title: Improving primary care in rural Alabama with a pharmacy initiative. Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. Implementation of Pharmaceutical Care Services for Patients with Hyperlipidemias by Independent Community Pharmacy Practitioners A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Effect of pharmaceutical care on optimum colestipol treatment in elderly hypercholesterolemic veterans. The effect of pharmacist intervention and patient education on lipid-lowering medication compliance and plasma cholesterol levels. Lipid levels and use of lipid-lowering drugs for patients in pharmacist-managed lipid clinics versus usual care in 2 VA Medical Centers. Impact of a Pharmaceutical Care Program in a Community Pharmacy on Patients with Dyslipidemia The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Long-term impact of a community pharmacist intervention on cholesterol levels in patients at high risk for cardiovascular events: extended follow-up of the second study of cardiovascular risk intervention by pharmacists (SCRIP-plus). Effect of intervention through a pharmaceutical care program on patient adherence with prescribed once-daily atorvastatin. Achieving cholesterol target in a managed care organization (ACTION) trial. Benefits of individualized counseling by the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong. Effects of "group detailing" on the prescribing of lipid-lowering drugs: a randomized controlled trial in Swedish primary care. Impact of pharmacist-conducted home visits on the outcomes of lipid-lowering drug therapy. Apparent discontinuation rates in patients prescribed lipid-lowering drugs.
abstract: The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life BACKGROUND Pharmacists have been shown to positively impact the outcomes of care for treatment of many different kinds of disease states . In particular , pharmacist-run lipid clinics have enjoyed varying degrees of success , depending on the outcome assessed . At our hospital , when a patient is transferred to the pharmacist-coordinated lipid clinic , the primary care pharmacist is responsible for ordering and interpreting labs and prescribing and monitoring lipid-altering therapy . OBJECTIVE This study was design ed to assess if there is a statistically significant difference between the magnitude of serum cholesterol reduction for patients receiving lipid-altering pharmacotherapy  when clinical ly trained pharmacists are actively prescribing and adjusting the drug therapy compared to other health care practitioners ( usual care ) . METHODS Patient records from the hospital computer data bases were retrospectively and r and omly selected for analysis . Following evaluation for inclusion s and exclusions , 41 patient records remained for statistical analysis for the cohort group , and 47 records remained from the group of patients managed by a clinical pharmacist . RESULTS Management of dyslipidemia by a clinical pharmacist was associated with a significant reduction in overall mean low-density lipoprotein ( LDL , 18.5 % ) compared to the cohort that did not have a clinical pharmacist as the primary manager of dyslipidemia ( 6.5 % , P=0.049 ) . This suggests improved clinical outcomes , defined as greater LDL reduction , when clinical pharmacists participate in lipid management , including drug prescribing . The magnitude reduction in LDL was found to be related to the number of clinical pharmacy visits ( 11.4 % for 1 visit , 23.2 % for 2 visits , and 23.7 % for > 3 visits ) , compared to the usual care group ( -11.0 % , 18.0 % , and 7.4 % ; statistically significant , P=0.038 , for > 3 visits only ) . These results occurred even though the group of dyslipidemic patients managed primarily by a clinical pharmacist contained a statistically greater number of patients with 2 or more risk factors and high-density lipoprotein ( HDL ) levels less than 40 mg/dL. CONCLUSION Interdisciplinary medical teams that include clinical pharmacists who are actively prescribing and adjusting lipid drug therapy may achieve greater reductions in LDL for patients who have been assessed with multiple risk factors compared to patients managed without clinical pharmacists . Active participation by clinical pharmacists in lipid management for patients with elevated LDL result ed in improved treatment success as measured by the magnitude reduction in LDL . The reduction in LDL was between 5 % and 22 % per visit greater for patients being treated by clinical pharmacists versus usual care , even in a patient population with more risk factors . These intermediate outcomes may translate into long-term outcomes in fewer cardiovascular events , improved quality of life for patients with dyslipidemia , and lower costs associated with sequelae of dyslipidemias 