Using pharmacists to support statin-prescribing in general practice improves patients’ chances of reaching their cholesterol targets and has a lasting effect on the prescribing behaviour of GPs, according to the results of a study published in PLOS ONE
The study, conducted in Glasgow, examined whether a pharmacist-led intervention in general practice, called the statin outreach service (SOS), could help patients reach their cholesterol targets by supporting doctors and nurses to identify cardiovascular patients who needed to be on statins and optimise simvastatin 40mg prescribing. Ten years of follow-up data have been collected since the intervention began in 2004.
Richard Lowrie, lead pharmacist in research and development at NHS Greater Glasgow and Clyde, who designed the study, says the results show that “more patients who needed to be on a statin were on a statin and the pharmacist’s intervention is the main reason for the difference between the two groups of practices”.
Before the service was implemented, 40% of patients had cholesterol levels below the target threshold. After 1.7 years, 69.5% of patients in the general practices that received the statin service had reached their cholesterol targets compared with 63.5% of patients at practices who did not receive the service (P=0.043).
A decade later, simvastatin 40mg prescribing was much higher in the general practices that received the pharmacist-led service than those that did not. When the study began, simvastatin 40mg prescribing was 9.4% in the general practices that continued with usual care and ten years later it was 37.8%. By comparison, in the general practices that received the SOS service, initial prescribing was 8.9% and ten years later this had risen to 59.0% (P<0.001).
“No other study has shown the long-acting impact of a pharmacist intervention,” says Lowrie, who explains that the main aim of the project was to change practice. “I want pharmacists to be able to do what we know to be effective and not just what is thought to be good — it adds confidence.”
After the year-long service had been completed, outcomes were tracked for patients who were deemed eligible for statin treatment to judge how successful the pharmacists had been at identifying patients who needed to be on statins. Patient inclusion criteria were based on the largest statin study at the time, the Heart Protection Study; 4,234 eligible patients were identified in the SOS arm and 3,352 in the usual care arm.
As part of the study, 31 general practices were randomised into two groups, one group received the SOS service from a pharmacist and the other group continued with usual care. Eleven pharmacists were trained to offer the service and were employed by the NHS to go into the practices for one day a week for 12 months. In addition to identifying patients with cardiovascular disease who would benefit from statins and optimising simvastatin 40mg prescribing, pharmacists also provided educational support and identified barriers to the implementation of statin prescribing. “For example, if time was the limiting factor then the pharmacist would help relieve the time pressure and if it was evidence that was a problem then the pharmacist could get a hospital consultant involved,” explains Lowrie.
The next step for Lowrie is looking at the long-term clinical impact. “We’re now looking at patient outcomes like heart attacks and we are planning on using this information to conduct an economic evaluation of the service that we can present to commissioners,” he says.
Although statin prescribing has increased in the past decade, Lowrie says that GP contract data show that not all patients are reached. “I hope there are more GP and pharmacist collaborations of this type,” he adds.