A Prospective Study of the Impact of a Critical Care Pharmacist Assigned as a Member of the Multidisciplinary Burn Care Team A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. Greater effect of enhanced pharmacist care on cholesterol management in patients with diabetes mellitus: a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions. Pharmacist-Led Shared Medical Appointments for Multiple Cardiovascular Risk Reduction in Patients With Type 2 Diabetes The impact of clinical pharmacist in a cardiac-surgery intensive care unit. Using pharmacists to improve risk stratification and management of stage 3A chronic kidney disease: a feasibility study Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. A Pharmacist Care Program Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. Impact of clinical pharmacists intervention on management of hyperglycemia in pregnancy in Jordan Rationale and design of the Study of a Tele-pharmacy Intervention for Chronic diseases to Improve Treatment adherence (STIC2IT): A cluster-randomized pragmatic trial. Pharmacist intervention in the prevention of heart failure for high-risk elderly patients in the community A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Underutilization of cardiovascular medications: effect of a continuity-of-care program. Economic impact of community pharmacist intervention in cholesterol risk management: an evaluation of the study of cardiovascular risk intervention by pharmacists. A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial Enhancing diabetes care by adding a pharmacist to the primary care team. Impact of providing psychiatry specialty pharmacist intervention on reducing drug‐related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open‐label study Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting. Benefits of individualized counseling by the pharmacist on the treatment outcomes of hyperlipidemia in Hong Kong. A Community-Based Pilot Study of a Diabetes Pharmacist Intervention in Latinos: Impact on Weight and Hemoglobin A1c Pharmacist Interventions in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials.
A critical care clinical pharmacy specialist was assigned to the burn center to make scheduled rounds with the physicians and to attend the weekly multidisciplinary burn team rounds . A prospect i ve 6-month study was completed to 1 ) determine the clinical impact of the pharmacist 's interventions and 2 ) quantify cost savings generated by these interventions . Prospect i ve data concerning clinical interventions by the pharmacist were collected during a 6-month period . Each intervention was independently review ed by two attending burn surgeons to determine its importance . A total of 165 interventions in 76 patients were documented . Following an independent review of each intervention by burn surgery attendings , 121 of 165 interventions were felt to have improved overall patient care , 42 of 165 prevented possible drug-related toxicity or organ dysfunction , 1 of 165 prevented a possible life-threatening event , and only 1 of 165 was considered insignificant . Drug changes suggested by the pharmacist result ed in a savings of $ 11,081.14 for the 6-month period . The integration of the critical care pharmacist into clinical rounds results in significant cost avoidance and improves overall patient care BACKGROUND It has been demonstrated in previous studies that pharmacist management of patients with type 2 diabetes mellitus ( T2DM ) in the outpatient setting not only improves diabetes-related clinical outcomes such as hemoglobin A1c but also blood pressure ( BP ) , total cholesterol ( TC ) , and quality of life . Improved control of BP and TC has been shown to reduce the risks of cardiovascular disease ( CVD ) , which has placed a heavy economic burden on the health care system . However , no study has evaluated the cost-effectiveness of pharmacist intervention programs with respect to the long-term preventive effects on CVD outcomes among T2DM patients . OBJECTIVES To ( a ) quantify the long-term preventive effects of pharmacist intervention on CVD outcomes among T2DM patients using evidence from a matched cohort study in the outpatient primary care setting and ( b ) assess the relative cost-effectiveness of adding a clinical pharmacist to the primary care team for the management of patients with T2DM based on improvement in CVD risks with the aid of an economic model . METHODS Clinical data between the periods of June 2007 to February 2010 were collected from electronic medical records at 2 separate clinics at Kaiser Permanente ( KP ) Northern California , 1 with primary care physicians only ( control group ) and the other with the addition of a pharmacist ( enhanced care group ) . Patients in the enhanced care group were matched 1:1 with patients in the control group according to baseline characteristics that included age , gender , A1c , and Charlson comorbidity score . The estimated 10-year CVD risk for both groups was calculated by