Diane Lamarre

A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study

Background: Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia. Methods: We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients’ adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors. Results: Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was −0.2 mmol/L (95% confidence interval [CI] −0.3 to −0.1), and the adjusted reduction was −0.05 (95% CI −0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34). Interpretation: Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.

Knowledge, Attitudes and Beliefs about Chronic Noncancer Pain in Primary Care: a Canadian Survey of Physicians and Pharmacists

Inaccurate knowledge, beliefs and attitudes held by health care professionals responsible for the treatment of chronic noncancer pain is a considerable barrier to the optimal treatment of these patients. In this study, the authors surveyed physicians and pharmacists caring for a cohort of chronic pain patients participating in the ACCORD program (Application Concertée des Connaissances et Ressources en Douleur) to evaluate their knowledge, attitudes and beliefs about chronic pain.

The Role of the Pharmacist in Humanitarian Aid in Bosnia-Herzegovina: The Experience of Pharmaciens Sans Frontières

BACKGROUND: Founded in 1985, Pharmaciens Sans Frontières (PSF) is a nongovernmental organization of pharmacists involved in humanitarian aid. PSF relied on approximately 100 expatriates in 1998, which included 50 pharmacists distributed throughout 24 missions (i.e., 14 emergency, 7 development, 3 assessment). It is necessary to add 200–250 local staff to this group. OBJECTIVE: To describe PSFs mission in Bosnia-Herzegovina from 1992 to 1999 and to define the pharmacists impact in the supply of medicines and the development of pharmaceutical care and services. RESULTS: In April 1992, at the beginning of Sarajevos siege, PSF sent a small team of three volunteer pharmacists to Bosnia-Herzegovina. The objective of the emergency phase (1992–1995) was to set up a massive supply program of essential medicines and medical and biologic materials and to implement a distribution system based on existing health centers. The signing of the Dayton peace agreement and a progressive return to peace and stability marked the beginning of the postemergency phase (1995–1997). This phase pursued previous objectives of establishing a distribution network and added the implementation of logistic centers. PSF widened its involvement to medical laboratory analysis, production of medicines, disposal of expired medications sent during the conflict, and the implementation of a national center for quality control. Currently, the development phases (1998–1999) objective is to provide adequate support for the reorganization of pharmaceutical care and services by establishing pharmacy work groups and developing and maintaining good relationships with the international community and Bosnia-Herzegovina pharmacists. CONCLUSIONS: Humanitarian aid is essential in major conflicts, as seen in the case of Bosnia-Herzegovina. Although it is difficult to evaluate the impact of the distribution network implemented by PSF, it allowed for a better provisioning of medications to the general population. PSF played an important role in such cases. In fact, PSF provides its pharmaceutical expertise to these embattled areas not only by offering financial support to the logistics or supplying of medications, but by offering professional support to the organization/reorganization of the pharmaceutical practice.

How to help patients manage their dyslipidemia: A primary care physician-pharmacist team intervention

Dyslipidemia treatment in primary care is far from optimal — adherence and persistence to pharmacotherapy are low, and physicians tend not to titrate statin dosages. Consequently, a large proportion of patients do not attain their recommended lipid targets. This has serious clinical and economic consequences. Several studies have shown that community-pharmacist interventions and collaborative management of pharmacotherapy by physicians and pharmacists improve dyslipidemia treatment. In Quebec, as a result of legislative changes (Bill 90) made in 2002, community pharmacists may initiate and adjust drug therapy in accordance with a physician’s prescription and request laboratory analyses when needed. This new legislation increases the potential for a physician-pharmacist team approach to the management of dyslipidemic patients. In Quebec, in order to implement these collaborative practices, a treatment protocol has to be approved by members of a hospital’s Conseil des Medecins, Dentistes et Pharmaciens (Council of Doctors, Dentists, and Pharmacists). In this article, we present a treatment protocol for the management of statin therapy that was developed by pharmacists (LL, JV, DL, MCV, SP), family physicians (MTL, EH), and a cardiologist (JG) as part of a randomized controlled trial. The treatment protocol describes a physician-pharmacist team intervention for the management of patients with dyslipidemia in a primary care setting.

Original Article: Compounding dermatologic preparations in developing countries

Access to medications and their proper use are essential in developing countries. An interdisciplinary team of dermatologists and pharmacists created a master list of preparations useful for treating the most common dermatologic disorders in tropical and equatorial areas. The first pilot project was done at Cardinal Leger Hospital in Leogane, Haiti. Training was given to local staff at that hospital in 2005. Four years later, the clinic continues to prepare and offer, at a reasonable price, drugs that the population needs.