Cardiovascular disease is a top killer and clearly more has to be done to reduce the impact worldwide. In the United States, heart disease is the leading cause of death according to the Centers for Disease Control and Prevention (CDC). The costs, both to public sector and private employer in economic productivity is high and ultimately contribute to accumulating national debt. The current health systems are more reactionary than proactive. What else can be done? Well according to a new study from the UK’s University of Birmingham, pharmacists infused into GP practice workflows could play an integral role in reducing and preventing cardiovascular disease. Why not give it a try?

The Study

Led by a team within the University of Birmingham School of Pharmacy and the Institute of Applied Health Research, the team poured through and analyzed medical literature covering relevant randomized controlled trials (clinical trials) assessing the effectiveness of pharmacists-led interventions offered in general practice and the extent that this approach had an impact on reducing cardiovascular risk event risk factors.

The study team found 21 clinical trials including 8,933 patients for this research. The identified pharmacist-led interventions ranged from counseling and physical assessment to patient education, medication review and counseling to medication management—the latter was the most common pharmacist-led intervention method.

The study was recently published in the British Journal of Clinical Pharmacology

The Findings

Overall there is a case to be made that pharmacists-led interventions could possibly be considered where it is feasible, perhaps for a pilot study based on these findings. This study reveals that they can lead to significant reductions in the medical risk factors of cardiovascular disease patients. These interventions include an array of material inputs from patient education and medication review and counsel to medication management—this level of engagement is critically needed for those patients at risk with conditions ranging from hypertension, diabetes and high cholesterol.

Comments

Cardiovascular disease is the number one killer in America. As healthcare costs continue to spiral out of control, an increasingly unhealthy and obese-prone population only contributes to escalating insurance costs, growing sickness and ultimately premature death. The economics of this epidemic are devasting. At least $200 billion is spent (likely more when considering indirect costs) and this according to some projections will approach a staggering half-a-trillion dollars by 2035

At least in America, neither political party seems that concerned about national debt accumulation, currently at $23 trillion, nor how disease such as cardiovascular contributes via the direct stimulant to increase spend and costs. The health care sector does benefit from the economics in the short term, as big systems furiously build new centers while consolidating,  but the whole system is underwritten by an unsustainable model of rapidly accumulating debt. Someday it will materially impact the dollar and the real payment will come due—and that won’t be a pretty picture– unless something is done immediately.

In the United States the pharmacy is a place that many a community resident visit frequently—across all demographics, classes, ethnicities and regions. Albeit online disruptive models from Mr. Bezos and company are in the works, the pharmacy represents an intriguing place in the community to engage.

Minority and socio-economic elements play into cardiovascular risk in America.  The health care system is often intimidating and community-level interventions—whether community clinics or pharmacies—where patient-level engagement and trust-building can occur could possibly represent an important contribution to disease risk reduction.  

Often for many patients at risk for cardiovascular problems the “whole person” must be treated—this involves more than just medication but a range of factors to be addressed—from lifestyle and dietary habits to a lack of exercise and need for healthcare education. Convenient targets abound (e.g. blame fast food or drug companies) but unless personal and collective lifestyle choices change the conditions will only worsen. A reduction in cardiovascular deaths (and associated costs) will only occur if governments, health systems, payers (public and private) and community organizations of all sorts “Think-out-of-the-Box” and dare to do things differently. For example nearly 80 million Americans currently depend on Medicaid for medical accessibility. Why not make cardiovascular improvement a fundamental target associated with waiver financing?

It is difficult to implement bold change in the current American healthcare milieu—where political correctness proscribes certain topics in open dialogue—but that must somehow be addressed collectively—or administrative bureaucratization driven by compliance professionals’ “CYA”  hamstring any positive direction; to dogmatic ideologues that automatically label interests for universal public health access as near communistic as if public health accessibility means the second coming of Karl Marx.

Yes as it stands today ideologues from all extreme positions have too much sway—making for a truly difficult environment to get down to the real business of working for real results in reducing critical health risks such as cardiovascular disease. And yes ultimately chipping away at accumulating national debt.

This University of Birmingham study offers a potential gift—a new way to consider how to deliver a cardiovascular prevention program. Pilots should be set up; tangible goals and objectives established; execution commenced and results measured. Don’t worry about the hurt feelings and political correctness—or for that matter being labeled a “Marxist”—there is bigger pain overcome.

Lead Research/Investigator

Abdullah Alshehri, University of Birmingham

Call to Action: Consider the findings and how a pilot could be implemented in a health system for example.

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