The clinical pharmacist's role in post-discharge follow-up of patients with coronary heart disease. A follow-up program.

Abstract

Coronary heart disease (CHD) is the leading cause of death world-wide. Studies indicate that patients are treated inadequately. Pharmaceutical care programs delivered by pharmacists are known to improve quality of care for patients with a variety of chronic and acute diseases, also CHD. Most of the programs are developed and carried out in the United States and United Kingdom. The overall aim of this PhD project was to develop a pharmacist-led follow-up program for patients with established CHD after hospital discharge. First, this thesis elucidates the development and validation of a medication assessment tool within secondary prevention of CHD (MAT-CHDSP). Second, the thesis describes the use of the MAT-CHDSP to identify non-adherence with clinical practice guideline recommendations. Third, the thesis presents the development of the clinical pharmacist-led follow-up program that was carried out as a randomized controlled trial (RCT) to explore the effects of the program. Last, the thesis describes a qualitative study in the participants’ experiences of the follow-up program. The MAT-CHDSP was found applicable for use in this patient population, and good validity, feasibility and reliability results were achieved. Improvement potentials in secondary prevention of CHD were revealed, especially regarding follow-up on unachieved therapeutic targets and lifestyle counselling. The one-year follow-up program was developed, where the RCT results showed an increase in documentation of lifestyle recommendations, however no significant impact on clinical outcomes in favour of the intervention group. The qualitative study did however indicate that the program was highly appreciated by the participants, that it influenced their knowledge of drugs and made them feel safe. In order to offer the follow-up program on a continuous basis to patients with CHD, several changes are warranted; most important, the collaboration with the prescriber needs to be strengthened.