Feature | Don't Go Breaking My Heart: Pharmacy Practice Models For CVD Prevention Programs

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A multidisciplinary team approach has long been advocated as a model to provide the best patient care. The Best Practices for Cardiovascular Disease Prevention Programs: A Guide to Effective Health Care System Interventions and Community Programs Linked to Clinical Services, a publication by the Division for Heart Disease and Stroke Prevention in the Centers for Disease Control and Prevention (CDC), further highlights a team-based care model for prevention strategies.

It focuses on effective strategies for management of hypertension and hyperlipidemia that have not been widely incorporated into contemporary practice. Four key domains are highlighted in the publication: 1) epidemiology and surveillance; 2) environmental approaches; 3) health care system interventions; and 4) community programs linked to clinical services.

One strategy that is highlighted to impact domains number three and four is to elevate pharmacy involvement in patient care. This goal can be accomplished in different ways as there are numerous types of pharmacy practice models in the community, clinic and hospital setting.

One model that promotes domains three and four that has evidence to support the health and economic impact of our patients is collaborative drug therapy management by developing a collaborative practice agreement (CPA).

This agreement between a qualified pharmacist and health care provider allows for the pharmacist to order laboratory testing and select, initiate, monitor and adjust medications. Establishing CPAs in a wide variety of settings including federally qualified health centers, patient-centered medical homes, managed care health systems, community pharmacies, hospital pharmacies and primary care clinics is encouraged.

For more information about establishing a CPA, the CDC has developed a tool kit called Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team.

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Including pharmacists as part of the team to complete other patient care-related tasks is also recommended. For example, one family practice clinic included pharmacists in their team-based approach to assist with analyzing patient self-monitored blood pressure to improve blood pressure control for their patients.

Other opportunities to engage pharmacists in caring for patients with hypertension and hyperlipidemia exist in the community setting and are classified as community health workers. These pharmacists are one of the most easily accessible health care professionals and can help improve health outcomes and patient knowledge in the community through education, counseling and outreach.

In order to help reduce drug costs and improve compliance, many states require or authorize pharmacists to switch Medicaid patients to an equivalent generic drug if a brand name drug is prescribed. Other opportunities exist through establishing medication therapy management services such as services on screening for hypertension, educating patients on medications and disease states, and advising patients on lifestyle modifications.

The health impact on patients has been shown to reduce therapeutic duplication, decrease medication burden and increase adherence, which can then result in decreased health care expenses both for the patient and the health care system.

These pharmacy practice models are just one component recommended to help with primary prevention strategies. A multidisciplinary team consisting of doctors, nurses, pharmacists, paramedics, community health workers, dieticians and others should work in collaboration to provide optimal care for our patients.

This article was authored by Katie B. Tellor, PharmD, FACC, associate professor of pharmacy practice at the St. Louis College of Pharmacy in St. Louis, MO.