Effectiveness of a Pharmacy Care Management Program for Veterans with Dyslipidemia

Purpose: To evaluate the effectiveness of a dyslipidemia care management program provided by clinical pharmacists.

Methods: A retrospective cohort design compared an intervention (IT) cohort of 213 patients referred to a clinical pharmacist for dyslipidemia management with 219 patients in a usual care (UC) cohort within two primary care clinics at a Veterans Affairs Medical Center.  Using multivariate regression models to adjust for baseline characteristics, the primary analyses compared low-density lipoprotein cholesterol (LDL),  total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and triglycerides (TGs) among the IT and UC cohorts at the final follow-up visits. Secondary analyses compared the change in TC, LDL, HDL and TGs, the proportion of patients achieving guideline concordant LDL goals, and the time to achieve LDL goals between the two groups.

Results: The mean change in initial to final lipid values in the IT cohort was LDL: -31 mg/dL, TC: -44 mg/dL, HDL: -1 mg/dL, TGs: -59 mg/dL versus the UC cohort LDL: -22 mg/dL, TC: -29 mg/dL, HDL: 0 mg/dL, TGs: -43 mg/dL.  Compared to the UC cohort, the adjusted difference in LDL for the IT cohort was -10.4 mg/dl (95% CI, -16.1 to -4.6, p<0.001) mg/dL and TC was -12.7 (95% CI, -21.3 to -4.1, p=0.004).  There was no difference in HDL and TGs.  LDL was controlled in 80.3% of patients in the IT cohort and 65.3% of patients in the UC cohort (adjusted OR, 2.6; 95% CI, 1.6-4.3, p<0.001).  Mean days to achieve goal LDL was 86.6 ± 59.3 and 332.2 ± 241.0 (p < 0.001) for the IT and UC cohorts, respectively.

Conclusion: Veteran patients referred to a clinical pharmacist achieved significant reductions in TC and LDL.  The time to achieve and the proportion of patients achieving target LDL goals were better in the pharmacist-managed cohort, supporting a continued role for pharmacy in dyslipidemia care management.