Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

Abstract

-Purpose. To examine the effect of an implemented pharmaceutical care program on coronary heart disease risk in elderly diabetic and hypertensive patients. Methods. A total of 200 elderly (≥60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements was evaluated at baseline and for 36 months. The intervention-group patients received pharmaceutical care from a clinical pharmacist, whereas the control-group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk of all patients. Results. A total of 194 patients completed the study. Significant reductions (P < 0.05) in the mean values (baseline vs. 36 months) of systolic blood pressure (156.7 mmHg vs. 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001), fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P < 0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL) cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m 2 vs. 26.1 kg/m 2 ; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P = 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group. Conclusion. The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.

Clinical Results of a Comprehensive Medication Management Program in a Diabetes Ambulatory Clinic

“…O farmacêutico avalia o paciente em sua totalidade, considerando todos os seus problemas de saúde e os medicamentos em uso, trabalha em conjunto com ele e os outros profissionais de saúde, corresponsabilizando-se pela farmacoterapia 5 . Estudos demonstram o impacto do GTM no cuidado a pacientes portadores de doenças crônicas, associado a resultados clínicos, econômicos e humanísticos satisfatórios [6][7][8][9][10][11] . Apesar de alguns grupos demonstrarem o impacto do serviço farmacêutico no manejo da doença, poucos estudos descrevem os resultados clínicos do GTM no Brasil.…”

Clinical outcomes of medication therapy management services in primary health care

“…In this study, this professional practice is materialized into the clinical service known as medication therapy management (MTM). MTM services follow the philosophy and patient care process of pharmaceutical care practice as proposed by Cipolle, Strand and Morley (2012) and, for this reason, they are called "pharmaceutical care-based MTM" (Ramalho de Oliveira, 2009;Obreli Neto et al, 2011;de Souza et al, 2007;Lee, Grace, Taylor, 2006;Cipolle, Strand, Morley, 2012).…”

“…Pharmacists in developing countries work mainly in activities related to acquisition and inventory control of drugs, with little involvement in direct patient care (Obreli Neto et al, 2011). There are a few published studies on the clinical outcomes of this practice in Brazil, mainly in the primary care setting (Mourão et al, 2013;Obreli Neto et al, 2011;Obreli Neto, Cuman, 2010;Lyra Júnior, Marcellini, Pelá, 2008;de Souza et al, 2007;.…”

“…Primary care is the main option for access to health care for approximately 70% of the Brazilian population (Obreli Neto et al, 2011). In primary care, the high prevalence of chronic conditions is associated with an increase in the use of medications Obreli Neto et al, 2011;Lee, Grace, Taylor, 2006).…”

“…In primary care, the high prevalence of chronic conditions is associated with an increase in the use of medications Obreli Neto et al, 2011;Lee, Grace, Taylor, 2006). Also, the high use of medications is associated with the development of DRPs, which can negatively impact on patients' health and increase the total health-care costs (Obreli Neto et al, 2011;Lee, Grace, Taylor, 2006;Cipolle, Strand, Morley, 2012).…”