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 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 : OBJECTIVE : To implement and evaluate pharmaceutical care services for patients with hyperlipidemias in the community pharmacy setting , to evaluate the results of a pharmaceutical care training process for pharmacists by using an assessment quiz , and to measure patient outcomes result ing from provision of pharmaceutical care to patients with hyperlipidemia . DESIGN : A prospect i ve study was conducted over a 1 -year period . Patients served as their own controls . SETTING : Two independent community pharmacies in Richmond , Virginia . PARTICIPANTS : Twenty-five adult patients with confirmed dyslipidemias completed the study . INTERVENTIONS : Study pharmacists assessed each patient and assisted in setting therapeutic goals ; patients also completed a visit with a registered dietitian . Drug therapy recommendations were made to physicians by the pharmacist when appropriate . Follow-up was scheduled with the pharmacist to ensure positive outcomes and reduce adverse effects . MAIN OUTCOME MEASURES : Fasting lipoprotein profiles were measured initially and at 6 and 12 months . The SF-36 survey , the MacKeigan-Larson satisfaction survey , and a patient opinion survey were administered initially and at the conclusion of the study . RESULTS : Total cholesterol and low-density lipoprotein cholesterol values were significantly decreased at 12 months compared with either the baseline or 6-month values ( p < 0.02 ) . Significant improvement was found in several domains of the surveys ; quality of life , patient satisfaction with pharmacy services , and patient opinions on the role of the pharmacist improved after the intervention . CONCLUSIONS : Pharmaceutical care may positively affect lipid values , quality of life , and patient satisfaction 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 We conducted a prospect i ve trial to determine whether a formal , integrated pharmaceutical care plan can enhance patient acceptance and compliance with colestipol therapy and improve outcomes .  Forty patients with hypercholesterolemia were equally divided and assigned to either a usual care or pharmaceutical care group . In the pharmaceutical care group compared with the usual care group , after 52 weeks , colestipol therapy result ed in a greater reduction in total cholesterol ( 12.5 % vs 7.3 % ) , low-density lipoprotein cholesterol ( LDL-C ; 16 % vs 9.4 % ) , and LDL-C : high-density lipoprotein cholesterol ( HDL-C ) ratio ( 24.4 % vs 12.2 % , p < 0.05 ) . The percentage of patients who achieved their LDL-C goal at week 52 was much greater in the pharmaceutical care group ( 29.4 % ) than in the usual care group ( 5.0 % , p < 0.05 ) . Co-management by a physician and a pharmacist of hypercholesterolemic veterans treated with colestipol can enhance patient acceptance of the drug , LDL-C reduction , and achievement of therapeutic goals BACKGROUND Dyslipidemias are a modifiable risk factor for coronary heart disease . The benefits of cholesterol reduction drug therapies are limited by poor patient compliance with drug regimens . OBJECTIVES To determine the impact of a community pharmacist pilot disease-management program on patient compliance with lipid-lowering drug therapy and on serum cholesterol levels . METHODS One hundred forty-nine patients who were nonadherent to prescribed hypolipidemic drug regimens were recruited for this six-month prospect i ve study . Each subject served as their own control . Pharmacists educated these patients on lipid disorders , the benefit of medication compliance and lifestyle modifications that reduce the risk for coronary heart disease . Pharmacists followed up participants by telephone at two-month intervals . Drug renewal rates were monitored throughout the study and plasma lipid levels were measured at study outset and study end . RESULTS Pharmacist intervention and patient-education programs significantly increased medication compliance , as shown by a 15.3 % increase ( P<0.05 ) in the number of compliant patients and an 11 day ( P<0.001 ) reduction in the average number of days to prescription renewal . Concurrently , levels of total cholesterol , triglycerides and low-density lipoprotein ( LDL ) cholesterol , were reduced by 6 % , 16.2 % , and 8.5 % ( P<0.001 , 0.01 , 0.01 ) , respectively . High density lipoprotein ( HDL ) cholesterol remained relatively unchanged ( + 0.7 % ) so that the LDL to HDL ratio was improved by 17.2 % overall ( P<0.01 ) . Almost all of the patients ( 99.2 % ) were satisfied with the program and expressed a willingness to pay an average $ 34.50 per 30 min consultation for the pharmacist services offered . CONCLUSION Pharmacists can contribute significantly to disease management of dyslipidemic individuals OBJECTIVE