Collaborative Cardiovascular Risk Reduction in Primary Care II

Abstract

Cardiovascular disease is the leading cause of death in Canada. Despite improvements in cardiovascular risk factor identification and management over the past couple decades, many patients are still not reaching their guideline-recommended blood pressure, cholesterol, or blood glucose targets. Although numerous studies have demonstrated benefits to incorporating pharmacists onto primary care teams to facilitate cardiovascular risk reduction, such initiatives are not currently being implemented on a widespread basis in Canada. Part of the reason for this may be that most studies have been conducted in specialized, tertiary care clinics, while the majority of Canadians receive care from family physicians. CCARP II was a prospective, before and after clinical initiative implemented to help bridge this gap between clinical research and current clinical practice. The purpose of CCARP II was to implement and evaluate a pharmacist-led collaboration to identify and manage cardiovascular risk factors in a real-world family medicine setting. The pharmacist screened 566 patients for uncontrolled cardiovascular risk factors over the 9-month study period. Of all patients screened, 186 (32.9%) were at moderate or high cardiovascular risk with one or more risk factors above target. Of those, 113 patients (60.8%) were referred back to the pharmacist by their physician for ongoing monitoring and follow-up. In this group of patients, statistically significant reductions in systolic blood pressure, LDL cholesterol, and the total cholesterol: HDL ratio were observed over the study period. In patients started on new medications over the study period, a high rate of persistence (87.8%) was observed. CCARP II demonstrated that there is still a need for systematic screening for unidentified or uncontrolled cardiovascular risk factors in adult patients visiting their physicians; almost one-third of patients in our study had one or more uncontrolled risk factors identified. This initial pilot project was successful in identifying patients with above-target cardiovascular risk factors, and subsequently aiding in the reduction of these risk factors towards target levels.