The Collaborative Cardiovascular Risk Reduction in Primary Care (CCARP) Study

STUDY OBJECTIVE: To evaluate whether a simple pharmacist protocol, consisting of patient screening and cardiovascular risk stratification, identification and reminders about uncontrolled risk factors, and drug adherence support, can significantly reduce cardiovascular risk. DESIGN: Prospective, randomized, controlled pilot study. SETTING: Large primary care medical clinic in Saskatoon, Saskatchewan, Canada. PATIENTS: One hundred seventy-six adult patients (mean age 60 yrs) who exhibited a 10-year Framingham risk score of 15% or greater, or a coronary artery disease risk equivalent (coronary artery disease, peripheral artery disease, cerebrovascular disease, or diabetes mellitus). INTERVENTION: Eligible patients initially met with the pharmacist to receive general counselling about cardiovascular disease and were then randomly assigned to receive ongoing follow-up by the pharmacist (follow-up group 88 patients) or to return to usual care (single-contact group 88 patients) for a minimum of 6 months. MEASUREMENTS AND MAIN RESULTS: The primary end point was mean reduction in the 10-year Framingham risk score. Secondary end points included individual modifiable risk factors (systolic and diastolic blood pressures; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol HDL, and triglyceride levels; total cholesterol:HDL ratio; and hemoglobin A(1c) value), as well as statin utilization, initiation, and adherence rates. Baseline characteristics were similar across both groups. Neither the mean reduction in 10-year risk (-2.68 for the follow-up group and -1.25 for the single-contact group, one-tailed p=0.098) nor individual risk factors were significantly different between groups. The proportion of patients exhibiting statin adherence of 80% or greater did not significantly differ between groups at study end (73.1% 57/78 and 80.0% 52/65, respectively, p=0.333). However, 85.2% (75/88) in the follow-up group continued with statin therapy at the end of the study compared with 67.0% (59/88) in the single-contact group (p=0.005). Statin initiations were more frequent in the follow-up group than in the single-contact group (75.0% 30/40) vs 48.9% [22/45, p=0.013). CONCLUSION: This simple cardiovascular care protocol for nonspecialist pharmacists did not result in a clear improvement to cardiovascular risk reduction success among patients in a primary care medical clinic. The intervention did, however, appear to improve statin utilization.