Evaluation of a pharmacist-led cardiovascular risk clinic for patients with diabetes attending a hospital out-patient clinic

Abstract

Cardiovascular disease is strongly associated with diabetes; hypertension is prominent in diabetic patients. In 2003 a pharmacist-led cardiovascular risk reduction clinic was established to reduce cardiovascular risk in diabetic patients.

The aim of this study was to evaluate the feasibility of outcome measures to inform a future prospective study to evaluate the pharmacist-led clinic and to measure the impact of the clinic on cardiovascular risk reduction.

A spreadsheet was designed to be populated with patients’ information from patients attending the pharmacist-led clinic and the usual care. The process of data collection was performed retrospectively by case note review.

Forty five patients were included in the intervention group (pharmacist's patients) and 42 in the control group (doctor's patients). There were significant differences in duration of diabetes (p=0.003), HbA1c (p=0.026) and number of comorbidities (p0.022) at baseline. The reduction in SBP was significant (p=0.0088) and the number of patients reaching target BP was significant (p =0.0036). Reduction in DBP, ACR and total cholesterol was insignificant. There was a significant difference in the number of antihypertensives started or increased (p<0.001) and a significant difference in the number of medication related problems actioned (p=0.0058).

Reduction in BP and the proportion of patients reaching target BP change in pharmaceutical care plan drug therapy problems actioned can be used as outcome measures and primary end point in the future study. Reduction in ACR and the number of hospital admission might be used as feasible outcome measures if the intervention and the control group in the future study are similar and randomised correctly.