Expanding the Role of Pharmacists in Treating Persons With Cardiovascular or Lung Diseases

Drugs used to treat cardiovascular and lung diseases are the most frequent cause of
hospitalizations and emergency department visits related to inadequate therapy or ADEs. ADEs
occur in 25% of patients who are able to walk and may cause up to 17% of hospital admissions
among the elderly. A lack of communication and coordination between the hospital setting and
the patient's own community setting, upon patient discharge, may contribute to the high
number of ADEs. By expanding the role of pharmacists and encouraging communication between
hospitals and pharmacists, the number of ADEs may be reduced. There have been a few small
studies that have examined the way patient information is transferred between hospital and
community pharmacists, but these studies did not involve the patients' primary care
physicians nor did they fully evaluate the effect of communication between hospital and
community pharmacists. The purpose of this study is to evaluate the effectiveness of
providing a pharmacist case manager to hospitalized patients with cardiovascular or lung
disease at reducing the number of ADEs, re-hospitalizations, and unscheduled medical visits.

This study will enroll individuals with certain conditions or diseases who are admitted to
the hospital. Participants will be randomly assigned to either a control group, a minimal
treatment group, or an enhanced treatment group. Participants in the minimal and enhanced
treatment groups will meet with a pharmacist case manager while in the hospital to conduct a
medication history review. The case manager will also meet with participants at the time of
hospital discharge and provide them with a discharge summary and educational materials.
Additionally, for participants in the enhanced treatment group, the case manager will do the
following: transfer the discharge summary data to the participant's community physician and
pharmacist; call the participant 3 to 5 days following discharge from the hospital and as
needed thereafter to resolve medication problems; and communicate with and make
recommendations to the participant's community physician and pharmacist. All participants
will meet with a study research nurse immediately after study entry to complete
questionnaires. Study nurses will also call all participants 30 and 90 days following
hospital discharge to collect adverse event information. Surveys will be completed by each
participant's pharmacist and primary care physician 90 days following the participant's
discharge from the hospital.

Inclusion Criteria:

- Speaks either English or Spanish

- Willing to obtain all long-term prescriptions from one community pharmacy during the
90-day study period

- Diagnosed with at least one of the following conditions: high blood pressure,
hyperlipidemia, heart failure, coronary artery disease, heart attack, stroke,
transient ischemic attack, asthma, chronic obstructive pulmonary disease (COPD),
diabetes, or receiving oral anticoagulation therapy

- Admitted to the general medicine, family medicine, cardiology, or orthopedics
services hospital department

Exclusion Criteria:

- Does not have a working telephone

- Has a hearing impairment that does not allow the use of a telephone

- Enrolled in Iowa Care (i.e., individual has no community physician or community
pharmacist following hospital discharge)

- Life expectancy estimated at less than 6 months at the time of study entry

- Dementia or cognitive impairment

- Severe psychiatric or psychosocial factors, including substance abuse, that may
impair the desire or ability to complete all aspects of the study

- Admission to the psychiatric, surgery, or hematology/oncology services hospital
department