Heart Disease and Stroke Prevention: Tailored Pharmacy-based Interventions to Improve Medication Adherence

The CPSTF finding is based on evidence from a systematic review of 48 studies (search period through August 2018).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 48 studies that measured intervention effects on medication adherence.

Medication Adherence

The systematic review team converted outcomes from 27 studies into adherent or non-adherent, based on whether patients possessed, took, or refilled their cardiovascular disease prevention medications at least 80% of the time.

• The proportion of patients considered adherent increased by a median of 6.9 percentage points (an increase of 9.9%)

The remaining 21 studies used various tools to measure adherence (e.g., objective provider counts or records, self-report) and reported generally favorable results.

Cardiovascular Disease Risk Conditions

A subset of 17 studies evaluated intervention effects on blood pressure control and lipid control.

• There was a median increase of 13.9 percentage points in the proportion of patients who achieved blood pressure control (13 studies)
  • This represents a relative increase of 35.3% (12 studies)
• Results were mixed for LDL (3 studies) and cholesterol (1 study).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

A systematic review of economic evidence shows tailored pharmacy-based adherence interventions are cost-effective for cardiovascular disease prevention. For patients with existing cardiovascular disease, the evidence shows averted healthcare cost exceeds the cost of intervention for a favorable return on investment (ROI) from a healthcare system perspective.

The systematic review included 38 studies (search period through May 2019). The studies evaluated interventions to prevent (29 studies) or manage existing (9 studies) cardiovascular disease. Monetary values are reported in 2018 U.S. dollars.

Intervention Cost

• The median cost per patient per year for interventions to prevent cardiovascular disease was $246 (19 studies).
• The median cost per patient per year for interventions to manage cardiovascular disease was $292 (6 studies).

Healthcare Cost

• The median change in healthcare cost per patient per year for interventions to prevent cardiovascular disease was -$355 (25 studies).
• The median change in healthcare cost per patient per year for interventions to manage cardiovascular disease was -$1784 (8 studies).

Total Cost

Total cost is measured as the sum of the change in healthcare cost due to intervention and the cost of intervention. A negative value indicates averted healthcare cost exceeds intervention cost.

• The median total cost per patient per year for interventions to prevent cardiovascular disease was -$49 (21 studies). The total cost estimates for cardiovascular disease prevention were inconsistent, with about half of the studies reporting positive total cost and half reporting negative total cost.
• The median total cost per patient per year for interventions to manage cardiovascular disease was -$1080 (7 studies). In all but one of the studies, the reduced healthcare cost exceeded the cost of intervention indicating net cost savings when implemented for patients with existing cardiovascular disease.

Cost-effectiveness

• The median cost per quality adjusted life year (QALY) saved for interventions to prevent cardiovascular disease was $11,298, which is below a conservative $50,000 threshold (5 studies).
• No studies reported cost-effectiveness outcomes for interventions to manage cardiovascular disease.

Based on results from the review, the finding should be applicable to patients with cardiovascular disease risk factors who receive medications from community or health system pharmacies.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How does intervention effectiveness vary with different intervention components? Are interventions more effective when tailored options include system-level approaches, such as refill synchronization or blister packaging?
• Within a tailored approach, are some adherence barriers commonly addressed by specific intervention options? Does evidence indicate that some adherence barriers can be removed with a specific component, allowing for some standardization in tailored interventions?
• How effective are tailored interventions when targeted to specific patients at risk for adherence barriers, such as patients with low income or low health-literacy?
• How effective are tailored interventions when implemented in pharmacies that serve minority and low-income communities?
• How effective are tailored interventions that engage community health workers and pharmacy technicians in appropriate assessment, coaching, or follow-up roles?
• Are these interventions cost-effective for patients with existing cardiovascular disease?
• What are the economic outcomes when interventions are implemented in rural areas?
• What are the clinical outcomes associated with reductions in healthcare costs and increases in quality adjusted life years? Economic evaluations will be more helpful if they include patient health outcomes (e.g., blood pressure, cholesterol) in their reports.
• Which components of healthcare use lead to the greatest changes in healthcare cost following implementation?

• Included studies were conducted in the United States (23 studies), Europe (12 studies), Canada (5 studies), Hong Kong (4 studies), and Australia (4 studies).
• Studies were implemented in community pharmacies (27 studies), health system pharmacies (14 studies), or a combination of both (5 studies). Across all studies, the median age for patients was 61.6 years (43 studies), and 52.1% were female (46 studies).
• Of the 48 included studies, 26 were randomized controlled trials, seven were other design with concurrent comparison, one was before and after with comparison, six used a retrospective cohort, and eight were before and after without a comparison.

Effectiveness Review

• Analytic Framework – Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

• Logic Model
• Text Description

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit

Economic Review

Summary Evidence Table – Economic Review

Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, et al. A pharmacist telephone intervention to identify adherence barriers and improve adherence among nonadherent patients with comorbid hypertension and diabetes in a Medicare Advantage Plan. Journal of Managed Care & Specialty Pharmacy 2016;22(1):63-73.

Akinbosoye OE, Taitel MS, Grana J, Hill J, Wade RL. Improving medication adherence and health care outcomes in a commercial population through a community pharmacy. Population Health Management 2016;19(6):454-61.

Alsabbagh MW, Lemstra M, Eurich D, Wilson TW, Robertson P, et al. Pharmacist intervention in cardiac rehabilitation: a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention 2012;32(6):394-9.

Aslani P, Rose G, Chen TF, Whitehead PA, Krass I. A community pharmacist delivered adherence support service for dyslipidaemia. European Journal of Public Health 2010;21(5):567-72.

Bajorek B, Lemay KS, Magin P, Roberts C, Krass I, et al. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges. Pharmacy Practice (Granada) 2016;14(2).

Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, et al. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): a cluster-randomized, controlled trial testing a focused adherence strategy involving community pharmacies. Journal of Human Pharmacology and Drug Therapy 2016;36(10):1055-64.

Blenkinsopp A, Phelan M, Bourne J, Dakhil N. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. International Journal of Pharmacy Practice 2000;8(3):165-75.

Bouvy ML, Heerdink ER, Urquhart J, Grobbee DE, Hoe AW, et al. Effect of a pharmacist-led intervention on diuretic compliance in heart failure patients: a randomized controlled study. Journal of Cardiac Failure 2003;9(5):404-11.

Brummel A, Carlson AM. Comprehensive medication management and medication adherence for chronic conditions. Journal of Managed Care & Specialty Pharmacy 2016;22(1):56-62.

Calvert SB, Kramer JM, Anstrom KJ, Kaltenbach LA, Stafford JA, et al. Patient-focused intervention to improve long-term adherence to evidence-based medications: a randomized trial. American Heart Journal. 2012 Apr 1;163(4):657-65.

Carter BL, Bergus GR, Dawson JD, Farris KB, Doucette WR, et al. A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. Journal of Clinical Hypertension 2008;10(4):260-71.

Chabot I, Moisan J, Gr goire JP, Milot A. Pharmacist intervention program for control of hypertension. Annals of Pharmacotherapy 2003;37(9):1186-93.

Chan C, Siu SC, Wong CK, Lee VW. A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. Journal of Cardiovascular Pharmacology and Therapeutics 2012;17(1):57-64.

Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Lee M, et al. Effect of a remotely delivered tailored multicomponent approach to enhance medication taking for patients with hyperlipidemia, hypertension, and diabetes: the STIC2IT Cluster randomized clinical trial. JAMA 2018;178(9):1182-9.

Colvin NN, Mospan CM, Buxton JA, Gillette C. Using Indian Health Service (IHS) counseling techniques in an independent community pharmacy to improve adherence rates among patients with diabetes, hypertension, or hyperlipidemia. Journal of the American Pharmacists Association 2018;58(4):S59-63.

