PUBLIC RELEASE DATE:
14-Apr-2014
Contact: Kim Barnhardt kim.barnhardt@cmaj.ca 613-520-7116 x2224 Canadian Medical Association Journal
Stroke patients managed by a pharmacist had a 12.5% improvement in blood pressure and low-density lipoprotein (LDL), or "bad" cholesterol levels compared with a control group, according to a clinical trial published in CMAJ (Canadian Medical Association Journal).
Patients who have a stroke or "mini stroke" (transient ischemic attack) are at high risk of adverse cardiovascular events. Management of high blood pressure and cholesterol after a stroke is important because it can substantially reduce the risk of a negative event; however, many patients receive suboptimal care.
Some evidence indicates designated "case managers" could better manage patients to reduce the risk.
Researchers undertook a randomized controlled trial to determine if a pharmacist case manager could improve blood pressure and cholesterol levels in people who had had strokes or mini strokes. The trial included 279 adult participants in Edmonton, Alberta, who either received care from a pharmacist or a nurse (control group) who managed the case over a 6-month period. About 60% of participants were 65 years of age or older and 58% were men.
Both nurses and pharmacists counselled participants on diet, smoking, exercise and other lifestyle factors; checked blood pressure and LDL levels and provided summaries to patients' physicians after each visit. In addition, pharmacists prescribed medications based on the current Canadian guidelines and adjusted doses to achieve the best result for each patient.
At the start of the study, none of the participants had blood pressure or cholesterol levels that met targets recommended in the Canadian Stroke Guidelines. By 6 months, both groups had significant improvements, with a 30% improvement in the control group managed by nurses and a 43% improvement in patients managed by pharmacists.
"Calling our control arm "usual care" would be a misnomer, and patients in the active control group (nurse-led group) showed a 30% absolute improvement in risk factor control over a 6-month period," writes Dr. Finlay McAlister, Division of General Internal Medicine, and the Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, with coauthors. "The 43% absolute improvement at 6 months seen in our pharmacist case manager group was achieved despite the fact that over three-quarters of patients were already taking an antihypertensive or lipid-lowering medication at baseline."
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Pharmacists can significantly improve blood pressure, cholesterol in stroke patients