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AJMC: Pharmacies, retail clinics uniquely positioned to deliver high-quality, low-cost cardio-prevention


NEW YORK — As the healthcare system increasingly moves toward value-based payments and accountable care, efficient prevention and a reduction in downstream healthcare costs will be shared by a broader team of providers, and retail pharmacies ought to be part of this conversation. That was a key message of an article authored by several CVS Health executives.

The article, titled "The Role of Retail Pharmacies in CVD Prevention After the Release of the ATP IV Guidelines," was authored by William Shrank, SVP, chief scientific officer and chief medical officer, provider innovation and analytics for CVS Health; Andrew Sussman, SVP and associate chief medical officer for CVS Health and president of CVS/minuteclinic; and Troyen Brennan, EVP and chief medical officer of CVS Health. It was published Thursday by the American Journal of Managed Care.

As the article states, November 2013 marked the release of the National Cholesterol Education Program Adult Treatment Panel IV (ATP IV) guidelines for cholesterol management. The guidelines fundamentally altered long-held conceptions about how to best manage hypercholesterolemia in order to reduce cardiovascular risk.

As the article states, “when the dust settles, it seems the quality of cholesterol management will shift to two key outcomes: 1) whether appropriate patients are initiated on therapy, and 2) whether treated patients adhere to therapy as prescribed. These are also commonly used quality measures. However, the adherence measure is often challenging for physicians to manage.”

According to the authors, “the evidence suggests that team-based, multi-factorial, data-driven approaches to adherence are far more effective than interventions driven by the physician alone. Pharmacists, and retail pharmacies more specifically, have consistently demonstrated that they are key partners in efforts to promote adherence. The evidence would suggest that, if adherence is our goal, we need to think about a very different paradigm than the old doctor-based, treat-to-target algorithm that has been relied upon in the past.”

In fact, the authors suggested that, “We may be reaching a tipping point, where community-based entities play an even greater role in collaborating with primary care providers to prevent cardiovascular disease. Americans visit their retail pharmacist far more frequently than their primary care physician’s office. Many retail pharmacies now offer point-of-care cholesterol testing and can certainly provide the risk-stratification needed to determine whether therapy is appropriate.”

Furthermore, many pharmacies also have retail clinics where prescriptions can be written based on widely accepted clinical guidelines for dosing and measurement.

“By placing the pharmacist and nurse practitioner at the center of efforts to prevent cardiovascular disease, the role of the pharmacy as a trusted health ambassador within neighborhoods is enhanced. As we think about how to improve the health of populations, this neighborhood-based approach to prevention may be a critical way to improve health and reduce total healthcare costs. However, doing so will require effective, real-time communication between pharmacies and primary care doctors, emphasizing the need for implementation of electronic medical records that connect both parties,” the authors stated.

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