A Pilot Study Evaluating Multiple Risk Factor Interventions by Community Pharmacists to Prevent Cardiovascular Disease: The PAART CVD Pilot Project
McNamara, KP and O'Reilly, SL and Dunbar, JA and Bailey, MJ and George, J and Peterson, GM and Jackson, SL and Janus, ED and Bunker, S and Duncan, G and Howarth, H, A Pilot Study Evaluating Multiple Risk Factor Interventions by Community Pharmacists to Prevent Cardiovascular Disease: The PAART CVD Pilot Project, The Annals of Pharmacotherapy, 46, (2) pp. 183-191. ISSN 1542-6270 (2012) [Refereed Article]
Background: There is insufficient evidence for the efficacy of comprehensive multiple risk factor interventions by pharmacists in the primary prevention of cardiovascular disease (CVD). Given the proven benefits of pharmacist interventions for individual risk factors, it is essential that evidence for a comprehensive approach to care be generated so that pharmacists remain key members of the health care team for individuals at risk of initial onset of CVD. Objective: To establish the feasibility of an intervention delivered by community pharmacists to reduce the risk of primary onset of CVD. Methods: A single-cohort intervention study was undertaken in 2008-2009. Twelve community pharmacists from 10 pharmacies who were trained to provide lifestyle and medicine management support to reduce CVD risk recruited 70 at-risk participants aged 50-74 years who were free from diabetes or CVD. Participants received a baseline assessment to establish CVD risk and health behaviors. An assessment report provided to patients and pharmacists was used to collaboratively establish treatment goals and, over 5 sessions, implement treatment strategies. Follow-up assessment at 6 months measured changes in baseline parameters. The primary outcome was the average change to overall 5-year risk of CVD onset. Results: Sixty-seven participants were included in the analysis. The mean participant age was 60 years and 73% were female. We observed a 25% (95% CI 17 to 33) proportional risk reduction in overall CVD risk. Significant reductions also occurred in mean blood pressure (-11/-5 mm Hg) and waist circumference (-1.3 cm), with trends toward improvement for most other observed risk factors. Conclusions: Findings support previous evidence of positive cardiovascular health outcomes following pharmacist intervention in other patient groups; we recommend generating randomized controlled trial evidence for a primary prevention population.