Pharmacy U

Reducing the risk of cardiovascular events in patients


A 2016 study has further strengthened the position that many pharmacists and healthcare experts have long claimed: When pharmacists’ scope of practice expands, patients receive better treatment and their health has the potential to improve greatly.


By David Silverberg


Published in the June issue of the “Journal of the American College of Cardiology,” the Canadian study found that intensive pharmacist intervention (including prescribing) may help reduce the risk of cardiovascular (CV) events in patients.


Based in Alberta, where a pharmacist’s scope of practice includes prescriptive authority, the study randomly assigned half the participants – patients at high risk of CV events, such as those with preexisting CV disease, diabetes, chronic kidney disease or high Framingham risk – to receive specialized care, including medication review, CV risk assessment, education and prescribing, and monthly follow-up visits over three months. The other half received usual pharmacist and GP care, with no specific intervention.


The study found a 21 per cent relative reduction in estimated risk for cardiovascular events in the advanced pharmacist care group compared to the control group.


The study also reported the intervention group had greater improvements in low-density lipoprotein cholesterol (–0.2 mmol/l; p < 0.001), systolic blood pressure (–9.37 mm Hg; p < 0.001), improved blood sugar control in those with diabetes, and a 20% reduction in smoking.


“While we’ve known how pharmacist intervention can help patients on an anecdotal level, we never had evidence before to support our claim…until now,” says Dr. Ross Tsuyuki, the study’s lead author and a professor of medicine (Cardiology) in the Faculty of Medicine and Dentistry at the University of Alberta. “If people see pharmacists more frequently than they see their physicians, it’s a great opportunity to improve patient care.”


Pharmacist invention key to increasing health benefits


What Tsuyuki and his team found supported their hypothesis: pharmacist intervention greatly reduced the risk of cardiovascular events in patients compared to those who didn’t receive the greater scope of practice.


“There’s great momentum and interest behind expanded scope of practice for pharmacists as an important and practicable advance in public health,” says Tsuyuki, who has presented these results at conferences from Japan to Germany, to Argentina.


In fact, British Columbia is aiming to follow the lead of Alberta and New Brunswick, the provinces with the widest prescriptive authority given to pharmacists.


Bob Nakagawa, registrar of the College of Pharmacists of B.C., says his province is preparing an updated framework on how pharmacists can expand their scope of practice, with the intention to bring a proposal to the Minister of Health later in 2017.


“Ross’s study demonstrates that pharmacists are very accessible and knowledgeable healthcare professionals,” says Nakagawa. “We’re very much inspired by what’s happening in Alberta and with the positive impact that they are having on the health of Albertans.”


The main challenge to spreading pharmacist intervention coast to coast, according to Alistair Bursey, chair of the Canadian Pharmacists Association, is financial. “We need funding in place to help expand the scope of what pharmacists do,” he notes. “We need stable funding for pharmacists to dispense medication, and increased funding for expanded practices across the country.”


Bursey says he’s emboldened by the recent study and has worked to ensure the federal government is aware of studies such as these “to realize how pharmacists can impact patient outcomes.”


Bursey stresses how funding these initiatives can actually offer “tremendous savings in healthcare,” he adds, “because if you invest in programs that can prevent hospital treatments of heart attack or stroke victims, it’s worth the investment.”


Tsuyuki adds, “A 21 per cent reduction in the risk for cardiovascular events, the leading cause of death and disability worldwide, is important for public health. And, it could be enacted with a simple stroke of a (healthcare policymakers’) pen.”


He also has a message for pharmacists happy with the ways things are today. “Things are clearly moving in the direction of pharmacists’ expanded scope of practice – and, responsible patient-centred care. If there’s such innovation in healthcare and you aren’t taking part, you have to ask yourself why you’re not excited about it. You’ve complained for years about being underappreciated as a primary care provider – now you have the opportunity – take it before someone else does!”