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CV Risk Reduction by Pharmacists at the Workplace
Study Questions:
What is the impact of a standardized pharmacist-driven cardiovascular (CV) risk-reduction program on the 10-year risk of CV disease?
Methods:
Employees of the University of British Columbia Vancouver voluntarily presented for screening and enrollment in the program. Subjects with an estimated 10-year CV disease risk of ≥10% (based on the Framingham Risk Score) or with at least 1 medication-modifiable CV disease risk factor (diabetes, hypertension, dyslipidemia, prior myocardial infarction, stroke, tobacco use, or obesity) were enrolled. This was a prospective, observational pre-post intervention study. The Comprehensive Medication Management intervention program consisted of pharmacists who were matched with individual patients who met approximately 5 times over the course of the study. They discussed patient’s CV health goals and communicated those to the patient’s care providers.
Results:
A total of 512 subjects was screened for eligibility with 207 enrolled and 178 analyzed (29 did not complete the study). Of that total, 85% were managed for primary CV disease prevention, and 15% had a history of prior CV disease event. The mean age of subjects was 51 years, and 54% were female; 56% were Caucasian, and 42% were Asian. At 12 months, the Framingham Risk Score was significantly lower from a baseline mean of 11.7 to a final mean of 10.7 (absolute difference mean 1.0, relative difference 8.5%; p < 0.001). Patients with the highest baseline Framingham Risk Score (≥20) had the greatest relative reduction in risk (18.1%, p < 0.001). Individually, systolic blood pressure, diastolic blood pressure, and body weight were each significantly lower at the end of the 12-month study period. Participant self-reported quality of life (as measured by EQ-5D-3L) and medication adherence (as measured by Morisky Medication Adherence Scale-8) also increased during the study.
Conclusions:
A clinically meaningful 1% absolute and 8.5% relative risk reduction in CV risk estimation was found in subjects enrolled in a pharmacist-run CV risk reduction program at a single large employer in Vancouver British Columbia. Based on the success of the program, pharmacist involvement was expanded at the employment site to include other preventative care initiatives, disease management programs, and mental health education.
Perspective:
Although the study did not meet its goal of a mean relative risk reduction of at least 20%, the impact of a structured pharmacist-run CV risk-reduction program demonstrated value in reducing CV risk factors and improving subjects’ quality of life and medication adherence.
Keywords: Cardiovascular Diseases, Risk Factors, Pharmacists, Workplace, Risk Reduction Behavior, Self Report, Medication Adherence, Quality of Life, Risk Reduction Behavior, Health Education, Disease Management
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