The objective of this study was to assess the effectiveness of pharmacist- managed dyslipidemia clinics at 2 Veterans Affairs medical centers since the release of the 2001 National Cholesterol Education Panel Adult Treatment Panel III ( NCEP ATP III ) guideline compared with the usual care ( UC ) provided by other health care professionals in the same setting . METHODS Analysis was performed through retrospective chart review of patients with a diagnosis of dyslipidemia who received care in either the Amarillo or Lubbock , Texas , pharmacist-managed lipid clinics ( LCs ) or UC from a primary care physician . Data from medical charts were abstract ed for date s of service from July 2001 to December 2003 for 115 patients selected r and omly from LC rolls matched with 115 patients with a diagnosis of dyslipidemia selected r and omly from UC . All patients had to have had at least 3 visits with the LC or 3 visits in UC with a billing code of dyslipidemia ; they were followed for at least 6 months after an initial visit in July 2001 or thereafter and were enrolled in the VA health care system for at least 1 year . Baseline lipid values were available for LC but not UC patients . Cholesterol target goals were determined according to NCEP ATP III guideline . RESULTS After an average of 21.6 months of follow-up , the proportion of patients in the LC group that attained goal level increased from 45.2 % at baseline to 82.6 % for total cholesterol ( TC ) and from 36.5 % at baseline to 64.3 % for lowdensity lipoprotein cholesterol ( LDL-C [ P < 0.001 for both comparisons ] ) . There was an average 24.5 mg/dL absolute reduction ( relative reduction , 19.4 % ) in LDL-C along with significant improvements in the other lipid levels ( P < 0.001 for TC and LDL-C , P = 0.007 for triglycerides [ TGs ] ) with the exception of highdensity lipoprotein cholesterol ( HDL-C ) , which declined from 40.0 mg/dL to 36.3 mg/dL ( P < 0.001 ) . A total of 50 patients ( 43.5 % ) were on lipid-lowering pharmacotherapy at baseline versus 108 patients ( 93.9 % ) at follow-up . Compared with UC , LC patients were more likely to have achieved goal LDL-C ( 64.3 % vs. 15.7 % for UC , P < 0.001 ) and TC ( 82.6 % vs. 40.9 % , P < 0.001 ) , but there was no difference in the proportion of patients at TG goal for LC ( 65.2 % ) compared with UC ( 52.2 % , P = 0.061 ) or at HDL-C goal ( 23.5 % for LC vs. 33.0 % for UC , P = 0.143 ) . A higher proportion of LC patients ( 93.9 % ) used  lipid-lowering agents  compared with UC patients ( 24.3 % , P < 0.001 ) . Sub analysis of patients on a lipid-lowering agent found that a significantly higher proportion ( 85.2 % ) in the LC group were at goal total cholesterol compared with 60.7 % for UC ( P = 0.012 ) and at goal LDL-C ( 66.7 % for LC vs. 39.3 % for UC , P = 0.016 ) . However , a lower proportion were at goal HDL-C for LC ( 21.3 % ) versus 42.9 % for UC ( P = 0.043 ) . Overall , only 11 LC patients ( 9.6 % ) attained goal levels for all 4 serum lipid values by the end of follow-up versus 2 UC patients ( 1.7 % , P = 0.019 ) . CONCLUSIONS Nearly two thirds of patients diagnosed with dyslipidemia and enrolled in a pharmacist-managed LC had LDL-C levels at or below NCEP ATP III target goal compared with 16 % of dyslipidemia patients who received UC from their primary care provider . The pharmacist-managed LC patients were also twice as likely ( 83 vs. 41 % ) to have attained the TC target goal , but there was no difference between the 2 groups in the proportion of patients who attained either TG or HDL-C target goals . Only 9.6 % of LC patients were at goal for all 4 individual lipid measures at the end of follow-up 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity STUDY OBJECTIVE To determine the effect of a community pharmacist intervention in patients at high risk for coronary heart disease on low-density lipoprotein cholesterol ( LDL ) levels 1 year after completion of the Second Study of Cardiovascular Risk Intervention by Pharmacists ( SCRIP- plus ) . METHODS Patients who completed the original study were invited to make a single return visit to their community pharmacy so that the pharmacist could measure their fasting LDL level using a point-of-care device . The primary outcome was change in LDL level from the 6-month ( final ) visit to the extended follow-up evaluation . RESULTS Of the 359 patients who completed the original 6-month visit , data were collected for 162 ( 45 % ) patients . The mean + /- SD LDL level at completion of the original study was 107.9 + /- 33.6 mg/dl ( 2.79 + /- 0.96 mmol/L ) ( an increase of 2.7 mg/dl [ 0.07 mmol/L ] , 95 % confidence interval -19.3 - 7.3 [ -0.5 - 0.19 ] ) . Sixty-one ( 38 % ) patients were at the target LDL level ( < 96.7 mg/dl [ < 2.50 mmol/L ] ) . CONCLUSION The LDL reduction was maintained 