The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist

Reilly, Val; Cavanagh, Margaret

doi:10.1023/b:phar.0000006526.55922.8d

Cited by 16 publications

(11 citation statements)

References 3 publications

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“…[295][296][297][298][299] All of the studies looked at clinics where practice nurses monitored lipid levels, blood pressure, medication use and other risk factors such as diet, exercise and smoking. Three studies [300][301][302] looked at the effect of nurse-led interventions in primary care on patient compliance with drug regimens for high blood pressure.…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

“…However, what small improvements there were may be misleading, as they relied on patients self-reporting. [295][296][297][298][299] In a study that looked at the effect of nurse-led interventions in primary care on patient compliance with drug regimens for high blood pressure, Schroeder et al 300 found that there was no effect on patient compliance, while another study 302 found that there was some improvement. Bane et al 301 concluded that compliance was more likely if patients felt that they had been 'listened to' by their GP in the initial consultation.…”

Section: Effectiveness Of Health Improvement Activities Undertaken Inmentioning

confidence: 99%

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The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

Section: Effectiveness Of Health Improvement Activities Undertaken Inmentioning

confidence: 99%

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

View full text Add to dashboard Cite

show abstract

“…describes a Pharmacist-Led Cardiac Risk Reduction Clinic (CRCC) in the USA, where risk reduction in terms of Framingham risk score for CHD was reduced in patients participating in the CRCC [11,12]. Reilly and Cavanagh describe a successful pharmacist-nurse-run clinic for patients with cardiovascular disease in terms of optimizing drug and lifestyle therapy [13]. Lee et al .…”

Section: Introductionmentioning

confidence: 99%

A pharmacist-led follow-up program for patients with coronary heart disease in North Norway–a qualitative study exploring patient experiences

2014

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BackgroundCoronary heart disease (CHD) is one of the leading causes of death worldwide. Scientific literature shows that prevention of CHD is inadequate. The clinical pharmacist’s role in patient-centred care has been shown favourable in a large amount of studies, also in relation to reduction of risk factors related to CHD. We developed and piloted a pharmacist-led follow-up program for patients with established CHD after hospital discharge from a hospital in North Norway. The aim of the present study was to explore how participants in the follow-up program experienced the program with regard to four main topics; medication knowledge, feeling of safety and comfort with medications, the functionality of the program and the clinical pharmacist’s role in the interdisciplinary team.MethodsWe performed semi-structured thematic interviews with four patients included in the program. After verbatim transcribing, we analysed the interviews using “qualitative content analyses” by Graneheim and Lundman. Trial registration http://www.clinicaltrials.gov: NCT01131715.ResultsAll participants appreciated the follow-up program because their medication knowledge had increased, participation had made them feel safe, they were reassured about the appropriateness of their medications, and they had become more involved in their own medication. The participants reported that the program was well structured and the clinical pharmacist was said to be an important caretaker in the health-care system. The importance of collaboration between pharmacists and physicians, both in hospital and primary care, was emphasized.ConclusionOur results indicate that the follow-up program was highly appreciated among the four participants included in this study. The results must be interpreted in the context of the health care system in Norway today. Here, few pharmacists are working in hospitals or in close relation to the general practitioners. In addition, physicians are short of time in order to supply appropriate medication information, both in hospital and primary care. Involving pharmacists in follow-up of patients with CHD seems to be highly appreciated among patients and may be a step towards improving patient care. The study is limited by the low number of participants.

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“…Reductions in all-cause mortality associated with CVD in the patients followed by the service, and high satisfaction with the CCCS, was reported by both patients and physicians. Similar positive outcomes were demonstrated in other team care approaches [17,18,19]. As such, adequately preparing health care students (HCSs) for the provision of interprofessional CVDRAM services may be a valuable strategy not only to promote the adoption and the full integration of CVD risk assessment into primary care services but, most importantly, to improve the cardiovascular health of the public.…”

Section: Introductionmentioning

confidence: 76%

Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

et al. 2017

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Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half (n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

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The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist

Abstract: A secondary heart disease clinic can benefit patients by optimising drug and lifestyle therapy. While the inclusion of a pharmacist confers clinical and economic benefits.

Cited by 16 publications

References 3 publications

The organisation and delivery of health improvement in general practice and primary care: a scoping study

The organisation and delivery of health improvement in general practice and primary care: a scoping study

A pharmacist-led follow-up program for patients with coronary heart disease in North Norway–a qualitative study exploring patient experiences

Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

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