Cluster-randomized trial to evaluate a centralized clinical pharmacy service in private family medicine offices
Open accessAbstract
Background: The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities. Methods and Results: This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects. There was no improvement in the Guideline Advantage score from baseline to 12 months in the control group (64.7% versus 63.1%, respectively; P =0.21). There was a statistically significant improvement in the intervention group from 63.3% at baseline to 67.8% at 12 months ( P =0.02). The estimated benefit of the intervention was 5.0%±2.4% (95% confidence interval=−0.5% to 10.4%; P =0.07). Several criteria were significantly better for intervention subjects, including appropriate statin therapy ( P <0.001), body mass index, screening ( P <0.001), and alcohol screening ( P <0.001). Only 13.7% of subjects with diabetes mellitus had hemoglobin A1c at goal at baseline, and this increased to 30.8% and 21.0% in the intervention and control group, respectively, at 12 months ( P =0.10). Conclusions: The centralized, remote pharmacist intervention was successfully implemented. The improvements in outcomes were modest, in part because of higher than expected baseline guideline adherence. Future studies of this model should focus on patients with uncontrolled conditions at high risk for cardiovascular events. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01983813
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Diabetes trials have inadequate equity-related considerations, which limits how relevant and applicable their data are to disadvantaged populations.
“There are inadequate equity-related considerations in DM trials limiting the relevance and applicability of their data to disadvantaged populations.1671”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1671]
The Discussion (page not provided) says this trial included few minority participants and that including more would improve its generalizability. That supports a concern about representation, but this was a trial of a pharmacy service for multiple cardiovascular risk conditions; it does not establish that diabetes trials generally have inadequate equity considerations or that their data are less applicable to disadvantaged populations broadly. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300 · see citing works
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., et al. (2014) · JAMA · doi:10.1001/jama.2013.284427 · Cited by 7,950 · see citing works
Self-citationStone, N. J., Robinson, J. G., Lichtenstein, A. H., Bairey Merz, C. N., Blum, C. B., Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D. M., et al. (2014) · Circulation · doi:10.1161/01.cir.0000437738.63853.7a · Cited by 7,081 · see citing works
Grundy, S. M., Cleeman, J. I., Merz, C. N. B., Brewer, H. B., Clark, L. T., Hunninghake, D. B., Pasternak, R. C., Smith, S. C., & Stone, N. J. (2004) · Circulation · doi:10.1161/01.cir.0000133317.49796.0e · Cited by 6,902 · see citing works
Heart Disease and Stroke Statistics—2011 Update: A Report From the American Heart Association
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Adams, R. J., Berry, J. D., Brown, T. M., Carnethon, M. R., Dai, S., de Simone, G., Ford, E. S., et al. (2011) · Circulation · doi:10.1161/cir.0b013e3182009701 · Cited by 6,149 · see citing works
Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005) · Circulation · doi:10.1161/01.cir.0000154900.76284.f6 · Cited by 3,985 · see citing works
Smith, S. C., Allen, J. K., Blair, S. N., Bonow, R. O., Brass, L. M., Fonarow, G. C., Grundy, S. M., Hiratzka, L. F., Jones, D. W., Krumholz, H. M., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.174516 · Cited by 2,087 · see citing works
Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005) · Hypertension · doi:10.1161/01.hyp.0000150859.47929.8e · Cited by 2,051 · see citing works
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., et al. (2006) · Stroke · doi:10.1161/01.str.0000199147.30016.74 · Cited by 1,873 · see citing works
Tunis (2003) · doi:10.1001/jama.290.12.1624 · Cited by 1,724 · see citing works
Standards of Medical Care in Diabetes—2008
Dora, J. M., Kramer, C. K., & Canani, L. H. S. (2008) · Diabetes Care · doi:10.2337/dc08-0109 · Cited by 1,413 · see citing works
Standards of Medical Care in Diabetes—2008
American Diabetes Association (2008) · Diabetes Care · doi:10.2337/dc08-s012 · Cited by 1,377 · see citing works
Primary Prevention of Ischemic Stroke
