Home' Australian Pharmacist : Australian Pharmacist July 2013 Contents Australian Pharmacist July 2013 I ©Pharmaceutical Society of Australia Ltd. 75
Pharmacists favoured their profession
having of a greater role in the detection
and management of FH. Pharmacists'
knowledge of cholesterol lowering
therapies was excellent, with 97% of
pharmacists selecting a statin as the first
line agent for managing FH (Table 1).
Pharmacists' knowledge of the appropriate
combination regimen to manage severe
hypercholesterolaemia was good with
59% selecting a statin plus ezetimibe
and an additional 15% selecting statin,
ezetimibe plus nicotinic acid as a preferred
combination regimen to achieve treatment
targets for plasma LDL-C. These treatment
selections are consistent with the Australian
Atherosclerosis Society FH Network 'Model
of Care' guidelines that recommend
statins for first line management of FH
with the addition of ezetimibe, with or
without nicotinic acid, to achieve target
LDL-C concentrations. Plasma LDL-C
targets for low, intermediate and high risk
FH are: <4.0 mmol/L, <3.0 mmol/L, and
<2.0 mmol/L respectively.3 In addition
to pharmacological management, it is
essential that health care professionals
encourage smoking cessation, adequate
aerobic physical activity, a diet low
in cholesterol and saturated fats and
management of non-lipid risk factors such
as diabetes and hypertension in the overall
management of FH.6
Pharmacists exhibited knowledge deficits
of FH in these areas; pathophysiology,
epidemiology, risk of inheritance, lipid
profile interpretation and awareness of
DLCN diagnostic requirements (e.g. genetic
testing and age criteria for premature
CHD). This may explain why almost half
of pharmacists reported that they would
not feel confident to recommend genetic
screening in at-risk individuals, provide
community awareness and education on
FH or to provide pharmacological and
lifestyle advice to affected individuals.
Increased knowledge of FH epidemiology,
pathology and the DLCN criteria may
facilitate improved case detection rates in
the community through opportunistically
testing selected patients presenting for a
Pharmacists may then refer the patient
to their GP for further assessment, which
may involve genetic testing. FH requires
aggressive lifelong management,
therefore, education is required to optimise
pharmacists' confidence in providing FH
patient education, medication counselling
and lifestyle advice, and for promoting
cascade screening.2,9 Avenues for educating
pharmacists about FH may include regular
education sessions for pharmacists that
attract continuing professional development
(CPD) points, as well as incorporating a
greater focus of FH into the university
Only a minority of pharmacists reported
that they would feel confident providing
point-of-care lipid monitoring. This is
reflected by very few pharmacists offering
full lipid panel analysis in their practice.
This is of concern, as point-of-care lipid
testing in the pharmacy setting has been
associated with significant clinical benefit
and positive patient outcomes in patients
with hypercholesterolaemia.9 The above
knowledge deficiencies may also explain
why the majority of pharmacists believed
general practitioners would be the most
effective professionals to detect and
A great opportunity exists for training
pharmacists in point-of-care testing and
in interpreting lipid profiles. Pharmacies
are highly accessible, thus by combining
increased awareness and knowledge of FH
with increased availability of point-of-care
full lipid profiles and guidelines on when to
refer a patient to their GP, it may be possible
to increase opportunistic FH detection rates.
The Australian Atherosclerosis FH Network
'Model of Care' guidelines describe
that cascade screening for FH using
pharmacy-based point-of-care LDL-C
testing followed by clinical (and possibly
genetic) confirmation by a specialist service
can be highly cost-effective.3 Early case
detection followed by appropriate medical
management including drug therapy has
also been associated with increased life
expectancy in individuals with FH.5 However,
deficiencies in financial support for point-of-
care testing (equipment purchase, education
and training, as well as poor remuneration
for performing a test) represent a significant
barrier to pharmacists participating in FH
detection and management.14 Funding to
support FH education and point-of-care
testing is thus required to offset the high
financial and personal costs associated with
premature CHD.3 Sources of funding to
further involve pharmacists in the care of FH
need to be explored.
