An Outpatient Pharmacist Strategy Improves Guideline Adherent Medication Prescribing in Patients with Vascular Disease.

Abstract

Lipid lowering therapies, antiplatelet therapy, and smoking cessation are cornerstones of best medical therapy in vascular diseases. However, prescribing rates remain poor. This study aimed to assess the impact of integration of a clinical pharmacist in the vascular outpatient clinic on statin and antiplatelet prescribing and smoking cessation interventions in patients with vascular disease. A single centre, prospective, cohort pilot study was performed comparing patients reviewed by pharmacists in the vascular outpatient clinic (June to December 2023) with historical controls of patients not reviewed by a pharmacist (July to December 2022). Patients reviewed in the outpatient clinic with lower extremity arterial, carotid artery, and aortic aneurysmal disease were included in statin and antiplatelet prescribing analyses, and all current smokers for smoking cessation analyses. Uni- and multivariable logistical regression analyses were performed to identify factors associated with prescribing following outpatient clinic review. The primary outcome was adjusted odds ratios (AORs) for the prescription of high intensity statins (rosuvastatin ≥ 20 mg or atorvastatin ≥ 40 mg) and antiplatelets following outpatient clinic review. Two hundred and fifty-eight patients were included in statin and antiplatelet analyses (pharmacist review: 94; without pharmacist: 164). Pharmacist review was associated with high intensity statin prescribing (AOR 3.38, 95% confidence interval [CI] 1.71 - 6.67; χ²_LR = 13.58, degrees of freedom [df] = 1, p < .001); however, it was not statistically significantly associated with antiplatelet prescribing (AOR 0.66, 95% CI 0.30 - 1.46; χ²_LR = 1.06, df = 1, p = .30). For 107 smokers, pharmacist review was associated with nicotine replacement therapy prescription (unadjusted odds ratio [OR] 3.98, 95% CI 1.38 - 11.52; χ²_LR = 7.05, df = 1, p = .008) and smoking cessation service referral (unadjusted OR 19.20, 95% CI 4.14 - 89.01; χ²_LR = 23.65, df = 1, p < .001). Pharmacist review of patients in an outpatient vascular clinic is a likely effective strategy to improve prescribing rates of guideline adherent statin therapy and smoking cessation service provision.