Eussen SR, Elst ME, Klungel OH, Rompelberg CJ, Garssen J, et al. A pharmaceutical care program to improve adherence to statin therapy: a randomized controlled trial. Annals of Pharmacotherapy 2010;44(12):1905-13.

Fikri-Benbrahim N, Faus MJ, Mart nez-Mart nez F, Sabater-Hern ndez D. Impact of a community pharmacists’ hypertension-care service on medication adherence. The AFenPA study. Research in Social and Administrative Pharmacy 2013 ;9(6):797-805.

Hedegaard U, Kjeldsen LJ, Potteg rd A, Bak S, Hallas J. Multifaceted intervention including motivational interviewing to support medication adherence after stroke/transient ischemic attack: a randomized trial. Cerebrovascular Diseases Extra 2014;4(3):221-34.

Hedegaard U, Kjeldsen LJ, Potteg rd A, Henriksen JE, Lambrechtsen J, et al. Improving medication adherence in patients with hypertension: a randomized trial. American Journal of Medicine 2015;128(12):1351-61.

Holdford DA, Inocencio TJ. Adherence and persistence associated with an appointment-based medication synchronization program. Journal of the American Pharmacists Association 2013;53(6):576-83.

Jalal ZS, Smith F, Taylor D, Finlay K, Patel H, et al. Impact of pharmacy care upon adherence to cardiovascular medicines: a feasibility pilot controlled trial. European Journal of Hospital Pharmacy 2016;23(5):250-6.

Kooij MJ, Heerdink ER, van Dijk L, van Geffen EC, Belitser SV, et al. Effects of telephone counseling intervention by pharmacists (TelCIP) on medication adherence; results of a cluster randomized trial. Frontiers in Pharmacology 2016;7:269.

Lee VW, Pang KK, Hui KC, Kwok JC, Leung SL, et al. Medication adherence: Is it a hidden drug-related problem in hidden elderly? Geriatrics & Gerontology International 2013;13(4):978-85.

Lee VW, Choi LM, Wong WJ, Chung HW, Ng CK, et al. Pharmacist intervention in the prevention of heart failure for high-risk elderly patients in the community. BMC Cardiovascular Disorders 2015;15(1):178.

L Lyons I, Barber N, Raynor DK, Wei L. The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence. BMJ Quality & Safety 2016;25(10):759-69.

Ma Y, Ockene IS, Rosal MC, Merriam PA, Ockene JK, et al. Randomized trial of a pharmacist-delivered intervention for improving lipid-lowering medication adherence among patients with coronary heart disease. Cholesterol 2010;2010.

McNamara KP, O’reilly SL, George J, Peterson GM, Jackson SL, et al. Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk. Health Education Research 2015;30(6):897-909.

Moore JM, Shartle D, Faudskar L, Matlin OS, Brennan TA. Impact of a patient-centered pharmacy program and intervention in a high-risk group. Journal of Managed Care Pharmacy 2013;19(3):228-36.

Morgado M, Rolo S, Castelo-Branco M. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. International Journal of Clinical Pharmacy 2011;33(1):132-40.

Murray MD, Young J, Hoke S, Tu W, Weiner M, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Annals of Internal Medicine 2007;146(10):714-25.

Nemerovski W, Young M, Mariani N, Bugdalski-Stutrud C, Moser LR. Project ImPACT: hypertension outcomes of a pharmacist-provided hypertension service. Innovations in Pharmacy 2013 4(3):126-34.

Ontario Pharmacists Association and Green Shield Canada. Impact of Community Pharmacist Interventions in Hypertension Management on Patient Outcomes: A Randomized Controlled Trial. Ontario Pharmacists Association and Green Shield Canada, 2014:1-31. Available from URL: https://www.opatoday.com/Media/Default/Reports/Hypertension%20Study%20-%20Final%20Report%20(January%208%202014).pdf [cited June 21, 2019].

Park H, Adeyemi A, Wang W, Roane TE. Impact of a telephonic outreach program on medication adherence in Medicare Advantage Prescription Drug (MAPD) plan beneficiaries. Journal of the American Pharmacists Association 2017;57(1):62-6.

Parker CP, Cunningham CL, Carter BL, Vander Weg MW, Richardson KK, et al. A mixed-method approach to evaluate a pharmacist intervention for veterans with hypertension. Journal of Clinical Hypertension 2014;16(2):133-40.

Pladevall M, Divine G, Wells KE, Resnicow K, Williams LK. A randomized controlled trial to provide adherence information and motivational interviewing to improve diabetes and lipid control. Diabetes Educator 2015;41(1):136-46.

Pringle JL, Boyer A, Conklin MH, McCullough JW, Aldridge A. The Pennsylvania Project: pharmacist intervention improved medication adherence and reduced health care costs. Health Affairs 2014;33(8):1444-52.

Robinson JD, Segal R, Lopez LM, Doty RE. Impact of a pharmaceutical care intervention on blood pressure control in a chain pharmacy practice. Annals of Pharmacotherapy 2010;44(1):88-96.

Solomon DK, Portner TS, Bass GE, Gourley DR, Gourley GA, et al. Part 2. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study. Journal of the American Pharmaceutical Association 1998;38(5):574-85.

Spence MM, Makarem AF, Reyes SL, Rosa LL, Nguyen C, et al. Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease. Journal of Managed Care Pharmacy 2014;20(10):1036-45.

Stanton-Robinson C, Al-Jumaili AA, Jackson A, Catney C, Veach S, et al. Evaluation of community pharmacist-provided telephone interventions to improve adherence to hypertension and diabetes medications. Journal of the American Pharmacists Association 2018;58(4S):S120-4.

Stewart K, George J, Mc Namara KP, Jackson SL, Peterson GM, et al. A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial). Journal of Clinical Pharmacy and Therapeutics 2014;39(5):527-34.

Stuurman-Bieze AGG, Hiddink EG, van Boven JFM, et al. Proactive pharmaceutical care interventions improve patients’ adherence to lipid-lowering medication. Annals of Pharmacotherapy 2013;47(11):1448-56.

Svarstad BL, Kotchen JM, Shireman TI, Brown RL, Crawford SY, et al. Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. Journal of the American Pharmacists Association 2013;53(5):520-9.

Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Preference and Adherence 2012;6:323.

Taylor CT, Byrd DC, Krueger K. Improving primary care in rural Alabama with a pharmacy initiative. American Journal of Health-System Pharmacy 2003;60(11):1123-9.

Twigg MJ, Wright D, Barton G, et al. The pharmacy care plan service: Service evaluation and estimate of cost-effectiveness. Research in Social and Administrative Pharmacy 2018; 15(1):1-9.

Villeneuve J, Genest J, Blais L, Vanier MC, Lamarre D, et al. A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study. Canadian Medical Association Journal 2010;182(5):447-55.

Wong MC, Liu KQ, Wang HH, Lee CL, Kwan MW, et al. Effectiveness of a pharmacist-led drug counseling on enhancing antihypertensive adherence and blood pressure control: a randomized controlled trial. Journal of Clinical Pharmacology 2013;53(7):753-61.

Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Cardiovascular Disease Prevention

Altavela JL, Jones MK, Ritter MJ. A prospective trial of a clinical pharmacy intervention in a primary care practice in a capitated payment system. J Manag Care Spec Pharm 2008;14(9):831-43.

Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy 2003;23(2):209-16.

Bosmans JE, van der Laan DM, Yang Y, Elders PJM, Boons C, et al. The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies. Front Pharmacol 2019;10:210.

Brophy L, Williams A, Berman EJ, Keleti D, Michael KE, et al. Collaborative DTM reduces hospitalization and healthcare costs in patients with diabetes treated with polypharmacy. Am J Manag Care 2014;20(3):e72-81.

Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc 2008;48(1):23-31.

Carter BL, Barnette DJ, Chrischilles E, Mazzotti GJ, Asali ZJ. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy 1997;17(6):1274-85.

