A Systematic Review of the Evidence for Pharmacist Care of Patients With Dyslipidemia

Authors

  • Theresa L. Charrois B.Sc.Pharm., M.Sc.,

    1. School of Pharmacy, Curtin University, Perth, Western Australia, Australia
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  • Monica Zolezzi B.Pharm., M.Sc.,

    1. Regional Pharmacy Services, Alberta Health Services-Edmonton Area, Alberta, Canada
    2. the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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  • Sheri L. Koshman Pharm.D.,

    1. the Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies
    2. the Division of Cardiology, Faculty of Medicine and Dentistry
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  • Glen Pearson Pharm.D.,

    1. the Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies
    2. the Division of Cardiology, Faculty of Medicine and Dentistry
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  • Mark Makowsky Pharm.D.,

    1. the Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies
    2. the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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  • Tamara Durec B.Sc.Pharm., M.L.I.S.,

    1. Durec Information Services Inc., St. Albert, Alberta, Canada
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  • Ross T. Tsuyuki Pharm.D., M.Sc., FCSHP, FACC

    Corresponding author
    1. the Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies
    2. the Division of Cardiology, Faculty of Medicine and Dentistry
    3. the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
    • School of Pharmacy, Curtin University, Perth, Western Australia, Australia
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  • Supported by the Centre for Community Pharmacy Research and Interdisciplinary Strategies, University of Alberta.
  • Dr. Tsuyuki has received unrestricted research funding from Merck & Co., Inc., AstraZeneca, sanofi-aventis, ManthaMed, Bristol-Myers Squibb, Apotex, Bayer Pharmaceuticals, and Medtronic, Inc. He has received speaking honoraria from Merck & Co., Inc., Novartis, Bayer Pharmaceuticals, sanofi-aventis, and Bristol-Myers Squibb.
  • Presented in part at the Canadian Pharmacists Association conference, Halifax, Nova Scotia, May 30–June 2, 2009; the 13th annual Cardiac Sciences Research Day, University of Alberta, Edmonton, Alberta, June 12, 2009; the Canadian Cardiovascular Congress, Edmonton, Alberta, October 24–28, 2009; and the Faculty Research and Development Day, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, November 30, 2009.

For reprints, visit https://caesar.sheridan.com/reprints/redir.php?pub=10089&acro=PHAR. For questions or comments, contact Ross T. Tsuyuki, Pharm.D., M.Sc., FCSHP, FACC, Division of Cardiology, EPICORE Centre/COMPRIS, University of Alberta, 220 College Plaza, 8215-112 Street NW, Edmonton, AB, Canada T6G 2C8; e-mail: ross.tsuyuki@ualberta.ca.

Abstract

Study Objective

To evaluate the effect of pharmacist care on patients with dyslipidemia.

Design

Systematic review of 21 randomized controlled trials.

Patients

A total of 5416 patients who received enhanced pharmacist care or standard care as part of a research study.

Measurements and Main Results

Nineteen databases and four trial registries were systematically searched from inception through February 21, 2010, with an update in September 2011. In addition, Web sites of relevant professional associations, scientific meetings, and research groups were reviewed, and manual searches of select journals were performed. A total of 8771 articles were identified, and 21 studies included. Data from the studies were analyzed using a random-effects model. The primary outcome measure assessed was the difference between the groups (pharmacist intervention vs standard care) in low-density lipoprotein cholesterol (LDL) level at the end of follow-up. Secondary outcome measures included the difference between the groups at the end of follow-up in total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; and the proportion of patients who achieved target lipid parameters, underwent lipid panel measurements, adhered to therapy, and/or were instructed to change their lipid-lowering therapy. At the end of follow-up, the mean LDL level was 10.7 mg/dl lower in the enhanced pharmacy care groups compared with the standard care groups (95% confidence interval [CI] –16.9 to –4.6 mg/dl), with moderate heterogeneity. The mean total cholesterol level was significantly lower in the enhanced pharmacy care groups compared with the standard care groups; however, these results were highly heterogeneous. Patients who received enhanced pharmacist care were also more likely than those receiving standard care to achieve target lipid parameters (odds ratio [OR] 2.46, 95% CI 1.43–4.25) and to have a lipid panel ordered or recommended by a pharmacist during the study (OR 2.05, 95% CI 1.30–3.24). Patients in the pharmacist intervention groups were almost twice as likely as patients in the standard care groups to have a change in lipid-lowering therapy (OR 1.82, 95% CI 1.09–3.06). Adherence data could not be analyzed.

Conclusion

This systematic review showed that enhanced pharmacist care improves lipid parameters, notably LDL levels, in patients with dyslipidemia. These results point to the benefit that pharmacist care can provide across the spectrum of dyslipidemia management, from screening patients to treating them to assisting them in the attainment of clinical targets.

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