Hospital Pharmacist‐Led Lipid Clinic for Surgical Patients with Peripheral Vascular Disease at a Regional Australian Hospital

Abstract

Aim To report patient and pharmacist experiences with a pharmacist‐led lipid clinic for surgical patients with PVD. Method A pharmacist completed a non‐medical prescribing course and tutelage under a cardiologist to enhance consultation and lipid management skills. Eligible patients were randomised into control or intervention groups. The intervention group was reviewed by the pharmacist during four 6‐weekly visits, and given lifestyle advice, lipid levels measured, and (if required) statins were initiated or adjusted. The control group was given dietary advice, a booklet on cholesterol management and lipid levels measured at baseline and 6 months. The intervention group completed a questionnaire on their experiences. The pharmacist's reflections on their role were also recorded. Results Of the 8 intervention group patients who completed the study, 5 reduced their low‐density lipoprotein (LDL) levels below 2 mmol/L, 2 reduced their LDL to 2 and 2.1 mmol/L, and 1 maintained their LDL at 2 mmol/L (mean 1.8, range 1.3–2.1). The entire control group (n = 6) had elevated LDL levels (mean 2.9 mmol/L, range 2.3–3.9). Statins were initiated or adjusted in 4 intervention group patients. Participants were highly satisfied with their pharmacist consultations. The pharmacist was positive about the training, self confidence and ability to answer questions, and less positive about the clinic setting, usefulness of the algorithm and point‐of‐care cholesterol testing. Conclusion A suitably trained hospital pharmacist can undertake extended roles with a prescribing element. However, the patient group and setting require careful consideration.

Exploring the potential for pharmacist prescribing in the management of hypertension in primary care: an Australian survey

“…It also supports previous research exploring the perspectives of a broad range of Australian pharmacists (including accredited pharmacists), which reported strongest support for an expanded prescribing role in hypertension management among a select range of chronic conditions . Furthermore, the prescribing interventions described by these pharmacists were assessed as being largely clinically appropriate by doctors themselves, in line with findings from other studies exploring the appropriateness and/or uptake of pharmacist recommendations in other contexts, for example in older patients, management of lipid disorders and in high‐risk medication, such as thromboprophylaxis in surgical patients . In the latter study, there was no difference in the appropriateness of treatment prescribed by pharmacists compared with resident medical officers, but prescribing by pharmacists was shown to contain fewer clinically significant omissions and fewer prescribing errors .…”