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Working with a pharmacist benefits stroke patients: study

By Allison Bond

NEW YORK (Reuters Health) - People who recently had a minor stroke are more likely to get their cholesterol and blood pressure under control if they see a pharmacist periodically as compared to a nurse, a new study found.

Keeping cholesterol and blood pressure in check is important because high levels can boost a patient's risk of having a heart attack, a bigger stroke or even of dying. But these risk factors tend to be poorly controlled.

"Our current system of care results in more than three-quarters of patients who've had a minor stroke still having inadequately controlled risk factors six months later," Dr. Finlay McAlister, the study's lead author from the University of Alberta in Edmonton, said.

His team's research was published in the Canadian medical journal CMAJ.

The researchers sought to close the gap in controlling risk factors through screening and feedback sessions with nurses or pharmacists, in addition to usual checkups.

They assigned 136 people who'd had a minor stroke, also known as a transient ischemic attack, to see a nurse every month for six months. Another 130 patients saw a pharmacist on the same schedule.

The participants were in their late 60s, on average. They all had systolic blood pressure or LDL ("bad") cholesterol that was higher than current recommendations.

Patients in the nurse-led group received advice regarding lifestyle choices that can improve blood pressure and cholesterol levels, such as exercising and quitting smoking. Nurses also checked participants' blood pressure and cholesterol, and sent the information to their primary care doctor for follow-up.

In the other group, in addition to teaching participants about lifestyle changes and checking blood pressure and cholesterol, pharmacists made changes to their blood pressure and cholesterol medications as needed.

People in both groups improved their blood pressure and cholesterol significantly over six months. But participants who met with a pharmacist did better as a whole: 43 percent of them met both blood pressure and cholesterol guidelines at the end of the study, as opposed to 31 percent of those in the nurse-led groups.

"Our study shows that case management by non-physician healthcare providers can improve risk factor management for at-risk patients, and that case management is more effective if the case manager can actively modify medications," McAlister told Reuters Health in an email.

Some of the study's authors have been consultants or given talks for companies that make blood pressure and cholesterol drugs, they note in the article.

Although the results support the idea of pharmacists providing care for people who are at risk of having a stroke, McAlister cautioned that medication changes should be made while working as part of a team with a primary care doctor or specialist, keeping these providers in the loop.

The pharmacists in the study prescribed medication under the supervision of the doctors involved in the research, and they followed a protocol for cholesterol and blood pressure treatment.

"This study wouldn't support calls for pharmacists to prescribe medications without team input or integration," which would threaten continuity of care, McAlister said.

The researchers did not compare how much it would cost to have patients see a nurse or pharmacist regularly, or whether either would pay off in the long run in terms of healthcare spending.

Pharmacist-based management in addition to usual primary care appointments could help patients with many chronic diseases, McAlister said. For example, this process has been shown to improve blood sugar control among people with diabetes.

"I think this system of case management could work for any patient with uncontrolled risk factors," McAlister said.

SOURCE: bit.ly/1noAcIa CMAJ, online April 14, 2014.

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