If ever there was a disease that naturally fit the pharmacist counseling model—with the potential for an enormous health-outcomes payoff—it is cardiovascular (CV) disease. According to the website of the American Pharmacists Association (APhA), CV disease causes one of every three deaths annually and accounts for about $1 of every $6 spent on healthcare. With over 2 million heart attacks and strokes each year, the APhA states, CV disease causes “an enormous loss of life and carries a huge financial burden for our country.”
Two of the primary CV risk factors, hypertension and hyperlipidemia, are largely silent diseases that, combined, affect more than 80 million Americans annually. Healthcare providers, especially those who interact with the public on a daily basis, are in the best position to bolster medication adherence among these patients.
In this issue’s continuing education (CE) article, “Primary and Secondary Prevention of Heart Disease,” Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh, advises that, during patient-counseling sessions, pharmacists should pinpoint patients with borderline or high blood pressure and strive to eliminate such contributing factors as heavy alcohol intake, obesity, excessive salt intake, and lack of exercise.
The APhA is on the same page, recommending that pharmacists extend effective counseling in several key CV areas. For example, they can make sure that new CV patients are familiar with their medication regimens and know dosing schedules, and the like. In addition, pharmacists can provide hypertension screenings and refer patients with higher readings to their physicians. Likewise, they can provide point-of-care lab tests to look for elevated cholesterol levels (especially the LDL variety) to hopefully head off a stroke or myocardial infarction.
Dr. Panesar, in her CE article, breaks pharmacist-counseling capabilities into two main areas—modifiable risk factors that enhance primary and secondary prevention. Primary CV risk factor prevention, she writes, includes smoking cessation; controlling blood pressure, cholesterol, and blood glucose levels; and the possible use of daily aspirin. Secondary prevention “builds upon primary prevention” and includes the application of such medications as beta-blockers, lipid-lowering therapy, ACE inhibitors, antiarrhythmics, and calcium channel blockers.
Healthcare professionals agree that one of the greatest risk factor culprits is smoking. “It is estimated,” Dr. Panesar writes, “that about 70% of adults in the U.S. want to stop smoking, and millions of them have tried to do so. This willingness presents a patient-counseling opportunity for pharmacists, who are in a pivotal position to help patients determine which smoking-cessation method is best for them. Additionally, pharmacists can discuss the benefits of smoking cessation with patients who may be at risk for heart disease and refer interested patients to an appropriate smoking-cessation professional.”
The APhA concurs, recommending that pharmacists offer smoking-cessation counseling in addition to glucose and diabetes screening. To ensure that patients fully understand all of their medication regimens, pharmacists can provide regular medication therapy management checkups to verify the dosing and administration schedules and identify every possible adverse drug interaction from among all of a patient’s prescribed and OTC medications and supplements. In addition, pharmacists can help identify possible duplicated medication therapy in patients’ regimens.
The APhA also points out that in addition to identifying patients at high risk for CV, optimizing doses for maximal benefit, counseling patients on drug and other therapy, and ensuring that patients are aware of adverse effects, pharmacists can assure that patients receive all necessary immunizations. They can even assist in the creation of patients’ personal medication lists—a current dossier of their vaccinations, medications, OTC products, vitamins, and supplements.
The pharmacist’s growing patient-counseling role permits numerous potential opportunities to help patients ward off heart disease and keep it at bay once identified. It’s up to pharmacists to embrace these opportunities and reap the maximum rewards for patients and the profession alike.
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