13 December 2007

Pharmacist Clinical Services Beneficial to
the Treatment Outcomes of Hyperlipidaemia



Coronary heart disease (CHD) is a major health issue in Hong Kong and has become the second leading cause of death since the 1960s. Figures from the Hong Kong Department of Health in 2005 showed that approximately 11 persons died from CHD each day. The prevalence of CHD and its mortality in Hong Kong are approaching a level that requires focused attention. CHD is also a cause of disability that has both direct and indirect cost implications to the health system. The most significant manifestation of CHD is acute myocardial infarction and it is estimated that the management of each patient costs nearly HK$73,000 per year. Therefore, the total estimated annual medical cost to manage all patients with acute myocardial infarction in Hong Kong is approximately HK$ 340 million.

It is well established that hyperlipidaemia is a significant modifiable risk factor for the development of CHD in particular the low density lipoprotein cholesterol (LDL), also known as the “bad” cholesterol. In order to evaluate whether pharmacist clinical services are beneficial to the treatment outcomes of hyperlipidaemia, a 24-month prospective controlled study was conducted by the School of Pharmacy at The Chinese University of Hong Kong at the lipid clinic of the Prince of Wales Hospital between October 2005 and October 2007. The lipid clinic serves patients with high lipid profiles whom have difficulties in reaching the targets. During this period, a total of 300 patients were recruited (150 in the intervention group and 150 in the control group). In the intervention group, apart from routine physician care, patients attended educational clinic visits conducted by a clinical pharmacist who assessed their lipid profiles and provided recommendations when goals were not met. Medication compliance and the proper use of drugs were assessed. Education on healthy lifestyles was reinforced. In between clinic visits, monthly telephone follow-ups were made to check on the progress of patients. In the control group, patients received usual medical care with no pharmacist intervention. Patients in both groups were asked to evaluate the benefits of the clinical pharmacy service via validated questionnaire surveys.

At the end of the study period, 58.7% patients in the intervention group achieved the recommended low-density lipoprotein cholesterol (LDL-C) goals compared with 45.3% in the control group. The intervention group achieved 23.6%, 15.3%, and 22.3% mean reduction in LDL-C, total cholesterol and triglyceride levels, respectively, compared with 3.7%, 5.2%, and 2.7% in the control group. A sustained reduction in total cholesterol of 1% is associated with a 2% to 3% reduction in CHD risk. Hence, following pharmacist intervention, patients in the intervention group achieved a 30% to 45% reduction in the risk of CHD, compared with 10% to 15% CHD risk reduction in the control group.

The main barriers to optimal hyperlipidaemic management in these patients identified included poor compliance with medications, lack of understanding of their disease, and poor healthy lifestyle behaviours (9.3% smoking, 16.3% high-fat diet, 22% limited physical activity). With pharmacist intervention, the overall compliance with medication in the intervention group was 79.8% at the end of the study, compared with 77.5% at baseline. Patients also demonstrated a better understanding of their own condition and opted for healthier lifestyles. In both groups (92.6% in intervention group and 90.1% in control group), patients felt that clinical pharmacy service was beneficial and helped improve their hyperlipidaemic management. In addition, patients commented that telephone follow-up calls were much more favourable than direct consultation.

In conclusion, the study demonstrated that clinical pharmacists could assist in hyperlipidaemic management by providing drug education and healthy lifestyle advice to patients, together with the assessment of lipid profiles and drug compliance. The results also showed the benefits of clinical pharmacy services in Hong Kong, which pave the way for further development of such services in other clinical areas like hypertension and diabetes mellitus.

Apart from that, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has released a new recommendation for cholesterol management in 2004. It suggested physicians to reassess high-risk CHD patients to have tighter cholesterol control and management.