Chan CW, Siu SC, Wong CK, Lee VW. A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. J Cardiovasc Pharmacol Ther 2012;17(1):57-64.

Chen JH, Ou HT, Lin TC, Lai EC, Kao YH. Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: a randomized controlled trial. Int J Clin Pharm 2016;38(1):88-95.

Christensen DB, Roth M, Trygstad T, Byrd JJ. Evaluation of a pilot medication therapy management project within the North Carolina State Health Plan. Journal of the American Pharmacists Association 2007;47(4):71-483.

Chung JS, Lee KK, Tomlinson B, Lee VW. Clinical and economic impact of clinical pharmacy service on hyperlipidemic management in Hong Kong. J Cardiovasc Pharmacol Ther 2011;16(1):43-52.

Connor SE, Snyder ME, Snyder ZJ, Pater Steinmetz K. Provision of clinical pharmacy services in two safety net provider settings. Pharm Pract (Granada) 2009;7(2):94-9.

C t I, Gr goire J-P, Moisan J, Chabot I, Lacroix GJP. A pharmacy-based health promotion programme in hypertension. PharmacoEconomics 2003;21(6):415-28.

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc 2003;43(2):173-84.

Dehmer SP, Maciosek MV, Trower NK, Asche SE, Bergdall AR, et al. Economic evaluation of the home blood pressure telemonitoring and pharmacist case management to control hypertension (Hyperlink) trial. J Am Coll Clin Pharm 2018;1(1):21 30.

Fabel PH, Wagner T, Ziegler B, Fleming PA, Davis RE. A sustainable business model for comprehensive medication management in a patient-centered medical home. J Am Pharm Assoc 2019;59(2):285-90.

Fishman PA, Cook AJ, Anderson ML, Ralston JD, Catz SL, et al. Improving BP control through electronic communications: an economic evaluation. Am. J. Manag. Care 2013;19(9):709.

Isetts BJ, Brummel AR, De Oliveira DR, Moen DW. Managing drug-related morbidity and mortality in the patient-centered medical home. Med Care 2012;50(11):997-1001.

Kraemer DF, Kradjan WA, Bianco TM, Low JA. A randomized study to assess the impact of pharmacist counseling of employer-based health plan beneficiaries with diabetes: the EMPOWER study. Journal of Pharmacy Practice 2012;25(2):169-79.

Kulchaitanaroaj P, Brooks JM, Chaiyakunapruk N, Goedken AM, Chrischilles EA, et al. Cost-utility analysis of physician pharmacist collaborative intervention for treating hypertension compared with usual care. Journal of Hypertension 2017;35(1):178-87.

Moore JM, Shartle D, Faudskar L, Matlin OS, Brennan TA. Impact of a patient-centered pharmacy program and intervention in a high-risk group. J Manag Care Pharm 2013;19(3):228-36.

Pringle JL, Boyer A, Conklin MH, McCullough JW, Aldridge A. The Pennsylvania Project: pharmacist intervention improved medication adherence and reduced health care costs. Health Aff (Millwood) 2014;33(8):1444-52.

Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm 2010;16(3):185-95.

Rashed SM, Goldstein S, Tolley E, Wilson-Relyea BJ. Cost outcomes of diabetes education in a specialized community pharmacy. Am J Pharm Benefits 2010;2(7):421-8.

Shireman TI, Svarstad BL. Cost-effectiveness of Wisconsin TEAM model for improving adherence and hypertension control in black patients. J Am Pharm Assoc 2016;56(4):389-96.

Spence MM, Makarem AF, Reyes SL, Rosa LL, Nguyen C, et al. Evaluation of an outpatient pharmacy clinical services program on adherence and clinical outcomes among patients with diabetes and/or coronary artery disease. J Manag Care Spec Pharm 2014;20(10):1036-45.

Twigg MJ, Wright D, Barton G, Kirkdale CL, Thornley T. The pharmacy care plan service: evaluation and estimate of cost-effectiveness. Res Social Adm Pharm 2019;15(1):84-92.

Vegter S, Oosterhof P, van Boven JF, Stuurman-Bieze AG, Hiddink EG, Postma MJ. Improving adherence to lipid-lowering therapy in a community pharmacy intervention program: a cost-effectiveness analysis. J Manag Care Spec Pharm 2014;20(7):722-3.

Wertz D, Hou L, DeVries A, Dupclay L, Jr., McGowan F, Malinowski B, et al. Clinical and economic outcomes of the Cincinnati Pharmacy Coaching Program for diabetes and hypertension. Manag Care 2012;21(3):44-54.

Yu J, Shah BM, Ip EJ, Chan J. A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. J Manag Care Pharm 2013;19(2):102-14.

Cardiovascular Disease Management

The Community Pharmacy Medicines Management Project Evaluation Team. The MEDMAN study: a randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease. Family Practice 2007;24(2):189-200.

Delate T, Olson KL, Rasmussen J, et al. Reduced health care expenditures after enrollment in a collaborative cardiac care service. Pharmacotherapy 2010;30(11):1127-35.

Ditusa L, Luzier AB, Brady PG, Reinhardt RM, Snyder BD. A pharmacy-based approach to cholesterol management. Am J Manag Care 2001;7(10):973-9.

Ellis SL, Carter BL, Malone DC, et al. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacotherapy 2000;20(12):1508-16.

Lopez Cabezas C, Falces Salvador C, Cubi Quadrada D, et al. Randomized clinical trial of a postdischarge pharmaceutical care program vs regular follow-up in patients with heart failure. Farmacia Hospitalaria 2006;30(6):328-42.

Murray MD, Young J, Hoke S, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 2007;146(10):714-25.

Polinski JM, Moore JM, Kyrychenko P, et al. An insurer’s care transition program emphasizes medication reconciliation, reduces readmissions and costs. Health Aff (Millwood) 2016;35(7):1222-9.

Scott A, Tinelli M, Bond C. Costs of a community pharmacist-led medicines management service for patients with coronary heart disease in England: healthcare system and patient perspectives. PharmacoEconomics 2007;25(5):397-411.

Tsuyuki RT, Fradette M, Johnson JA, et al. A multicenter disease management program for hospitalized patients with heart failure. J Card Fail 2004;10(6):473-80.

Vegter S, Oosterhof P, van Boven JF, Stuurman-Bieze AG, Hiddink EG, Postma MJ. Improving adherence to lipid-lowering therapy in a community pharmacy intervention program: a cost-effectiveness analysis. J Manag Care Spec Pharm 2014;20(7):722-3.

Implementation Resources

• CDC’s Division for Heart Disease and Stroke Prevention developed an implementation resource to help communities and health systems implement tailored pharmacy-based interventions to improve medication adherence for cardiovascular disease prevention.

Related Reviews and Recommendations

• The CPSTF identified two systematic reviews that examined the effectiveness of related approaches. Milosavljevic et al. (2018) reviewed pharmacist interventions for chronic disease management, and Van Driel et al. (2018) reviewed adherence interventions implemented in ambulatory settings regardless of the implementer.

A research librarian searched for published studies in the following databases: PubMed, Embase (OVID), PsycINFO (OVID), Medline, Scopus, Cochrane, ERIC, CINAHL, Sociological Abstracts (ProQuest). Additional studies were identified via suggestions from subject matter experts and hand-searches from reference lists.

Studies searched and screened for inclusion were published in English from the beginning of database through August 2018 and were limited to countries with high income economies as defined by the World Bank.

