Summary

Working with Leeds Teaching Hospitals NHS Trust, Boehringer Ingelheim UKIE established a new innovative cardiometabolic clinic. It helped empower patients to better manage their condition, freeing up consultant time to manage more complex patients. 

Project outline and outcome

Working with Leeds Teaching Hospitals NHS Trust, Boehringer Ingelheim UKIE established a new innovative cardiometabolic clinic. Around 1/4 of patients who suffer a heart attack have type 2 diabetes (T2D). The presence of diabetes increases the risk of death by >2.5 times when compared to heart attack patients without the disease. The pharmacist-delivered clinics scheduled for 6-8 weeks post heart attack, are a patient-centred approach to reducing risk.

The aim of the clinic is to:

• Optimise and reduce the cardiovascular risk factors among patients with T2D and cardiovascular disease.
• Provide better support for patients, including education and self-management.
• Enable patients discharged from clinic to have better diabetes control through improved medication adherence and medication optimisation by providing strategies to address a number of factors that may impact an individuals’ adherence to their medications.
• Enable timely interventions to reduce the need for further treatment escalation and reduced hospital stays.
• Offer patients with T2D post-MI, the use of guideline directed cardio-protective diabetes agents.
• Identify the training needs to develop advanced pharmacists who can run such clinics as part of a multi-disciplinary team.

Since its founding, the ‘one-stop clinic’ has helped reduce the waiting list burden for diabetes review. While some patients still need a review by a diabetes specialist, many receive optimisation of their cardio-renal-metabolic (CaReMe) medicines and risk factors without needing a referral to the diabetes service. Additionally, a reduction in patient visits required in both primary and secondary care. The combination of face to face and a virtual clinic approach is convenient for patients and reduces the pressure on the outpatient services.

Interim results demonstrate the importance of a CaReMe approach in cardiovascular risk reduction with patients achieving improvements in their HbA1c, lipid profile and BP control as well as a fall in BMI.

Better for patients:

• Thanks to the success of this clinic, patients were empowered with the tools needed to adopt healthier lifestyles, e.g., 38 per cent of patients who attended clinic were provided with a home blood pressure monitor to better optimise BP, and 65 per cent of smokers were provided smoking cessation advice including the prescribing of smoking cessation therapy.
• With 100 per cent of patients surveyed expressing that their concerns relating to heart/diabetes health were addressed.

Better for the NHS:

• Improved workforce utilisation – upskilling pharmacists allowing consultant physicians to manage more complex patients.
• HCP skills (pharmacist) matched to patient needs – a high patient need exists to uncover barriers to adherence, provide health education and medicine optimisation.
• Improved compliance with guidelines – prescribing of guideline recommended pharmacological therapies in line with NICE and local guidelines.
• Optimising therapy for the multimorbid patient – including recommended therapies for post MI secondary prevention, diabetes, and renal disease where identified.