the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Risk Engine ( version 2 ) based on age , sex , race , smoking status , atrial fibrillation , duration of diabetes , levels of A1c , systolic BP ( SBP ) and TC , and high-density lipoprotein cholesterol ( HDL-C ) observed at 12 months . There was no statistical difference in the baseline clinical inputs to the Risk Engine ( A1c [ P=0.115 ] , SBP [ P=0.184 ] , TC [ P=0.055 ] , and HDL-C [ P=0.475 ] ) between the 2 groups . A Markov model was developed to simulate the estimated CVD outcomes over 10 years and to estimate cost-effectiveness . The final outcomes examined included incremental cost and effectiveness measured by life years and per quality -adjusted life year gained . Both deterministic sensitivity analysis ( SA ) and probabilistic SA were conducted to examine the robustness of the results . RESULTS The estimated risks for coronary heart disease ( CHD ) and stroke ( both nonfatal and fatal ) at the end of the follow-up were consistently lower in the enhanced care group compared with the control group , even though baseline risks in both groups were similar . The absolute risk reduction ( ARR ) between the enhanced care and control groups increased over time . For example , the ARR for nonfatal CHD risk in year 1 was 0.5 % ( 1.2 % vs. 0.7 % ) , whereas the ARR increased to 5.5 % in year 10 ( 14.8 % vs. 9.3 % ) . Similarly , the ARR between the enhanced care and the control groups was calculated as 0.3 % for fatal CHD in year 1 and increased to 4.6 % in year 10 . Results from the Markov model suggest that the enhanced care group was shown to be a dominant strategy ( less expensive and more effective ) compared with the control group in the 10-year evaluation period in the base-case ( average or mean results ) scenario . Sensitivity analysis that took into account the uncertainty in all important variables , such as wage of pharmacists , utility weight ( the degree of preference individuals have for a particular health state or condition ) , response rate to pharmacists ' care , and uncertainty associated with the estimated 10 years of CVD risk , revealed that the relative value of enhanced care was robust to most of the variations in these parameters . Notably , the level of cost-effectiveness measured by net monetary value depends on the time horizon adopted by the payers and the magnitude of CVD risk reduction . The enhanced care group has a higher chance of being considered as a cost-effective strategy when a longer time horizon such as a minimum of 4 to 5 years is adopted . CONCLUSIONS Adding pharmacists to the health care management team for diabetic patients improves the long-term CVD risks . The longer-term CVD risk reductions were shown to be more dramatic than the short-term reduction . A longer time horizon adopted by health plans in managing T2DM patients has a higher probability of making the intervention cost-effective STUDY OBJECTIVE To determine the effect of enhanced pharmacist care on cholesterol management in patients with and without diabetes mellitus . METHODS We conducted a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists ( SCRIP ) , a 54-center r and omized trial of pharmacist intervention compared with usual care in patients at high risk for cardiovascular events . The patients involved had atherosclerotic disease or diabetes . We compared the effect of pharmacist intervention in patients with and without diabetes . The primary end point was a composite of performing a fasting cholesterol profile , or adding or increasing the dosage of a cholesterol-lowering drug . Secondary end points were individual components of the primary end point and change in 10-year risk for cardiovascular events , using the Framingham risk equation . RESULTS Of the 675 patients enrolled in the SCRIP study , 294 ( 44 % ) had diabetes .  Enhanced pharmacist care had a more beneficial effect on cholesterol management in those with diabetes ( odds ratio [ OR ] 4.8 ) than without diabetes ( OR 2.1 ) , p=0.01 . Secondary end points showed similar trends , and reduction in Framingham risk was greater in patients with diabetes than without . CONCLUSION Pharmacist intervention for dyslipidemia appears to have a greater impact in patients with diabetes . Results of this sub study suggest that pharmacists should target this patient group for interventions in cholesterol risk management INTRODUCTION Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients . Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level . In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated . METHODOLOGY We conducted a prospect i ve , pre-post interventional study among patients with hyperglycemia . The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards . Clinical pharmacists review ed patients ' medical charts for proper insulin administration , evaluated nurses ' technique for  insulin injection and blood glucose measurement , and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management . RESULTS The percentage of controlled r and om blood sugar increased from 13.8 % in the pre-intervention to 22.3 % in the post-intervention group ( p value < 0.01 ) . On the other h and , the percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group . CONCLUSION Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service . Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different setting s for diabetes control Purpose To assess whether VA MEDIC-E ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH ] Extended for 6 months ) , a pharmacist-led shared medical appointments program , could improve attainment of target goals for hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to st and ard primary care after 6 months of intervention . Methods A r and omized , controlled trial of VA MEDIC-E ( n = 50 ) versus st and ard primary care ( n = 49 ) in veterans with type 2 diabetes , hemoglobin A1c ( A1C ) > 7 % , blood pressure ( BP ) > 130/80 mmHg , and low density lipoprotein cholesterol ( LDL-C ) > 100mg/dl ( 2.59 mmol/l ) in the previous 6 months was conducted . The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions . Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist . Evaluation measures included lab values of A1C , LDL cholesterol , BP , and goal attainment of these values , and diabetes self-care behavior question naires at 6 months . Results The r and omization groups were similar at baseline in all cardiovascular risk factors except for LDL , which was significantly lower in the MEDIC-E arm . At 6 months , significant improvements from baseline were found in the intervention arm for exercise , foot care , and goal attainment of A1C , LDL-C , and BP but not in the control arm . Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk OBJECTIVE To evaluate the  clinical pharmacists ' interventions  in an intensive care unit ( ICU ) setting with regard to their acceptance by the medical team , frequency , clinical significance , and targeted patient 's outcomes . METHODS This is a prospect i ve , non-comparative , observational study evaluating the  clinical pharmacist interventions in an ICU setting from December 2002 to May 2003 . The study was conducted in a 19-bed Cardiac-Surgery ICU at King Faisal Specialist Hospital & Research Center , a tertiary-care hospital in Riyadh , Saudi Arabia . The clinical pharmacist performed daily multi-disciplinary team rounds , with documentation of all his interventions . On the same day , a physician , who is a part of the team , verified all interventions for validity and clinical significance . The institutional Office of Research Affairs approved the study . RESULTS The clinical pharmacist intervened 394 times on the 600 patients [ 0.66 intervention-per-patient ] . The medical team accepted almost all interventions ( 94.3 % ) . The main drug-related problems were the following : no drug prescribed for medical condition ( 33.2 % ) , inappropriate dosing regimen ( 28.9 % ) , and no indication for drug use ( 14.3 % ) . Approximately 55.7 % of the interventions targeted enhancing therapeutic outcomes , whilst 21.8 % of interventions result ed in the prevention of an adverse drug reaction . The interventions that may have result ed in decreasing mortality , preventing , or reducing organ damage , or decreasing hospitalization , represented 8.1 % of all interventions . CONCLUSION Participation of a clinical pharmacist in the daily multidisciplinary team rounds in an ICU setting significantly reduces unfavorable morbidities and enhances therapeutic outcomes Background Measurement of albuminuria to stratify risk in chronic kidney disease ( CKD ) is not done universally in the primary care setting despite recommendation in KDIGO ( Kidney Disease Improving Global Outcomes ) guidelines . Pharmacist medication therapy management ( MTM ) may be helpful in improving CKD risk stratification and management . Methods We conducted a pragmatic , cluster-r and omized trial using seven primary care clinic sites in the Geisinger Health System to evaluate the feasibility of pharmacist MTM in patients with estimated glomerular filtration rate ( eGFR ) 45–59 ml/min/1.73 m2 and uncontrolled blood pressure ( ≥150/85 mmHg ) . In the three pharmacist MTM sites , pharmacists were instructed to follow a protocol aim ed to improve adherence to KDIGO guidelines on testing for proteinuria and lipids , and statin and blood pressure medical therapy . In the four control clinics , patients received usual care . The primary outcome was proteinuria screening over a follow-up of 1 year . A telephone survey was administered to physicians , pharmacists , and patients in the pharmacist MTM arm at the end of the trial . Results Baseline characteristics were similar between pharmacist MTM ( n = 24 ) and control ( n = 23 ) patients , although pharmacist MTM patients tended to be younger ( 64 vs. 71 y ; p = 0.06 ) and less likely to have diabetes ( 17 % vs. 35 % ; p = 0.2 ) or baseline proteinuria screening ( 41.7 % vs. 60.9 % , p = 0.2 ) . Mean eGFR was 54 ml/min/1.73 m2 in both