Search Strategy Effectiveness Review

Database: PubMed

#1
“Hypertension”[Mesh] OR “Blood Pressure”[Mesh] OR “Hypercholesterolemia”[Mesh] OR “Cholesterol”[Mesh] OR “Aspirin”[Mesh] OR “hypertension”[Title/Abstract] OR “blood pressure”[Title/Abstract] OR “cholesterol”[Title/Abstract] OR “hypercholesterol”[Title/Abstract] OR “hypercholesterolemia”[Title/Abstract] OR “acetylsalicylic acid”[Title/Abstract] or “ASA”[Title/Abstract] OR “aspirin”[Title/Abstract] OR “high blood pressure” OR “high cholesterol” OR “high level lipid” OR “high lipid level” or “high lipid levels” OR “high level lipids” OR hyperlipidemias[MeSH Terms] OR “blood fat” or “blood fats” OR “blood lipid” or “blood lipids” OR “lower blood pressure” “lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” OR “lowering cholesterol” OR “lower lipid” or “lower lipids” or “lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” OR “Antihypertensive Agents”[Mesh] OR “Anticholesteremic Agents”[Mesh] OR hypercholesterol*[Title/Abstract] OR hyperlipid*[Title/Abstract] OR “high cholesterol”[Title/Abstract] OR “hmg coa statins”[Title/Abstract] OR hyperlipidemia[MeSH Terms] OR hyperlipidemia OR lipids OR cholesterol OR “statin”[Title/Abstract] OR “hmg coa statins” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors”[Mesh] OR “cardiovascular disease risk factors” or “heart disease risk” or “cardiovascular risk factors” or “heart attack risk” or “stroke risk” OR “comprehensive cardiovascular disease risk reduction”[Title/Abstract]

#2
“United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States”[MeSH] OR “United Kingdom”[MeSH] OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#3
Pharmacist* or “pharmacy services” or “pharmaceutical care” or “pharmacy care”

#4
Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or compliant or persistent or discontinue* or discontinuing OR “Medication Adherence”[Mesh] OR “Patient Compliance”[Mesh]

#5
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or advocating or advocate* or increase* or increasing or improve* or improving or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR “Guideline Adherence”[Mesh] OR strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

#6
#1 AND #2 AND #3 AND #4 AND #5 English[lang]

#7
“cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] OR “coronary heart disease”[Title/Abstract] OR “coronary heart diseases”[Title/Abstract] or “ischemic”[Title/Abstract] OR “coronary artery disease”[Title/Abstract] OR “coronary artery diseases”[Title/Abstract] OR “heart disease”[Title/Abstract] OR “heart diseases”[Title/Abstract] or “heart attack”[Title/Abstract] OR “heart attacks”[Title/Abstract] OR “stroke”[Title/Abstract] OR “strokes”[Title/Abstract] OR “myocardial infarction”[Title/Abstract] OR myocardial infarctions[Title/Abstract] or “heart failure”[Title/Abstract] OR “cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] or “cerebrovascular disease”[Title/Abstract] OR “cerebrovascular diseases”[Title/Abstract] OR “cerebrovascular event”[Title/Abstract] OR “cerebrovascular events”[Title/Abstract] OR “angina”[Title/Abstract] OR “coronary disease”[MeSH Terms] OR “coronary artery disease”[MeSH Terms] OR “ischemia”[MeSH Terms] OR “ischemic preconditioning, myocardial”[MeSH Terms] OR “ischemic attack, transient”[MeSH Terms] OR “hypoxia ischemia, brain”[MeSH Terms] OR “myocardial ischemia”[MeSH Terms] OR “heart diseases”[MeSH Terms] OR “myocardial infarction”[MeSH Terms] OR “stroke”[MeSH Terms] OR “cerebrovascular disorders”[MeSH Terms] OR “basal ganglia cerebrovascular disease”[MeSH Terms] OR “angina pectoris”[MeSH Terms] OR cardiomyopathy OR “heart arrhythmia”or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

#8
#2 AND #3 AND #4 AND #5 AND #7 AND English[lang]

#9
#6 OR #8

Database: Embase (OVID)

1. (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2. (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3. (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4. (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5. (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6. or/1-5

7. (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8. 6 and 7

9. (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10. (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11. (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12. (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13. (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14. (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15. (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16. (decrease* or decreasing efficacy* or success*).mp.

17. (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18. (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19. (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20. (evaluat* or promotion* or preparation*).mp.

21. or/9-11

22. or/12-20

23. (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24. (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25. exp united states/

26. exp united kingdom/

27. or/23-26

28. (“cardiovascular disease” or “cardiovascular diseases”).mp.

29. exp cardiovascular disease/

30. coronary heart disease*.mp.

31. (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

32. (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

33. (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

34. (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

35. (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

36. (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

37. or/28-36

38. 8 and 21 and 22 and 27

39. 7 and 21 and 22 and 27 and 37

40. limit 38 to english language

41. limit 39 to english language

42. 40 or 41

Database: PsycINFO (OVID)

1. (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2. (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3. (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4. (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5. (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6. or/1-5

7. (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8. 6 and 7

9. (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10. (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11. (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12. (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13. (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14. (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15. (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16. (decrease* or decreasing efficacy* or success*).mp.

17. (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18. (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19. (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20. (evaluat* or promotion* or preparation*).mp.

21. or/9-11

22. or/12-20

23. (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24. (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25. exp united states/

26. exp united kingdom/

27. or/23-26

28. (“cardiovascular disease” or “cardiovascular diseases”).mp.

29. exp cardiovascular disease/

30. coronary heart disease*.mp.

31. (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

32. (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

33. (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

34. (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

35. (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

36. (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

37. or/28-36

38. 8 and 21 and 22 and 27

39. 7 and 21 and 22 and 27 and 37

40. limit 38 to english language

41. limit 39 to english language

42. 40 or 41

Database: Medline (OVID)

1. (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2. (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3. (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4. (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5. (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6. or/1-5

7. (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8. 6 and 7

9. (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10. (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11. (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12. (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13. (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14. (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15. (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16. (decrease* or decreasing efficacy* or success*).mp.

17. (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18. (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19. (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20. (evaluat* or promotion* or preparation*).mp.

21. or/9-11

22. or/12-20

23. (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24. (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25. exp united states/

26. exp united kingdom/

27. or/23-26

28. (“cardiovascular disease” or “cardiovascular diseases”).mp.

29. exp cardiovascular disease/

30. coronary heart disease*.mp.

31. (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

32. (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

33. (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

34. (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

35. (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

36. (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

37. or/28-36

38. 8 and 21 and 22 and 27

39. 7 and 21 and 22 and 27 and 37

40. limit 38 to english language

41. limit 39 to english language

42. 40 or 41

Database: Scopus

#1
TITLE-ABS-KEY ( “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR ” hypercholesterol*” OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” or “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”)

#2
TITLE-ABS-KEY (“pharmacist” OR “pharmacists” OR “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”)

#3
TITLE-ABS-KEY(adherence OR nonadherence OR compliance OR dropout OR persistence OR “medication reconciliation” OR “medication possession” OR “Medication Adherence” OR “Patient Compliance” OR compliant or adherent OR “treatment refusal” or persistent or dropout* or “drop out” or “dropped out” or discontinue* OR discontinuing)

#4
TITLE-ABS-KEY(“medication therapy management” OR reminder OR remind OR reminds OR reminded OR reminding OR improve* OR improving OR advocating OR advocate* OR persistent OR increase* OR increasing OR manage OR managed OR management OR collaborate* OR collaborative OR program OR programs OR programmed OR programming OR intervention* OR strategy OR strategies OR pilot OR reduction OR reduce* OR reducing OR control OR controls OR controlled OR controlling OR monitor OR monitors OR monitored OR monitoring OR decrease* OR decreasing OR efficacy* OR success* OR effect OR effects OR effective* OR counsel* OR support OR supportive OR supporting OR supported OR recommend* OR centered OR “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “patient education” or “provider education” OR evaluat* or promotion* or preparation*)

#5
TITLE-ABS-KEY ( Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”)

#6
#1 AND #2 AND #3 AND #4 AND #5 LIMIT-TO ( LANGUAGE , “English” )

#7
TITLE-ABS-KEY(“cardiovascular disease” or “coronary heart disease” or “ischemic” or “coronary artery disease” or “heart disease” or “heart attack” or “stroke” or “myocardial infarction” or “heart failure” or “cardiovascular disease” or “cerebrovascular disease” or “cerebrovascular event” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” OR cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis)

