Pharmacist prescribing practices in a clinical pharmacy cardiac risk service

Todd, Brittany A.; Lamprecht, Donald G.; Stadler, Sheila L.

doi:10.2146/ajhp150781

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…While we identified that 41.4% of patients with coronary ASCVD 76 years and older had received HIST at the end of our study period, it is reasonable to expect that this rate could have been and currently might be higher. The CDTM protocol that the CPCRS practices under lists advanced age as a mitigating circumstance to alter treatment strategies based on statin tolerance and other patient specific factors 13. In practice, this may have manifested in patients with advanced age being treated less aggressively as patients with an intolerance were treated with a lower intensity statin or no statin.…”

Section: Discussionmentioning

confidence: 99%

“…Kaiser Permanente Colorado (KPCO), an integrated health care delivery system providing care to more than 660,000 patients in Colorado at 30 medical offices has a comprehensive cardiac risk reduction service called the Clinical Pharmacy Cardiac Risk Service (CPCRS). The CPCRS is a clinical pharmacy specialist-managed, physician-directed, protocol-driven secondary cardiovascular prevention service that uses a systems-based approach to focus on the long-term medication management of more than 16,000 patients with ASCVD 11-13. Greater than 95% of KPCO members with ASCVD are enrolled in the CPCRS.…”

Section: Introductionmentioning

confidence: 99%

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Trends in high intensity statin use among secondary prevention patients 76 years and older

Wood

Delate

Stadler

et al. 2019

Pharm Pract (Granada)

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Background: High intensity statin therapy (HIST) is the gold standard therapy for decreasing the risk of recurrent atherosclerotic cardiovascular disease (ASCVD); however, little is known about the use of HIST in older adults with ASCVD. Objectives: The aim of this cross-sequential study was to determine trends in statin intensity in older adults over a 10-year timeframe. Methods: The study was conducted in an integrated healthcare delivery system. Patients were 76 years or older with validated coronary ASCVD. Data were collected from administrative databases. Statin intensity level was assessed in eligible patients on January 1st and July 1st from January 1, 2007 to December 31, 2016. Results: Overall, a total of 5,453 patients were included with 2,119 (38.9%) and 3,334 (61.1%) categorized as HIST and Non-HIST, respectively. Included patients had a mean age of 79.8 years and were primarily male and white and had a cardiac intervention. The rate of HIST use increased from 14.5% to 41.3% over the study period (p<0.001 for trend). Conversely, the rates of moderate and low intensity statin use decreased from 61.8% and 9.8% to 41.2% and 4.8%, respectively (both p<0.001 for trend). Similar trends were identified for females and males. Conclusions: The percentage of patients with ASCVD 76 years and older who received HIST substantially increased from 2007 to 2016. This trend was identified in both females and males. Future comparative effectiveness research should be conducted in this patient population to examine cardiac-related outcomes with HIST and Non-HIST use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trends in high intensity statin use among secondary prevention patients 76 years and older

Wood

Delate

Stadler

et al. 2019

Pharm Pract (Granada)

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“…In the United States, team‐based care models comprising various combinations of cardiologists and APPs have been pioneered for the management of chronic cardiovascular conditions, ranging from chronic heart failure management to coronary artery disease and lipid‐management clinics . Additionally, data from a primary‐care outreach network in Oregon demonstrated improved lipid monitoring and higher rates of lipid‐lowering prescriptions in patients with DM managed remotely by a clinical pharmacist‐physician team .…”

Section: Discussionmentioning

confidence: 99%

Treatment in a preventive cardiology clinic utilizing advanced practice providers effectively closes atherosclerotic cardiovascular disease risk‐management gaps among a primary‐prevention population compared with a propensity‐matched primary‐care cohort: A team‐based care model and its impact on lipid and blood pressure management

