INTEGRATE

An integrated general practice and pharmacy-based intervention to promote the prescription and use of appropriate preventive medications among individuals at high cardiovascular risk

Extensive evidence demonstrates the benefits of a number of drugs for the prevention of cardiovascular disease (CVD) events, particularly in those at high risk. However, there are substantial evidence-practice gaps in Australian primary healthcare settings. The study will test the hypothesis that an integrated intervention combining three evidence based approaches:

  1. point-of-care electronic decision support in general practice;
  2. availability of CVD polypills (fixed dose-combination of generic blood pressure (BP) lowering, lipid modifying ± and antiplatelet drugs);
  3. a pharmacy-led medication adherence intervention will increase prescription and long-term use of recommended medications, leading to improvements in CVD risk factor levels

The electronic clinical decision support system (HealthTracker) incorporates a single, extensively validated screening and management algorithm, based on a synthesis of recommendations from several guidelines for CVD, kidney disease and diabetes prevention and management. Data from the patient record pre-populate the tool which then provides point-of-care recommendations based on that patient’s absolute CVD risk estimate. If the patient is receiving sub-optimal screening or management, the practitioner is provided tailored recommendations to address this. A risk communication tool is included that assists patients to understand their CVD risk.

There is good evidence that pharmacy-led initiatives can improve both initial adherence to and longer-term persistence with prescribed medications. Pharmacists will administer a questionnaire for assessing medication adherence in patients presenting with new CVD preventative medication prescriptions (either for an existing medication or for a new medication). They will then offer and provide the advice and support to those with an unsatisfactory questionnaire score.

These strategies will be systematically evaluated in a pragmatic cluster RCT in 70 Australian General Practice and Pharmacy pairs (35 intervention and 35 control), with the primary outcome being the proportion of high-risk patients who were not on full treatment at baseline achieving recommended target BP and LDL-C target levels at study end.

The study is being conducted By Monash University and the George Institute for Global Health, NSW and is funded by the NHMRC.