Study of Cardiovascular Risk Intervention by Pharmacists - SCRIP

Description:

SCRIPT was designed to determine the efficacy of a program of intervention by community-based Canadian pharmacists on the process of lipid risk management in high-risk coronary heart disease patients.

Hypothesis:

Patients receiving the pharmacist-based program intervention would have improved lipid risk management.

Study Design

Study Design:

Patients Enrolled: 675
Mean Follow Up: 16 weeks
Female: 39

Patient Populations:

One of the following: previous cardiovascular event (myocardial infarction, unstable angina, cerebrovascular accident); previous CABG or PCI; stable angina; peripheral vascular disease; or diabetes combined with at least 1 other cardiovascular risk factor.

Exclusions:

Enrolled in another lipid-lowering study or a formal rehabilitation program. Presence of a disease that might limit long-term survival.

Primary Endpoints:

Combination of 3 parameters indicating an improvement in lipid risk management: measurement of complete lipid panel by primary care physician; new prescription for any lipid-lowering medication; or increase in dose of lipid-lowering medication.

Secondary Endpoints:

Separate components of the primary endpoint.

Drug/Procedures Used:

Patients allocated to the intervention arm received a brochure and education about cardiovascular risk factors; assessment of cardiovascular risk factors; point-of-care total cholesterol measurement; a patient contact form completed by the pharmacist and faxed to the primary care physician; and follow-up at 2, 4, 8, 12, and 16 weeks. Usual care involved the informational brochure on heart disease and risk factors but minimal follow-up.

Principal Findings:

The trial was stopped early by the external data monitoring committee due to the benefit seen. The primary composite endpoint (cholesterol improvement, new prescription for lipid-lowering medication, or increase in dose of prior lipid-lowering medication) occurred in 57% of the intervention group and 31% of patients receiving usual care (p<0.0001). Each of the individual endpoints also were improved with intervention: fasting cholesterol panel (53% intervention vs 29% usual care, p<0.0001); new prescription for a cholesterol-lowering drug (10% vs 4%, p<0.003); and changed dose of cholesterol-lowering drug (3% vs 1%, p=0.074). The 4-month costs per patient based on provincial government data was slightly higher in the intervention group than in the usual care group ($34.11 vs $27.74) based on physician visits, cholesterol profiles, and medications.

Interpretation:

This community-based pharmacist intervention program led to a significant improvement in the management of cholesterol risk in high-risk coronary heart disease patients. The cost to implement this program appears to be relatively minimal.

References:

Annals of Pharmacotherapy 1999;33:910-919. Trial design Pharmacotherapy 2001 May;21(5):627-635.

Clinical Topics: Dyslipidemia, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Diet, Chronic Angina

Keywords: Myocardial Infarction, Stroke, Follow-Up Studies, Angina, Stable, Canada, Physicians, Primary Care, Risk Factors, Peripheral Vascular Diseases, Risk Management, Cholesterol, Diabetes Mellitus, Fasting


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