#8
#2 AND #3 AND #4 AND #5 AND #7 LIMIT-TO ( LANGUAGE , “English” )

#9
#6 OR #8

Database: Cochrane (Wiley)

#1
(pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”):ti,ab,kw

#2 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or discontinue* or discontinuing

#3
(medication therapy management or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation):ti,ab

#4
Hypertension OR Blood Pressure OR Cholesterol OR hypercholesterol* OR aspirin OR acetylsalicylic acid OR ASA OR high lipid levels OR high level lipids OR blood fat OR blood fats OR blood lipid OR blood lipids OR stroke risk OR lower lipid OR lower lipids OR lowered lipid OR lowered lipids OR lowering lipid OR lowering lipids OR Antihypertensive Agents OR Anticholesteremic Agents OR hyperlipid* OR statins OR statin OR Hydroxymethylglutaryl-CoA Reductase Inhibitors OR cardiovascular disease risk OR heart disease risk OR cardiovascular risk factors OR heart attack risk OR comprehensive cardiovascular disease risk reduction

#5
“United Kingdom” or “United States” or “Scotland” or “Wales” or “England” or “United States” or “United Kingdom” or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada or “Cayman Islands” or “Channel Islands” or Chile or Croatia or Curacao or Cyprus or “Czech Republic” or Denmark or Estonia or “Equatorial Guinea” or “Faeroe Islands” or Finland or France or “French Polynesia” or Germany or Greece or Greenland or Guam or “Hong Kong” or Iceland or Ireland or “Isle of Man” or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or “New Caledonia” or “New Zealand” or “Northern Mariana Islands” or Norway or Oman or Poland or Portugal or “Puerto Rico” or Qatar or “Russian Federation” or Russia or “San Marino” or “Saudi Arabia” or Singapore or “Sint Maarten” or “Saint Maarten” or “St Martin” or “Saint Martin” or “Slovak Republic” or Slovenia or Spain or “St Kitts” or Nevis or Sweden or Switzerland or Taiwan or “Trinidad” or “Tobago” or Turks or Caicos or Uruguay or “United Arab Emirates” or “U S Virgin Islands”

#6
(cardiovascular disease or cardiovascular diseases or coronary heart disease or coronary heart diseases or ischemic or coronary artery disease or coronary artery diseases or heart disease or heart diseases or heart attack or heart attacks or stroke or strokes or myocardial infarction or myocardial infarctions or heart failure or cerebrovascular disease or cerebrovascular diseases or cerebrovascular event or cerebrovascular events or angina or coronary disease or coronary artery disease or ischemia or ischemic myocardial preconditioning or ischemic attack or hypoxia ischemia or myocardial ischemia or heart diseases or myocardial infarction or stroke or cerebrovascular disorders or basal ganglia cerebrovascular disease or angina pectoris or cardiomyopathy OR heart arrhythmia or irregular heartbeat OR congenital heart disease OR valvular heart disease or valve heart disease OR peripheral artery disease OR thromboembolic disease OR congestive heart failure OR atherosclerosis):ti,ab

#7
#1 AND #2 AND #3 AND #4 AND #5

#8
#1 AND #2 AND #3 AND #5 AND #6

#9
#7 or #8

Limit to English

Database: ERIC (ProQuest)

1
pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

2
Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or persistent or discontinue* or discontinuing or “Medication Adherence” OR “Patient Compliance” or dropout* or “drop out” or “drop outs” or “dropped out”

3
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or “patient education” OR evaluat* or promotion* or preparation*

4
“Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”

5
“cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

6
Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

7
1 AND 2 AND 3 AND 4 AND 6

8
1 AND 2 AND 3 AND 5 AND 6

9
7 OR 8

Database: Sociological Abstracts (ProQuest)

1
pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

2
Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or persistent or discontinue* or discontinuing or dropout* or “drop out” or “drop outs” or “dropped out”

3
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or adherent or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing OR “Guideline Adherence” OR “Medication Adherence” OR “Patient Compliance” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

4
“Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”

5
“cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

6
Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

7
1 AND 2 AND 3 AND 4 AND 6

8
1 AND 2 AND 3 AND 5 AND 6

9
6 OR 7

Database: CINAHL (EbscoHost)

Search modes – Boolean/Phrase

Limiters – Language: English

S1
pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

S2
“Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk” OR “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

S3
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or adherent or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing OR “Guideline Adherence” OR “Medication Adherence” OR “Patient Compliance” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

S4
Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal or ” OR “Medication Adherence” OR “Patient Compliance” or adherent or discontinue* or discontinuing OR persistent or compliant

S5
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

S6
Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

S7
S1 AND S2 AND S4 AND S5 AND S6

S8
S1 AND S3 AND S4 AND S5 AND 6

S9
S7 OR S8

Economic Review

In June 2019, a research librarian used the terms listed below to search the following databases: PubMed, Embase, PsycINFO, Medline, Scopus, Cochrane, ERIC, CINAHL, Sociological Abstracts, and EconLit. The search period covered July 2018 through May 2019, bridging the search performed for the effectiveness review (through August 2018).

The search was limited to high income countries as defined by the World Bank. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies that may have been missed. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.

Database: PubMed

Date Searched : 6/4/2019
Results: 4

Search Strategy:

#1
“Hypertension”[Mesh] OR “Blood Pressure”[Mesh] OR “Hypercholesterolemia”[Mesh] OR “Cholesterol”[Mesh] OR “Aspirin”[Mesh] OR “hypertension”[Title/Abstract] OR “blood pressure”[Title/Abstract] OR “cholesterol”[Title/Abstract] OR “hypercholesterol”[Title/Abstract] OR “hypercholesterolemia”[Title/Abstract] OR “acetylsalicylic acid”[Title/Abstract] or “ASA”[Title/Abstract] OR “aspirin”[Title/Abstract] OR “high blood pressure” OR “high cholesterol” OR high level lipid OR high lipid levels OR hyperlipidemias[MeSH Terms] OR “blood fat” or “blood fats” OR “blood lipid” or “blood lipids” OR “lower blood pressure” “lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” OR “lowering cholesterol” OR “lower lipid” or “lower lipids” or “lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” OR “Antihypertensive Agents”[Mesh] OR “Anticholesteremic Agents”[Mesh] OR hypercholesterol*[Title/Abstract] OR hyperlipid*[Title/Abstract] OR “high cholesterol”[Title/Abstract] OR “hmg coa statins”[Title/Abstract] OR hyperlipidemia[MeSH Terms] OR hyperlipidemia OR lipids OR cholesterol OR “statin”[Title/Abstract] OR “hmg coa statins” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors”[Mesh] OR “cardiovascular disease risk factors” or “heart disease risk” or “cardiovascular risk factors” or “heart attack risk” or “stroke risk” OR “comprehensive cardiovascular disease risk reduction”[Title/Abstract]

#2
“United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States”[MeSH] OR “United Kingdom”[MeSH] OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#3
Pharmacist* or “pharmacy services” or “pharmaceutical care” or “pharmacy care”

#4
Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or compliant or persistent or discontinue* or discontinuing OR “Medication Adherence”[Mesh] OR “Patient Compliance”[Mesh]

#5
“medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or advocating or advocate* or increase* or increasing or improve* or improving or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR “Guideline Adherence”[Mesh] OR strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

#26 (cost[Text Word] OR cost effective[Text Word] OR cost benefit[Text Word]) OR “economics”[Subheading] OR “costs and cost analysis”[MeSH Terms] OR “cost-benefit analysis “[MeSH Terms]

#28 (#1 AND #2 AND #3 AND #4 AND #5 AND #26) English[lang]