groups  . The pharmacist MTM intervention did not significantly improve total proteinuria screening at the population level ( OR 2.6 , 95 % CI : 0.5–14.0 ; p = 0.3 ) . However , it tended to increase screening of previously unscreened patients ( 78.6 % in the pharmacist MTM group compared to 33.3 % in the control group ; OR 7.3 , 95 % CI : 0.96–56.3 ; p = 0.05 ) . In general , the intervention was well-received by patients , pharmacists , and providers , who agreed that pharmacists could play an important role in CKD management . A few patients contacted the research team to express anxiety about having a CKD diagnosis without prior knowledge . Conclusions Pharmacist MTM may be useful in improving risk stratification and management of CKD in the primary care setting , although implementation requires ongoing education and multidisciplinary collaboration and careful communication regarding CKD diagnosis . Future studies are needed to establish the effectiveness of pharmacist MTM on slowing CKD progression and improvement in cardiovascular outcomes .Trial registration Clinical Trials.gov , NCT02208674Registered August 1 , 2014 , first patient enrolled September 30 , BACKGROUND Adverse drug events and medication errors are threats to quality care . Inpatient studies suggest that a pharmacist may reduce these events , but outpatient studies have not been forthcoming . METHODS We conducted a pooled analysis of 2 r and omized controlled trials to determine the effect of pharmacist intervention on adverse drug events and medication errors . We studied 800 outpatient cases of hypertension stratified into complicated ( n = 535 ) and uncomplicated ( n = 265 ) . Patients in the complicated stratum had heart failure or other cardiovascular complication .  Computer programs examined 1-year electronic record data to identify events classified as adverse drug events and preventable or potential adverse drug events . Medication errors included preventable and potential adverse drug events . RESULTS Of the 800 participants ( mean [ SD ] age , 59 [ 10 ] years ) , 484 ( 90.5 % ) and 258 ( 97.4 % ) participants remained in the complicated and uncomplicated strata , respectively , at 12 months . Compared with the control group , the risk of any event was 34 % lower in the intervention group ( risk ratio , 0.66 ; 95 % confidence interval [ CI ] , 0.50 - 0.88 ) , including a lower risk of adverse drug events ( risk ratio , 0.65 ; 95 % CI , 0.47 - 0.90 ) , preventable adverse drug events ( risk ratio , 0.52 ; 95 % CI , 0.25 - 1.09 ) , potential adverse drug events ( risk ratio , 0.70 ; 95 % CI , 0.40 - 1.22 ) , and medication errors ( risk ratio , 0.63 ; 95 % CI , 0.40 - 0.98 ) . CONCLUSIONS This post hoc analysis suggests that pharmacist intervention to improve medication use in out patients with cardiovascular disease decreases the risk of adverse drug events and medication errors . Further studies are needed to confirm this finding Objective : To investigate the effect of a pharmacist care program on cardiovascular risks in type 2 diabetic patients . Methods : A 9-month , prospect i ve , r and omized , controlled study was conducted in a public hospital in Hong Kong . Patients in the intervention group had regular drug-counseling sessions with pharmacists in addition to routine medical care , whereas patients in the control group received only routine medical care . The primary outcome was the change in coronary heart disease ( CHD ) risk . Results : A total of 105 patients completed the study . Patients in the intervention group had a statistically significant reduction in CHD risk compared to those in the control group ( −1.64 % ± 3.56 % ; n = 51 vs −0.01 % ± 3.08 % ; n = 54 , P = .013 ) . For stroke , a reduction in risk was noted in the intervention group , while an increased risk was noted in the control group ( −1.06 % ± 1.82 % vs 0.31 % ± 2.51 % , P = .002 ) . In addition , hemoglobin A1c levels were significantly reduced in the intervention group compared with the control group ( −1.57 % ± 1.50 % vs –0.40 % ± 1.19 % , P < .001 ) ; a similar profile was seen with low-density lipoprotein cholesterol ( −0.36 ± 0.76 vs −0.03 ± 0.74 , P = .026 ) . Furthermore , there were nonsignificant improvements in high-density lipoprotein cholesterol , triglyceride , and blood pressure in the intervention group . The increased level of underst and ing regarding medications in the intervention group was statistically significant ( P < .001 ) , yielding a better enhancement in compliance compared with patients in the control group ( 22.5 % ± 13.4 % vs 2.0 % ± 5.0 % , P < .001 ) . Conclusion : The pharmacist care program implemented in this study demonstrated a significant cardiovascular risk reduction in type 2 diabetic patients ; therefore such a program would be a valuable addition to a multidisciplinary care of diabetic patients 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 Background and objective Hyperglycemia in pregnancy is a risk factor for cardiovascular disease and postpartum ( PP ) diabetes . This study aim ed to assess the impact of the clinical pharmacist-assisted program ( CPAP ) of optimizing drug therapy and intensive education on main management outcome measures of patient knowledge about diabetes , Quality of life ( QoL ) as measured by SF-36 including maternal complications , fasting plasma glucose ( FPG ) control , and HbA1c . Method This is a r and omized controlled study . Pregnant ( 20–28 weeks ) patients with hyperglycemia received CPAP ( n = 51 ) as compared with conventional management  ( n = 34 ) . Patients were then followed up for 6 weeks pp . Results A significant change was shown in the intervention group for diabetes knowledge ( 3.47 % vs. control 2.03 % , P < 0.05 ) and three aspects of health-related QoL. The need for caesarian delivery ( 58.8 % vs. control 35.3 % ) and severe episodes of hypoglycemia ( 0 % vs. control 8.8 % ) were significantly ( P < 0.05 ) reduced in the intervention group . Six weeks PP reduction in HbA1c values was greater in the intervention group ( − 0.54 % vs. control − 0.08 % , P = 0.04 ) with more FPG-controlled patients during pregnancy ( 94 % vs. control 64.7 % ) . Conclusion Clinical pharmacist assisted services in the management of pregnancy hyperglycemia fundamentally and significantly improve knowledge and disease control BACKGROUND Approximately half of patients with chronic cardiometabolic conditions are nonadherent with their prescribed medications . Interventions to improve adherence have been only modestly effective because they often address single barriers to adherence , intervene at single points in time , or are imprecisely targeted to patients who may not need adherence assistance . OBJECTIVE To evaluate the effect of a multicomponent , behaviorally tailored pharmacist-based intervention to improve adherence to medications for diabetes , hypertension , and hyperlipidemia . TRIAL DESIGN The STIC2IT trial is a cluster-r and omized pragmatic trial testing the impact of a pharmacist-led multicomponent intervention that uses behavioral interviewing , text messaging , mailed progress reports , and video visits . Targeted patients are those who are nonadherent to glucose-lowering , antihypertensive , or statin medications and who also have evidence of poor disease control . The intervention is tailored to patients ' individual health barriers and their level of health activation . We cluster-r and omized 14 practice sites of a large multispecialty group practice to receive either the pharmacist-based intervention or usual care .  STIC2IT has enrolled 4,076 patients who will be followed up for 12months after r and omization . The trial 's primary outcome is medication adherence , assessed using pharmacy cl aims data . Secondary outcomes are disease control and health care re source utilization . CONCLUSION This trial will determine whether a technologically enabled , behaviorally targeted pharmacist-based intervention results in improved adherence and disease control . If effective , this strategy could be a scalable method of offering tailored adherence support to those with the greatest clinical need Background Heart failure has become one of the major causes of hospitalization worldwide . Hypertension , diabetes mellitus and hyperlipidemia are the major causes of heart failure . In order to effectively prevent heart failure , blood pressure , blood glucose and cholesterol levels shall be closely monitored and controlled as well as medication adherence . This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in high risk elderly patients in the community of Hong Kong . Aim This study aim ed to investigate the role of pharmacist intervention in prevention of heart failure in highrisk elderly patients in the community of Hong Kong . Methods This prospect i ve uncontrolled study was conducted between July 2012 and April 2013 with two revisits every 3 to 4 months to review elderly patients ’ medication profiles as well as assess their blood pressure ( BP ) , r and om capillary blood glucose ( RCBG ) level , cholesterol levels , signs and symptoms of heart failure and the compliance level . The results collected at the baseline data were analyzed and compared with those collected at the last follow-up visit . Result A significant increase in number of subjects free of symptoms of heart failure ( 31.88 % , p < 0.001 ) was found . For chronic disease management , significant reduction in LDL-cholesterol level ( -0.86 ± 0.56mmol/L , p = 0.038 ) and triglyceride level ( -1.15 ± 1.09mmol/L , p < 0.001 ) was observed in overall participants . Yet , no significant reduction in BP level or RCBG level was observed in overall subjects . Significant reduction in mean Morisky Medication Adherence Score ( -0.54 ± 1.50 , p = 0.005 ) indicated improvement in medication compliance in participants . Conclusion The Pharmacy Outreach service has a significant role in prevention of heart failure , by means of minimizing heart failure symptoms , improving medication compliance and enhancing