Optimising Cardiometabolic Pharmacotherapy in Primary Care Through Pharmacist Integration in Collaborative Prescribing

OBJECTIVES

This study evaluated the impact of pharmacists within a collaborative prescribing model in a General Practitioner (GP) clinic to address gaps in cardiometabolic risk factor control. Pharmacist-Supported Care (PSC) was assessed for non-inferiority to Standard-Care (SC) in achieving cardiometabolic therapeutic targets (glycaemic, lipid, and blood pressure control) through pharmacotherapy optimisation. 

MATERIALS & METHODS

This retrospective cohort study was conducted in a private GP clinic from 1 October 2023 to 31 January 2026. Adults with ≥1 cardiometabolic condition (diabetes, hypertension, or dyslipidaemia) and ≥12 months follow-up were included. Patients were stratified into PSC (≥2 pharmacist visits) or SC (<2 pharmacist visits). The primary outcome was attainment of ≥1 new cardiometabolic therapeutic target at 1 year, based on guideline thresholds, with a predefined non-inferiority margin of 10%. Secondary outcomes included medication optimisation activities, vaccinations administered, blood tests, and care escalation.

RESULTS

A total of 151 patients were analysed. Therapeutic target attainment was higher in PSC than SC (41.7% vs 36.7%), with an absolute risk difference of +4.96% (95% CI: -10.6% to +20.5%). PSC showed higher attainment for hyperlipidaemia and diabetes, while hypertension control was similar.[JN1.1] Baseline characteristics were comparable except for ethnicity. The pharmacist performed 116 medication optimisation interventions, including laboratory monitoring, dose adjustments, and medication initiation. The pharmacist also administered 34.7% of vaccinations[XW2.1] and 27.3% of blood tests. Post-hoc power was 9.2%.

CONCLUSION

Pharmacist integration into GP clinics supports cardiometabolic pharmacotherapy optimisation, but the study was underpowered to confirm non-inferiority to standard care and could not exclude clinically meaningful differences.