Pharmacist-led cholesterol lowering
I always advise pharmacists who I train to start of by setting up a cholesterol clinic. When I joined my first GP practice, I found this an easy clinic to set up and to run. There are lots of guidelines available and it is quite a straightforward clinic to run and to set up. As the amount of clinical knowledge required is less than with diabetes, asthma, COPD and contraceptive clinics, it is an ideal clinic to start off with as it helps ease you in to a new patient facing role.
Cholesterol is measured by having a blood test at the surgery. A high level of cholesterol is called hypercholesterolaemia. High cholesterol levels can lead to an increased risk of cardiovascular disease. A high cholesterol reading and thus the risk of cardiovascular disease can be reduced through general measures such as exercise and diet. If this does not work, then treatment with medication can be considered. Certain medications called statins lower the amount of cholesterol in the blood. They can prevent related medical conditions and increase life expectancy. Whether or not it's worth taking them will depend on what other risk factors a patent has.
The lipid clinic I set up was one where I my patients came in for face to face appointments – this meant that I was seeing patients face to face within 3 weeks of starting my new role! I believe any other clinic would have worried me in the beginning as there are so many red flags to look out for and so many exceptions within the guidelines. Three years later, I still run the clinic but most of my patients are now contacted and reviewed by telephone.
This is how I went about setting up the clinic:
I spent a few days looking for current, up to date guidelines for the management of high cholesterol.
http://mm.wirral.nhs.uk/document_uploads/guidelines/Lipid-lowering-guidelines-V3.pdf
https://www.gponline.com/lipid-modification-nice-guideline/cardiovascular-system/article/1380713
https://www.diabetes.co.uk/Diabetes-and-cholesterol.html
It was important for me to understand the NICE guidelines but also to have an understanding of how those particular guidelines came about and other UK and foreign lipid lowering guidelines. This way I felt I could portray myself as an expert in this area and later this helped me when discussing benefits of certain treatments and being able to justify decisions I made for my patients. I then went on to reading up about the first step to cholesterol lowering; diet and exercise.
I found a leaflet which I could prit off and give to my patinets or send electronically to supplement the advice I gave my patients. The nhs patient advice website has some great advice https://www.nhs.uk/conditions/high-cholesterol/treatment/
Set up shortcuts to websites so you can refer to these during discussions. I was speaking to a patient about good oily fish and they asked me if tuna fish from cans is as good as tuna steaks and I had to google the answer in front of them. I now know the answer and have a shortcut to a list of fish that are good for lowering cholesterol so I can specifically refer patients to the correct information.
I ordered cholesterol leaflets from British Heart Foundation and gave these out to my patients.
https://www.bda.uk.com/foodfacts/cholesterol.pdf
Important ones were NICE guidelines, and any research into how Once I had read and understood the current guidelines I was able to write up a protocol which I shared with my GP tutor. She was happy that I had covered all areas of concern and signed it off and before you know it I had my first patient sitting in front of me!
