title: A randomized trial of a community-based approach to dyslipidemia management: Pharmacist prescribing to achieve cholesterol targets (RxACT Study).
abstract: BACKGROUND
  Dyslipidemia is an important risk factor for cardiovascular disease but is suboptimally managed. Pharmacists are accessible primary care professionals and with expanded scopes of practice (including prescribing), could identify and manage patients with dyslipidemia. We sought to evaluate the effect of pharmacist prescribing of dyslipidemia medications on the proportion of participants achieving target LDL-cholesterol (LDL-c) levels.
  
  
  METHODS
  We conducted a randomized controlled trial in 14 community pharmacies in Alberta, Canada. We enrolled adults with uncontrolled dyslipidemia as defined by the 2009 Canadian Dyslipidemia Guidelines. Intervention was pharmacist-directed dyslipidemia care, including assessment of cardiovascular risk, review of LDL-c, prescribing of medications, health behaviour interventions and follow-up every 6 weeks for 6 months. Usual care patients received their lipid results and a pamphlet on cardiovascular disease and usual care from their physician and pharmacist. Primary outcome was the proportion of participants achieving their target LDL-c (<2 mmol/L or ≥50% reduction) at 6 months between groups.
  
  
  RESULTS
  We enrolled 99 patients with a mean (SD) age of 63 (13) years, 49% male and baseline LDL-c of 3.37 mmol/L (0.98). Proportion of patients achieving LDL-c target was 43% intervention versus 18% control (p= 0.007). Adjusted odds of achieving target LDL-c were 3.3 times higher for the intervention group (p= 0.031), who also achieved greater reduction in LDL-c (1.12 mmol/L, SE = 0.112) versus control (0.42 mmol/L, SE = 0.109), for an adjusted mean difference of 0.546 mmol/L (SE = 0.157),p< 0.001.
  
  
  CONCLUSIONS
  Pharmacist prescribing resulted in >3-fold more patients achieving target LDL-c levels. This could have major public health implications.
authors.affiliation: EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
authors.affiliation: EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
authors.forename: Meagen
authors.initials: M
authors.lastname: Rosenthal
authors.affiliation: EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Pearson