmaceutical Care on Re source Utilization and Outcomes in Veterans Affairs Medical Centers ) study . A total of 523 patients were r and omized into the intervention arm at nine Veterans Affairs medical centers if they were considered to be at high risk for drug-related problems . Patients r and omized to the control group had no interventions  and they are not reported . Using a st and ard form , pharmacists were asked to document the length of visit , method of contact , medical conditions addressed , and drug-related problems addressed and resolved during each contact . Seventy-eight ambulatory care clinical pharmacists documented 1855 contacts over 12 months , an average of 3.54 + /- 2.31/patient . The length of visits was 15 minutes or more for 73 % of contacts . In-person contacts accounted for 1421 visits ( 76.6 % ) , with the remainder being telephone contacts . During each contact the average number of drug-related problems addressed and resolved were 1.64 + /- 1.16 and 1.14 + /- 0.98 , respectively . More drug-related problems were addressed and resolved when visits were 15 minutes or longer ( p=0.001 ) and when the contact was in person ( p=0.001 ) . These data may provide information to clinical pharmacists developing pharmacy-managed clinics for patients at high risk for drug-related problems . The information may be a benchmark for types of interventions that can be made , as well as the time commitments required to make them OBJECTIVE To investigate the effect of pharmacist management of poorly controlled diabetes mellitus in a community-based primary care group . STUDY DESIGN R and omized controlled trial of pharmacist management of diabetes compared with usual medical care . METHODS Patients 18 years or older with glycosylated hemoglobin ( A1C ) levels of 9.0 % or higher were enrolled . Patients were r and omly assigned to an intervention group ( n = 52 ) or a control group ( n = 51 ) . Management in the control group included the use of registries and targeted patient outreach . The intervention group participated in the same outreach program plus medication management , patient education , and disease control by a pharmacist . RESULTS Nonparametric data showed median A1C decreases of 1.50 % for the intervention group and 0.40 % for the control group ( P = .06 ) . Significantly more patients in the intervention group improved their A1C level by at least 1.0 % relative to the control group ( 67.3 % vs 41.2 % , P = .02 ) . Most of this benefit was seen for patients of nonwhite race/ethnicity compared with control subjects ( 56.3 % vs 22.7 % , P = .03 ) . Male patients showed significantly greater benefit as well , with a median A1C decrease of 1.90 % vs 0.15 % for controls ( P = .03 ) . CONCLUSIONS Patients with poorly controlled diabetes improved A1C levels significantly when pharmacist management was added to an aggressive organizational diabetes management program . Our results suggest that clinical ly trained pharmacists can help primary care providers improve diabetes management , especially among male patients and among patients of nonwhite race/ethnicity We evaluated a structured pharmaceutical care program for elderly patients ( > 65 yrs ) with congestive heart failure ( CHF ) based on objective measures of disease control , quality of life , and use of health care facilities in a r and omized , controlled , longitudinal , prospect i ve clinical trial . The 42 patients in group A received education from a pharmacist on the disease and its treatment , and lifestyle changes that could help control symptoms . Patients also were encouraged to monitor their symptoms and comply with prescribed drug therapy . If necessary , dosage regimens were simplified in liaison with hospital physicians . The 41 control patients ( group B ) received st and ard care . The following outcome measures were assessed in all patients at baseline ( before the start of the trial ) and at 3 , 6 , 9 , and 12 months : 2-minute walk test , blood pressure , body weight , pulse , forced vital capacity , quality of life [ disease-specific ( Minnesota Living with Heart Failure question naire ) and generic ( SF-36 ) ] , knowledge of symptoms and drugs , compliance with therapy , and use of health care facilities ( hospital admissions , visits to emergency room , emergency calls ) . Patients in group A showed improved compliance with drug therapy , which in turn improved their exercise capacity compared with those in group B ; education on management of symptoms , lifestyle changes , and dietary recommendations were also of benefit . Group A patients significantly improved knowledge of their drug therapy over the 12-month study and had fewer hospital admissions compared with group B patients . They also had improved outcomes compared with group B , despite the small sample s. An extension of this trial to other sites with pooling of results would provide additional evidence of the value of this structured program in elderly patients with CHF BACKGROUND The multidisciplinary approach to managing heart failure has been shown to improve outcomes . The role of a clinical pharmacist in treating heart failure has not been evaluated . METHODS One hundred eighty-one patients with heart failure and left ventricular dysfunction ( ejection fraction < 45 ) undergoing evaluation in clinic were r and omized to an intervention or a control group . Patients in the intervention group received clinical pharmacist evaluation , which included medication evaluation , therapeutic recommendations to the attending physician , patient education , and follow-up telemonitoring . The control group received usual care . The primary end point was combined all-cause mortality and heart failure clinical events . All clinical events were adjudicated by a blinded end point committee . RESULTS Baseline characteristics were similar except for slightly higher age in the intervention group . Median follow-up was 6 months . All-cause mortality and heart failure events were significantly lower in the intervention group compared with the control group ( 4 vs 16 ; P= .005 ) . In addition , patients in the intervention group received higher angiotensin-converting enzyme inhibitor doses as reflected by the median fraction of target reached ( 25th and 75th percentiles ) , 1.0 ( 0.5 and 1 ) and 0.5 ( 0.1875 and 1 ) in the intervention and control groups , respectively ( P<.001 ) . The use of other vasodilators in angiotensin-converting enzyme inhibitor-intolerant patients was higher in the intervention group ( 75 % vs 26 % ; P= .02 ) . CONCLUSIONS Outcomes in heart failure can be improved with a clinical pharmacist as a member of the multidisciplinary heart failure team . This observation may be due to higher doses of angiotensin-converting enzyme inhibitors and /or closer follow-up Objective To test whether a drug review and symptom self management and lifestyle advice intervention by community pharmacists could reduce hospital admissions or mortality in heart failure patients . Design R and omised controlled trial . Setting Home based intervention in heart failure patients . Participants 293 patients diagnosed with heart failure were included ( 149 intervention , 144 control ) after an emergency admission . Intervention Two home visits by one of 17 community pharmacists within two and eight weeks of discharge . Pharmacists review ed drugs and gave symptom self management and lifestyle advice . Controls received usual care . Main outcome measures The primary outcome was total hospital readmissions at six months . Secondary outcomes included mortality and quality of life ( Minnesota living with heart failure question naire and EQ-5D ) . Results Primary outcome data were available for 291 participants ( 99 % ) . 136 ( 91 % ) intervention patients received one or two visits . 134 admissions occurred in the intervention group compared with 112 in the control group ( rate ratio=1.15 , 95 % confidence interval 0.89 to 1.48 ; P=0.28 , Poisson model ) . 30 intervention patients died compared with 24 controls ( hazard ratio=1.18 , 0.69 to 2.03 ; P=0.54 ) . Although EQ-5D scores favoured the intervention group , Minnesota living with heart failure question naire scores favoured controls ; neither difference was statistically significant . Conclusion This community pharmacist intervention did not lead to reductions in hospital admissions in contrast to those found in trials of specialist nurse led interventions in heart failure . Given that heart failure accounts for 5 % of hospital admissions , these results present a problem for policy makers who are faced with a shortage of specialist provision and have hoped that skilled community pharmacists could produce the same benefits . Trial registration number IS RCT N59427925 AIMS To evaluate whether a structured community pharmacy-based smoking cessation programme ( the PAS model ) would give rise to a higher smoking cessation rate compared with ad hoc advice from pharmacists . DESIGN A r and omized controlled trial comparing a structured intervention with usual care . SETTING One hundred pharmacists working in community pharmacies in N. Irel and and 24 in London took part in the study and were each asked to enroll 12 smokers ; 44 % of pharmacists who were trained managed to recruit one or more smokers during the recruitment period of approximately 1 year . PARTICIPANTS A total of 484 smokers were enrolled by the pharmacists and individually r and omized into the PAS intervention group ( N = 265 ) or the control group ( N = 219 ) . INTERVENTION The PAS intervention involved a structured counselling programme , an information leaflet and a follow-up weekly for the first 4 weeks then monthly as needed . MEASUREMENTS The primary outcome measure of this study was self-reported smoking cessation for 12 months with cotinine validation at the 12-month follow-up . FINDINGS Of smokers in the PAS group , 14.3 % ( 38 ) were abstinent up to 12 months compared with 2.7 % ( 6 ) in the control group ( p < 0.001 for the difference ) . CONCLUSION The community pharmacy-based PAS smoking cessation service can be an effective method of helping people stop smoking when delivered by pharmacists willing to adopt this approach AIMS To examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates . METHODS A total of 240 Type 2 diabetes patients were recruited into a r and omized , controlled , prospect i ve clinical trial with a 12-month follow-up . A range of clinical measures , medication adherence and health-related quality of life ( Short Form 36 ) were evaluated at baseline and up to 12 months . Intervention group patients received pharmaceutical care from a clinical pharmacist , whereas control group patients received their usual care from medical and nursing staff . The primary outcome measure was change in HbA(1c ) . British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients . RESULTS A total of 234 patients completed the study . Significant reductions ( P < 0.001 ) in mean values ( baseline vs. 12 months ; 95 % confidence interval ) of HbA(1c)[8.5 % ( 8.3 , 8.7 ) vs. 6.9 % ( 6.7 , 7.1 ) ] , systolic [ 131.4 mmHg ( 128.1 , 134.7 ) vs. 127.2 mmHg ( 124.4 , 130.1 ) ] and diastolic blood pressure [ 85.2 mmHg ( 83.5 , 86.8 ) vs. 76.3 mmHg ( 74.9 , 77.7 ) ] were observed in the intervention group ; no significant changes were noted in the control group . The mean Framingham risk prediction score in the intervention group was 10.56 % ( 9.7 , 11.4 ) at baseline ; this decreased to 7.7 % ( 6.9 , 8.5 ) ( P < 0.001 ) at 12 months but remained unchanged in the control group . CONCLUSIONS The pharmaceutical care programme result ed in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period Objective Poor metabolic control and high associated morbidity and mortality among type 2 diabetic patients require a level of care from the pharmacist that goes beyond usual dispensing . The aim of the present study was to evaluate the improvement in metabolic control , the resolution of drug-related problems ( DRPs ) and the increase in patient awareness of diabetes as outcomes of a pharmacotherapy follow-up program in type 2 diabetic patients . Method R and omized controlled trial conducted in 14 community pharmacies in the province of Pontevedra ( Spain ) with 112 patients between February 2003 and March 2004 . The control group received the usual care , and the intervention group patients were included in a pharmacotherapy follow-up program . This individualized program , which consists of the detection and resolution of DRPs and diabetes education , involves patients in their own care in order to obtain maximum benefit from the medication they use . Main outcome measures HbA1c , Fasting Blood Glucose ( FBG ) , lipid profile , blood pressure , body mass index ( BMI ) , DRPs and knowledge were evaluated at the onset of the program and periodically until conclusion . Results There was a significant difference in changes from baseline between the intervention and the control group in DRPs ( 1.7±1.2 versus 3.1±1.2 P<0.0001 ) , knowledge ( 17.9±3.7 versus 11.4±6.7 points P<0.0001 ) , HbA1c ( 7.9±1.7 versus 8.5±1.9 % P<0.0001 ) , FBG ( 154±61.3 versus 168±57.8 mg/dl P=0.0004 ) , total cholesterol ( 202±41.5 versus 217±43.5 mg/dl P=0.0054 ) and SBP ( 135±16.4 versus 150±19.9 mmHg P=0.0006 ) . Conclusions A substantial number of patients showed an improvement in their outcomes for the chosen metabolic indicators . Pharmacotherapy follow-up programs conducted by community pharmacists can play an important role in achieving therapeutic goals in patients with type 2 diabetes . This study shows that the incorporation of type 2 diabetic patients in a