title: A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study.
abstract: BACKGROUND
  Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia.
  
  
  METHODS
  We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients' adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors.
  
  
  RESULTS
  Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was -0.2 mmol/L (95% confidence interval [CI] -0.3 to -0.1), and the adjusted reduction was -0.05 (95% CI -0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34).
  
  
  CONCLUSIONS
  Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.
authors.affiliation: Faculties of Pharmacy, Université de Montréal, Montréal, Que.
authors.forename: Julie
authors.initials: J
authors.lastname: Villeneuve
authors.forename: Jacques
authors.initials: J
authors.lastname: Genest
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Vanier
authors.forename: Diane
authors.initials: D
authors.lastname: Lamarre
authors.forename: Marc
authors.initials: M
authors.lastname: Fredette
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Lussier
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.forename: Eveline
authors.initials: E
authors.lastname: Hudon
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
mesh_terms: D002170:Canada; D008078:Cholesterol, LDL / Q000097:blood*; D003157:Community Pharmacy Services; D003324:Coronary Artery Disease / Q000097:blood / Q000517:prevention & control; D003376:Counseling; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D010595:Pharmacists; D010821:Physicians, Family; D011320:Primary Health Care; D012306:Risk
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents