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Heart Failure Assessment at the Community Pharmacy Level - A Feasibility Pilot Study

      Introduction

      A key element missing in disease management programs for heart failure (HF) is participation of the non-hospital community pharmacy (i.e., retail pharmacy). The purpose of this study is to determine if a simple and efficient clinical tool will allow community pharmacists to identify patients at risk for worsening heart failure.

      Methods

      The One Minute Clinic for Heart Failure (TOM-C HF) was developed as a simple 6-item symptom screening tool to be used by pharmacists during routine patient/customer interactions. Training was accomplished in part through web based tutorials including viewing mock pharmacist/patient interactions. Patients were identified and entered into the study either through self-declaration of their HF condition or by verbal confirmation when asked by the pharmacist.

      Results

      A total of 65 unique patients were evaluated in 4 pharmacies in the upper Midwest over a 4 month period. The application of this clinical tool took between 1-5 minutes in over 80% of the interactions. Forty three patients (66%) had one or more signs or symptoms of worsening HF (mean 1.5 ± 1.5) since their last reported visit with their physician or last refill.
      Pharmacist directly contacted the physician office in 16% of the cases; patients were advised to seek early follow up in the remaining cases.

      Conclusion

      In this pilot study, the TOM-C HF tool was used to identify patients in the community pharmacy setting that appear to be developing worsening HF in a time efficient manner. Inclusion of the community pharmacists as an early screen for HF decompensation may be an important link in disease management programs to help reduce hospital readmission rates. Future studies will need to address whether use of the TOM-CHF tool can favorably impact clinical outcomes.
      Tabled 1
      Sign and Symptoms [N (%)]
      Edema25 (39%)
      Shortness of Breath22 (34%)
      Dizziness18 (28%)
      > 5 lb weight gain16 (24%)