The clinical and economic impact of a secondary heart disease prevention clinic jointly implemented by a practice nurse and pharmacist.
BACKGROUND
A primary care practice in the West of Scotland used clinical governance funding to develop a heart disease prevention clinic to target patients with existing heart disease. The practice nurse enlisted the help of the practice pharmacist and the protocol for the clinic was subsequently developed with the involvement of both practitioners.


OBJECTIVE
The aim of this project was to identify and offer health screening and appropriate disease modifying treatment to patients of a primary care (or general medical) practice suffering from cardiovascular heart disease in a clinic run jointly by a practice nurse and pharmacist.


METHODS
Patients identified by the practice pharmacist were offered a full health screen. Their clinical parameters were assessed and appropriate disease modifying drug therapy and lifestyle advice was offered in a review clinic with the practice nurse and pharmacist.


RESULTS
The practice pharmacist identified over 212 patients over a 30-month period. A majority demonstrated hypertension (91%) and angina (89%), while over half (57%) had suffered a heart attack. Statin therapy was modified in a large number of patients (47%) and the number of patients with satisfactory total cholesterol levels has increased from 30% to 57% (P < 0.001). Aspirin and beta-blocker therapy has been initiated in a significant number of patients (53% and 26% respectively). Twelve patients (6%) stopped smoking; however, many 42% continued to smoke. The general medical doctors (GPs) who demonstrated a change in their own practice readily accepted changes to therapy recommended by the practice nurse and pharmacist. The practice pharmacist offset the additional cost of drug spend on statin therapy by making savings in other therapeutic areas.


CONCLUSIONS
A secondary heart disease clinic can benefit patients by optimising drug and lifestyle therapy. While the inclusion of a pharmacist confers clinical and economic benefits.
Reilly
Val
V
Burnbank Medical Centre, Burnbank, Hamilton, Lanarkshire, Scotland. valreilly@beeb.net
Cavanagh
Margaret
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy; D002985:Clinical Protocols; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D012307:Risk Factors; D012907:Smoking
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin