The Pharmaceutical Journal
Vol 271 No 7256 p16
5 July 2003

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Pharmacist-led blood pressure clinic for diabetes patients wins award

The winners of the Pharmaceutical Care Awards 2002 were presented with their awards at a dinner held at the Savoy Hotel in London on 27 June. The awards, organised by The Journal and sponsored by GlaxoSmithKline, were presented by Professor Martin Kendall. Finalists presented their work at a conference held in the afternoon before the dinner

A pharmacist-led hypertension and cardiac risk clinic for patients with diabetes mellitus

Andrew Lowey, MRPharmS (clinical pharmacist), Sara Moore, MRPharmS (clinical pharmacist) Catherine Norris, MRPharmS, (clinical services manager), Peter Hammond, (FRCP) (consultant physician and endocrinologist) Harrogate Healthcare NHS Trust, David Wright, (senior lecturer in pharmacy practice, University of Bradford at the time the study was undertaken)

Reducing high blood pressure and lowering high lipid levels are known to reduce the risk of complications in patients with diabetes. Hence pharmacists at Harrogate Healthcare NHS Trust set up a hypertension and cardiac risk clinic to monitor and treat diabetes patients who have blood pressures and cholesterol levels above target ranges.

Patients are referred to the clinic by a consultant endocrinologist or a specialist diabetes nurse. Once baseline blood pressure and cholesterol have been established, pharmacists use an evidence-based algorithm to adjust antihypertensive medicines. Consideration is also given to introducing a statin or aspirin. Pharmacists educate patients about any changes made to their medicines and other aspects of their disease. Each patient attends once every four weeks.

After 12 weeks of treatment (three visits) patients have mean reductions in blood pressure of 12mmHg and in serum cholesterol of 0.5mmol/L. Since the clinic was set up in May 2002, 80 patients have been treated, and 21 of these have reached their target blood pressure (140/80mmHg) and been discharged to their general practitioner.

Commenting on their success in reducing blood pressure, including in a patient who previously had blood pressure above the target range for nine years, Andrew Lowey said that "it is the intensive nature of the care that is key to results".
– Contributed by Rachel Graham, staff editor, Hospital Pharmacist.

FINALIST: Overseeing the safe management of high risk drugs from the hospital to the community

High risk drug monitoring clinic — expanding the pharmacist's role

Sasha Beresford MRPharmS (principal pharmacist, complex medicines clinic, Carol Stevens, MRPharmS (director of clinical pharmacy), Michael Cross MRPharmS (director of pharmacy), Barts and the London NHS Trust

Certain high-risk drugs used in the management of inflammatory bowel conditions, such as azathioprine, mycophenolate and sulfasalazine, require careful monitoring to be used safely. Pharmacists at Barts and the London NHS Trust therefore set up a clinic to target these drugs, which are generally initiated in hospitals, and oversee their safe management in the community.

Recently diagnosed patients are seen by a consultant gastroenterologist before pharmacists explain the importance of blood monitoring to them and discuss their drug therapy. Follow-up patients are generally seen only by a pharmacist, who takes their blood samples and monitors their treatment. Communication with general practitioners is improved by drawing up monitoring guidelines and sending out standard letters promptly, as is communication with patients (by providing a hand-held drug monitoring booklet and information sheets). The patient-focused approach also means that outpatients spend less time at the hospital.

Presenting the work, Sasha Beresford said that pharmacists had become an "integral part of the outpatients' multidisciplinary team". The service is to be extended to rheumatology and dermatology.
— Contributed by Rachel Graham, staff editor, Hospital Pharmacist.