Liu Yifei, Mentele Leslie J, McDonough Randal P, Carruthers Kara M, Doucette William R
Program of Pharmaceutical Socioeconomics, College of Pharmacy, University of Iowa, Iowa City 52242, USA.
J Am Pharm Assoc (2003). 2008 Jul-Aug;48(4):515-7. doi: 10.1331/JAPhA.2008.07099.
To determine 10-year coronary heart disease (CHD) risk for union workers and their dependents in a pharmacist-managed health screening program.
Two local unions of plumbers and electricians contracted with a community pharmacy to provide health screening services for union workers and their dependents. Patients chose any one or any combination of three clinical tests: blood pressure, total cholesterol, and HDL cholesterol. At the end of the screening, which took approximately 35 minutes, the participants received brief patient education from pharmacists and a printout of their results. Pharmacists provided the services based on their in-store screening experience and, before the screening, received training on 10-year CHD risk calculation and guidelines regarding cholesterol treatment. Framingham scoring was applied to calculate 10-year CHD risk for participants who chose all three clinical tests.
265 patients (55.8% men, average age 57.7 years) participated in the screening program. Frequency of cardiovascular disease (CVD) risk factors ranged from 25.5% (diastolic blood pressure) to 52.5% (total cholesterol). Using Framingham scoring, 10-year CHD risk was calculated for 226 patients, with 119 (52.7%) patients having less than 10% risk with zero to one CVD risk factor, 73 (32.3%) having 10% to 20% risk with two or more CVD risk factors, and 34 (15%) having greater than 20% risk with two or more risk factors.
Pharmacists provided intermediate- and high-risk participants with guideline-based recommendations such as referring them to physicians for further assessment, therapeutic lifestyle changes, and medication treatment. Community pharmacists were able to identify individuals with intermediate or high 10-year CHD risk. Based on 10-year CHD risk assessment, further pharmacist-managed interventions, such as a cardiovascular risk management program, can be conducted.
在一项由药剂师管理的健康筛查项目中，确定工会工人及其家属患冠心病（CHD）的10年风险。
两个当地的水管工和电工工会与一家社区药房签约，为工会工人及其家属提供健康筛查服务。患者可选择三项临床检查中的任意一项或任意组合：血压、总胆固醇和高密度脂蛋白胆固醇。在大约35分钟的筛查结束时，参与者接受了药剂师提供的简短患者教育以及其检查结果的打印件。药剂师根据他们在店内的筛查经验提供服务，并且在筛查前接受了关于10年冠心病风险计算以及胆固醇治疗指南的培训。应用弗雷明汉评分法来计算选择了所有三项临床检查的参与者的10年冠心病风险。
265名患者（55.8%为男性，平均年龄57.7岁）参与了筛查项目。心血管疾病（CVD）风险因素的出现频率从25.5%（舒张压）到52.5%（总胆固醇）不等。使用弗雷明汉评分法，为226名患者计算了10年冠心病风险，其中119名（52.7%）患者的风险低于10%，有零至一个心血管疾病风险因素；73名（32.3%）患者的风险为10%至20%，有两个或更多心血管疾病风险因素；34名（15%）患者的风险高于20%，有两个或更多风险因素。
药剂师为中高风险参与者提供了基于指南的建议，例如将他们转介给医生进行进一步评估、改变治疗性生活方式以及药物治疗。社区药剂师能够识别出10年冠心病风险处于中高水平的个体。基于10年冠心病风险评估，可以开展进一步的由药剂师管理的干预措施，如心血管风险管理项目。