#29 “cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] OR “coronary heart disease”[Title/Abstract] OR “coronary heart diseases”[Title/Abstract] or “ischemic”[Title/Abstract] OR “coronary artery disease”[Title/Abstract] OR “coronary artery diseases”[Title/Abstract] OR “heart disease”[Title/Abstract] OR “heart diseases”[Title/Abstract] or “heart attack”[Title/Abstract] OR “heart attacks”[Title/Abstract] OR “stroke”[Title/Abstract] OR “strokes”[Title/Abstract] OR “myocardial infarction”[Title/Abstract] OR myocardial infarctions[Title/Abstract] or “heart failure”[Title/Abstract] OR “cardiovascular disease”[Title/Abstract] OR “cardiovascular diseases”[Title/Abstract] or “cerebrovascular disease”[Title/Abstract] OR “cerebrovascular diseases”[Title/Abstract] OR “cerebrovascular event”[Title/Abstract] OR “cerebrovascular events”[Title/Abstract] OR “angina”[Title/Abstract] OR “coronary disease”[MeSH Terms] OR “coronary artery disease”[MeSH Terms] OR “ischemia”[MeSH Terms] OR “ischemic preconditioning, myocardial”[MeSH Terms] OR “ischemic attack, transient”[MeSH Terms] OR “hypoxia ischemia, brain”[MeSH Terms] OR “myocardial ischemia”[MeSH Terms] OR “heart diseases”[MeSH Terms] OR “myocardial infarction”[MeSH Terms] OR “stroke”[MeSH Terms] OR “cerebrovascular disorders”[MeSH Terms] OR “basal ganglia cerebrovascular disease”[MeSH Terms] OR “angina pectoris”[MeSH Terms] OR cardiomyopathy OR “heart arrhythmia”or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

#36 (#2 AND #3 AND #4 AND #5 AND #26 AND #29) English[ lang]

#28 OR #36

Publication date from 2018/07/01 to 2019/05/31

Database: Embase (OVID)

Date Searched : 6/4/2019
Results: 41

Search Strategy:

1 (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2 (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3 (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4 (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5 (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6 or/1-5

7 (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8 6 and 7

9 (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10 (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11 (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12 (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13 (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14 (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15 (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16 (decrease* or decreasing efficacy* or success*).mp.

17 (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18 (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19 (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20 (evaluat* or promotion* or preparation*).mp.

21 or/9-11

22 or/12-20

23 (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24 (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25 exp united states/

26 exp united kingdom/

27 or/23-26

28 (“cardiovascular disease” or “cardiovascular diseases”).mp.

29 exp cardiovascular disease/

30 coronary heart disease*.mp.

31 (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

32 (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

33 (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

34 (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

35 (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

36 (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

37 or/28-36

38 exp Economics/ or exp “Costs and Cost Analysis”/

39 (cost or costs or economic or economics or benefit).mp.

40 or/38-39

41 (201807* or 201808* or 201809* or 201810* or 201811* or 201812* or 2019*).dc.

42 8 and 21 and 22 and 27 and 40 and 41

43 7 and 21 and 22 and 27 and 37 and 40 and 41

44 limit 42 to english language

45 limit 43 to english language

46 44 or 45

Database: PsycINFO(OVID)

Date Searched : 5/28/2019
Results: 0

Search Strategy:

1 (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2 (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3 (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4 (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5 (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6 or/1-5

7 (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8 6 and 7

9 (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10 (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11 (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12 (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13 (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14 (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15 (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16 (decrease* or decreasing efficacy* or success*).mp.

17 (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18 (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19 (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20 (evaluat* or promotion* or preparation*).mp.

21 or/9-11

22 or/12-20

23 (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24 (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25 or/23-24

26 (“cardiovascular disease” or “cardiovascular diseases”).mp.

27 exp cardiovascular disorders/

28 coronary heart disease*.mp.

29 (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

30 (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

31 (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

32 (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

33 (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

34 (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

35 or/26-34

36 exp “costs and cost analysis”/

37 (cost or costs or cost benefit analys* or health care cost).mp.

38 36 or 37

39 (201807* or 201808* or 201809* or 201810* or 201811* or 201812* or 2019*).up.

40 8 and 21 and 22 and 25 and 38 and 39

41 7 and 21 and 22 and 35 and 38 and 39

42 40 or 41 0

Database: Medline (OVID)

Date Searched : 6/4/2019
Results: 9

Search Strategy:

1 (“Hypertension” or “Blood Pressure” or “Hypercholesterolemia”).mp.

2 (“Hypercholesterolemia” or “high blood pressure” or “high cholesterol” or “high level lipid” or “high lipid level” or “high lipid levels” or “high level lipids” or hyperlipidemias or “blood fat” or “blood fats” or “blood lipid” or “blood lipids” or “lower blood pressure lowered blood pressure” or “lower cholesterol” or “lowered cholesterol” or “lowering cholesterol” or “lower lipid” or “lower lipids”).mp.

3 (“lowered lipid” or “lowered lipids” or “lowering lipid” or “lowering lipids” or “Antihypertensive Agents” or “Anticholesteremic Agents” or hypercholesterol* or hyperlipid* or “high cholesterol” or “hmg coa statins” or hyperlipidemia or hyperlipidemia or lipids or cholesterol).mp.

4 (“statins” or “statin” or Hydroxymethylglutaryl-CoA Reductase Inhibitors).mp.

5 (cardiovascular disease risk or heart disease risk or cardiovascular risk or heart attack risk or stroke risk).mp.

6 or/1-5

7 (Pharmacist* or pharmacy services or pharmaceutical care or pharmacy care).mp.

8 6 and 7

9 (Adherence or nonadherence or compliance or dropout* or drop out* or dropped out).mp.

10 (persistence or medication reconciliation or discontinue* or discontinuing or medication possession).mp.

11 (Medication Adherence or compliant or treatment refusal or noncomplian* or non-complian* or Patient Compliance).mp.

12 (medication therapy management or patient education or reminder* or remind or reminds or reminded or reminding).mp.

13 (improve* or improving or adherent or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate*).mp.

14 (collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing).mp.

15 (control or controls or controlled or controlling or monitor or monitors or monitored or monitoring).mp.

16 (decrease* or decreasing efficacy* or success*).mp.

17 (support or supportive or supporting or supported or recommend* or centered or Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce*).mp.

18 (effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing).mp.

19 (Guideline Adherence or Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or provider education or patient education).mp.

20 (evaluat* or promotion* or preparation*).mp.

21 or/9-11

22 or/12-20

23 (French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or (Ireland or Isle of Man or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein) or (Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or New Caledonia) or (New Zealand or Northern Mariana Islands or Norway or Oman or Poland or Portugal) or (Puerto Rico or Qatar or Russian Federation or Russia or San Marino or Saudi Arabia)).tw. or (Singapore or Sint Maarten or Saint Maarten or St Martin or Saint Martin or Slovak).af. or (Slovenia or Spain or St Kitts or Nevis or Sweden or Switzerland or Taiwan).af. or (Trinidad or Tobago or Turks or Caicos or Uruguay or United Arab Emirates or U S Virgin Islands).af.

24 (United Kingdom or United States or Scotland or Wales or England or United States or (United Kingdom or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas) or (Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada) or (Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic) or (Denmark or Estonia or Equatorial Guinea or Faeroe Islands or Finland or France)).af.

25 23 or 24

26 (“cardiovascular disease” or “cardiovascular diseases”).mp.

27 exp cardiovascular disease/

28 coronary heart disease*.mp.

29 (“ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease”).mp.

30 (“heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or myocardial infarctions or “heart failure” or “cardiovascular disease” or “cardiovascular diseases”).mp.

31 (“cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “myocardial ischemic preconditioning”).mp.

32 (“transient ischemic attack” or “brain hypoxia ischemia” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease”).mp.

33 (angina pectoris or cardiomyopathy or heart arrhythmia or irregular heartbeat or congenital heart disease or valvular heart disease or valve heart disease or peripheral artery disease).mp.

