Pharmacist management of a hyperlipidemia clinic

A hyperlipidemia clinic in which a pharmacist provides primary care is described. The clinic was established at a Veterans Affairs medical center in January 1990. A pharmacist performs limited physical assessments, refers patients to other clinics as necessary, orders laboratory and diagnostic tests, and selects and monitors the use of lipid-lowering medications. Interventions are performed according to the pharmacist's clinical judgment; there is no set protocol. Recommendations for patient management are approved by an attending physician, who prescribes the antilipemic drugs. The pharmacist teaches patients about hyperlipidemia, the impact of diet and life-style, and the mechanism of action, administration, and adverse effects of the antilipemics prescribed. The pharmacist also monitors compliance, laboratory test values, and the response to treatment. Treatment is modeled after the recommendations of the National Cholesterol Education Program. If a patient has not achieved the targeted cholesterol concentration after receiving dietary therapy for three months, further education about diet and lifestyle is provided. If, after three more months, the cholesterol level remains high, drug therapy is begun. Four antilipemic drugs--colestipol, gemfibrozil, lovastatin, and niacin--are used in the clinic. Since it began operating, the clinic has enrolled 284 patients. Compliance with the lipid-lowering agents has ranged from 43% to 100%. Adverse effects have accounted for the majority of cases of noncompliance. A pharmacist provides primary care for patients with hyperlipidemia in an ambulatory-care clinic.