Journal article
Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices
Circulation Cardiovascular quality and outcomes, Vol.11(6), pp.e004188-e004188
06/2018
DOI: 10.1161/CIRCOUTCOMES.117.004188
PMCID: PMC5996776
PMID: 29884657
Abstract
The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities.
This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects. There was no improvement in the Guideline Advantage score from baseline to 12 months in the control group (64.7% versus 63.1%, respectively;
=0.21). There was a statistically significant improvement in the intervention group from 63.3% at baseline to 67.8% at 12 months (
=0.02). The estimated benefit of the intervention was 5.0%±2.4% (95% confidence interval=-0.5% to 10.4%;
=0.07). Several criteria were significantly better for intervention subjects, including appropriate statin therapy (
<0.001), body mass index, screening (
<0.001), and alcohol screening (
<0.001). Only 13.7% of subjects with diabetes mellitus had hemoglobin A1c at goal at baseline, and this increased to 30.8% and 21.0% in the intervention and control group, respectively, at 12 months (
=0.10).
The centralized, remote pharmacist intervention was successfully implemented. The improvements in outcomes were modest, in part because of higher than expected baseline guideline adherence. Future studies of this model should focus on patients with uncontrolled conditions at high risk for cardiovascular events.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01983813.
Details
- Title: Subtitle
- Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices
- Creators
- Barry L Carter - Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)Barcey Levy - Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)Brian Gryzlak - Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)Yinghui Xu - Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)Elizabeth Chrischilles - Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)Jeffrey Dawson - Department of Biostatistics, College of Public Health (J.D.)Mark Vander Weg - University of Iowa. Iowa City Veterans Administration Health Care System (M.V.W.)Alan Christensen - Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences (M.V.W., A.C.)Paul James - Department of Family Medicine, University of Washington, Seattle (P.J.)Linnea Polgreen - Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.)
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.11(6), pp.e004188-e004188
- DOI
- 10.1161/CIRCOUTCOMES.117.004188
- PMID
- 29884657
- PMCID
- PMC5996776
- NLM abbreviation
- Circ Cardiovasc Qual Outcomes
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Publisher
- United States
- Grant note
- R01 HL116311 / NHLBI NIH HHS
- Language
- English
- Date published
- 06/2018
- Academic Unit
- Pharmacy; Public Health Administration; Epidemiology; Psychological and Brain Sciences; Economics; Biostatistics; Family and Community Medicine; Pharmacy Practice and Science; Injury Prevention Research Center; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9983995061402771
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