THE PHYSICIAN AND PHARMACIST TEAM - AN EFFECTIVE APPROACH TO CHOLESTEROL REDUCTION

OBJECTIVE: To assess the effect of a program that encourages teamwork between physicians and pharmacists on attempts to lower total choleste rol levels and to meet recommended goals proposed by the National Chol esterol Education Program (NCEP). DESIGN: A single-blind, randomized, controlled trial lasting 6 months. SETTING: An ambulatory primary care center. PATIENTS: A sample of 94 patients with total cholesterol leve ls of 240 mg/dL (6.2 mmol/L) or higher. INTERVENTION: Equal numbers of patients were randomly assigned to a control arm in which standard me dical care was received and an intervention arm which implemented clos e interaction between physicians and pharmacists. MEASUREMENTS AND MAI N RESULTS: Absolute change in total cholesterol levels from baseline v alues and the percentage of patients who achieved an NCEP goal after 6 months of intervention were determined. The rate of success in achiev ing NCEP goals in the intervention arm was double the rate in the cont rol arm (43% vs 21%, p < .05). Total cholesterol levels in the interve ntion arm declined 44 +/- 47 mg/dL (1.1 +/- 1.2 mmol/L) versus 13 +/- 51 mg/dL (0.3 +/- 1.3 mmol/L) in the control arm (p < .01). The effect of intervention on reducing total cholesterol levels was similar for men and women and did not appear to be altered by age. The effect of i ntervention was greatest in patients with coronary heart disease (p < .01) followed by those without disease but with two or more coronary h eart disease risk factors (p < .05). An effect of intervention was abs ent in patients without coronary heart disease and with fewer than two risk factors. CONCLUSIONS: Attempts to lower total cholesterol levels and achieve NCEP goals are likely to be more successful when combined with programs that include teamwork between physicians and pharmacist s. Some programs, however, may be more successful for high-risk patien ts, for whom it is often easier to provide more aggressive therapies. Although altering adverse lipid profiles in lower-risk patients may be difficult, achieving optimal cholesterol levels could have an importa nt impact on preventing movement to higher risk strata.