pharmacotherapy follow-up program may contribute to achieve positive clinical outcomes and will contribute to the implementation and progress of pharmacotherapy follow-up programs in community pharmacies Few studies have demonstrated an effect of educational interventions on glycaemic control in persons with Type 2 diabetes longer than 3 - 6 months after baseline . We aim ed to investigate the effectiveness of an experience-based group educational programme 24 months after baseline and to pinpoint mediators that might play a role in achieving desired metabolic outcomes . We conducted a r and omised controlled trial inviting self-referred persons with Type 2 diabetes ( N=77 r and omised ) . The pharmacist-led , year-long intervention was based on participants ' experiences of glucose regulation during the monthly group discussion s. We measured HbA1c at 0 , 6 , 12 , and 24 months and a question naire was administered at baseline and final follow-up . Our findings indicated that participating in the intervention programme significantly decreased HbA1c by 0.4 % at 24 months after baseline . Initial HbA1c , satisfaction with own diabetes-related knowledge , and treatment were found directly related to glycaemic outcomes . The intervention group exercised more in order to lower blood-glucose levels and was also more able to predict current blood-glucose levels before measuring it . Experience-based group education was effective in decreasing participants ' HbA1c 1-year after completed intervention . Early effect of the intervention was followed by relapse after 12 months and a new , significant decrease at 24 months ; this dual course implies that follow-up of educational interventions should involve several consecutive measurements to capture possible late effects . Both biomedical and subjective factors played a role in accounting for the variance of HbA1c at 2-year follow-up after baseline OBJECTIVE The study aim ed to investigate the clinical impact of pharmacist-physician co-managed programme on the management of  hyperlipidaemia . METHODS The study was a prospect i ve r and omized controlled trial . Adult patients were selected if : ( i ) they were taking one or more lipid-lowering agents with a valid lipid panel before their next follow up ; ( ii ) had a baseline lipid profile within the previous 6 months ; ( iii ) their lipid panel did not reach the targeted low-density lipoprotein-cholesterol ( LDL-C ) goal based on the National Cholesterol Education Programme Adult Treatment Panel III . Pharmacists interviewed patients in the intervention group for 15 - 30 min to provide consultation on the drug regimen and lifestyle modifications . A telephone follow-up every 4 weeks and a follow-up interview on the date of the physician visit were scheduled . Patients in the control group received routine conventional care . The primary outcome measurement was the change in lipid panel between baseline and at the end of study . RESULTS One hundred and eighteen patients were recruited to the study [ 58 patients in intervention group ( mean age 63 + /- 10 years old ) and 60 in control group ( mean age 61 + /- 12 years old ) ] . Starting with similar baseline levels , the end of study LDL-C and total cholesterol levels for the intervention and control groups were LDL-C : 2.80 + /- 0.89 mmol/L and total cholesterol 4.75 + /- 1.08 mmol/L vs. LDL-C : 3.24 + /- 0.78 mmol/L and total cholesterol 5.18 + /- 0.93 mmol/L , respectively . The differences were statistically significant ( P < 0.0015 ) . CONCLUSION The study showed that a pharmacist-physician co-managed programme for hyperlipidaemic patient was effective in getting more patients to reach their target lipid levels Background Coronary heart disease ( CHD ) is the most common cause of death in the UK . CHD cost the UK National Health Service ( NHS ) £ 3.5 billion in 2003 . The economic impact of community pharmacists providing a medicines management service for patients with CHD has not been rigorously evaluated ; the full economic costs of such interventions are rarely presented in the literature . Objective To examine the incremental costs of a 1-year community pharmacistled medicines management service for patients with CHD in the UK , from a healthcare system and patient perspective . Methods and participants A cost-minimisation analysis was conducted alongside a multicentre r and omised controlled trial . The primary study participants were patients with CHD identified from general practice computer records . Patients ( intervention , n = 980 ; control , n = 