Goldstein, L. B., Adams, R. J., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C., Culebras, A., DeGraba, T. J., Gorelick, P. B., Guyton, J. R., et al. (2006) · Stroke · doi:10.1161/01.str.0000223048.70103.f1 · Cited by 1,359 · see citing works
Green, B. B. (2008) · JAMA · doi:10.1001/jama.299.24.2857 · Cited by 653 · see citing works
Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., et al. (2013) · JAMA · doi:10.1001/jama.2013.6549 · Cited by 591 · see citing works
Currell, R., Urquhart, C., Wainwright, P., & Lewis, R. (2000) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002098 · Cited by 463 · see citing works
Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns
Nkansah, N., Mostovetsky, O., Yu, C., Chheng, T., Beney, J., Bond, C. M., & Bero, L. A. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000336.pub2 · Cited by 341 · see citing works
Williams, M. A., Fleg, J. L., Ades, P. A., CHAITMAN, B. R., Miller, N. H., Mohiuddin, S. M., Ockene, I. S., Taylor, C. B., & WENGER, N. K. (2002) · Circulation · doi:10.1161/01.cir.0000013074.73995.6c · Cited by 329 · see citing works
Physician and Pharmacist Collaboration to Improve Blood Pressure Control
Carter, B. L. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.358 · Cited by 313 · see citing works
Self-citationImpact of Pharmacist Care in the Management of Cardiovascular Disease Risk Factors
Santschi, V. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.399 · Cited by 298 · see citing works
Campbell, M. K., Fayers, P. M., & Grimshaw, J. M. (2005) · Clinical Trials · doi:10.1191/1740774505cn071oa · Cited by 275 · see citing works
The Quality of Pharmacologic Care for Vulnerable Older Patients
Higashi, T., Shekelle, P., Solomon, D. H., Knight, E. L., Roth, C. P., Chang, J. T., KAMBERG, C. J., MacLean, C. H., Young, R. T., Adams, J., et al. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-9-200405040-00011 · Cited by 238 · see citing works
Impact of pharmacist care in the management of cardiovascular disease risk factors
(2012) · Clinical Governance An International Journal · doi:10.1108/cgij.2012.24817aaa.011 · Cited by 212 · see citing works
The Effectiveness of Pharmacist Interventions on Cardiovascular Risk
Tsuyuki, R. T., Hamarneh, Y. N. A., Jones, C., & Hemmelgarn, B. R. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.03.528 · Cited by 211 · see citing works
Carter, B. L., BERGUS, G. R., Dawson, J. D., Farris, K. B., Doucette, W. R., Chrischilles, E. A., & Hartz, A. J. (2008) · Journal of Clinical Hypertension · doi:10.1111/j.1751-7176.2008.07434.x · Cited by 207 · see citing works
Self-citationRodondi, N., Peng, T., Karter, A. J., Bauer, D. C., Vittinghoff, E., Tang, S. S. K., Pettitt, D., Kerr, E. A., & Selby, J. V. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-7-200604040-00006 · Cited by 206 · see citing works
Barnett, M., Frank, J., Wehring, H. J., Newland, B., VonMuenster, S., Kumbera, P. A., Halterman, T., & Perry, P. J. (2009) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2009.15.1.18 · Cited by 185 · see citing works
Cardiac Performance Measure Compliance in Outpatients
Chan, P. S.-F., Oetgen, W. J., Buchanan, D. M., Mitchell, K. R., Fiocchi, F. F., Tang, F., Jones, P. G., Breeding, T., Thrutchley, D., Rumsfeld, J. S., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.03.043 · Cited by 159 · see citing works
Carter, B. L., Coffey, C. S., Ardery, G., Uribe, L., Ecklund, D. J., James, P. A., Egan, B. M., Weg, M. W. V., Chrischilles, E. A., & Vaughn, T. E. (2015) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.114.001283 · Cited by 142 · see citing works
Self-citationResults of the Medicare Health Support Disease-Management Pilot Program
McCall, N. T., & Cromwell, J. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1011785 · Cited by 102 · see citing works
Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System
Ma, J. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.381 · Cited by 69 · see citing works
Carter, B. L., Clarke, W. R., Ardery, G., Weber, C. A., James, P. A., Weg, M. W. V., Chrischilles, E. A., Vaughn, T. E., & Egan, B. M. (2010) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.109.908038 · Cited by 46 · see citing works
Self-citationPhysician-pharmacist collaboration versus usual care for treatment-resistant hypertension
Smith, S. M., Carris, N. W., Dietrich, E. A., Gums, J. G., Uribe, L., Coffey, C. S., Gums, T. H., & Carter, B. L. (2016) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2016.01.010 · Cited by 42 · see citing works
Self-citationReducing cardiovascular disease risk in medically underserved urban and rural communities