34 (thromboembolic disease or congestive heart failure or atherosclerosis).mp.

35 or/26-34

36 exp “costs and cost analysis”/

37 (cost or costs or cost benefit analys* or health care cost).mp.

38 36 or 37

39 (201807* or 201808* or 201809* or 201810* or 201811* or 201812* or 2019*).dt.

40 8 and 21 and 22 and 25 and 38 and 39

41 7 and 21 and 22 and 35 and 38 and 39

42 limit 40 to english language

43 limit 41 to english language

44 42 or 43 10

Database: Scopus

Date Searched : 6/4/2019
Results: 13

Search Strategy:

#1 TITLE-ABS-KEY ( “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR ” hypercholesterol*” OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” or “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”)

#2 TITLE-ABS-KEY (“pharmacist” OR “pharmacists” OR “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”)

#3 TITLE-ABS-KEY(adherence OR nonadherence OR compliance OR dropout OR persistence OR “medication reconciliation” OR “medication possession” OR “Medication Adherence” OR “Patient Compliance” OR compliant or adherent OR “treatment refusal” or persistent or dropout* or “drop out” or “dropped out” or discontinue* OR discontinuing)

#4 TITLE-ABS-KEY(“medication therapy management” OR reminder OR remind OR reminds OR reminded OR reminding OR improve* OR improving OR advocating OR advocate* OR persistent OR increase* OR increasing OR manage OR managed OR management OR collaborate* OR collaborative OR program OR programs OR programmed OR programming OR intervention* OR strategy OR strategies OR pilot OR reduction OR reduce* OR reducing OR control OR controls OR controlled OR controlling OR monitor OR monitors OR monitored OR monitoring OR decrease* OR decreasing OR efficacy* OR success* OR effect OR effects OR effective* OR counsel* OR support OR supportive OR supporting OR supported OR recommend* OR centered OR “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “patient education” or “provider education” OR evaluat* or promotion* or preparation*)

#5 TITLE-ABS-KEY ( Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”)

#7 TITLE-ABS-KEY (cost or costs or economic or economics or benefit)

#9 #1AND #2 AND #3 AND #4 AND #6 AND #7 LIMIT-TO (LANGUAGE , “English” )

#10 PUBDATETXT ( “July 2018” OR “August 2018” OR “September 2018” OR “October 2018″ OR ” November 2018″ OR “December 2018” ) OR PUBYEAR = 2019

#11 #9 AND #10

#12 TITLE-ABS-KEY(“cardiovascular disease” or “coronary heart disease” or “ischemic” or “coronary artery disease” or “heart disease” or “heart attack” or “stroke” or “myocardial infarction” or “heart failure” or “cardiovascular disease” or “cerebrovascular disease” or “cerebrovascular event” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” OR cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis)

#17 #2 AND #3 AND #4 AND #6 AND #7 AND #12 LIMIT-TO ( LANGUAGE , “English” )

#18 #10 AND #17

#19 #11 OR #18

Database: Cochrane (Wiley)

Date Searched : 6/4/2019
Results: 1

Search Strategy:

#1 (pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”):ti,ab,kw

#2 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or discontinue* or discontinuing

#3 (medication therapy management or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or persistent or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation):ti,ab

#4 Hypertension OR Blood Pressure OR Cholesterol OR hypercholesterol* OR aspirin OR acetylsalicylic acid OR ASA OR high lipid levels OR high level lipids OR blood fat OR blood fats OR blood lipid OR blood lipids OR stroke risk OR lower lipid OR lower lipids OR lowered lipid OR lowered lipids OR lowering lipid OR lowering lipids OR Antihypertensive Agents OR Anticholesteremic Agents OR hyperlipid* OR statins OR statin OR Hydroxymethylglutaryl-CoA Reductase Inhibitors OR cardiovascular disease risk OR heart disease risk OR cardiovascular risk factors OR heart attack risk OR comprehensive cardiovascular disease risk reduction

#5 “United Kingdom” or “United States” or “Scotland” or “Wales” or “England” or “United States” or “United Kingdom” or Andorra or Antigua or Barbuda or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Belgium or Bermuda or Brunei or Darussalam or Canada or “Cayman Islands” or “Channel Islands” or Chile or Croatia or Curacao or Cyprus or “Czech Republic” or Denmark or Estonia or “Equatorial Guinea” or “Faeroe Islands” or Finland or France or “French Polynesia” or Germany or Greece or Greenland or Guam or “Hong Kong” or Iceland or Ireland or “Isle of Man” or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Malta or Monaco or Netherlands or “New Caledonia” or “New Zealand” or “Northern Mariana Islands” or Norway or Oman or Poland or Portugal or “Puerto Rico” or Qatar or “Russian Federation” or Russia or “San Marino” or “Saudi Arabia” or Singapore or “Sint Maarten” or “Saint Maarten” or “St Martin” or “Saint Martin” or “Slovak Republic” or Slovenia or Spain or “St Kitts” or Nevis or Sweden or Switzerland or Taiwan or “Trinidad” or “Tobago” or Turks or Caicos or Uruguay or “United Arab Emirates” or “U S Virgin Islands”

#6 (cardiovascular disease or cardiovascular diseases or coronary heart disease or coronary heart diseases or ischemic or coronary artery disease or coronary artery diseases or heart disease or heart diseases or heart attack or heart attacks or stroke or strokes or myocardial infarction or myocardial infarctions or heart failure or cerebrovascular disease or cerebrovascular diseases or cerebrovascular event or cerebrovascular events or angina or coronary disease or coronary artery disease or ischemia or ischemic myocardial preconditioning or ischemic attack or hypoxia ischemia or myocardial ischemia or heart diseases or myocardial infarction or stroke or cerebrovascular disorders or basal ganglia cerebrovascular disease or angina pectoris or cardiomyopathy OR heart arrhythmia or irregular heartbeat OR congenital heart disease OR valvular heart disease or valve heart disease OR peripheral artery disease OR thromboembolic disease OR congestive heart failure OR atherosclerosis):ti,ab

#7 cost or costs or economic or economics or benefit

#1 AND #2 AND #3 AND #4 AND #5 AND #7

#8 #1 AND #2 AND #3 AND #5 AND #6

#9 #7 or #8

Limit to English

Database: ERIC (ProQuest)

Date Searched : 5/28/2019
Results: 0

Search Strategy:

1 pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

2 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or adherent or persistent or discontinue* or discontinuing or “Medication Adherence” OR “Patient Compliance” or dropout* or “drop out” or “drop outs” or “dropped out”

3 “medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered OR “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or “patient education” OR evaluat* or promotion* or preparation*

4 “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”

5 “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

6 Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Saint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

7 cost OR costs OR costly OR economic* OR benefit

8 1 AND 2 AND 3 AND 4 AND 6 AND 7 and dates = 4

8 1 AND 2 AND 3 AND 5 AND 6 AND 7 and dates

9 7 OR 8

Database: CINAHL (EbscoHost)

Date Searched: 5/29/2019
Results: 3

Search Strategy:

Search modes – Boolean/Phrase
Limiters – Language: English

S1 pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

S2 “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk” OR “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic”

S3 “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

S4 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal or ” OR “Medication Adherence” OR “Patient Compliance” or adherent or discontinue* or discontinuing OR persistent or compliant

S5 “medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

S6 Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Saint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

S7 cost or costs or economic or economics or benefit

S8 S1 AND S2 AND S4 AND S5 AND S6 AND S7 AND
Limiters – Published Date: 20180701-20190531

S9 S1 AND S3 AND S4 AND S5 AND S6 AND S7
Limiters – Published Date: 20180701-20190531

S10 S8 OR S9

Database: Sociological Abstracts (ProQuest)

Date Searched : 5/29/2019
Results: 6

Search Strategy:

1 pharmacist or pharmacists or “pharmacy services” OR “pharmaceutical care” OR “pharmacy care”