500 ) from 38 general practice s in nine geographical areas in the UK were included in the study .Intervention and outcomes measures The intervention consisted of a review of pharmaceuticals and lifestyle advice by pharmacists in their premises , with recommendations communicated to the patient ’s GP . The main outcome measure was the incremental cost per patient in the intervention group compared with the control group . Annual costs ( £ , 2003/4 values ) included the costs of the intervention ( training and delivery costs ) , the usual costs of NHS treatment ( costs of pharmaceuticals , GP and hospital visits ) and costs borne by patients . Data were collected in the 12 months before and 12 months after the intervention . Results The total NHS cost increased between baseline and follow-up in both groups ( from £ 1243 to £ 1286 [ 3 % ] in the control group and from £ 1410 to £ 1433 [ 2 % ] in the intervention group).The greater cost in the intervention group largely reflects the additional cost of the pharmacist training and the time taken to deliver the intervention ; the difference in costs between the intervention and control groups , after controlling for differences in costs at baseline at follow-up , was statistically significant ( p = 0.001 ) . The costs of pharmaceuticals was higher in the intervention group ( £ 769.20 vs £ 742.3 ; p = 0.04).According to the sensitivity analysis , the intervention cost would need to decrease by 35 % to achieve equivalence between costs in each arm of the trial . Difference to costs of patients and their carers at follow-up were not statistically significant . Conclusions The introduction of a 1-year pharmacist-led medicines management service is likely to increase the total cost of CHD treatment and prevention from the healthcare perspective , as the cost of the intervention outweighed the observed reduction in the cost of drugs in the intervention group . No changes in costs from the patient perspective were found The impact of clinical pharmacy services on direct drug costs in a coronary care unit ( CCU ) was studied . An observational , nonr and omized study was conducted on all patients admitted to the CCU to evaluate the impact of clinical pharmacy services on direct drug costs .  Clinical pharmacy services were introduced into the CCU in July 1998 . Patient characteristics , mean drug costs per admission , mean drug category costs per admission , and total hospital costs per admission  were determined for October 1997 to June 1998 ( nonintervention period ) , July 1998 to March 1999 ( intervention period 1 ) , and April 1999 to December 1999 ( intervention period 2 ) . The Clini-Trend program was used to estimate the total reduction in drug costs associated with documented pharmacist interventions from January to December 1999 . Mean patient age , sex , admitting diagnosis-related group , Medicare case-mix index , ventilator days , length of stay , and number of deaths did not differ significantly among the three study periods . Mean + /- S.D. drug costs per admission for the nonintervention period were $ 374.05 + /- $ 75.51 . With the introduction of clinical pharmacy services , mean + /- S.D. drug costs per admission were $ 381.94 + /- $ 66.16 ( p > 0.1 for intervention period 1 compared with the nonintervention period ) and $ 233.74 + /- $ 84.16 ( p = 0.002 for intervention period 2 compared with the nonintervention period ) . From January to December 1999 , 4151 pharmacist interventions were documented . The estimated reduction in drug costs associated with the interventions totaled $ 372,384 . A pharmacist 's clinical services in the CCU allowed for significant estimated reductions in total drug costs This study evaluated the economic impact of patient-focused pharmacist intervention in the community retail setting in patients with hypertension , diabetes , asthma , and /or hypercholesterolemia .  