Towards OPtimising Care of Regionally-Based Cardiac Patients With a Telehealth Cardiology Pharmacist Clinic (TOPCare Cardiology)

• Published in: Heart, lung & circulation lung & circulation, 2021-07, Vol.30 (7), p.1023-1030
• Main Authors: Livori, Adam C., Bishop, Jaclyn L., Ping, Sophie E., Oqueli, Ernesto, Aldrich, Rosemary, Fitzpatrick, Aaron M., Kong, David C.M.
• Format: Article
• Language: English
• Subjects: Cardiology; Medication; Outpatients; Pharmacist; Telehealth
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2020.12.015

Cardiovascular disease is a major burden on the health of Australians, and cardiac health disparities exist for those who live outside of metropolitan areas. Poor patient medication literacy was identified by cardiologists at a regional Victorian health service as a barrier to medication optimisation and a factor in inefficiency in their service. Studies in Australia and overseas have shown pharmacists involved in multi-disciplinary and pre-admission models result in more accurate medication histories, increased patient medication knowledge and lower medication related adverse events. This study introduced a telehealth cardiology pharmacist clinic, with the primary aim of reducing cardiologist time gathering medication information and secondary aims of investigating the patient and cardiologist experience. A cardiology pharmacist clinic was introduced where a pharmacist undertook a consultation with a patient in the days preceding their appointment with their cardiologist. The primary outcome of this study was to determine whether a cardiology pharmacist consultation undertaken prior to a cardiologist consultation reduces the time spent by the cardiologist gathering medication information. This was measured via direct observation of cardiologist consultations with and without a prior cardiology pharmacist clinic consultation. Descriptive and inferential statistics were performed to assess differences in time spent gathering the patient’s medication information by the cardiologist. The secondary outcomes included differences between: the total length of cardiologist consultations, the number of cardiologist appointments with a medication uncertainty, and attendance rates for cardiologist consultations with and without a prior cardiology pharmacist clinic consultation. Other secondary outcomes included a quantitative survey assessing patient satisfaction with the pharmacist consultation, satisfaction with telehealth, confidence in medication management. Finally, clinician perceptions of the value of the pharmacist consultation were explored via semi-structured interviews. The time spent gathering medication information immediately before, and during, the cardiologist appointment reduced from 4.66 minutes without a prior cardiology pharmacist clinic consultation to 0.66 minutes with a prior cardiology pharmacist clinic consultation (difference 4 min, 95% CI: 3.27–4.77 p≤001). There was a 4.1-minute reduction in the mean consultation length of the cardiologist