Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care

The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities.

This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects.

Inclusion criteria

Section A: Demographic Criteria

• Patient was seen in your clinic or practice at least once in the past 24 months
• English-speaking male or female
• Age is 50 or older at medical record screening

Section B: Risk Factors - Must have at least one of the following conditions

• Uncontrolled diabetes (Hemoglobin A1c > or + 7.5)
• Elevated LDL cholesterol > 110 for patients with PAD, CAD, stroke or diabetes or > 140 otherwise
• Elevated blood pressure with:

• Systolic BP >= 140 or Diastolic BP >=90 in persons with diabetes or chronic kidney disease OR
• Systolic BP >= 150 in persons with uncomplicated hypertension

Section C: Cardiovascular Conditions - total number of risk factors in Section B (above) plus number of conditions Section C (below) must be THREE OR MORE

• History of coronary artery disease
• Previous Heart Attack
• History of Stroke
• History of Transient Ischemic Attack
• History of Atrial fibrillation
• History of Peripheral Vascular Disease / claudication
• History of carotid artery disease
• Current smoker
• Obesity with BMI > 30

Exclusion criteria

Section D: Exclusion Criteria - has NONE of the following:

• Inability to give informed consent
• Pregnant
• Diagnosis of pulmonary hypertension (Note: secondary pulmonary hypertension is OK)
• Cancer diagnosis with a life expectancy estimated less than 2 years
• Residence in a nursing home or diagnosis of dementia
• No telephone or a hearing impairment not allowing them to use a phone
• Refusal to consider attempting to use the internet at home, community center, library, medical office or other source to access the PHRM
• Patient has plans to move from the area or transfer care to a different clinic in the next 12 months
• Omron blood pressure cuff cannot be used on patient's arm for any reason