Multidisciplinary, multiple risk factor cardiovascular disease primary prevention programme in community pharmacy : a feasibility study : a thesis presented in partial fulfilment of the requirements for the degree of MSc Programme in Nutrition & Dietetics, School of Sport, Exercise and Nutrition, Massey University, Albany, New Zealand

Abstract

Background: Community pharmacy cardiovascular disease (CVD) primary prevention interventions, led by pharmacists, are effective. However, the majority of these have targeted single CVD risk factors and most have not adequately assessed the impact of dietary and physical activity behaviour. A multidisciplinary and multi- risk factor approach that involves collaboration between dietitians (dietary and physical activity consultations) and pharmacists (pharmacological treatment) may provide additional risk reduction benefits for participants. Objective: To assess the feasibility of implementing a community pharmacy-based CVD primary prevention programme using a multidisciplinary approach to motivate lifestyle behaviour change in participants at risk of CVD. The primary outcome was change in estimated five-year CVD risk. Methods: A 16-week single cohort pre- and post-test study was undertaken in two community pharmacies with twelve participants aged 40-74 years who had risk factors associated with increased CVD. Participants received dietary and physical activity advice at baseline and every four weeks by a student dietitian as well as pharmacological management assessment at baseline, 16 weeks and as needed by a pharmacist. Biochemical (blood lipids, blood pressure, HbA1c) and anthropometric (body composition, weight, height, waist and hip circumference) measures were compared at baseline, eight and 16 weeks. Behavioural measures (diet, physical activity and medication use) were compared between baseline and 16 weeks. Results: Eleven participants (68±5.2 years) completed the programme. Significant reductions from baseline to 16 weeks were observed for mean systolic and diastolic blood pressure (-5.47, p = 0.04 and -4.06mmHg, p = 0.01 respectively) and mean total cholesterol reduced significantly from baseline to eight weeks, (-0.43mmol/L; p = 0.005) but not between baseline and 16 weeks. The average diet quality score significantly improved by 12.6% from 65.9 to 74.2 out of 100 during the intervention period (p = 0.007). Other CVD risk factor measures showed a trend towards improvement. Five-year CVD risk did not significantly improve. Conclusions: Results are comparable to existing literature on interventions to reduce CVD in the community pharmacy setting. Findings within this small cohort, particularly the improvements seen in diet, support the inclusion of dietitians for the primary prevention of CVD in community pharmacies. A larger scale, controlled study will help in determining the extent of efficacy with this approach.