A pharmacy-based approach to cholesterol management

Objective: To determine the clinical and economic impact of a pharmacy-base d cholesterol management program in patients with cardiovascular disease. Study Design: Demonstration project. Patients and Methods: From January 1, 1999, through June 30, 1999, 300 pati ents with a documented history of cardiovascular disease were enrolled in a pharmacy-based cholesterol program. A similar group of 150 randomly select ed patients receiving usual care during the same period served as the compa rator group. The following were collected for both groups: patient demograp hics, comorbidities, fasting lipid profiles, cholesterol medication, cost o f medication, and cardiovascular events. The McNemar symmetry chi (2) test was used to compare appropriate laboratory monitoring, receipt of cholester ol medication, and achievement of target low-density lipoprotein cholestero l levels at baseline and I year for both groups. Kruskal-Wallis analysis of variance was used to compare the cost of therapy for both groups at baseli ne and follow-up. Results: Mean +/- SD age of program and usual care patients was 67 +/- 10 a nd 69 +/- 11 years, respectively. At I year, > 95% of program patients were receiving appropriate laboratory monitoring. In 1 year, the percentage of patients reaching target low-density lipoprotein cholesterol levels increas ed from 45% to 72% (P < .01) and from 33% to 43% (P = .26) in program and u sual care patients, respectively. Despite increased medication use among pr ogram patients, their cost per patient per month was lower at 1-year follow -up vs baseline. Conclusion: Regular patient interaction and close patient monitoring allowe d the pharmacy-based lipid management program to improve cholesterol manage ment in patients with cardiovascular disease.