Specially trained pharmacists intervened by providing targeted patient education , performing systematic patient monitoring , offering feedback and behavior modification , and communicating regularly with patients ' physicians to enable early intervention for drug-related problems . We evaluated prescription drug costs and total medical costs by comparing cl aims data from 188 patients enrolled in the program at three intervention pharmacies with data from 401 control patients at five nonparticipating pharmacies from the same retail chain . For all disease states , the average cost per prescription was significantly higher in the group receiving intervention than in the control group . Differences in total monthly prescription costs were significant only for patients with asthma , with higher monthly costs in the group receiving intervention . Substantial savings were demonstrated across all cost analyses for total monthly medical costs . Savings ranged from a conservative estimate of $ 143.95 per patient per month to $ 293.39 per patient per month when accounting for the possible influence of age , comorbid conditions , and disease severity . Our data indicate that pharmacist intervention in this community pharmacy-based disease management model substantially reduced monthly health care costs in patients with hypertension , hypercholesterolemia , diabetes , and asthma OBJECTIVE To evaluate a pharmacist-conducted educational and monitoring programme , design ed to promote dietary and lifestyle modification and compliance with lipid-lowering drug therapy , for patients with dyslipidaemia . METHODS This was a prospect i ve , r and omized , controlled study . The participants were 94 adults , with 81 completing the study ( intervention group : 39 ; control group : 42 ) , with a cardiovascular-related diagnosis and discharged from hospital , between April and October 2001 , on lipid-lowering drug therapy .  Patients in the intervention group were visited at home monthly by a pharmacist , who educated the patients on the goals of lipid-lowering treatment and the importance of lifestyle issues in dyslipidaemia and compliance with therapy , assessed patients for drug-related problems , and measured total blood cholesterol levels using point-of-care testing . Patients in the control group received st and ard medical care . The main outcome measure was total blood cholesterol levels after 6 months , and an evaluation of patient and general practitioner satisfaction with the programme . RESULTS There was no significant difference in baseline total blood cholesterol levels between the two groups . The reduction over the course of the study in cholesterol levels within the intervention group was statistically significant ( 4.9 + /- 0.7 to 4.4 + /- 0.6 , P<0.005 ) , whereas there was no change within the control group ( P=0.26 ) . At follow-up , 44 % of the intervention group patients and 24 % of the control group patients had cholesterol levels below 4.0 mmol/L ( P=0.06 ) . The reduction in total cholesterol in the intervention group should translate to an expected 21 % reduction in cardiovascular mortality risk and a 16 % reduction in total mortality risk -- more than twice the risk reduction achieved in the control group . In addition , the programme was very well received by the patients and their general practitioners , by satisfaction question naire . CONCLUSION A pharmacist-conducted educational and monitoring intervention improved the outcomes of lipid-lowering drug therapy PURPOSE The outcomes of pharmacist-managed diabetes care services in a community health center were studied . METHODS Eligible patients were over age 18 years and had a diagnosis of type 2 diabetes mellitus . Patients were r and omly assigned by the clinical pharmacist and nurse to the intervention group ( n = 76 ) or control group ( n = 73 ) . Patients in the intervention group were enrolled in a pharmacist-managed diabetes care program . Patients in the control group received the st and ard diabetes care . The primary endpoint was reduction in glycosylated hemoglobin ( HbA(1c ) ) ; secondary outcome measures included weight loss , an improved body mass index , decreased blood pressure , and an improved lipid panel . Quality -of-life measures ( health level , satisfaction , impact , worry about disease , and worry about social and vocational issues ) were also assessed . RESULTS Demographic differences between groups were not remarkable . Mean HbA(1c ) levels fell significantly ( p < 0.05 ) from baseline to nine months in both groups . A difference of 1.0 was reported between the groups ' HbA(1c ) levels ( 95 % confidence interval , 0.08 - 1.78 ; p < 0.05 ) . Satisfaction level improved from 63.7 to 77.4 in the intervention group , which was significant when compared with the control group , whose satisfaction score improved from 57.0 to 63.4 ( p < 0.05 ) . CONCLUSION Patients with type 2 diabetes mellitus who received pharmacist-managed diabetes care  demonstrated improved HbA(1c ) , systolic blood pressure , and low-density-lipoprotein cholesterol levels and quality -of-life measures and met treatment goals more often than patients receiving st and ard care Background Pharmacists