chronic disease management , particularly cholesterol management in community elderly patients . This study provided a reference for further investigation and evaluation of the role of pharmacists in preventing heart failure in the high-risk community elderly patients 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 PURPOSE The effect of hospital pharmacists ' enhanced communication with patients and community providers on the underutilization of key cardiovascular medications was studied . METHODS Patients enrolled in the Iowa Continuity of Care study were eligible for inclusion in this study if they had a diagnosis of hypertension , hyperlipidemia , heart failure , coronary artery disease , or a combination of these diagnoses . Eligible patients also had to be admitted to the internal medicine , family medicine , cardiology , or orthopedics services and receive their usual medical care in the community and their prescriptions from a community pharmacy . Patients were r and omized to receive minimal intervention , enhanced intervention , or usual care . For the minimal- and enhanced-intervention groups , pharmacy case managers ( PCMs ) performed comprehensive medication reconciliations and identified drug-related problems within 24 hours of admission . The PCMs made recommendations to the inpatient care team and to patients ' community physicians . For patients in the enhanced-intervention group , the PCM developed a  discharge care plan containing the patient 's discharge medication list . PCMs made specific recommendations to optimize regimens that did not meet current guidelines or medications that were underutilized . Medication underutilization was assessed at admission , discharge , 30 days after discharge , and 90 days after discharge . RESULTS A total of 732 patients were enrolled in this study . There were no significant differences among the three study groups . Overall , the rate of underutilization remained constant among all three groups , despite enhanced pharmacist involvement in both intervention groups . CONCLUSION Enhanced interventions by PCMs had no effect on the underutilization of key cardiovascular drugs during hospitalization or after hospital discharge 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 Background Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease ( CKD ) . Multidisciplinary efforts may improve care for patients with chronic disease .  Pharmacist based interventions have effectively improved management of hypertension . We performed a pragmatic , r and omized , controlled trial to evaluate the effect of a pharmacist based quality improvement program on 1 ) outcomes for patients with CKD and 2 ) adherence to CKD guidelines in the primary care setting . Methods Patients with moderate to severe CKD receiving primary care services at one of thirteen community-based Veterans Affairs outpatient clinics were r and omized to a multifactorial intervention that included a phone-based pharmacist intervention , pharmacist-physician collaboration , patient education , and a CKD registry ( n = 1070 ) or usual care ( n = 1129 ) . The primary process outcome was measurement of parathyroid hormone ( PTH ) during the one year study period . The primary clinical outcome was blood pressure ( BP ) control in subjects with poorly controlled hypertension at baseline . Results Among those with poorly controlled baseline BP , there was no difference in the last recorded BP or the percent at goal BP during the study period ( 42.0 % vs. 41.2 % in the control arm ) . Subjects in the intervention arm were more likely to have a PTH measured during the study period ( 46.9 % vs. 16.1 % in the control arm , P < 0.001 ) and were on more classes of antihypertensive medications at the end of the study ( P = 0.02 ) . Conclusions A one-time pharmacist based intervention proved feasible in patients with CKD . While the intervention did not improve BP control , it did improve guideline adherence and increased the number of antihypertensive medications prescribed to subjects with poorly controlled BP . These findings can inform the design of quality improvement programs and future studies which are needed to improve care of patients with CKD.Trial registration Clinical Trials.gov : NCT01290614 PURPOSE The impact of pharmacist interventions on short-term clinical markers and long-term cardiovascular risk in patients with type 2 diabetes is investigated . METHODS Selected health outcomes were retrospectively analyzed in 147 adults with type 2 diabetes whose care was managed by a team of providers including a pharmacist ( the enhanced care group ) and a matched sample of patients ( n = 147 ) managed by a primary care physician only ( the control group ) . All patients received services through the same health maintenance organization ( HMO ) . The primary study endpoints were ( 1 ) the changes from baseline to 12-month follow-up in glycosylated hemoglobin ( HbA(1c ) ) , low-density lipoprotein cholesterol ( LDL-C ) , and blood pressure ( BP ) values , ( 2 ) rates of attainment of HbA(1c ) , LDL-C and BP goals , and ( 3 ) changes from baseline in predicted 10-year risks of coronary heart disease ( CHD ) and stroke . RESULTS During the 12-month study period , the mean HbA(1c ) value was decreased from 9.5 % to 6.9 % in the enhanced care group and from 9.3 % to 8.4 % in the control group ( p < 0.001 ) ; patients in the enhanced care group were significantly more likely to attain goals for HbA(1c ) ( odds ratio [ OR ] , 3.9 ) , LDL-C ( OR , 2.0 ) , and BP reduction ( OR , 2.0 ) and three times more likely to attain all three goals ( OR , 3.2 ) . The estimated 10-year risk of CHD was decreased from 16.4 % to 9.3 % with enhanced care versus a reduction from 17.4 % to 14.8 % with usual care ( p < 0.001 ) . CONCLUSION The addition of a pharmacist to an HMO primary care team improved short-term surrogate markers as well as long-term cardiovascular risk in adult patients with type 2 diabetes WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient 's function and quality of life . Due to the complicated neurobiological aetiology of autism spectrum disorder ( ASD ) , a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population . We evaluate the impact of providing specialty psychiatry ( PS ) pharmacist intervention in identifying and resolving drug-related problems ( DRPs ) among children with ASD associated with disruptive behaviours . METHODS An eight-week-long , prospect i ve , r and omized open-label study was conducted . Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included . They were r and omly assigned to an intervention or a control group . Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist , while those in control group were cared by a hospital pharmacist . The primary outcome was the number of patients who resolved of at least one DRP by the end of the study . The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability ( ABC-I ) scores between the two groups . RESULTS Twenty-five patients were r and omly assigned to either an intervention or control group . At week 8 , the total number of patients who resolved of at least one DRP was 13 ( 52 % ) in the intervention group and 4 ( 16 % ) in the control group , respectively ( P=.016 ) . Improper drug selection , medication non-adherence and subtherapeutic dosage were the most common DRPs . Mean ABC-I scores improved in the intervention group more than in the control group ( 9.8±5.6 vs 17.7±7.9 ; P<.001 ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD . The reduction in common DRPs mostly result ed from the PS pharmacist interventions , including selection of antipsychotic agent , adjustment of dosage based on ABC-I scores and provision of individualized drug counselling . Reducing DRPs led to the improvement of any disruptive behaviour . In addition , multidisciplinary team should develop drug therapy protocol s to promote the role of pharmacists in this setting OBJECTIVE T o examine whether quality of care ( QOC ) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes . DESIGN R and omized controlled trial . SETTING A family health network with 8 family physicians , 5 nurses , and 11 administrative personnel serving 10 000 patients in a rural area near Ottawa , Ont . PARTICIPANTS Patients 50 years of age and older at risk of experiencing adverse health outcomes ( N = 241 ) . INTERVENTIONS At-risk patients were r and omly assigned to receive usual care from their family physicians or Anticipatory and Preventive Team Care ( APTCare ) from a collaborative team composed of their physicians , 1 of 3 nurse practitioners , and a pharmacist . MAIN OUTCOME MEASURES Quality of care for chronic disease management ( CDM ) for diabetes , coronary artery disease , congestive heart failure , and chronic obstructive pulmonary disease . RESULTS Controlling for baseline demographic characteristics , the APTCare approach improved CDM QOC by 9.2 % ( P < .001 ) compared with traditional care . The APTCare intervention also improved preventive care by 16.5 % ( P < .001 ) . We did not observe significant differences in other secondary outcome measures ( intermediate clinical outcomes , quality of life [ Short-Form 36 and health-related quality of life scales ] , functional status [ instrumental activities of daily living scale ] and service usage ) . CONCLUSION Additional re sources in the form of collaborative multidisciplinary care teams with intensive interventions in primary care can improve QOC for CDM in a population of older at-risk patients . The appropriateness of this intervention will depend on its cost-effectiveness . TRIAL REGISTRATION NUMBER NCT00238836 ( CONSORT ) 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 Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications . This study used a r and omized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics . The intervention included a focused discussion and two individual pharmacist counseling sessions on medication , nutrition , exercise , and self-care to promote behavior