1 year after completion of the extended follow-up . Since most patients were still not at the target LDL level , this finding suggests that continuing intervention is necessary to help patients reach this target AIMS Correct execution of prescribed dosing regimen(s ) is essential for patients to benefit from lipid lowering treatments . The objective of this study was to estimate the effect of a pharmaceutical care program on the adherence of once-daily atorvastatin treatment in patients with elevated cholesterol levels . METHODS In both linguistic regions of Belgium , two districts were r and omized between usual care and a supportive intervention program . Eligible patients included hyperlipemic subjects taking atorvastatin for at least 3 months . ' Adherence ' was defined as the proportion of days during which the electronic device record showed that the patient had taken the daily dose . ' Persistence ' quantifies how long the treatment is executed . RESULTS A total of 392 patients from 35 pharmacies were included in the intent-to-treat ( ITT ) analysis of the data ( 194 patients received intervention and 198 in the control group ) . The intervention result ed in a 6.5 % increase in post-baseline adherence ( p < 0.001 ) mainly driven by a 13 % increase in persistence at 1 year ( p = 0.002 ) . CONCLUSION A supportive pharmaceutical care program consisting of review by patient and pharmacist of each patient 's electronically compiled dosing history , plus educational reminders , improves patient adherence to the once-daily atorvastatin dosing regimen , mainly by extending persistence STUDY OBJECTIVES To objective ly compare the results of a collaborative approach using pharmacists with the results of usual care for achieving a low-density lipoprotein cholesterol ( LDL ) goal of 100 mg/dl or less in out patients with documented coronary heart disease ( CHD ) who are not at goal , and to document the effect on LDL after removal of such a collaborative model from the study population . DESIGN Prospect i ve , multiclinic , controlled study . SETTING Four clinics of a 19-clinic staff model health maintenance organization in Minneapolis and St. Paul , Minnesota . Two clinics treated the intervention patients , two the controls ; one clinic for each group was suburban , and one for each was urban . PATIENTS Four hundred eighty-one patients aged 18 years or older with CHD and whose LDL levels were not at goal .  INTERVENTION Clinical pharmacists implemented the physician-approved care plan for each intervention patient ; activities included managing lipid-lowering drug therapy and educating patients on cardiovascular risk reduction . MEASUREMENTS AND MAIN RESULTS Primary outcomes were changes in LDL level and the proportion of patients achieving goal LDL in the intervention versus the usual care ( control ) group . Secondary outcomes were the sustainability of the impact observed up to 18 months after discontinuation of the intervention . Mean+/-SD baseline LDL levels were 131+/-28 and 131+/-26 mg/dl ( p = NS ) for the intervention and control groups , respectively . After a mean of 6.5 months follow-up , 107 ( 72 % ) patients in the intervention group and 61 ( 18 % ) patients in the control group had attained their LDL goal ( p<0.001 ) . Mean LDL levels were reduced by 35.6 mg/dl ( 27.5 % ) and 6.7 mg/dl ( 4.6 % ) in the intervention and control groups , respectively ( p<0.001 ) . When the active program was discontinued , results of the 18-month follow-up indicated that 85 ( 65 % ) intervention patients remained at goal compared with 96 ( 42 % ) controls ( p<0.001 ) . CONCLUSION This trial provides quantitative evidence to support the effectiveness of the collaborative approach as an intervention to optimize management of patients with CHD whose LDL levels are not at goal ; this approach is specifically called for in the executive summary of the National Cholesterol Education Program Adult Treatment Panel III . Furthermore , this study documents both the magnitude and sustainability of the impact collaborative care models can have in managed care environments A prospect i ve controlled study on the benefits of pharmacists ' individualized counseling on drug compliance , cholesterol concentration reduction , attainment of National Cholesterol Education Program ( NCEP ) Adult Treatment Panel III ( ATP III ) low-density lipoprotein cholesterol ( LDL-C ) goals , and patient satisfaction was carried out in a private community hospital in Hong Kong . All patients who were newly prescribed with lipid-lowering drugs for primary prevention were included . The patients in the individualized counseling group received " intense " counseling and follow-up of cholesterol concentration by a pharmacist for 3 months . The control group received routine counseling .  