Identifying At-Risk Patients
Identifying At-Risk Patients
Objective: To demonstrate whether a community pharmacist can be successful in identifying and referring patients with elevated blood pressure and/or increased risk of stroke.
Setting: An independent community pharmacy and well-elderly housing facility in rural Iowa.
Practice Description: The pharmacy had dedicated space for patient care activities, had a community pharmacy practice resident, and served as a clerkship site for a local school of pharmacy. One of three well-elderly housing facilities in the same community was used as a screening site for the stroke prevention program.
Practice Innovation: All adults entering the pharmacy during the time the blood pressure project was underway were offered a free blood pressure screening. If readings were elevated, patients were referred to their primary care provider. For stroke prevention, a screening using the American Heart Association stroke risk assessment protocol was held at the pharmacy and the well-elderly housing facility.
Main Outcome Measures: Blood pressure categories and stroke risk (normal, mild, moderate, and high) categories obtained during the screening.
Results: A total of 351 patients were screened for hypertension. Of these, 216 (62%) had readings greater than 140/90 mm Hg. Of the 121 patients referred to their physician, 43 (36%) had a regimen change. A total of 50 patients were screened for stroke risk. Results of the risk assessments for patients screened were normal, 4%; mild, 26%; moderate, 32%; high, 38%.
Conclusion: These projects demonstrated that, through ongoing screening programs, community pharmacists are in an ideal position to screen patients at risk for cardiovascular and cerebrovascular disease and refer patients to their physicians for further evaluation.
Hypertension is a major risk factor for cardiovascular morbidity and mortality from coronary artery disease (including ischemic heart disease, myocardial infarction, and sudden death), cardiac disease (left ventricular hypertrophy and congestive heart failure), renal failure, and blindness. Hypertension also greatly increases the risk for developing cerebrovascular disease. At least 50 million people in the United States have elevated blood pressure, and, according to the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), the rates of awareness, treatment, and control of hypertension have declined slightly in recent years.
Stroke is the leading cause of disability and the third leading killer in America. In 1999 strokes killed 167,366 people, accounting for about 1 of every 14.3 deaths. The American Heart Association (AHA) has identified several factors that influence the risk of stroke, including increasing age, male sex, heredity, race, prior stroke, high blood pressure, cigarette smoking, diabetes mellitus, carotid artery disease, heart disease, transient ischemic attacks, high red blood cell count, and sickle cell anemia.
JNC VI suggests that community screening for high blood pressure is an important strategy for primary prevention of hypertension. Screening programs are also vital for monitoring progress and promoting adherence to therapy for high blood pressure and identifying patients at increased risk for stroke.
Community pharmacists are in a strong position to identify patients at risk for cardiovascular and cerebrovascular disease through simple hypertension and stroke screening programs. The potential benefit of screening is supported by a 1999 study conducted by researchers at the University of Minnesota and Ohio State University in which community pharmacists reported an average of 59 face-to-face interactions with individuals daily. In fact, positive clinical, economic, and humanistic outcomes have been demonstrated in hypertensive patients receiving comprehensive pharmaceutical care in community pharmacies. Despite these demonstrated benefits, relatively few community pharmacists regularly screen their patients for hypertension or other risk factors for cerebrovascular disease. This may be due to the assumption that formal programs such as those described in the previously cited studies are too difficult or time-consuming for the average community pharmacist.
In this article we describe two screening projects conducted at Travis Pharmacy (now Nishna Valley Pharmacy), an independent community pharmacy in Shenandoah, Iowa, (pop. approximately 6,000) that serves as a community pharmacy residency and clerkship site for the University of Nebraska Medical Center College of Pharmacy. We hope that by sharing the results of our screening projects we will encourage other community pharmacists to implement similar services.
Objective: To demonstrate whether a community pharmacist can be successful in identifying and referring patients with elevated blood pressure and/or increased risk of stroke.
Setting: An independent community pharmacy and well-elderly housing facility in rural Iowa.
Practice Description: The pharmacy had dedicated space for patient care activities, had a community pharmacy practice resident, and served as a clerkship site for a local school of pharmacy. One of three well-elderly housing facilities in the same community was used as a screening site for the stroke prevention program.
Practice Innovation: All adults entering the pharmacy during the time the blood pressure project was underway were offered a free blood pressure screening. If readings were elevated, patients were referred to their primary care provider. For stroke prevention, a screening using the American Heart Association stroke risk assessment protocol was held at the pharmacy and the well-elderly housing facility.
Main Outcome Measures: Blood pressure categories and stroke risk (normal, mild, moderate, and high) categories obtained during the screening.
Results: A total of 351 patients were screened for hypertension. Of these, 216 (62%) had readings greater than 140/90 mm Hg. Of the 121 patients referred to their physician, 43 (36%) had a regimen change. A total of 50 patients were screened for stroke risk. Results of the risk assessments for patients screened were normal, 4%; mild, 26%; moderate, 32%; high, 38%.
Conclusion: These projects demonstrated that, through ongoing screening programs, community pharmacists are in an ideal position to screen patients at risk for cardiovascular and cerebrovascular disease and refer patients to their physicians for further evaluation.
Hypertension is a major risk factor for cardiovascular morbidity and mortality from coronary artery disease (including ischemic heart disease, myocardial infarction, and sudden death), cardiac disease (left ventricular hypertrophy and congestive heart failure), renal failure, and blindness. Hypertension also greatly increases the risk for developing cerebrovascular disease. At least 50 million people in the United States have elevated blood pressure, and, according to the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), the rates of awareness, treatment, and control of hypertension have declined slightly in recent years.
Stroke is the leading cause of disability and the third leading killer in America. In 1999 strokes killed 167,366 people, accounting for about 1 of every 14.3 deaths. The American Heart Association (AHA) has identified several factors that influence the risk of stroke, including increasing age, male sex, heredity, race, prior stroke, high blood pressure, cigarette smoking, diabetes mellitus, carotid artery disease, heart disease, transient ischemic attacks, high red blood cell count, and sickle cell anemia.
JNC VI suggests that community screening for high blood pressure is an important strategy for primary prevention of hypertension. Screening programs are also vital for monitoring progress and promoting adherence to therapy for high blood pressure and identifying patients at increased risk for stroke.
Community pharmacists are in a strong position to identify patients at risk for cardiovascular and cerebrovascular disease through simple hypertension and stroke screening programs. The potential benefit of screening is supported by a 1999 study conducted by researchers at the University of Minnesota and Ohio State University in which community pharmacists reported an average of 59 face-to-face interactions with individuals daily. In fact, positive clinical, economic, and humanistic outcomes have been demonstrated in hypertensive patients receiving comprehensive pharmaceutical care in community pharmacies. Despite these demonstrated benefits, relatively few community pharmacists regularly screen their patients for hypertension or other risk factors for cerebrovascular disease. This may be due to the assumption that formal programs such as those described in the previously cited studies are too difficult or time-consuming for the average community pharmacist.
In this article we describe two screening projects conducted at Travis Pharmacy (now Nishna Valley Pharmacy), an independent community pharmacy in Shenandoah, Iowa, (pop. approximately 6,000) that serves as a community pharmacy residency and clerkship site for the University of Nebraska Medical Center College of Pharmacy. We hope that by sharing the results of our screening projects we will encourage other community pharmacists to implement similar services.
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