in various setting s have been effective in initiating diabetes treatment . Patients with diabetes require ongoing disease management , and community pharmacists are in a strategic position to provide such extended care . Little is known , however , about the effects of community pharmacist – provided interventions beyond the initial treatment period . Objective To evaluate the effect of community pharmacist – provided extended diabetes care service on primary clinical outcomes , including hemoglobin A1c ( A1C ) , low-density lipoprotein cholesterol ( LDL-C ) , and blood pressure , and on patients ' reported self-care activities . Methods A r and omized controlled trial was conducted in patients with diabetes . Participants had already completed at least 2 diabetes education sessions at a local diabetes education center .  Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient . Interventions included discussing medications , clinical goals , and self-care activities with patients and recommending medication changes to physicians when appropriate . The main outcome measures were 12-month changes in A1C , LDL-C , blood pressure , and self-report of self-care activities . Results Seventy-eight patients participated in the study ( 36 intervention , 42 control ) ; 66 were included in the final analysis ( 31 intervention , 35 control ) . Compared with changes in the control group , patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities ( 1.25 and 0.73 more days/wk , respectively ) . The mean 12-month changes for A1C , LDL-C , and blood pressure were not significantly different between the 2 study groups . Conclusions Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period , study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities . Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service PURPOSE To assess the efficacy of a pharmacist-led , primary care-based , disease management program to improve cardiovascular risk factors and glycated hemoglobin ( A(1C ) ) levels in vulnerable patients with poorly controlled diabetes . METHODS A r and omized controlled trial of 217 patients with type 2 diabetes and poor glycemic control ( A(1C ) level > or=8.0 % ) was conducted at an academic general medicine practice from February 2001 to April 2003 . Intervention patients received intensive management from clinical pharmacists , as well as from a diabetes care coordinator who provided diabetes education , applied algorithms for managing glucose control and decreasing cardiovascular risk factors , and addressed barriers to care . Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider . Outcomes were recorded at baseline and at 6 and 12 months . Primary outcomes included blood pressure , A(1C ) level , cholesterol level , and aspirin use . Secondary outcomes included diabetes knowledge , satisfaction , use of clinical services , and adverse events . RESULTS For the 194 patients ( 89 % ) with 12-month data , the intervention group had significantly greater improvement than did the control group for systolic blood pressure ( -9 mm Hg ; 95 % confidence interval [ CI ] : -16 to -3 mm Hg ) and A(1C ) level ( -0.8 % ; 95 % CI : -1.7 % to 0 % ) . Change in total cholesterol level was not significant . At 12 months , aspirin use was 91 % in the intervention group versus 58 % among controls ( P < 0.0001 ) . Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients . There were no significant differences in use of clinical services or adverse events . CONCLUSION Our comprehensive disease management program reduced cardiovascular risk factors and A(1C ) levels among vulnerable patients with type 2 diabetes and poor glycemic control BACKGROUND Pharmacist-physician comanagement of hypertension has been shown to improve office blood pressures ( BPs ) . We sought to describe the effect of such a model on 24-hour ambulatory BPs . METHODS We performed a prospect i ve , cluster-r and omized , controlled clinical trial , enrolling 179 patients with uncontrolled hypertension from 5 primary care clinics in Iowa City , Iowa . Patients were r and omized by clinic to receive pharmacist-physician collaborative management of hypertension ( intervention ) or  usual care ( control ) for a 9-month period . In the intervention group , pharmacists helped patients to identify barriers to BP control , counseled on lifestyle and dietary modifications , and adjusted antihypertensive therapy in collaboration with the patients ' primary care providers . Patients were seen by pharmacists a minimum of every 2 months . Ambulatory BP