We evaluated the effectiveness of pharmacist-managed
pharmacotherapy clinics in implementing and maximizing
therapy with agents known to reduce the morbidity and mortality associated with
cardiovascular disease. This was a retrospective chart review of 150 patients who were treated for
coronary artery disease in primary care clinics. Appropriate treatment of
hypercholesterolemia occurred in 96% of patients referred to a clinical pharmacy specialist, compared with 68% of those followed by primary care providers alone (p<0.0001). Eighty-five percent and 50%, respectively, achieved goal
low-density lipoprotein (
LDL) values below 105 mg/dl (p<0.0001). Appropriate
therapy with
aspirin or other antiplatelet or
anticoagulant drugs was prescribed in 97% and 92%, respectively (p=0.146). As appropriate
therapy with these agents was high in both groups, the ability to detect a difference between groups was limited. Among patients with an ejection fraction below 40%, appropriate
therapy with an
angiotensin-converting enzyme inhibitor or acceptable alternative was 89% and 69%, respectively (p<0.05). Twenty-seven
cardiac events were documented in the clinical pharmacy group, versus 22 in the primary care group (p=0.475). Despite the relatively high percentage of patients reaching goal
LDL in the primary care group, referral to clinical pharmacy specialists resulted in statistically significant increases in the number of patients appropriately treated for
hypercholesterolemia and achieving goal
LDL.