Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Alberta Vascular Risk Reduction Community Pharmacy Project: RxEACH
Brief Summary: Cardiovascular disease (disease of the heart and blood vessels) is one of the leading causes of death in Canada. It also carries a financial burden on the Canadian economy with a yearly cost close to $21 billion divided between loss of productivity and healthcare costs. The majority of cardiovascular disease cases (90%) are caused by factors that can be controlled and modified. These factors include high blood pressure, high cholesterol, diabetes (high blood sugar), tobacco smoking, unhealthy diet, obesity, physical inactivity and high alcohol consumption. Such factors are very common and not very well controlled and so individuals who have any of these factors would be at risk of having cardiovascular disease. As such controlling these factors will reduce the risk of having cardiovascular disease and improve the individuals' quality of life. Pharmacists frequently work with patients and their family doctor to provide cardiovascular care. Having a pharmacist involved in cardiovascular care may help patients with cardiovascular disease or at risk of having the disease because they are more accessible and may have more opportunities to educate people about cardiovascular medications. This might lead to better prevention and control of cardiovascular disease.

Purpose:

The research study will assess if a community pharmacy cardiovascular risk reduction intervention can help reduce cardiovascular risk.

Procedure:

If the individual has an elevated blood pressure, cholesterol, blood sugar, waist circumference or body weight or is physically inactive, have an unhealthy diet, a smoker or taking medications for any of the previously mentioned conditions, the pharmacist will assess the cardiovascular disease risk \[risk of having a cardiovascular event (e.g. heart attack or a stroke)\] using a computer program. If the individual is at high risk s/he will be asked to take part in the study.

If the individual agrees to take part in the study s/he will be randomly assigned to either the Usual Care Group or the Advanced Care Group. All participants have an equal chance of being assigned to either group. If assigned to the Usual Care Group, the individual will receive the care and services that would normally be provided by the pharmacist. At 3 months, the pharmacist will see the individual who will be offered the Advanced Care at that time.

If assigned to the to Advanced Care Group, the individual will be asked to meet with the pharmacist every 3-4 weeks over a 3 month period. During these meetings, the pharmacist will conduct an assessment that may include blood pressure, waist circumference, height and weight measurements and talk to the individual about their cardiovascular risk and medications. The individual and the pharmacist will come up with a plan for how to try to lower his/her cardiovascular risk. The pharmacist will discuss this plan with their family doctor. The individual will be asked to conduct some laboratory tests before the 3 months visit; these tests may include HbA1c (a blood test to measure blood sugar control over the last 3 months) and cholesterol to assess the effect of the intervention on cardiovascular risk.


Options:
A: Inclusion Criteria:

* Patients diagnosed with Bipolar I Disorder
* Have been discharged from the Clinic of Saint John of God -La Ceja-
* Have been resulting from external consultation (outpatient) of the Clinic of Saint John of God -La Ceja-
* Male and female patients aged between 18 and 65 years
* Living in Medellin or any of the following eastern municipalities in the department of Antioquia.

Exclusion Criteria:

* Patients with first episode of manic type, schizoaffective disorder, bipolar disorder II, cyclothymia and other bipolar spectrum disorders, personality disorders that seem bipolar disorder, sociopathic disorder.
* Epilepsy
* Patients unable to comply with the protocol requirements, including severe alcohol and drug use.
* Patients with diagnostic uncertainty.
* Pregnancy or breastfeeding
* Infection with the human immunodeficiency virus (HIV).
* Chronic decompensate disease (no significant diseases): blood pressure values above 180/110 mmHg, total cholesterol above 300 mg / dL, low density cholesterol greater than 160 mmHg, hemoglobin A1c greater than 9%, lower oxygen saturation 90%.
* Mental retardation, presence of any cognitive impairment that prevents understands and signs informed consent.
* Refusal to sign informed consent (Consent must be obtained before any study-related procedures are conducted).
* Illiteracy.
* Patients in electroconvulsive therapy.
B: Inclusion Criteria:

* age 50 and older
* prescription for at least one cardiovascular medication for heart failure
* plan to receive care and prescriptions at the study health care facility
* ability to hear within the normal range of conversation
* English speaking
* willingness to obtain echocardiography

Exclusion Criteria:

* dementia
C: Inclusion Criteria:

* Adults (≥18 years of age) at high risk for cardiovascular events, including:

  * Patients with diabetes
  * Patients with chronic kidney disease \[eGFR \<60 ml/min/1.73m2 and/or (ACR \>= 30 mg/mmol or two consecutive ACR tests which are \>= 3 mg/mmol)\]
  * Patients with established atherosclerotic vascular disease including cerebrovascular disease (prior stroke or transient ischemic attack), cardiovascular disease (myocardial infarction, acute coronary syndrome, stable angina, or revascularization), or peripheral arterial disease (symptomatic and/or ankle brachial index \<0.9).
  * Primary prevention patients with multiple risk factors and Framingham risk score \>20%
  * In order to qualify for inclusion, all patients must have at least one uncontrolled risk factor (i.e., blood pressure, LDL-cholesterol, HbA1c, or current smoking)

Exclusion Criteria:

* Unwilling to participate/sign consent form
* Unwilling or unable to participate in regular follow-up visits
* Pregnancy
D: Inclusion Criteria:

* A stroke specialist-determined ischemic stroke or TIA within the past year (including ocular strokes/TIA such as amaurosis fugax).
* Presence of systemic hypertension (average systolic blood pressure over two visits - i.e., SPC visit and study screening visit- exceeding 140 mmHg) OR fasting LDL cholesterol exceeding 2.0 mmol/L OR total: HDL cholesterol ratio exceeding 4.0 at SPC visit.

Exclusion Criteria:

* Neurological event considered to be due to intracranial hemorrhage (e.g., ICH, SAH), or trauma induced, or related to structural heart disease such as ASD/VSD or endocarditis.
* Foreshortened life-expectancy (e.g., active malignancy), hypertensive crisis (clinic systolic BP \> 200 mm Hg), or severe comorbidities.
* Institutionalized in a long-term care facility.
* Cognitive impairment (defined as a score of \> 5 on the Short Portable Mental Status questionnaire).
* Already on maximal therapy for risk factors (on 3 antihypertensive drugs at maximal dose if hypertension is inclusion criterion or on maximal dose statin if hyperlipidemia is inclusion criterion).

Answer: C