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Livori MClinPharm AC, Ademi Z, Ilomäki J, Pol D, Morton JI, Bell JS. Use of secondary prevention medications in metropolitan and non-metropolitan areas: an analysis of 41,925 myocardial infarctions in Australia. Eur J Prev Cardiol 2023:zwad360. [PMID: 37987181 DOI: 10.1093/eurjpc/zwad360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND People in remote areas may have more difficulty accessing healthcare following myocardial infarction (MI) than people in metropolitan areas. We determined whether remoteness was associated with initial and 12-month use of secondary prevention medications following MI in Victoria, Australia. METHOD We included all people alive at least 90 days post-discharge following MI between July 2012 and June 2017 in Victoria, Australia (n=41,925). We investigated dispensing of P2Y12 inhibitors (P2Y12i), statins, ACE-inhibitors or angiotensin receptor blockers (ACEI/ARBs), and beta-blockers within 90 days post-discharge. We estimated 12-month medication use using proportion of days covered (PDC). Remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA). Data were analyzed using adjusted parametric regression models stratified by STEMI and NSTEMI. RESULTS There were 10,819 STEMI admissions and 31,106 NSTEMI admissions. Following adjustment across NSTEMI and STEMI, there were no medication classes dispensed in the 90-days post-discharge that differed in a clinically significant way from the least remote (ARIA=0) to the most remote (ARIA=4.8) areas. The largest difference for NSTEMI were ACEi/ARB, with 71%(95%CI 70-72%) versus 80%(76%-83%). For STEMI, it was statins with 89%(88-90%) versus 95%(91-97%). Predicted PDC for STEMI and NSTEMI were not clinically significant across remoteness, with the largest difference in NSTEMI being P2Y12i with 48%(47-50%) versus 55%(51-59%), and in STEMI it was ACEi/ARB with 68%(67-69%) versus 76%(70-80%). CONCLUSION Remoteness does not appear to be a clinically significant driver for medication use following MI. Possible differences in cardiovascular outcomes in metropolitan and non-metropolitan areas are not likely to be explained by access to secondary prevention medications.
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Affiliation(s)
- Adam C Livori MClinPharm
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- Grampians Health, Ballarat, VIC, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Derk Pol
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia
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Livori AC, Pol D, Levkovich B, Oqueli E. Optimising adherence to secondary prevention medications following acute coronary syndrome utilising telehealth cardiology pharmacist clinics: a matched cohort study. Int J Clin Pharm 2023; 45:722-730. [PMID: 36940081 PMCID: PMC10026199 DOI: 10.1007/s11096-023-01562-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Adherence to secondary prevention medications following acute coronary syndromes (ACS) is a predictor of future major adverse cardiovascular events. Underutilisation of these medications is associated with higher risk of major adverse cardiovascular events globally. AIM To explore the effects of a telehealth cardiology pharmacist clinic on patient adherence to secondary prevention medications in the 12 months following ACS. METHOD Retrospective matched cohort study within a large regional health service comparing patient populations before and after implementation of pharmacist clinic with 12-month follow up. Patients who received percutaneous coronary intervention for ACS were consulted by the pharmacist at 1, 3- and 12-months. Matching criteria included age, sex, presence of left ventricular dysfunction and ACS type. Primary outcome was difference in adherence in adherence at 12 months post ACS. Secondary outcomes included major adverse cardiovascular events at 12 months and validation of self-reported adherence using medication possession ratios from pharmacy dispensing records. RESULTS There were 156 patients in this study (78 matched pairs). Analysis of adherence at 12 months demonstrated an absolute increase in adherence by 13% (31 vs. 44%, p = 0.038). Furthermore, sub-optimal medical therapy (less than 3 ACS medication groups at 12 months) reduced by 23% (31 vs. 8%, p = 0.004). CONCLUSION This novel intervention significantly improved adherence to secondary prevention medications at 12 months, a demonstrated contributor to clinical outcomes. Primary and secondary outcomes in the intervention group were both statistically significant. Pharmacist-led follow up improves adherence and patient outcomes.
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Affiliation(s)
- Adam C Livori
- Pharmacy Department, Grampians Health Ballarat, 1 Drummond St Nth, Ballarat, VIC, 3350, Australia.
- Centre for Medicine Use and Safety, Monash University, Clayton, VIC, Australia.
| | - Derk Pol
- Pharmacy Department, Grampians Health Ballarat, 1 Drummond St Nth, Ballarat, VIC, 3350, Australia
- Monash Heart, Clayton, VIC, Australia
- Latrobe Regional Hospital, Traralgon, VIC, Australia
| | - Bianca Levkovich
- Pharmacy Department, Grampians Health Ballarat, 1 Drummond St Nth, Ballarat, VIC, 3350, Australia
- Centre for Medicine Use and Safety, Monash University, Clayton, VIC, Australia
| | - Ernesto Oqueli
- Pharmacy Department, Grampians Health Ballarat, 1 Drummond St Nth, Ballarat, VIC, 3350, Australia
- School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Livori AC, Prosser A, Levkovich B. Clinical outcome measures in the assessment of impact of pharmacists in cardiology ambulatory care: A systematic review. Res Social Adm Pharm 2023; 19:432-444. [PMID: 36253283 DOI: 10.1016/j.sapharm.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
AIMS Pharmacists are involved in the care of patients with cardiac disease within the ambulatory setting across multiple modes of delivery and practice settings. There is a lack of consensus surrounding the assessments used to measure the impact of pharmacist care. This heterogeneity may undermine confidence and limit utilisation of pharmacists in cardiology ambulatory care. A systematic review was conducted to understand how pharmacist interventions in cardiology ambulatory care were assessed and the impacts of these interventions on patient-centred outcomes. METHODS AND RESULTS A comprehensive search was conducted of MEDLINE, CINAHL Plus, Cochrane Register of Randomised Controlled Trials and EMBASE from 2000 to 2020 with search terms involving pharmacist interventions among cardiology patients in the ambulatory care setting; with studies restricted to randomised controlled trials. Search results were independently screened by two reviewers. The Cochrane Risk of Bias in Randomised Trials tool was used for quality assessment of the included studies. Assessments of pharmacist impact were analysed and compared to established quality indicators of cardiology care. The search produced 3380 individual studies, following screening, 26 studies involving 9013 participants met inclusion criteria. Across the 26 included studies, eleven different intervention types were identified. Four main outcome measures assessing the impact of these interventions were identified: direct measure of cardiovascular disease risk factor, major adverse cardiovascular events, medication adherence, validated risk score for cardiovascular events. There was a high degree of variance in both the way these interventions influenced the outcome as well the outcome measures selected to assess the impact of the intervention. Of the 26 studies, sixteen listed positive impacts on primary outcomes and the remaining 10 listed neutral effects. CONCLUSION Several outcome measures have been used to assess the impact of pharmacist intervention in cardiology ambulatory care. Aligning outcome measures with known indicators of cardiology care quality, as well as more detailed descriptions of intervention, will provide clinicians vital information in designing effective and measurable interventions in cardiology ambulatory care.
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Affiliation(s)
- Adam C Livori
- Ballarat Health Services, Victoria, Australia; Monash University, Victoria, Australia.
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Lau G, Vo T, Rivers G. Evaluating the role of a hospital pharmacist in a cardiac day ward. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:341-344. [PMID: 36773008 DOI: 10.1093/ijpp/riad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To evaluate the role of clinical pharmacists in cardiac day wards. METHODS A service evaluation was conducted during 24 February 2020-27 March 2020 to assess the role of clinical pharmacists for all patients admitted to an Australian tertiary hospital cardiac day ward. KEY FINDINGS Overall, 297 patients were included. Medication review occurred for 80% (237/297) and a best possible medication history was obtained for 65% (193/297) of patients. Acceptance of interventions for medication-related problems was 93% (84/90). When compared with medication plans outlined in standard catheterisation laboratory documentation without pharmacist input, a pharmacist medication review resulted in increased documentation of medication plans in the patient's medical record at the time of discharge (20% (1/5) versus 95% (142/150), P < 0.001). CONCLUSION Pharmacists can optimise the medication management of patients in cardiac day wards by performing medication review, and facilitating implementation and communication of medication changes at hospital discharge to patients and primary healthcare providers.
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Affiliation(s)
- Grace Lau
- Monash Health, Pharmacy Department, Victoria, Australia
| | - Tin Vo
- Monash Health, Pharmacy Department, Victoria, Australia
| | - Graham Rivers
- Monash Health, Pharmacy Department, Victoria, Australia
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Huynh S, Rush L, Dadalias D, Githinji D, Ta M, Poole SG, Percival M, Bell C, Warner V, Nguyen D. Time and motion study quantifying the activities of the cardiology, respiratory and geriatric clinical pharmacist. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Huynh
- Pharmacy Department Alfred Health Melbourne Australia
| | - Lily Rush
- Pharmacy Department Alfred Health Melbourne Australia
| | | | - Danson Githinji
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Melissa Ta
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Susan G. Poole
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Mia Percival
- Pharmacy Department Alfred Health Melbourne Australia
| | - Chloe Bell
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Victoria Warner
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - David Nguyen
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
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