Clinical impact of medication reviews with follow-up in cardiovascular older adult patients
- Publication Type:
- Thesis
- Issue Date:
- 2020
Open Access
Copyright Clearance Process
- Recently Added
- In Progress
- Open Access
This item is open access.
๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: In Chile, cardiovascular disease (CVD) risk factors are controlled in as few as 30% of cases. Pharmacist-led medication reviews with follow up (MRF) have shown effectiveness under these conditions. We postulate that providing MRF in primary care in Chile could improve the control of CVD.
๐ข๐ฏ๐ท๐ฒ๐ฐ๐๐ถ๐๐ฒ๐: To evaluate the effect of MRF on CVD in primary care by assessing the clinical effect of MRF on older patients with CVD risk in primary care in Chile.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐ผ๐น๐ผ๐ด๐: A systematic literature search was conducted to explore literature on the effect of MR on ambulatory CVD risk patients, including randomised and cluster randomised trials (c-RCT). Meta-analyses used the odds ratio (OR) for therapeutic goals and raw differences for continuous data, with 95% prediction intervals (PI) to account for heterogeneity.
A c-RCT was then conducted in primary care centres in a metropolitan region of Chile. Older patients with moderate to high CVD risk and five or more medications were recruited from a CVD risk program and received either pharmacist-led MRF or usual care for a year. Generalised estimating equations adjusted for covariates were used for analysis during each visit. A sub-analysis of patients with chronic kidney disease (CKD) was conducted.
๐ฅ๐ฒ๐๐๐น๐๐: The meta-analyses included 69 studies with a total of 11 644 patients. Demographic characteristics were similar between studies. MRF increased the control of hypertension (OR 2.73 [95% PI 1.05, 7.08]), type 2 diabetes mellitus (OR 3.11 [95% PI 1.17, 5.88]) and cholesterol (OR 1.91 [95% PI 1.05, 3.46]).
In the Polaris trial, 324 patients from 12 primary care centres (174 in the MRF group and 150 in the usual care group, 6 centres each) received, on average, four visits by pharmacists in one year. Significant effects were found for the control of hypertension (OR 4.37 [2.54โ7.51]), cholesterol (OR 3.67 [2.13โ6.33]), type 2 diabetes (6.97 [3.69โ13.2]) and medication adherence (OR 6.60 [1.36โ31.9]) as well as for the number of medications (-0.86 [-1.14 to -0.58]) and CVD risk (-2.27 [-2.84 to -1.69]). In total, 159 patients had CKD (71 in the usual care group and 88 in the MRF group). The OR for hypertension control was 8.41 (3.46โ20.4), with reductions in systolic blood pressure (-15.3 mmHg [-20.3 to -10.3]), serum potassium (-0.50 mEq/L [-0.65 to -0.35]), the albumin-to-creatinine ratio (-53.1 mg/g [-92.3 to -13.9]) and LDL cholesterol (-27.8 mg/dL [-37.6 to -17.9]).
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: This work provides local evidence to support the implementation of MRF in primary care in Chile. Including pharmacists in programs for CVD could improve the quality of care for older adults with polypharmacy.
Please use this identifier to cite or link to this item: