A collaborative disease management program for managing cholesterol in hospital patients

The clinic will be run by an experienced clinical pharmacist as per protocols under the supervision of a physician. A competency package will be developed for the pharmacist undertaking the role around Peripheral Vascular Disease and hyperlipidaemia. Intervention group patients will be given appointments to see the trained pharmacist at an out-patient clinic every six weeks. An algorithim with a patient sticker will be signed by the physician ahead of patient’s clinic visit. During the first visit the pharmacist will review the patient’s lipid levels. Patients who are not already on lipid lowering medication will be started on a suitable dose of lipid lowering medication (e.g. Pravastatin 40mg or equivalent). For those who are already on lipid lowering medication, adjustments in the dosing regimen will be done if needed, as per the algorithm and clinic protocols. The pharmacist will review pateint’s medication regimen for drug interactions and adverse reactions. The pharmacist will educate the patient, emphasising the need for adherence to drug therapy and non-pharmacological management such as exercise, dietary control and life style changes. Direct dispensing at the point of care will be used to enhance medication adherence. At the subsequent visit (after six weeks) if lipid levels have not reduced by at least 10%, dose increases will be ordered. This will be a doubling of the dose of statin or its equivalence ( for example, pravastatin 40mg changed to 40mg atorvastatin). Feedback on lipid levels with reinforcement on the importance of adherence to treatment recommendations will be provided to the patient. Review of lipid levels, dosage adjustment and patient feedback will continue to be offered at each of the three subsequent six weekly visits. Minimal input from the physician will be sought for the running of the clinic. However, patients whose management is beyond the competence of the pharmacist (e.g. uncontrolled diabetes, high LDL resistant to two successive dosage changes) will be referred to the physician in charge of the clinic or other relevant health professional (e.g. dietician). Such patients will continue to be part of the intervention arm after the particular referral.