changes . Sessions were culturally adapted for language , diet , family participation , and cultural beliefs . Clinical outcomes were measured at baseline and three months . Nineteen intervention and 24 control participants completed the study . Mean BMI reduction was greater for intervention than for control group participants ( –0.73± 0.07 kg/m2 versus + 0.37±0.02 kg/m2 p<.009 respectively ) . Hemoglobin A1c was significantly reduced by 0.93±0.45 % in the intervention group only . There was no significant difference in blood glucose , blood pressure , or lipid levels . An innovative culturally-sensitive pharmacist intervention improved selected clinical outcomes among Latino diabetics BACKGROUND Diabetes mellitus is a major health problem that is growing rapidly worldwide . A collaborative and integrated team approach in which pharmacists can play a pivotal role should be sought when managing patients with diabetes . OBJECTIVE To identify and summarize the main outcomes of pharmacist interventions in the management of type 2 diabetes .  METHODS PubMed , Cochrane Central Register of Controlled Trials , and Web of Science were search ed for r and omized controlled trials evaluating the effectiveness of any pharmacist intervention directed at patients with type 2 diabetes in comparison with usual care . Outcome measures of interest included glycosylated hemoglobin ( Alc ) , blood glucose , blood pressure , lipid profile , body mass index ( BMI ) , 10-year coronary heart disease ( CHD ) risk , medication adherence , health-related quality of life ( HRQoL ) , and economic outcomes . The risk of bias in included studies was assessed using the Cochrane risk of bias tool . RESULTS Thirty-six studies were included in this systematic review , involving 5,761 participants . The studies evaluated the effects of several pharmacist interventions carried out in various countries and in different health care facilities , such as community pharmacies , primary care clinics , and hospitals . The number of studies reporting each outcome of interest varied . Alc was evaluated in 26 studies , of which 24 reported a greater reduction in this outcome in the intervention group compared with the control group , with the difference in change between groups ranging from -0.18 % to -2.1 % . Eighteen studies assessed change in systolic blood pressure , of which 17 studies reported a greater improvement in this outcome in the intervention group , with the difference in change between groups varying between -3.3 mmHg and -23.05 mmHg . For diastolic blood pressure , a greater effect was also observed in the intervention group in 14 out of 15 studies , with the difference in change between groups varying between -0.21 mmHg and -9.1 mmHg . Thirteen studies described total cholesterol as an outcome measure , of which 10 reported a greater improvement in this outcome in the intervention group , with the difference in change between groups ranging from + 18.95 mg dL(-1 ) to -32.48 mg dL(-1 ) . With regard to low-density lipoprotein cholesterol , a greater reduction in this parameter in the intervention group was documented in 12 out of 15 studies , with the difference in change between groups varying between + 7.35 mg dL(-1 ) and -30 mg dL(-1 ) . Similarly , favorable data were reported on high-density lipoprotein cholesterol in the intervention group in 9 out of 12 studies that assessed this outcome , with the difference in change between groups ranging from -5.8 mg dL(-1 ) to + 11 mg dL(-1 ) . Data on triglycerides were also reported in 12 studies , of which 9 reported a greater reduction in triglycerides levels in the intervention group , with the difference in change between groups varying between + 12 mg dL(-1 ) and -62 mg dL(-1 ) . Overall , a beneficial effect on BMI was also described in the intervention group in 12 out of 14 studies . Of note , in all 6 studies that estimated the 10-year CHD risk among study patients , a greater improvement in the intervention group versus the control group was found . In addition , pharmacist interventions also had a positive impact on medication adherence and HRQoL in most studies that ascertained these outcomes . Finally , although only 3 studies conducted a cost-effectiveness analysis , pharmacist interventions proved to be cost-effective . CONCLUSIONS The findings from this review clearly support the involvement of pharmacists as members of health care teams in the management of patients with type 2 diabetes . DISCLOSURES This systematic review was not funded . The authors declare that they have no conflicts of interest . Concept and study design were created by Pousinho , Morgado , and Alves . Pousinho took the lead in data collection , along with Alves , and data interpretation was performed by Pousinho , Falcão , and Alves . The manuscript was primarily written by Pousinho , along with Alves , and revised by Alves , Morgado , and Falcão
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 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 .