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Associate Clinical Professor of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Division of Family Medicine, 301 Governors Drive, Huntsville, Alabama 35801-5123, fax 256/551-4573. andrumr{at}auburn.edu
Assistant Clinical Professor of Pharmacy Practice, Auburn University Harrison School of Pharmacy
Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G359
Of the 22 patients enrolled, 11 (50%) completed the initial visit and 6 follow-up visits. The mean number of follow-up visits was 5 (range 1-6). All patients were white, 59% were male, and the mean age was 55 years (range 28-67). The mean body mass index was 33.6 kg/m2 (range 22-49). More than half (54.6%) of the participants had no prescription insurance and were enrolled in a medication assistance program. There was a high incidence of cardiovascular risk factors in the patient population at baseline. The low-density lipoprotein cholesterol (LDL-C) goals were levels less than 100 mg/dL for 64% of patients, less than 130 mg/dL for 27%, and less than 160 mg/dL for 9%.
At baseline, the LDL-C level was at goal in 3 (13.6%) patients. A nonfasting lipid panel was documented in 7 (5%) of 132 recorded lipid panels. LDL-C goal attainment improved from 14% at the initial visit to 50% at the last available follow-up visit (p = 0.01). Of the 11 patients who completed all follow-up visits, 64% achieved their goal. The LDL-C level goal was achieved during one or more follow-up visits in 16 (73%) patients.
The difference in mean LDL-C level from the initial visit to the last available follow-up visit was not significant (Table 1). However, when individual patient changes were analyzed among patients with a calculable LDL-C value at both the initial and last available follow-up visits (n = 13), the mean ± SD LDL-C level decreased significantly from 141 ± 33 to 115 ± 41 mg/dL (p = 0.02). The mean total cholesterol and triglyceride levels decreased significantly from the initial visit to the last available follow-up visit. There were no liver-associated enzyme elevations requiring changes in lipid therapy. Nonadherence to lipid-lowering therapy was reported in 9 (41%) patients during 17 (13%) of the 132 patient visits.
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A total of 21 lipid therapy interventions were made during the study, including therapy initiated 6 times, changed 7 times, dose increased 6 times, and additional therapy added twice. Pharmacists made a total of 43 nonlipid interventions during the study.
Access to adequate healthcare services is a continual concern in rural areas. Clinical pharmacists can offer a valuable service to address this problem by providing disease-state management programs and patient education. Ours was a small pilot study in a newly established site for a clinical pharmacist, with a single group, pre-post design. Therefore, the conclusions to be drawn are limited. However, as of February 27, 2006, outcomes from the collaboration between clinical pharmacists and nurse practitioners have not been published and may represent a unique opportunity for clinical pharmacy services.
Footnotes
Presented as a poster at the American College of Clinical Pharmacy annual meeting, Atlanta, GA, November 3, 2003.
References
This article has been cited by other articles:
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  M. R. Andrus and D. B. Clark Provision of pharmacotherapy services in a rural nurse practitioner clinic Am. J. Health Syst. Pharm., February 1, 2007; 64(3): 294 - 297. [Abstract] [Full Text] [PDF]
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