A Randomized Controlled Trial to Assess Pharmacist-Physician Collaborative Practice in the Management of Metabolic Syndrome in a University Medical Clinic in Jordan

BACKGROUND: The prevalence of metabolic syndrome is increasing worldwide,and patients with metabolic syndrome have increased risk of developing cardiovascular disease and type 2 diabetes. Although specific criteriavary, the National Cholesterol Education Program Adult Treatment Panel III(NCEP/ATP III) criteria (2002) defined metabolic syndrome as the presence of 3 or more of the following 5 components: waist circumference more than 102 centimeters (cm) for men or more than 88 cm for women; triglycerides 150 milligrams per deciliter (mg per dL) or more; high-density lipoprotein cholesterol (HDL-C) less than 40 mg per dL for men or less than 50 mg perdL for women; blood pressure (BP) 130/85 millimeters mercury (mm Hg) ormore; and fasting blood glucose 110 mg per dL or more. OBJECTIVES: To evaluate the effect of a pharmacist-physician collaborative practice compared with usual care in the management of patients withmetabolic syndrome as defined by the NCEP/ATP III criteria. METHODS: A prospective, randomized controlled trial conducted in family medicine outpatient clinics in Jordan enrolled 199 patients who met theNCEP/ATP III criteria for metabolic syndrome during an enrollment period from March 15, 2009, through May 10, 2009. Patients were randomized into 2 groups, with 110 in the intervention group (pharmacist-physician collaborative practice) and 89 in usual care (physician only). The patients in the intervention group were provided with pharmacist recommendations and pharmaceutical care counseling. Outcome measures included metabolic syndrome status (binomial) and changes in mean values for each metabolic syndrome component (waist circumference, triglycerides, HDL-C, fasting blood glucose, and systolic and diastolic BP) and for body weight. A contingency table with a Pearson chi-square test was used to assess by group differences in metabolic syndrome status after 6 months of followup.In difference-in-difference analyses, t-tests (Mann-Whitney U tests when appropriate) were used to assess by-group differences in changes in the individual metabolic syndrome components and body weight. RESULTS: From baseline to follow-up, 39.1% (n = 43) of intervention group patients versus 24.7% (n = 22) of usual care patients were successfully shifted from a status of metabolic syndrome to no metabolic syndrome(P = 0.032). Three of 7 outcome measures were improved more in the intervention group compared with the usual care group. Mean (SD) triglyceride(mg per dL) declined by 30.9 (54.4) from 189.3 (79.6) to 158.4 (77.3) inthe intervention group and by 14.5 (50.7) from 202.5 (88.0) to 188.5 (89.0)in the usual care group (P = 0.029). For the intervention and usual caregroups, mean baseline systolic BPs were 134.7 (16.2) mm Hg and 134.6(12.2) mm Hg, respectively, declining after 6 months follow-up by 12.1(20.1) mm Hg in the intervention group versus 6.9 (14.6) mm Hg in the usual care group (P = 0.018). Mean baseline diastolic BPs were 83.6 (10.7)mm Hg and 83.6 (7.9) mm Hg, respectively, declining by 7.2 (12.6) mm Hgin the intervention group versus 4.9 (8.1) mm Hg in the usual care group(P = 0.049). CONCLUSIONS: Compared with usual care provided by physicians only, pharmacist involvement in the clinical management of patients with metabolic syndrome increased the proportion of patients who no longer met criteria for the syndrome after 6 months follow-up and improved control of BP and triglycerides.