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American Journal of Health-System Pharmacy, Vol. 67, Issue 4, 290-294
Copyright © 2010 by American Society of Health-System Pharmacists
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Influence of pharmacist intervention on prescribing of angiotensin-converting-enzyme inhibitors, angiotensin II-receptor blockers, and aspirin for diabetic patients

 Brandon LaMarr, Connie Valdez, Katie Driscoll and Mary Ryan

BRANDON LAMARR, B.A., PHARM.D., is Pharmacy Resident, Southern Arizona Veterans Affairs Healthcare System, Tucson; at the time of this study he was student, School of Pharmacy, University of Colorado Denver (UCD), Aurora. CONNIE VALDEZ, PHARM.D., M.S.ED., is Associate Professor, Department of Clinical Pharmacy, School of Pharmacy, UCD. KATIE DRISCOLL, PHARM.D., is Chemotherapy Pharmacist, Denver Veterans Affairs Medical Center, Denver, CO; at the time of this study she was Pharmacy Practice Resident, Pharmacy Service, Eastern Colorado Veterans Affairs Health Care System, Denver. MARY RYAN, PHARM.D., is Clinical Pharmacist, Children’s Hospital, Aurora, CO

Address correspondence to Dr. LaMarr at the Southern Arizona Veterans Affairs Healthcare System, 3601 South 6th Avenue (13-119), Tucson, AZ 85723 (brandon.lamarr2{at}va.gov).


Purpose. The influence of pharmacist intervention on the prescribing of angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), and aspirin for patients with diabetes was evaluated.

Methods. A retrospective chart review was performed for diabetic patients seen in a family medicine clinic. Patients were included in the analyses if they were 18–88 years old, had a diagnosis of type 1 or type 2 diabetes, had been seen in the family medicine clinic between July 2006 and October 2008, and had received a consultation by pharmacy services. All selected charts were reviewed to assess appropriate use of ACE inhibitor, ARB, and aspirin therapy, as recommended by American Diabetes Association (ADA) guidelines, before and after pharmacist intervention. Typical pharmacist interventions consisted of direct consultation with the prescriber and therapeutic education sessions conducted by pharmacy personnel. All patients were seen and evaluated by pharmacy personnel before meeting with the prescriber.

Results. Before pharmacist intervention, 41 (59%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 24 (34%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA. After pharmacist intervention, 63 (90%) of 70 patients were receiving appropriate ACE inhibitor or ARB therapy and 48 (68%) of 71 patients were receiving appropriate aspirin therapy as recommended by ADA (p < 0.0001 for both differences).

Conclusion. A pharmacy intervention program in a primary care setting was associated with a significant increase in prescriber adherence to ADA guidelines for ACE inhibitor or ARB therapy and for aspirin therapy in diabetic patients.

Index terms: American Diabetes Association; Angiotensin antagonists; Angiotensin-converting-enzyme inhibitors; Aspirin; Diabetes mellitus; Education; Interventions; Pharmaceutical services; Pharmacists; Physicians; Platelet aggregation inhibitors; Prescribing; Protocols; Rational therapy

 

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