Stroke survivors who had regular appointments with a pharmacist improved their blood pressure and bad cholesterol levels significantly in six months, according to a new Canadian study that points to the benefits that could flow from further expanding the powers of pharmacists in this country.
The research found that 43 per cent of patients in Edmonton who met monthly with a pharmacist managed to reduce their blood pressure and low-density lipoprotein cholesterol to the levels recommended in the Canadian Stroke Network’s guidelines – a better outcome than a control group that saw nurses instead.
The key difference appeared to be that the pharmacists were empowered to prescribe and adjust medications, whereas the nurses could only recommend changes and send the patients back to their primary-care doctors, said Finlay McAlister, one of the co-authors of the study, published Monday in the Canadian Medical Association Journal.
“It’s certainly more convenient for the patient because it cuts out one more visit,” said Dr. McAlister, a professor of general internal medicine at the University of Alberta Hospital in Edmonton.
“We know if we correct the risk factors, we’ll prevent not only strokes, but also heart attacks and deaths, so I think there’s a payoff there for the health-care system and also, of course, for the patients.”
The new findings shine a light on how, in some provinces, pharmacists’ jobs have evolved from simply filling prescriptions to helping patients better manage their health.
“Within the last five years there’s been quite dramatic change,” said Phil Emberley, director of pharmacy innovation for the Canadian Pharmacists Association. “There were a couple of provinces that were pioneers in all of this. Alberta is definitely one of them.”
However, the rules vary across jurisdictions, meaning patients in some provinces have access to fewer services at their local drug store or at family health clinics that include pharmacists.
For instance, pharmacists are allowed to prescribe for minor ailments in Alberta, Saskatchewan and Manitoba, but nowhere else.
Pharmacists can order and interpret lab tests in Alberta, Manitoba, New Brunswick and Nova Scotia, but not elsewhere.
They can administer drugs by injection – including, most prominently, the flu shot – only in British Columbia, Alberta, Manitoba, Ontario, New Brunswick and Nova Scotia.
In some places, that has changed dramatically how and where people are vaccinated against influenza. In 2009-2010, B.C. pharmacists administered 27,000 flu shots; by 2012-2013, the figure had skyrocketed to 184,000.
“I think that there is a feeling in both the physician professions, as well as in pharmacy and nursing, that it would be better if these regulations were standardized across provinces,” said Cara Tannenbaum, a professor of medicine and pharmacy at the University of Montreal.
Dr. Tannenbaum, who co-wrote an analysis of the role of pharmacists in the CMAJ last summer, said it was only “natural” that pharmacists trained in medication management be given equal responsibility for the drugs they dispense. She was not involved in the new study.
Although supportive of expanding pharmacists’ scope of practice, she cautioned that communication lapses between pharmacists and doctors could pose a problem.
“If a pharmacist makes a recommendation to change a prescription, the physician isn’t always available to pick up the phone,” she said, adding patients would be wise to pick one pharmacy and stick with it.
The new study was conducted between 2009 and 2012 and included 279 survivors of minor strokes, 220 of whom stuck with the study for the full six months.
Of those, half were placed in the group with pharmacists and half with nurses. The nurse-led group was considered an “active” control because it offered patients more attention than they would normally receive after a minor stroke.
At the outset of the study, none of the participants’ blood pressure or LDL cholesterol levels met the Canadian Stroke Network’s guidelines, even though most were already being treated for both conditions. By the end, 43.4 per cent of the patients in the pharmacy group met the targets, as did 30.9 per cent in the nurse-led control group.