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A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial.

Garcia BH, Giverhaug T, Høgli JU, Skjold F, Småbrekke L - Pharm Pract (Granada) (2015)

Bottom Line: The difference was statistically significant for the documented lifestyle advices in intervention group patients.No significant improvements in biomedical risk factors were observed in favor of the intervention group.A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention.

View Article: PubMed Central - PubMed

Affiliation: Hospital Pharmacy of North Norway; & Department of Pharmacy, University of Tromsø . Tromsø ( Norway ). beate.garcia@uit.no.

ABSTRACT

Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors.

Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months. The control group received standard care from their general practitioner. Primary outcomes were adherence to clinical guideline recommendations concerning prescription, therapy goal achievement and lifestyle education defined in the medication assessment tool for secondary prevention of CHD (MAT-CHDSP). Secondary outcomes included changes in the biomedical risk factors cholesterol, blood pressure and blood glucose.

Results: Ninety-four patients completed the trial, 48 intervention group patients and 46 controls. Appropriate prescribing was high, but therapy goal achievement was low in both groups. Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end, 78.4% vs. 62.0%, p<0.001. The difference was statistically significant for the documented lifestyle advices in intervention group patients. No significant improvements in biomedical risk factors were observed in favor of the intervention group.

Conclusions: The study showed an increased guideline adherence in both study groups. This indicates that attention to clinical practice guideline recommendations in itself increases adherence - which may be a clinical pharmacist task. A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention. Amendments to the follow-up program are suggested before implementation in standard patient care can be recommended.

No MeSH data available.


Related in: MedlinePlus

Patient flow during the randomized controlled trial*Patient were assessed for eligibility during 205 days.
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Figure 2: Patient flow during the randomized controlled trial*Patient were assessed for eligibility during 205 days.

Mentions: About half of the eligible patients did not want to participate. Inclusion was stopped before the estimated sample size was achieved, because of the predefined enrolment period. Finally, 102 patients were recruited, and 51 were randomized to each study group. Eight patients (7.8%) were lost to follow-up, see Figure 2. A total of 48 IG patients and 46 CG patients were subjected for analysis. The study groups did not differ significantly, see Table 1.


A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial.

Garcia BH, Giverhaug T, Høgli JU, Skjold F, Småbrekke L - Pharm Pract (Granada) (2015)

Patient flow during the randomized controlled trial*Patient were assessed for eligibility during 205 days.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482847&req=5

Figure 2: Patient flow during the randomized controlled trial*Patient were assessed for eligibility during 205 days.
Mentions: About half of the eligible patients did not want to participate. Inclusion was stopped before the estimated sample size was achieved, because of the predefined enrolment period. Finally, 102 patients were recruited, and 51 were randomized to each study group. Eight patients (7.8%) were lost to follow-up, see Figure 2. A total of 48 IG patients and 46 CG patients were subjected for analysis. The study groups did not differ significantly, see Table 1.

Bottom Line: The difference was statistically significant for the documented lifestyle advices in intervention group patients.No significant improvements in biomedical risk factors were observed in favor of the intervention group.A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention.

View Article: PubMed Central - PubMed

Affiliation: Hospital Pharmacy of North Norway; & Department of Pharmacy, University of Tromsø . Tromsø ( Norway ). beate.garcia@uit.no.

ABSTRACT

Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors.

Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months. The control group received standard care from their general practitioner. Primary outcomes were adherence to clinical guideline recommendations concerning prescription, therapy goal achievement and lifestyle education defined in the medication assessment tool for secondary prevention of CHD (MAT-CHDSP). Secondary outcomes included changes in the biomedical risk factors cholesterol, blood pressure and blood glucose.

Results: Ninety-four patients completed the trial, 48 intervention group patients and 46 controls. Appropriate prescribing was high, but therapy goal achievement was low in both groups. Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end, 78.4% vs. 62.0%, p<0.001. The difference was statistically significant for the documented lifestyle advices in intervention group patients. No significant improvements in biomedical risk factors were observed in favor of the intervention group.

Conclusions: The study showed an increased guideline adherence in both study groups. This indicates that attention to clinical practice guideline recommendations in itself increases adherence - which may be a clinical pharmacist task. A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention. Amendments to the follow-up program are suggested before implementation in standard patient care can be recommended.

No MeSH data available.


Related in: MedlinePlus