Bové, A. A., Santamore, W. P., Homko, C. J., Kashem, A. M., Cross, R. C., McConnell, T. R., Shirk, G., & Menapace, F. J. (2011) · American Heart Journal · doi:10.1016/j.ahj.2010.11.008 · Cited by 38 · see citing works
Secondary Prevention Risk Interventions Via Telemedicine and Tailored Patient Education (SPRITE)
Shah, B. R., Adams, M. B., Peterson, E. D., Powers, B. J., Oddone, E. Ž., Royal, K., McCant, F., Grambow, S. C., Lindquist, J. H., & Bosworth, H. B. (2011) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.110.951160 · Cited by 36 · see citing works
Pharmacist‐Led Cardiac Risk Reduction Model
Taveira, T. H., Wu, W., Martin, O. J., Schleinitz, M. D., Friedmann, P. D., & Sharma, S. C. (2006) · Preventive Cardiology · doi:10.1111/j.1520-037x.2006.05339.x · Cited by 34 · see citing works
Pharmacist intervention for blood pressure control: medication intensification and adherence
Gums, T. H., Uribe, L., Weg, M. W. V., James, P. A., Coffey, C. S., & Carter, B. L. (2015) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2015.05.005 · Cited by 34 · see citing works
Self-citationEapen, Z. J., Liang, L., Shubrook, J. H., Bauman, M. A., Bufalino, V. J., Bhatt, D. L., Peterson, E. D., & Hernandez, A. F. (2014) · American Heart Journal · doi:10.1016/j.ahj.2014.06.007 · Cited by 33 · see citing works
Development and Reliability Testing of the Clinical Pharmacist Recommendation Taxonomy
Hoth, A. B., Carter, B. L., Ness, J., et al. (2007) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.27.5.639 · Cited by 27 · see citing works
Self-citationEvolution of “The Guideline Advantage”
Bufalino, V. J., Bauman, M. A., Shubrook, J. H., Balch, A. J., Boone, C. A., Vennum, K., Bradley, S., Wender, R. C., Minners, R., & Arnett, D. K. (2014) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/hcq.0000000000000003 · Cited by 21 · see citing works
Selection bias and subject refusal in a cluster-randomized controlled trial
Yang, R., Carter, B. L., Gums, T. H., Gryzlak, B. M., Xu, Y., & Levy, B. T. (2017) · BMC Medical Research Methodology · doi:10.1186/s12874-017-0368-7 · Cited by 19 · see citing works
Self-citationCarter, B. L., Levy, B. T., Gryzlak, B. M., et al. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.04.014 · Cited by 14 · see citing works
Self-citationCarter, B. L., & Ardery, G. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.116.004432 · Cited by 14 · see citing works
Self-citationThe Future of Medicare Part D Drug Plans—Results From a Roundtable Discussion
Balfour, D. C., III, Evans, S., Januska, J., Lee, H. Y., Lewis, S. J., Nolan, S. R., Noga, M., Stemple, C., & Thapar, K. (2009) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2009.15.s1.18 · Cited by 11 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.003 · Cited by 596 · see citing works
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
- Authors
- Carter, B. L., Levy, B., Gryzlak, B., Xu, Y., Chrischilles, E., Dawson, J., Vander Weg, M., Christensen, A., James, P., & Polgreen, L.
- Affiliations
- University of Iowa (US)
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.)
- Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)
- Department of Biostatistics, College of Public Health (J.D.)
- Department of Internal Medicine, Carver College of Medicine (M.V.W., A.C.)
- University of Washington (US)
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2018-06
- Volume
- 11
- Issue
- 6
- Pages
- e004188-e004188
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC5996776
- OpenAlex
- W2806629360
- Cited by
- 46
- References
- 44
- Citations by year
- 2025: 3 · 2024: 7 · 2023: 9 · 2022: 13 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 2
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL116311)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- clinical pharmacy services, guideline adherence, cardiovascular risk factors, statin therapy, diabetes mellitus, HbA1c, alcohol screening, rural primary care, team-based care, cardiovascular disease prevention
- MeSH terms
- Aged, Cardiovascular Diseases, Centralized Hospital Services, Female, Humans, Iowa, Male, Middle Aged, Patient Care Team, Pharmacists, Pharmacy Service, Hospital, Practice Patterns, Physicians', Preventive Health Services, Primary Health Care, Private Practice, Prospective Studies, Risk Factors, Time Factors, Cluster Analysis, Treatment Outcome, Models, Organizational, Practice Guidelines as Topic, Risk Assessment, Delivery of Health Care, Integrated, Remote Consultation, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
