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Pharmacy World & Science

, Volume 29, Issue 5, pp 541–545 | Cite as

The cost-effectiveness of pharmacist-led treatment of cardiac risk in patients with type 2 diabetes

  • Andrew Lowey
  • Sara Moore
  • Catherine Norris
  • David Wright
  • Jonathan Silcock
  • Peter Hammond
Research Article

Abstract

Aim

People with type 2 diabetes mellitus have an increased risk of cardiovascular and cerebrovascular disease compared with the general population. Following attempts to change lifestyle, pharmacological treatment is necessary to modify this risk. However, the use of medicines may be sub-optimal because of infrequent or inadequate medication review.

Setting

Harrogate District Hospital, a medium-sized district general hospital in a rural area of North Yorkshire, England.

Method

A pharmacist-led hospital clinic was established to manage diabetic patients suffering from resistant hypertension with or without hyperlipidaemia. Patients with two consecutive elevated blood pressure (BP) readings (>140/80 mmHg) were recruited via referral from out-patient clinics and diabetic nurse specialists. A range of clinical indicators were assessed on referral. The pharmacist prepared individualised patient information and a patient-held record card. An evidence-based algorithm was used to make adjustments (every 4 weeks) to anti-hypertensive medication. If necessary treatment of hyperlipidaemia was also optimised. Published data was used to predict the 10-year risk of coronary heart disease and cerebrovascular accident for each patient before and after intensive medicines management. Patients were discharged from the clinic after two consecutive target BP measurements.

Results

It is estimated that these risks were reduced by 11.9 and 9.6%, respectively, at a cost per event avoided of £34,708 and £63,320.

Conclusion

Intensive pharmacist-led clinics are potentially a cost-effective way to improve the cardiovascular health of patients with type␣2 diabetes.

Keywords

Diabetes mellitus Hypertension Hyperlipidaemia Pharmacy Cost-effectiveness Cardiovascular risk United Kingdom Pharmacoeconomics Pharmacist 

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Notes

Acknowledgements

We would like to thank the following members of staff at Harrogate Healthcare NHS Trust for their help and support: Dr. Mike Toop, Consultant Chemical Pathologist, The Diabetic Specialist Nursing Team, Angela Wardman, Senior Pharmacist, Medicines Information, Pam Calvert, Director of Pharmacy, Dr. Sean Brotheridge, Consultant Physician, Dr. Hugh Larkin, Consultant Physician.

References

  1. 1.
    Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000;321:412–419PubMedCrossRefGoogle Scholar
  2. 2.
    Stratton IM, Adler AT, Neil HAW, Matthews DR, Manley SE, Cull CA et al. Epidemiological associations of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ 2000;321:405–412PubMedCrossRefGoogle Scholar
  3. 3.
    Diabetes NSF Team. National service framework for diabetes: standards. London:Department of Health;2001Google Scholar
  4. 4.
    Yki-Jarvinen H. Management of type 2 diabetes mellitus and cardiovascular risk: lessons from intervention trials. Drugs 2000;60:975–983Google Scholar
  5. 5.
    UKPDS Group. The UKPDS risk engine: a model for the risk of coronary heart disease in type 2 diabetes (UKPDS 56). Clin Sci 2001; 101:671–679CrossRefGoogle Scholar
  6. 6.
    National Institute for Clinical Excellence (2002). Management of type 2 diabetes: management of blood pressure and blood lipids (Guideline H). London: NICE;2002 (ISBN 1-84257-251-2)Google Scholar
  7. 7.
    Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission Publications;2001 (ISBN 1-86240-321-X)Google Scholar
  8. 8.
    Crown J. Review of prescribing, supply and administration of medicines. London:NHS Executive; 1998Google Scholar
  9. 9.
    Secretary of State for Health. Health & Social Care Act 2001. London: Stationary Office;2001 [Chapter 15]. Google Scholar
  10. 10.
    National Health Service (Pharmaceutical Services) (General Medical Services) and (Charges for Drugs and Appliances). Amendment Regulations 2003. London: The Stationary Office;2003 [Statutory Instruments 2003 No. 1084]Google Scholar
  11. 11.
    Ramsay LE, Williams B, Johnson GD, MacGregor GA, Poston L, Potter JF et al. Guidelines for the management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypertens 1999;13:569–592PubMedCrossRefGoogle Scholar
  12. 12.
    Pyorala K, Pedersen TR, Kjekshus J, Faergerman O, Olsson AG, Thorgeirsson G. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. Diabetes Care 1997;20:614–620PubMedCrossRefGoogle Scholar
  13. 13.
    Goldberg R, Mellies MJ, Sacks FM, Moyé LA, Howard BV, Howard WJ et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analysis in the cholesterol and recurrent events (CARE) trial. Circulation 1998;98:2513–2519PubMedGoogle Scholar
  14. 14.
    Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7–22CrossRefGoogle Scholar
  15. 15.
    Olsson AG, Eriksson M, Johnson O, Kjellstrom T, Lanke J, Larsen ML et al. A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: the treat-to-target (3T) study. Clin Ther 2003;25:119–138PubMedCrossRefGoogle Scholar
  16. 16.
    British National Formulary No 43 (March 2002) (Published by British Medical Association & Royal Pharmaceutical Society of Great Britain) ISBN 0521770297Google Scholar
  17. 17.
    Gaede P, Vedel P, Larsen N, Jensen GVH, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM 2003; 348:383–393PubMedCrossRefGoogle Scholar
  18. 18.
    UKPDS Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703–713Google Scholar
  19. 19.
    The HOPE Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE sub-study. Lancet 2000;355:253–259CrossRefGoogle Scholar
  20. 20.
    Secretary of State for Health. The NHS plan: a plan for investment, a plan for reform. London; Department of Health; 2000 (Cm 4818-I)Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Andrew Lowey
    • 1
  • Sara Moore
    • 1
    • 2
  • Catherine Norris
    • 1
  • David Wright
    • 3
  • Jonathan Silcock
    • 4
  • Peter Hammond
    • 1
  1. 1.Pharmacy DepartmentHarrogate & District Foundation TrustHarrogateUK
  2. 2.Pharmacy Department, Gledhow WingLeeds Teaching Hospitals NHS Trust, St. James University HospitalLeedsUK
  3. 3.School of Chemical Sciences and PharmacyUniversity of East AngliaNorwichUK
  4. 4.Pharmacy Practice and Medicines Management GroupUniversity of LeedsLeedsUK

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