was measured at baseline and at study end . RESULTS Baseline and end-of- study ambulatory BP profiles were evaluated for 175 patients . Mean ( SD ) ambulatory systolic BPs ( SBPs ) , reported in millimeters of mercury , were reduced more in the intervention group than in the control group : daytime change in ( Δ ) SBP , 15.2 ( 11.5 ) vs 5.5 ( 13.5 ) ( P < .001 ) ; nighttime ΔSBP , 12.2 ( 14.8 ) vs 3.4 ( 13.3 ) ( P < .001 ) ; and 24-hour ΔSBP , 14.1 ( 11.3 ) vs 5.5 ( 12.5 ) ( P < .001 ) . More patients in the intervention group than in the control group had their BP controlled at the end of the study ( 75.0 % vs 50.7 % ) ( P < .001 ) , as defined by overall 24-hour ambulatory BP monitoring . CONCLUSION Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control . Trial Registration clinical trials.gov Identifier : NCT00201045 BACKGROUND The aim of the trial was to evaluate the effectiveness of a program of cooperation between physician and pharmacist to reduce cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure ( BP ) control , appropriate changes in antihypertensive medications , and beneficial changes in lifestyle . METHODS The 132 subjects in this r and omized , controlled trial were in the age range of 40 - 79 years . The inclusion criteria were : systolic BP ( SBP ) ranging from 140 - 179 mm Hg and /or diastolic BP ( DBP ) ranging from 90 - 99 mm Hg and treatment-naive ( untreated for hypertension ) ; or on a regimen of medication for hypertension . Of these 132 subjects , 124 ( 94 % ) were already receiving treatment with antihypertensive medications . Equal numbers of subjects were r and omly assigned to one of two groups : a physician-pharmacist intervention group ( n = 66 ) and a control group ( n = 66 ) . RESULTS The 6-month follow-up rate was 97 % in both groups . At 6 months , the mean decrease in SBP/DBP , as measured at home in the morning , was 2.9/3.3 mm Hg in the intervention group relative to baseline ( P = 0.02 and P < 0.0001 for SBP and DBP , respectively ) . The mean decrease in home morning SBP in the intervention group was not significantly greater than in the control group . However , the DBP decline was significantly greater in the intervention than control groups , which showed a mean decrease of 2.8 mm Hg ( confidence interval : -5.5 to -0.1 ; P = 0.04 ) . The percentage of patients in whom control of home morning BP was achieved was 53 % in the intervention group and 47 % in the control group ( P = 0.40 ) . A higher percentage of patients in the intervention group , relative to the control group , were able to reduce the use of antihypertensive medications ( 31 vs. 8 % , P < 0.0001 ) , and fewer patients in this group required additional medications or increases in dosage relative to the controls ( 11 vs. 28 % , P = 0.03 ) . Patients of the intervention group were more likely to show reduction in body mass index and sodium intake and to stop smoking , as compared with the control group . CONCLUSIONS A program of cooperation between physician and pharmacist was successful in reducing cardiovascular risk factors in patients with mild to moderate hypertension by promoting better blood pressure ( BP ) control , appropriate changes in antihypertensive medications , and beneficial changes in lifestyle
target: 68 % of the outcomes reported showed that clinical pharmacy services were associated with better improvement in patients ' outcomes compared with the control group .
  The involvement of a pharmacist demonstrated an ability to improve CVD outcomes through providing educational intervention , medicine management intervention , or a combination of both .
  These interventions result ed in improved CVD risk factors , improved patient outcomes , and reduced number of drug-related problems with a direct effect on CVD control .
  These improvements may lead to an improvement in patient quality of life , better use of health care re sources , and a reduced rate of mortality
background: BACKGROUND Cardiovascular disease ( CVD ) is considered to be the main cause of death and one of the most common diseases affecting health care systems worldwide .
  Many methods have been used to improve CVD outcomes , one of which is to involve clinical pharmacists in the direct care of patients with CVD .
  OBJECTIVE To perform a systematic review assessing the effectiveness of clinical pharmacist interventions within a multidisciplinary team in the secondary prevention of CVD , using studies conducted on patients with heart failure , coronary heart disease , or those with CVD risk factors .