Barbara Gobis, Director of the Pharmacists Clinic at the University of British Columbia, is leading research on the importance of pharmacist-led intervention on employee cardiovascular risk reduction in the workplace.
By Barbara Gobis, BSc(Pharm), RPh, ACPR, MScPhm, PCC
Great employees are a worthwhile investment. It should be no surprise that Canadian employers are working harder and spending more to recruit and retain skilled employees in an increasingly competitive labour market. As the population ages, how do employers keep those employees healthy and productive over the long term? How do employers maintain employees with corporate memory and experience within the organization? Chronic disease rates are rising and wearing away at the health of those valuable employees.
Pharmacists have a professional responsibility to promote health and prevent diseases in our communities and society, and cardiovascular disease (CVD) is a priority. CVD is the second leading cause of death in Canada. Most CVD has modifiable risk factors, such as high blood pressure, diabetes, dyslipidemia, sedentary lifestyle, poor eating habits, smoking and stress.
Employee education and prevention efforts in the workplace have been shown to reduce modifiable cardiovascular (CV) risk factors. Even as early as 2006, more than two-thirds of Canadian companies had an employer-initiated wellness program to reduce CV risk.
Unfortunately, none of the programs involved the most accessible professionals in health care — pharmacists. Pharmacist care is associated with statistically significant reductions in blood pressure, cholesterol and smoking for out-patients with CVD risk factors.
Recently published data from the CAMMPUS (Cardiovascular Assessment and Medication Management by Pharmacists at the UBC Site) study at the University of British Columbia Pharmacists Clinic quantifies the impact of pharmacist-led intervention on employee CV risk reduction in the workplace. In this study, more than 500 people received a standard CV risk assessment and more than 40 per cent were found to be at significant risk of a CV event within the next decade using criteria from the Framingham Risk Score (FRS).
Employees with elevated risk were invited to receive 12 months of pharmacist-led intervention and results were available for 178 participants (86 per cent completion rate). The results showed that, as a result of receiving the pharmacist intervention, participants achieved significant reductions in FRS, weight, blood pressure and work productivity losses. Participants also reported significant increase in medication adherence, quality of life, improved health and well-being. Another positive aspect was how participants demonstrated a strong desire to work with pharmacists on their wellness efforts, and after working with a pharmacist, felt they were empowered with the knowledge to better manage their own health.
These findings provide the proof and impetus for community pharmacists to work with local employers, including their own employers, to offer research-proven CV wellness programs for employees. All that is needed is for a champion within the pharmacy team to propose and lead the effort.
Here’s how it could work:
- Start by identifying a local employer and the people within the organization who care about employee well-being. This could be someone in human resources, occupational health, finance or disability management.
- Offer a heart health awareness service to identify people with unmanaged risk, and share results of the CAMMPUS research that demonstrates how pharmacist-led interventions can lead to improved health.
- Use the simplified FRS formula that includes BMI, weight and blood pressure only. More complex (and expensive) cholesterol measurements are not needed for preventive health and awareness services.
- Offer ongoing service to anyone with FRS >10. Ongoing service includes regular check-ins on body mass index, weight, blood pressure and cholesterol. Often, risk factors can be modified through medication intervention where the patient sets a health goal and sees the pharmacist regularly for check-in, support and intervention as needed. The service concludes when risk factors are reduced.
- Charge the employer for service. Fees charged in CAMPPUS ranged from $15 to $70 per service appointment. Offer additional services. This could range from in-service education in the workplace, smoking cessation and other services that all support heart health and reduced CV risk.
While pharmacists need to be involved in service delivery, registered technicians, pharmacy students and others can also be involved in set-up and some aspects of implementing a CV risk reduction program.
The time is right, the evidence exists, and workplace wellness initiatives are an excellent way to improve the health of people in the community, in addition to leveraging the skills and expertise of the community pharmacy team.
Barbara Gobis is Director of the Pharmacists Clinic at the University of British Columbia, Canada’s first university-affiliated, pharmacist-led patient care clinic.
Navigating Change: 2018 Business Council Skills Survey. Business Council of Canada. Morneau Shepell. April 4, 2018. https://thebusinesscouncil.ca/wp-content/uploads/2018/04/Navigating-Change-2018-Skills-Survey-1.pdf
Chronic disease in the workplace: Focus on prevention and support. SunLife Financial. https://www.sunlife.ca/static/canada/Sponsor/About%20Group%20Benefits/Group%
Health Professions ActL Pharmacists Regulation. Amended July 26, 2016. http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/417_2008#section3
The 10 leading causes of death, 2012 [Internet]. Statistics Canada. 2015. http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14296-eng.htm#moreinfo
Carnethon M, Whitsel LP, Franklin BA, Kris-Etherton P, et al. Workplace wellness programs for cardiovascular disease prevention. A policy statement from the American Heart Association. Circulation, 120(17), 1725-1741. DOI: 10.1161/CIRCULATIONAHA.109.192653.
Macdonald S, Csiernik R, Durand P, Rylett M, Wild C. Prevalence and factors related to Canadian workplace health programs. Can J Public Health. 2006;2:121-125. https://www.jstor.org/stable/41994698
Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011 Sep 12;171(16):1441-53. doi: 10.1001/archinternmed.2011.399.
Gobis B, Kapanen AI, Reardon J, et al. Cardiovascular Risk Reduction in the Workplace With CAMMPUS (Cardiovascular Assessment and Medication Management by Pharmacists at the UBC Site). Ann Pharmacother 2019; https://journals.sagepub.com/doi/full/10.1177/1060028018823330