2 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal” or persistent or discontinue* or discontinuing or dropout* or “drop out” or “drop outs” or “dropped out”

3 “medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or adherent or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or discontinue* or discontinuing OR “Guideline Adherence” OR “Medication Adherence” OR “Patient Compliance” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

4 “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk”

5 “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic” or “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

6 Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR “United Kingdom” OR Scotland OR Wales OR England OR “United States” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR “Saint Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR Trinidad OR Tobago OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”

7 cost or costs or costly OR economic* OR benefit

8 1 AND 2 AND 3 AND 4 AND 6 AND 7 AND pd(20180701-20190531)

9 1 AND 2 AND 3 AND 5 AND 6 AND 7 AND pd(20180701 2019-5031)

10 8 OR 9

Database: EconLit (EbscoHost)

Date Searched : 6/4/2019
Results: 18

Search Strategy:
Search modes – Boolean/Phrase
Limiters – Language: English
Requested no date limit

S16 S11 AND S14 AND S15

S15 pharmacy OR pharmacies OR pharmacist OR “pharmaceutical care”

S14 S12 OR S13

S13 “medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

S12 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal or ” OR “Medication Adherence” OR “Patient Compliance” or adherent or discontinue* or discontinuing OR persistent or compliant

S11 S9 OR S10

S10 “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk” OR “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic”

S9 “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

S8 S3 AND S6 AND S7

S7 pharmacy OR pharmacies OR pharmacist OR “pharmaceutical care

S6 S4 OR S5

S5 “medication therapy management” or “patient education” or reminder* or remind or reminds or reminded or reminding or improve* or improving or advocating or advocate* or increase* or increasing or manage or managed or management or collaborate* or collaborative or program or programs or programmed or programming or intervention* or strategy or strategies or pilot or reduction or reduce* or reducing or control or controls or controlled or controlling or monitor or monitors or monitored or monitoring or decrease* or decreasing or efficacy* or success* or effect or effects or effective* or counsel* or support or supportive or supporting or supported or recommend* or centered or “Guideline Adherence” OR Intervention* or strategy or approach or process or policy or policies or encourage* or enforce* or equity or “provider education” or evaluat* or promotion* or preparation*

S4 Adherence or nonadherence or compliance or dropout* or persistence or “medication reconciliation” or “medication possession” or compliant or “treatment refusal or ” OR “Medication Adherence” OR “Patient Compliance” or adherent or discontinue* or discontinuing OR persistent or compliant

S3 S1 OR S2

S2 “Hypertension” OR “Blood Pressure” OR “Cholesterol” OR hypercholesterol* OR “aspirin” OR “acetylsalicylic acid” or “ASA” OR “high lipid levels” OR “high level lipids” OR “blood fat” OR “blood fats” OR “blood lipid” OR “blood lipids” OR “stroke risk” OR “lower lipid” OR “lower lipids” OR “lowered lipid” OR “lowered lipids” OR “lowering lipid” OR “lowering lipids” OR “Antihypertensive Agents” OR “Anticholesteremic Agents” OR hyperlipid* OR “statins” OR “statin” OR “Hydroxymethylglutaryl-CoA Reductase Inhibitors” OR “cardiovascular disease risk” OR “heart disease risk” OR “cardiovascular risk factors” OR “heart attack risk” OR “cardiovascular disease” or “cardiovascular diseases” or “coronary heart disease” or “coronary heart diseases” or “ischemic”

S1 “coronary artery disease” or “coronary artery diseases” or “heart disease” or “heart diseases” or “heart attack” or “heart attacks” or “stroke” or “strokes” or “myocardial infarction” or “myocardial infarctions” or “heart failure” or “cerebrovascular disease” or “cerebrovascular diseases” or “cerebrovascular event” or “cerebrovascular events” or “angina” or “coronary disease” or “coronary artery disease” or “ischemia” or “ischemic preconditioning, myocardial” or “ischemic attack, transient” or “hypoxia ischemia, brain” or “myocardial ischemia” or “heart diseases” or “myocardial infarction” or “stroke” or “cerebrovascular disorders” or “basal ganglia cerebrovascular disease” or “angina pectoris” or cardiomyopathy OR “heart arrhythmia” or “irregular heartbeat” OR “congenital heart disease” OR “valvular heart disease” or “valve heart disease” OR “peripheral artery disease” OR “thromboembolic disease” OR “congestive heart failure” OR atherosclerosis

Milosavljevic A, Aspden T, Harrison J. Community pharmacist led interventions and their impact on patients’ medication adherence and other health outcomes: a systematic review. International Journal of Pharmacy Practice. 2018. vol 26(5): 387-397.

Van Driel ML, Morledge MD, Ulep R, et al. Interventions to improve adherence to lipid-lowering medication. Cochrane Database Syst Rev. 2016.

Patnode CP, Henderson JT, Thompson JH, Senger CA, Fortmann SP, et al. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Evidence Synthesis No. 134. AHRQ Publication No. 14-05200-EF-1. Rockville (MD): Agency for Healthcare Research and Quality; 2015. Available at URL: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions-september-2015

Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther. 2014. vol. 39(3): 240-247.

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Tailored interventions may be implemented as one component of the broader Pharmacists’ Patient Care Process (Joint Commission of Pharmacy Practitioners 2014). Steps in the process (i.e., collect, assess, plan, implement, follow-up, and monitor) closely align with the process for selecting tailored actions to remove or reduce patient adherence barriers.
  • CDC has a resource guide to help pharmacies implement this process: Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists [PDF – 632 kB]
• The Million Hearts Initiative provides action guides that detail organizational considerations and options to address medication adherence for cardiovascular disease prevention.
• The CPSTF recommends the following intervention approaches that complement this one.
  • Team-Based Care to Improve Blood Pressure Control
  • Text Messaging Interventions for Medication Adherence Among Patients with Chronic Diseases
  • Reducing Out-of-Pocket Costs for Cardiovascular Disease Preventive Services for Patients with High Blood Pressure and High Cholesterol
• This review did not evaluate adherence to medications for smoking cessation. Counseling and assisting tobacco-using patients to quit are important contributors to cardiovascular disease risk reduction (USPSTF). Pharmacists can play an important role in supporting patient efforts to obtain, initiate, and complete cessation treatments (Saba et al. 2014).
• While pharmacists or pharmacy residents may need to be involved in decisions about counseling content and additional adherence services for patients, implementers might consider how other staff, such as pharmacy technicians, can support the interventions. Roles for technicians could include tool-based assessment of patient barriers, instruction on use of patient adherence tools, and delivery of adherence reminders.
• Community health workers might also be able to play a role. The CPSTF recommends engaging community health workers for cardiovascular disease prevention. Implementation research could evaluate coordinated work between community health workers and community-based pharmacies in underserved communities.
• Finding a space to provide tailored interventions may be a challenge for some pharmacies. Several included studies provided space in the patient’s primary care setting, while a few others delivered interventions by telephone.
• In some settings, collaborative practice agreements (CPAs) may be used to formalize relationships between pharmacists and other healthcare providers. CPAs specify what functions (beyond a pharmacist’s typical scope of practice) can be delegated to pharmacists by the collaborating prescribers. The terms used and the functions provided under a CPA vary from state to state based on pharmacists’ and prescribers’ scope of practice and states’ collaborative practice laws. Pharmacists should consult their state board of pharmacy before implementing a program.
  • Most of the studies included in this review used a team-based care approach that provided patients with contact, communication, or feedback from a primary care provider (29 studies). CDC offers guidance on using CPAs for team-based care: Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide

Healthy People 2030

Healthy People 2030 includes the following objective related to this CPSTF recommendation.

• Improve cardiovascular health in adults — HDS-01
• Reduce coronary heart disease deaths — HDS-02
• Reduce stroke deaths — HDS-03
• Increase control of high blood pressure in adults — HDS-05
• Increase cholesterol treatment in adults — HDS-07