Physician-pharmacist collaborative care plans have little impact on clinical outcomes

The use of a physician-pharmacist collaborative care plan to manage lipid control in patients with high cholesterol does not have significant clinical impact, found an article in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj090533.pdf.

The role of community pharmacists is expanding worldwide. More than 40 states in the US have collaborative practice laws and in Quebec, pharmacists can start and adjust drug therapy in accordance with a physician's prescription.

A study was conducted to see if the use of a physician-pharmacist collaborative care plan, a partnered health care team in which health care professionals are responsible for specific aspects of patient care, could be effective in managing lipid control. In this study, physicians were responsible for prescribing cholesterol-lowering medication and pharmacists provided counseling, requested laboratory tests, monitored the effectiveness and safety of treatment and adjusted the medication accordingly.

The study showed no evidence of a significant clinical impact on lipid control which may be due to the recruitment of patients with modestly elevated cholesterol and the more frequent prescription of high-potency medications by physicians in the "usual care group".

"In a primary care collaborative model, where community pharmacists are responsible for providing counseling on lifestyle changes and adjusting lipid-lowering medication, patients had more health-professional visits, more laboratory tests and were more likely to have their lipid-lowering treatment modified and report making lifestyle changes," write Dr. Lalonde, Centre de santé et de services sociaux de laval, Cité-de-la-Santé Hospital, and coauthors. "However, this did not translate into significant clinical impact on lipid control."

The study was conducted by researchers from the University of Montreal, Centre de santé et de services sociaux de Laval; McGill University Health Centre, Royal Victoria Hospital, Montreal; Cité-de-la-Santé Hospital, Laval University; and HEC Montreal, Quebec, Canada.

The authors conclude that collaborative care is feasible for managing dyslipidemia but in future studies the long-term benefits should be evaluated in patients at high-risk for coronary heart disease.