A limitation of this study was the use of
a convenience sample of pharmacists
attending a continuing education event
and therefore the findings may not be
representative of the general Australian
pharmacists' opinion. Although the majority
of respondents were females working in
the metropolitan area, this is in keeping
with broader demographic of pharmacists
We did not collect age or time in practice
information as demographics and this may
also restrict generalisability of results.
The majority of pharmacists were in favour
of a greater role in the detection and care
of individuals with FH. Efforts to augment
pharmacists' knowledge and awareness
of FH are required. However, it is unlikely
that increased knowledge and awareness
of FH alone will lead to increased FH
detection by pharmacists. An adequate
remuneration model may be required to
encourage pharmacists to conduct point-
of-care lipid testing and patient education.
1. Bender R, Bell DA, Hooper AJ, Edwards G, van Bockxmeer FM,
Watts GF, et al. Screening for familial hypercholesterolaemia.
2. Goldberg AC, Hopkins PN, Toth PP, Ballantyne CM, Rader DJ,
Robinson JG, et al. Familial Hypercholesterolemia: Screening,
diagnosis and management of pediatric and adult patients:
Clinical guidance from the National Lipid Association Expert
Panel on Familial Hypercholesterolemia. J Clin Lipidol. 2011;5(3,
3. Watts GF, Sullivan DR, Poplawski N, van Bockxmeer F, Hamilton-
Craig I, Clifton PM, et al. Familial hypercholesterolaemia: A model
of care for Australasia. Atheroscler Suppl. 2011;12(2):221--63.
4. Burnett JR, Hooper AJ. Common and rare gene variants affecting
plasma LDL cholesterol. Clin Biochem Rev. 2008;29(1):11--26.
5. Marks D, Wonderling D, Thorogood M, Lambert H, Humphries
SE, Neil HAW. Cost effectiveness analysis of different approaches
of screening for familial hypercholesterolaemia. BMJ [Internet].
6. The Cardiac Society of Australia and New Zealand (CSANZ).
Guidelines for the diagnosis and management of Familial
Hypercholesterolaemia 2010: At: www.csanz.edu.au/LinkClick.as
7. Sullivan DR, Hamilton-Craig I, van Bockxmeer F, Watts GF.
INTERIM Guidelines for the Diagnosis and Management of
Familial Hypercholesterolaemia. Heart Lung Circ. 2012;21(3):159--
8. Leren TP. Cascade genetic screening for familial
hypercholesterolemia. Clin Genetics [Internet]. 2004;66(6):483--7.
9. Krass I, Walker AT, Watts GF. Detection and care of familial
hypercholesterolaemia in the community: is there a role for the
pharmacist? Int J Clin Pharm [Internet]. 2012;34(4):501--5.
10. Anderson C. Health promotion in community pharmacy: the UK
situation. Patient Educ Couns. 2000;39(2--3):285--91.
11. Benrimoj SI, Frommer MS. Community pharmacy in Australia.
Aust Health Rev. 2004;28(2):238--46.
12. McGlynn S, Reid F, McAnaw J, Chinwong S. Pharmaceutical care:
coronary heart disease. Pharm J. 2000;265:194-205.
13. Simoens S, Foulon E, Dethier M, Mathieu C, Laekeman G.
Promoting targeted screening for Type 2 diabetes mellitus:
the contribution of community pharmacists. Diabet Med.
14. Joyce A, Sunderland V, Burrows S, McManus A, Howat P, Maycock
B. Community pharmacy's role in promoting healthy behaviours.
J Pharm Pract Res [Internet]. 2007;37(1):42--4.
15. Chen T. Pharmacy Workforce Planning Study: Literature
review. Sydney; 2008. At: www.humancapitalalliance.com.au/
Links Archive Australian Pharmacist June 2013 Australian Pharmacist August 2013 Navigation Previous Page Next Page