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Community pharmacist outreach program directed at physicians treating congestive heart failure
C J Turner1, P Parfrey, K Ryan
1School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262, USA. christopher.turner@uchsc.edu
Insights
Digoxin and furosemide effectively identify congestive heart failure (CHF) patients. A pharmacist outreach program did not improve angiotensin-converting-enzyme (ACE) inhibitor use but served as a quality assurance tool.
Area of Science:
- Pharmacology
- Cardiology
- Health Services Research
Background:
- Congestive heart failure (CHF) management often involves digoxin and furosemide.
- Angiotensin-converting-enzyme (ACE) inhibitors are crucial for CHF treatment but may be underutilized.
- Pharmacist-led interventions can potentially improve medication adherence and outcomes.
Purpose of the Study:
- To assess the predictive value of digoxin and furosemide for identifying CHF patients.
- To evaluate the utilization of ACE inhibitors in CHF patients.
- To determine the effectiveness of a pharmacist outreach program in increasing ACE inhibitor use.
Main Methods:
- A study on Newfoundland's Avalon Peninsula involved community pharmacists and physicians.
- Pharmacists identified patients on digoxin and furosemide, with or without ACE inhibitors or angiotensin II-receptor inhibitors.
- Physicians confirmed CHF diagnoses and ACE inhibitor use; intervention groups received academic detailing on ACE inhibitors.
Main Results:
- Digoxin and furosemide had a 94% positive predictive value for identifying CHF patients.
- 76% of CHF patients on digoxin and furosemide were prescribed an ACE inhibitor.
- Only 36% of CHF patients on ACE inhibitors received the target dosage; the outreach program showed no significant prescribing changes.
Conclusions:
- Digoxin and furosemide are reliable indicators for CHF identification.
- Pharmacist outreach did not significantly alter ACE inhibitor prescribing patterns or dosages.
- The pharmacist outreach program proved valuable for quality assurance in CHF management.
Abstract:
The predictive value of digoxin and furosemide treatment for identifying patients receiving treatment for congestive heart failure (CHF), the use of angiotensin-converting-enzyme (ACE) inhibitors in this population, and the ability of a pharmacist outreach program to address underutilization of ACE inhibitors were studied. All physicians and owner-managers of community pharmacies on Newfoundland's Avalon Peninsula were asked to participate in the study. Pharmacists who agreed to participate were asked to list patients of the participating physicians with prescriptions for (1) furosemide and digoxin with and without an ACE inhibitor or angiotensin II-receptor inhibitor and (2) an ACE inhibitor. Physicians were visited by a pharmacist and asked whether each of their patients receiving digoxin and furosemide was being treated for CHF and to identify further cases of CHF among their patients receiving an ACE inhibitor. Intervention-group physicians received academic detailing on the use and dosage of ACE inhibitors and angiotensin II-receptor inhibitors for CHF. Both groups were reinterviewed after three months to establish what if any changes in therapy had occurred for each patient discussed during the first visit. The positive predictive value of digoxin and furosemide treatment for identifying patients receiving treatment for CHF was 94%. Seventy-six percent of patients identified by physicians as CHF patients who were taking digoxin and furosemide were treated with an ACE inhibitor. Thirty-six percent of patients treated with an ACE inhibitor for CHF received the targeted dosage. Four physicians stated that the outreach visit influenced their prescribing, but there was no significant difference in ACE inhibitor prescribing between the intervention and control groups. A pharmacist outreach program involving the use of prescription records and academic detailing did not affect prescribing or dosages of ACE inhibitors but demonstrated value as a quality assurance tool.