Statin Interchange by Pharmacist Collaborative Practice Agreement (CPA)

Study Overview
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Brief Summary
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A group of   225 patients were switched from atorvastatin to an equivalent statin either by their physicians usual management or by an collaborative pharmacist coordinated process. We will compare the results of pharmacist process to the standard medical practice to find potentially which process is more effective, safer and efficient. We are surveying a total of 35 physicians, 12 using the pharmacist coordinated process and 23 not, comparing their satisfaction of the 2 processes.

Detailed Description
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This study is a retrospective analysis of patients converted from atorvastatin to another equivalent statin. It is observational because the patients were all on atorvastatin, had been informed by their prescription drug plan that it would not be covered, and that if agreed they would be changed to an equivalent that is covered by their plan. The patients were either converted with the help of pharmacist by collaborative practice agreement (CPA)or upon contacting their physician requesting a different medication. We are comparing the percentage first converted to the equivalent dose in each group and whether patients continued to be at hyperlipidemia treatment goal after the interchange.

Official Title
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Statin Therapeutic Interchange by Pharmacist Collaborative Practice Process

Conditions
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Hypercholesterolemia

Intervention / Treatment
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* Drug: atorvastatin


Participation Criteria
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Eligibility Criteria
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225 insured eligible subjects, 35 PCIM physicians

Ages Eligible for Study
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Minimum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Eligible plan beneficiaries on atorvastatin<br>A group of 225 eligible patients would no longer have atorvastatin covered by their prescription plan and would need to be changed to another equivalent anti-hyperlipidemic agent. | Drug: atorvastatin<br>* All patients desired to change atorvastatin 10, 20mg to an equivalent that is covered by their prescription plan. This is accomplished by either pharmacists by MD/Pharmacist practice agreement or physicians in usual practice<br>* Other names: interchanged to simvastatin, pravastatin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determine if a process of pharmacist practice agreement is effective in changing from atorvastatin 10, 20mg to a therapeutic equivalent dose. | We compared doses selected for therapeutic equivalency for the new statin Did the process result in selecting a safe and effective statin alternative? | 3 to 9 months after conversion from atorvastatin | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Was the process regarded as efficient and satisfying to physician compared to usual practice. | A satisfaction survey of physicians who utilized the pharmacist collaborative practice agreement(CPA) will be compared to satisfaction of phycians who were not able to use the CPA. Was the process regarded as efficient and satisfying to physician compared to usual practice. | 5 months post conversion | 
| Did the patients' low density lipoprotein(LDL) cholesterol require further statin dose intervention? | Of patients who had a follow up LDL cholesterol, how many required another intervention after failing to stay within treatment goal. Physicians usually measure each of these patients within 3 months of a change of treatment and annually thereafter. We will look at follow up LDL cholesterol and liver function test (LFT) as recommended. | 6-12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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low density lipoprotein (LDL) cholesterol, statin, dose equivalent, Hypercholesterolemia (defined by LDL guidelines)