Fentanes

Hei

Holuby

et al. 2018

Clinical Cardiology

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Background Advanced practice providers (APPs) can fill care gaps created by physician shortages and improve adherence/compliance with preventive ASCVD interventions. Hypothesis APPs utilizing guideline‐based algorithms will more frequently escalate ASCVD risk factor therapies. Methods We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity‐matched cohort (PMC) of 595 patients enrolled in primary‐care clinics alone. PCC patients were risk‐stratified using Framingham Risk Score (FRS) and coronary artery calcium scoring (CACS). Results Baseline demographics were balanced between the groups. CACS was more commonly obtained in PCC patients (P < 0.001), resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low‐FRS PCC patients with CACS ≥75th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC (P < 0.001). Post‐intervention mean LDL‐C, non–HDL‐C, and triglycerides (all P < 0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients (P = 0.004) in the PCC group. Aggressive LDL‐C and non–HDL‐C treatment goals (<70 mg/dL, P = 0.005 and < 130 mg/dL, P < 0.001, respectively), were more commonly achieved in high‐FRS PCC patients. Median post‐intervention SBP was lower among intermediate and low FRS patients (P = 0.001 and P < 0.001, respectively). Cumulatively, this resulted in a reduction in median post‐intervention PCC FRS across all initial FRS risk categories (P < 0.001 for all). Conclusions APPs within a PCC effectively risk‐stratify and aggressively manage ASCVD risk factors, resulting in a reduction in post‐intervention FRS.

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“…All prescription proposals were accepted by physicians before and after PBPM. The number of interviews before antiretroviral therapy (ART) initiation (median [range]) decreased from 2 [1][2][3][4][5] to 1 [1][2][3] after PBPM introduction, suggesting the time to introduction of treatment has been shortened. Before the introduction of PBPM, nine patients required a change in their ART prescriptions and four patients were hospitalized (one patient was hospitalized due to an error in the self-administration of anti-HIV medicines, two patients were hospitalized due to interruptions in medication, and one patient was hospitalized for the treatment of other diseases).…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

“…CDTM collaborations have spread throughout the country with demonstrated clinical efficacy. Pharmacists in the United States and Australia also actively participate in treating HIV patients, thus improving treatment outcomes and reducing medical expenses [2,3]. However, Japan is legally prohibited from operating this type of system.…”

Section: Introductionmentioning

confidence: 99%

Impact of physician−pharmacist collaborative protocol-based pharmacotherapy management for HIV outpatients: a retrospective cohort study

Urano

Ishibashi

Matsumoto

et al. 2020

J Pharm Health Care Sci

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Background: Effective treatment for human immunodeficiency virus (HIV) infection requires close cooperation among healthcare professionals. This is because maintaining continuity with treatment regimens is important in anti-HIV therapy. In addition, explaining medication use is more important than that for other diseases. Since 2010, pharmacists at the Mie University Hospital have been interviewing patients, selecting drugs, and formulating medication plans for HIV-positive patients. In August 2011, we established the physician and pharmacist-led collaborative Protocol-based Pharmacotherapy Management (PBPM) to increase the efficacy and safety of treatment, while reducing the burden on physicians. In the present study, we evaluated the outcomes associated with PBPM for HIV pharmacotherapy. Methods: We prepared protocols for drug selection, timing of interventions, and methods of intervention according to various guidelines. This study included 40 HIV-positive patients receiving outpatient care between January 2009 and February 2017. Of these patients, 17 received treatment before implementing PBPM and 23 patients received treatment afterward. We compared the intervention parameters between before and after the implementation of PBPM.

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Pharmacist prescribing practices in a clinical pharmacy cardiac risk service

Abstract: The CPCRS at KPCO has demonstrated successful maintenance of a clinical pharmacy service including pharmacist prescribing under a CDTM model to manage patients with ASCVD.

Cited by 11 publications

References 11 publications

Trends in high intensity statin use among secondary prevention patients 76 years and older

Trends in high intensity statin use among secondary prevention patients 76 years and older

Impact of physician−pharmacist collaborative protocol-based pharmacotherapy management for HIV outpatients: a retrospective cohort study

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