Efficacy of a Pharmacist‐Led Cardiovascular Risk Reduction Clinic for Diabetic Patients With and Without Mental Health Conditions

Abstract

Coexisting mental health conditions (MHCs) attenuate treatment effects in diabetes. A retrospective analysis was performed of a pharmacist‐led cardiovascular risk reduction clinic (CRRC) targeting hypertension, diabetes, hyperlipidemia, and tobacco use in patients with at least one CRRC visit between January 2001 and January 2002. The United Kingdom Prospective Diabetes Study (UKPDS) risk change (after/before CRRC) for those with and without MHCs was compared. Of the 297 with diabetes and complete UKPDS data, 40.7% had at least 1 MHC (22.3% had a severe MHC). Patients with MHCs had a similar number of CRRC visits (4.7±2.6 vs 4.4±2.6) but had a lower baseline UKPDS score (0.31±0.18 vs 0.40±0.20; P=.001) compared with non‐MHC patients. The risk change after CRRC was similar for those with and without MHCs (0.10±0.13 vs 0.10±0.14; P=.82), but patients with MHCs had a longer CRRC enrollment (245±152 vs 205±161 days; P<.03). The efficacy of the CRRC model to reduce cardiovascular risk is not attenuated by a concomitant MHC.

Pharmacist-Led Group Medical Appointment Model in Type 2 Diabetes

“…[8][9][10] Clinical pharmacists at the Veterans Health Affairs have prescriptive authority to manage medication therapy under federal regulation, and there are data to support their effectiveness in the management of diabetes and cardiovascular risk factors in the individual clinic settings. 11,12 Pharmacists can also be trained to be diabetes educators and participate in diabetes self-management education programs. 13 However, it is unknown whether the use of clinical pharmacists in lieu of physicians in a group medical appointment program for the management of diabetes and associated cardiac risk factors is feasible or efficacious.…”

Enhancing diabetes care by adding a pharmacist to the primary care team

“…They demonstrated that compared with standard care, adding pharmacists to the primary care team resulted in a median absolute reduction in the UKPDS risk score of 1.0% after 1 year. 22 The study described in this article also used the UKPDS risk engine but demonstrated even greater (i.e., up to 4.5-fold) reductions in the estimated 10-year Am J Health-Syst Pharm-Vol 70 May 15, 2013 of enhanced versus usual care might have been even greater.…”

Dietary approaches to hypertension: A call to pharmacists to promote lifestyle changes

“…Pharmacists at VA medical centers assessed diet at baseline and developed action plans that included referral to nutritionists as part of an individualized program. 23 A community pharmacy study also incorporated lifestyle changes. Patients with uncontrolled hypertension were enrolled at nine community pharmacies in the same region and chain.…”