Fifty patients completed the study ( 26 in the individualized group , 24 in the control group ) .  Compliance was assessed , and those patients who achieved 75 % compliance were defined as compliers . In the individualized group , 76.9 % were compliers compared with 41.7 % in the control group ( p < 0.01 ) . The individualized group achieved 28.3 % , 27.7 % , and 26.1 % reduction in total cholesterol , LDL-C , and triglycerides , respectively , compared with 15.3 % , 16.3 % , and 10.6 % in the control group ( p < 0.05 for all ) . Also in the individualized group , 80.8 % achieved the ATP III LDL-C goals compared to 58.3 % in the control group ( p < 0.05 ) . Of patients in the individualized group , 85 % felt that the pharmacist counseling service could improve their disease management . The study demonstrated that pharmacists ' individualized counseling , together with the assessment of  cholesterol concentrations , had positive impacts on the management of hyperlipidemia , including improved drug compliance , better treatment endpoints , and patient satisfaction The objective was to study the effect of " academic group detailing " on the prescribing of lipid-lowering drugs in Swedish primary care . A r and omized controlled trial was conducted , r and omization being by group . Groups of doctors at 134 community health centres were r and omly allocated to an intervention and a control group . The 67 intervention health centres were offered four sessions , conducted by a pharmacist , with group information on guidelines for the management of hyperlipidaemia . The number of prescriptions of lipid-lowering drugs per month increased in the intervention health centres and the increase was statistically different from the corresponding change in the control health centres among women in the age group 30 - 65 years ( p = 0.03 ) . The prescription of first-line lipid-lowering drugs increased by 20 % in the intervention health centres ( p = 0.03 ) . " Academic group detailing " by pharmacists to primary care doctors can be an effective method for influencing prescribing practice 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 OBJECTIVE To evaluate apparent discontinuation rates in patients newly prescribed lipid-lowering drugs . DESIGN AND SETTING A prospect i ve survey of 12 months ' dispensing data in 138 community pharmacies across metropolitan Sydney . PATIENTS 610 adults ( 49 % men ) with a mean age of 58 years ; 91 % of prescriptions were from general practitioners ; prescribed drugs were simvastatin ( 54 % ) , pravastatin ( 31 % ) and gemfibrozil ( 15 % ) . MAIN OUTCOME MEASURE The number of patients failing to collect prescription refills . RESULTS 60 % of patients ( 95 % confidence interval [ CI ] , 56%-64 % ) apparently discontinued their medication over 12 months . Half of the apparent discontinuations occurred within three months and a quarter within one month of starting treatment . The predominant reasons for discontinuation were : patient unconvinced about need for treatment ( 32 % ) , poor efficacy ( 32 % ) and adverse events ( 7 % ) . Only half of those experiencing poor efficacy were switched to another drug . The relative risk ( RR ) of discontinuation was lower in older patients ( age 65 + v. < 50 years : RR 0.66 ; 95 % CI 0.47 - 0.93 ) and in those using other cardiovascular drugs ( RR 0.69 ; CI 0.56 - 0.86 ) , but was increased in those showing early evidence of poor compliance ( RR 1.77 ; CI 1.33 - 2.35 ) . Discontinuation appeared to be unrelated to sex , the source of the prescription ( general practitioner or specialist ) , past use of lipid-lowering drugs or the cost of medication . CONCLUSIONS High apparent discontinuation rates with lipid-lowering drugs suggest significant wastage of re sources in treatments that are initiated but not continued and a lost opportunity for heart disease prevention . Many patients appear to discontinue therapy for illogical reasons and this may be amenable to intervention
target: A clinical ly relevant but not statistically significant reduction in triglycerides was found .
  No impact on HDL-C levels was found .
  Patients ' adherence to pharmacotherapeutic regimens and quality of life were considered possibly not sensitive and possibly sensitive to pharmacist interventions , respectively .
  Total cholesterol is sensitive to pharmacist interventions , while LDL-C and triglyceride levels are possibly sensitive to those interventions .
background: BACKGROUND Hyperlipidemia increases the risk of cardiovascular diseases , and control is pivotal for preventing disease complications .
  Multidisciplinary interventions , including those performed by pharmacists , are important for improving patients ' outcomes .
  OBJECTIVE To quantify the impact of pharmacist interventions in enhancing patients ' outcomes .