Project Name: Pharmacist-Led Lipid Management Model of Care at PCN Level

Project Summary:

The key aim of the Collaborative Working Project is to improve lipid management at speed and scale at the PCN level and improve the quality of care for patients with with Atherosclerotic Cardiovascular Disease (ASCVD) and uncontrolled lipid levels.

The project in Wallsend PCN aims to address critical limitations within the system to the identification and treatment of ASCVD patients to ensure that appropriately treated patients benefit from all available therapies without unnecessary delay.  

The service will aim to achieve:

1. Identification of sub-optimally treated patients who are not achieving lipid levels as specified by local guidelines
2. Identification of patients who have previously not tolerated or refused alternative lipid modification therapies
3. Review treatment options in a consultative way with patients
4. Counsel and optimise patients where appropriate

Planned Milestones:

  • PCN Level Lipid Management pathway/protocol development 
  • Collection of baseline data, in line with the measure of success 
  • Collection of 3 months clinical activity data & Project Review meeting to discuss project progress. 
  • Collection of 6 months clinical activity data & Project Review meeting to discuss project progress. 
  • Collection of 9 months clinical activity data & Project Review meeting to discuss project progress. 
  • Collection of 12 months clinical activity data & Project Review meeting to discuss project progress. 
  • Collection of 15 months clinical activity data & Project Review meeting to discuss project progress. 
  • Collection of 18 months clinical activity data & Project Review meeting to discuss project progress. 
  • Analysis of project data, and Submission of Outcomes Summary  
  • Development of Final Project Write-up by 3rd Party

Expected Benefits:

Anticipated benefits for patients:

  • Improved access to lipid management care leading to optimal diagnosis and management of ASCVD treatments.
  • Enhanced experience and counselling around ASCVD with ongoing management of the condition.
  • The additional capacity will provide additional time and support from PCN HCP with their lipid management, focusing on patients who may have previously not attended GP appointment or been lost to follow-up.
  • Reduced risk of ASCVD event leading to reduced risk of patient mortality and morbidity.

Anticipated benefits for partner organisation:

  • Increased proportion of ASCVD patients reviewed by primary care
  • Increased proportion of ASCVD patients receiving expert and timely review closer to home
  • Reduction in ASCVD referral rates to secondary care
  • Increased proportion of patients receiving guideline-directed pharmacotherapy
  • Insight into benefits of primary care pharmacist led lipid management clinics in primary care
  • Opportunity to show the impact of the CWP to create lasting change in lipid management within the PCN

Anticipated benefits for Novartis:

  • Insight on the appropriate use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicine 
  • Enhanced reputation, and supporting Novartis’ vision that no patient should have to wait for an extraordinary life by supporting high quality Collaborative Working with the NHS which addresses the problem of health inequalities 
  • Ethical, professional, and transparent relationship between Novartis and the NHS 

Start Date & Duration: August 2022 – 22 months

UK2208261741 

Project Name: Pharmacist-Led Lipid Management Model of Care at PCN Level

Partner Organisation(s): The Village Green Surgery, for and on behalf of the Wallsend Primary Care Network, NE28 6BB

Completion Date: 27/08/2024

Outcome Summary:

This project demonstrated potential to reduce cardiovascular risk across Wallsend PCN through lipid management optimisation and reduction in non-HDL-C (non-high density lipoprotein cholesterol), plus education for both staff and patients on the importance of effective lipid management and achieving target non-HDL-C in secondary prevention of cardiovascular disease. 

Key Project Outcomes Data:

A total of 1,412 patients were reviewed as part of this project – 42.8% of those achieved a target as specified in local guidelines non-HDL-C as a result.

A total of 943 interventions were made across the duration of the project- this included optimisation of treatment and lifestyle advice. 

The average non-HDL-C in the patients involved in the project was reduced from 3.5mmol/L to 2.7mmol/L (22% reduction).

Outcomes:

Overall, the project has demonstrated the effectiveness of optimizing lipid lowering therapy to achieve a target non-HDL-C. Reduction in cholesterol could  reduce the patient's risk of a coronary event in the future; this in turn has a direct impact on NHS resources, funding and workload.

The results of the project show that from 1,412 patients reviewed, 42.8% of these have successfully achieved a target as specified in local guidelines  of non-HDL-C . The average non-HDL-C from the patients involved in the project has been reduced from 3.5mmol/L to 2.7mmol/L – A total reduction of -0.8mmol/L.

This project has given the opportunity to educate both NHS Healthcare Professionals (HCPs) and patients on the importance of recognising an elevated lipid profile and working towards reducing non-HDL-C to a target level through lifestyle modification and lipid management optimisation.

One of the challenges we faced throughout the project was related to the interpretation of blood results on the EMIS system. Any lipid profile is automatically marked as 'Normal', irrespective of the non-HDL-C level. Therefore, it is the responsibility of the clinician to identify an elevated cholesterol, record it , and address the elevated risk with the patient. By conducting this project, we have been successful in highlighting this issue across three practices within Wallsend in order to increase staff awareness. Going forward, this should ensure more abnormal lipid profiles are addressed by the MDT and the patient treatment is optimised accordingly.

Patients being prescribed sub-optimal lipid-lowering therapies were identified and directly liaised with to modify their treatments. Going forward, we plan to discuss the outcomes of this project with each surgery to highlight the positive outcomes on patient health through the optimisation of lipid lowering therapies. 

Conclusion:

To conclude, the figures represent a reduction in cardiovascular risk achieved for the patients of Wallsend PCN. All three surgeries continue to work towards achieving target non-HDL-C for secondary prevention patients.

Going forward, we hope to see cholesterol management integrated into the nursing team’s work as part of the annual review process. This would enable lipids to be checked and promptly addressed if needed. In order to achieve this, we plan to present the outcomes of this project to each practice within the PCN and discuss options going forward as to how the nursing teams could be involved in pushing forward the progress we have made with managing cholesterol levels in secondary prevention patients.

We believe we have developed a model of care which is both transferable and sustainable. 

  • The use of CDRC searches to identify patients who require optimisation. These are more detailed and robust than the integrated searches that are already part of the clinical system. 
  • Skill mix. Using a pharmacy technician to identify, review and triage patients based on clinical measures is a cost-effective way of utilising clinical resources allowing the clinical pharmacist to deal with more complex cases and to prescribe lipid lowering therapy. 

 

FA-11380180 | March 2025