Million Hearts^TM: Pharmacist-Delivered Care to Improve Cardiovascular Health

More than two million people have a heart attack or stroke each year in the United States.^1,2 More than 2,200 Americans die of cardiovascular disease (CVD) each day, representing an average of one death every 39 seconds.¹ However, many of these deaths are preventable.

Risk factors for heart disease and stroke include high blood pressure, high cholesterol, diabetes, smoking, obesity, nutritional choices, and lack of physical activity.³ Aiming to prevent one million heart attacks and strokes during a five-year period through appropriate aspirin therapy, blood pressure control, cholesterol management, and smoking cessation (ABCS), the Million Hearts^TM campaign calls for a concerted effort in targeting cardiovascular health.⁴ Million Hearts has two primary goals: (1) to empower Americans to make healthy choices and (2) to improve care for people who need treatment.

In the September 2012 issue of Public Health Reports, the U.S. Surgeon General noted that such a comprehensive effort requires the commitment of many public health and medical professionals, among others, to improve Americans' cardiovascular health.⁵ This commitment can be the stimulus needed to fully leverage existing cost-effective health-care delivery models. Million Hearts encourages regional, state, and local partners to identify and engage multiple approaches to realize the greatest health impact.⁶ The encouraged partnerships and approaches include expanded collaboration among health-care providers, pharmacists, and physicians, as well as efforts to maximize the use of each professional to the fullest extent of education and licensure.

Because CVD prevention and care involve both the clinical and community realms,⁷ pharmacists are uniquely positioned to contribute to the Million Hearts campaign goals. Evidence-based data demonstrate that pharmacists in many practice settings deliver clinical services that improve access to care, quality of care, cost-effectiveness, and patient outcomes, including those outcomes directly related to the ABCS of Million Hearts.^8–13 As the most accessible health-care professionals in a community, pharmacists are trusted by patients and have the clinical training and the capacity to provide patient care throughout the continuum of chronic diseases, including prevention, chronic disease management, patient education, adherence counseling, and provider consultation. As essential members of the health-care team, pharmacists in multiple practice settings function as health-care providers to deliver patient care services, such as the ABCS for CVD.

Working in collaboration with other health-care providers, pharmacist-delivered patient care continues to evolve and transform as the pharmacist's scope of practice expands to meet the nation's health-care needs. This scope includes addressing the burden of CVD. As an example, federal pharmacists have managed chronic conditions collaboratively with other health-care providers for 50 years.⁸ Pharmacists in the Department of Veterans Affairs, Department of Defense, and U.S. Public Health Service (PHS) have been providing preventive services (e.g., smoking cessation) and direct patient care, such as the management of hypertension, diabetes, and dyslipidemia. In these settings, pharmacists conduct blood pressure screenings, monitor and interpret laboratory results, perform some physical assessment, and adjust patients' medications as appropriate. They discuss therapeutic lifestyle changes with patients, provide tobacco use screening and cessation services, consult with physicians on therapeutic plans, and provide follow-up care. Evidence-based data and physician input suggest this is a well-accepted paradigm of care that improves patient outcomes.⁸

Similarly, many nonfederal practice settings have also expanded pharmacists' roles to provide these types of services through collaboration with physicians and health-care teams. State Medicaid programs are listed as potential partners for Million Hearts, and more than 40 states have specific regulatory authorization allowing pharmacists to provide expanded patient care through collaborative practice agreements with physicians.⁸ This type of collaboration through regulatory authorization can be leveraged to advance the goals of the Million Hearts campaign. Americans deserve this type of optimized and effective care. As suggested, it will take a commitment to work together.

With approximately 275 million people visiting pharmacies each week,¹⁴ and a pharmacy typically located within two miles of every home, pharmacists in the community setting are an incredible asset with unparalleled potential to greatly improve the nation's health. Pharmacists can serve as key providers within communities to deliver services and serve as a point of entry to care for patients. The wide accessibility of pharmacists within communities means that patients have increased access to a cadre of highly trained health-care professionals who can help address prevention and chronic care through the use of medications.

As shown in the Figure, the pharmacy profession has joined the Million Hearts campaign nationwide and implemented numerous activities to engage students, communities, state legislatures, and patients, including:

Figure.

Pharmacy organizations with Million Hearts^TM-related activities^a

^aThis is a partial list of Million Hearts campaign-related activities. For additional information, go to: http://www.millionhearts.hhs.gov

^bAmerican Pharmacists Association. APhA-ASP Operation Heart [cited 2012 Aug 4]. Available from: URL: http://www.pharmacist.com/apha-aspoperation-heart

CVD = cardiovascular disease

• Pharmacy Blood Pressure Challenge: Launched by the American Pharmacists Association (APhA) Foundation, the challenge encourages pharmacists to perform blood pressure screenings and talk with at least one patient per day about blood pressure control. Pharmacists can report their impact online, and aggregated data will be shared to demonstrate pharmacists' overall positive health impact.¹⁵

• Operation Heart: Led by APhA's Academy of Student Pharmacists, Operation Heart reported that in only six months, about 5,700 students delivered services to approximately 42,000 patients and provided education outreach to approximately 1,850,000 patients.¹⁶

• The National Alliance of State Pharmacy Associations and the Alliance for Patient Medication Safety: These two organizations have also encouraged state pharmacy associations to develop community outreach activities and engage in policy development.

• Walgreens: The national retailer is engaging its more than 26,000 health-care providers to offer free blood pressure testing in consultation with a Walgreens pharmacist.

These wide-reaching national and community-based initiatives demonstrate the commitment and positive contribution to Million Hearts by pharmacists throughout the nation, regardless of practice setting.

In addition, serving as public health professionals across 15 agencies and five U.S. departments, Commissioned Corps pharmacists of the PHS are in a unique position to facilitate partnerships among stakeholders for a united effort against CVD through Million Hearts. Much of Commissioned Corps pharmacists' work and contributions are accomplished through the diverse network of practice settings and duty assignments including patient care, regulatory science, research, policy development, Medicare enhancements, and public health. Since the publication of “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General 2011,”⁸ various groups have moved forward to expand their scope of practice and officially recognize pharmacists as health-care providers. Academia, pharmacy organizations, and state and federal pharmacy continue to work together with physicians, other health-care and public health professionals, and health leadership to transform health-care delivery with the goal of improving patient care and the nation's public health. This type of change increases the potential for pharmacists to provide additional support to programs such as Million Hearts and to sustain services that can help to reduce the nation's CVD burden.

As a U.S. Assistant Surgeon General and the Chief Professional Officer for PHS Pharmacy, I have the privilege of working with many of the stakeholders to support the Million Hearts campaign. PHS Pharmacy encourages everyone to join in the Million Hearts campaign and improve the nation's cardiovascular health. Some of the actions you can take include:

• Expanding your practice to include pharmacist-physician collaboration to meet a specific cardiovascular health need;

• Educating patients and other providers on all the services that could potentially be offered to assist in improving cardiovascular health;

• Integrating ABCS into collaborative practice or team-based care; and

• Leading healthy lifestyles and being role models for health for our patients.

Taking any or all of these steps will put our nation on a path forward as we improve Americans' cardiovascular health and overall health.