The Impact of a Pharmacist-Driven, Interprofessional Lipid Optimization Workflow in a Transitions of Care (LOW-TOC)...

Pharmacists are in a unique position to lead an interprofessional, cardiovascular (CV) team to advanced lipid management in patients with atherosclerotic cardiovascular disease (ASCVD). The role of pharmacist-driven care teams for lipid management in the transition of care space (TOC) is not well defined.

The objective of this study was to evaluate the clinical effectiveness of a pharmacist-driven, interprofessional lipid optimization workflow in the transitions of care (LOW-TOC) setting versus routine inpatient optimization workflow, termed passive optimization (PO).

This observational study investigated the utilization of a population-health based, quality improvement (QI) initiative at an urban teaching hospital over a four-month period. Eligible patients with ASCVD were identified and evaluated for intervention in the TOC space by trained pharmacists. An interprofessional approach (LOW-TOC) was used to update lipid panels and optimize statin and non-statin therapies. The primary outcome of interest was the increase in the number of successful lipid optimizations with the LOW-TOC model. Secondary outcomes observed specific lipid optimization outcomes including updated lipid panels and statin and non-statin optimization.

In total, 207 patients with established ASCVD had 174 possible lipid optimization recommendations identified (89 in LOW-TOC, 85 in PO). A total of 96 lipid optimizations were accepted and implemented. The number of optimizations using the novel LOW-TOC workflow was significantly greater than those of the passive model (86/96 [89.6%] LOW-TOC vs. 10/96 [10.4%] PO, p < 0.0001). LOW-TOC significantly increased the number of statin and non-statin initiations and improved low-density lipoprotein-cholesterol (LDL-C) monitoring.

The implementation of the LOW-TOC approach to CV team-based lipid management was associated with significantly increased optimizations compared with the standard process typically utilized in many health systems. These findings support the utility of pharmacists leading the CV team in optimizing lipid management using a population health model in TOC settings.