Academic journal article American Journal of Pharmaceutical Education

Multi-Site Heart Disease Risk Assessment Service Provided by Pharmacy Students

Academic journal article American Journal of Pharmaceutical Education

Multi-Site Heart Disease Risk Assessment Service Provided by Pharmacy Students

Article excerpt

INTRODUCTION

Advanced pharmacy practice experiences (APPEs) in the ambulatory care setting are completed during the fourth year of the doctor of pharmacy (PharmD) curriculum at the Albany College of Pharmacy and Health Sciences. Ambulatory care APPEs provide pharmacy students with direct patient care opportunities, where students participate in pharmaceutical care services such as patient medication interviews, medication reviews, and patient counseling. Pharmacy students have demonstrated value as providers of clinical services. (1) Pharmacy students, working within a practice model where they function as less-experienced colleagues, can offer services not routinely provided by pharmacy staff members. (2) Although time devoted to training pharmacy students may initially decrease the pharmacist's productivity, overall output of the pharmacy service will increase as the students independently provide services previously not offered. To best facilitate this model of practice, care must be taken to select services that previously had not been offered by the pharmacy unit, with activities that are straightforward and guideline or protocol driven, making them easier for a less-experienced colleague or student pharmacist to provide. (3) The coronary heart disease risk assessment service described in this study was built around these premises.

Coronary heart disease (CHD) is the single leading cause of death among both men and women in America today, causing about 1 in every 6 deaths. (4) In 2010, an estimated 785, 000 American will suffer a new coronary attack, and nearly 470,000 will have a recurrent attack. About every 25 seconds in America, 1 person will have a coronary event, and about every minute, 1 person will die from a coronary event. This high prevalence of CHD suggests that a significant number of patients seen in the ambulatory care setting are likely to have coronary heart disease or predisposing risk factors. Among those who died suddenly of CHD in 2005, 50% of men and 64% of women had no previous symptoms of the disease, underscoring the importance of CHD risk factor identification and management in at-risk adults. The potential economic value of CHD risk reduction is real, considering the estimated $177.1 billion in direct and indirect costs of CHD in 2010.

A physician-implemented CHD risk-factor evaluation and communication program to lower predicted CHD risks has proven to be effective. (5) Computer-based educational software also may be acceptable to CHD patients of various ages, serving as an effective method for increasing CHD knowledge among persons with the disease. (6)

The 10-year risk for developing CHD can be predicted using the Framingham risk algorithm which assesses cardiovascular risk based on multiple risk factors including: the patient's age, gender, blood pressure, total cholesterol, HDL cholesterol, history of diabetes, history of left ventricular hypertrophy, and smoking history. (7,8) Simple to administer, the algorithm uses computer software requiring specific laboratory and physical examination values readily accessible in the ambulatory care setting.

The purpose of this study was to assess the educational value of a clinical service provided to ambulatory care patients by pharmacy students. The CHD risk service was developed to increase patient awareness and educate patients about modifiable and non-modifiable risk factors using both paper and computerized presentations of patient-specific CHD risk. The study assessed patient satisfaction and pharmacy student learning associated with the service.

DESIGN

The study population consisted of adult patients presenting for a scheduled physician or pharmacist visit at medical practices specializing in internal medicine, family practice, or diabetes. Eligibility requirements included documentation of at least 1 Framingham CHD risk factor (age >45 years for men, >55 years for women, hypertension, dyslipidemia, left ventricular hypertrophy, smoking, diabetes), and a fasting lipid panel completed within the past 2 years. …

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