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A Randomized Trial of the Effect of Community Pharmacist Intervention on Cholesterol Risk Management
The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP)
Ross T. Tsuyuki, BSc(Pharm),PharmD,MSc;
Jeffrey A. Johnson, BSP,PhD;
Koon K. Teo, MB,PhD;
Scot H. Simpson, BSP,PharmD;
Margaret L. Ackman, BSc(Pharm),PharmD;
Rosemarie S. Biggs, BPharm;
Andrew Cave, MD,MClSc;
Wei-Ching Chang, PhD;
Vladimir Dzavik, MD;
Karen B. Farris, BSPharm,PhD;
Donna Galvin, BSc(Pharm);
William Semchuk, MSc,PharmD;
Jeff G. Taylor, BSP,PhD;
for the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP) Investigators
Arch Intern Med. 2002;162:1149-1155.
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 aimed 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 randomized 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 randomized 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.
From the Division of Cardiology (Drs Tsuyuki, Simpson, Chang, and Dzavik) and the Departments of Family Medicine (Dr Cave) and Public Health Sciences (Dr Johnson), Faculty of Medicine and Dentistry, and the Faculty of Pharmacy and Pharmaceutical Sciences (Dr Johnson), University of Alberta, Edmonton; the Division of Cardiology, McMaster University, Hamilton, Ontario (Dr Teo); Regional Pharmacy Services, Capital Health, Edmonton (Dr Ackman); Broadmoor Pharmacy, Sherwood Park, Alberta (Ms Biggs); the College of Pharmacy, The University of Iowa, Iowa City (Dr Farris); CPS Consultants, Okotoks, Alberta (Ms Galvin); the Pharmacy Department, Regina Health District, Regina, Saskatchewan (Dr Semchuk); and the College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon (Dr Taylor).
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