Clinical Overview: Pharmacist Intervention for Patients on Cardiovascular Drugs

As medication experts, pharmacists provide information to patients regarding their prescriptions. Because pharmacists are easily accessible, patients frequently call and visit community pharmacies for guidance.

Without information about medications, patients may experience drug-related problems, which leads to high costs and even morbidity or mortality. A British study reported that 66% of patients who started new medications experienced drug-related problems within 10 days of initiation.

The National Centre for Development of Pharmacy Practice in Norway researched the effects of pharmacist intervention on drug-related problems. Patients who initiated new cardiovascular medications received counseling from pharmacists 1-2 and 3-5 weeks after filling the prescription.

Afterwards, patients completed a questionnaire about counseling satisfaction. Medisinstart, a standard pharmacy health care service in Norway, tracked pharmacist counseling and patient drug-related problems later to identify trends.

Pharmacist interventions provided advice that was patient-specific to identify and solve problems. Some patients had adverse effects (AEs), but not all of them received counseling regarding management.

Compared to patients who did not receive advice, those who received guidance during the first consultation were more likely to have their problems solved at consultation 2 (61.2% vs 42.6%). The researchers were interested in examining problems that persisted or developed after consultation 1 because they demonstrate that repeated consultation is necessary for optimal intervention.

Repeated consultation is also important for medications such as statins, which has symptoms that could develop months after consultation 2. If given the opportunity to counsel more, pharmacists could fix drug-related problems and medication adherence issues.

The study used 2 questionnaires: a beliefs about medicine questionnaire (BMQ) and a satisfaction survey. The BMQ was scored for patients’ belief in the necessity of the medication and their concerns for the medication.

Higher scores indicated a strong necessity or strong concern for a new medication. Patients with higher BMQ concern scores were associated with more drug-related problems and AEs.

Investigators believe these AEs were due to the nocebo effect (detrimental effects because of belief). These patients were more concerned at baseline and reported more AEs during consultations.

The satisfaction survey showed that female patients, older patients, those with longer first consultations, and those receiving their first consultation face-to-face were more likely to report higher satisfaction. Improved communication (longer consultation, face-to-face interaction) directly corresponded with improved satisfaction scores. Patient satisfaction is one way to measure quality of health care services.

The study enrolled 629 patients with 566-570 of the patients responding to the questionnaire. The study’s limitations were the lack of the control group and the non-validated questionnaire.

These limitations prevented researchers from concluding that a reduction in the need for information and a decrease in drug-related problems were directly related to intervention. The investigators demonstrated that there could be a relationship between intervention and a decrease in drug-related problems, however, additional randomized, controlled trials are necessary.

About the Author

DylanDeCandia is a 2023 PharmD candidate at the University of Connecticut.

RESOURCES

• Bremer S, Henjum S, Sæther EM, Hovland R. Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs. Res Social Adm Pharm. 2022 Jun 16:S1551-7411(22)00183-8. doi: 10.1016/j.sapharm.2022.06.005. Epub ahead of print. PMID: 35750567.
• Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13:172–175.