title: Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.
abstract: We examined the impact of ambulatory care clinical pharmacist interventions on clinical and economic outcomes of 208 patients with dyslipidemia and 229 controls treated at nine Veterans Affairs medical centers. This was a randomized, controlled trial involving patients at high risk of drug-related problems. Only those with dyslipidemia are reported here. In addition to usual medical care, clinical pharmacists were responsible for providing pharmaceutical care for patients in the intervention group. The control group did not receive pharmaceutical care. Seventy-two percent of the intervention group and 70% of controls required secondary prevention according to the National Cholesterol Education Program guidelines. Significantly more patients in the intervention group had a fasting lipid profile compared with controls (p=0.021). The absolute change in total cholesterol (17.7 vs 7.4 mg/dl, p=0.028) and low-density lipoprotein (23.4 vs 12.8 mg/dl, p=0.042) was greater in the intervention than in the control group. There were no differences in patients achieving goal lipid values or in overall costs despite increased visits to pharmacists. Ambulatory care clinical pharmacists can significantly improve dyslipidemia in a practice setting designed to manage many medical and drug-related problems.
authors.affiliation: University of Colorado Health Sciences Center, School of Pharmacy, Denver, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Ellis
authors.forename: B L
authors.initials: BL
authors.lastname: Carter
authors.forename: D C
authors.initials: DC
authors.lastname: Malone
authors.forename: S J
authors.initials: SJ
authors.lastname: Billups
authors.forename: G J
authors.initials: GJ
authors.lastname: Okano
authors.forename: R J
authors.initials: RJ
authors.lastname: Valuck
authors.forename: D J
authors.initials: DJ
authors.lastname: Barnette
authors.forename: C D
authors.initials: CD
authors.lastname: Sintek
authors.forename: D
authors.initials: D
authors.lastname: Covey
authors.forename: B
authors.initials: B
authors.lastname: Mason
authors.forename: S
authors.initials: S
authors.lastname: Jue
authors.forename: J
authors.initials: J
authors.lastname: Carmichael
authors.forename: K
authors.initials: K
authors.lastname: Guthrie
authors.forename: R
authors.initials: R
authors.lastname: Dombrowski
authors.forename: D R
authors.initials: DR
authors.lastname: Geraets
authors.forename: M
authors.initials: M
authors.lastname: Amato
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D016903:Drug Monitoring / Q000191:economics; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D010595:Pharmacists / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL