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Table 4 Patient cases

From: Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service

Weight reduction, improved blood pressure control Improved lipid profile Increased physical activity and smoking cessation
Mrs X: 30 years old Mr Y: 42 years old Mr Z: 71 years old
Data were available from the patients’ second through sixth appointment. During this period, the patient was able to implement an effective diet and exercise program with the assistance of the NP, which allowed her to lose weight and reduce her blood pressure. She lost six kilograms, and her blood pressure reduced from 131/88 to 125/75. Her waist circumference reduced from 133 cm to 120 cm. While she had not incorporated extensive changes to her lifestyle, simply being able to make small adjustments in her habits has enabled improvements. These small changes include walking her dog at a faster rate, stepping up and down a curb and making better choices for breakfast, such as smoothies. Whilst she may still opt for something sugary, it is now a matter of eating a small bar of chocolate rather than a bag of lollies. This case portrays an ideal case of a patient who has been able to incorporate small changes, and achieve results. She visited the pharmacy frequently and consulted with the NP. This indicates the significance of the metabolic clinic, as well as the patient-centred service provided by the pharmacy. Mr Y was identified as being overweight, requiring a diet and exercise program. A blood test result revealed high lipid levels, with total cholesterol being 7.9 mmol/L and triglycerides being 5.7 mmol/L. As a result, the NP initiated him on rosuvastatin (Crestor®). This medication reduced his total cholesterol to 5 mmol/L and triglycerides to 2.8 mmol/L. Six months later, the patient decided to cease the rosuvastatin (Crestor®), as he did not understand why there was a need for him to continue. Following this, another blood test result showed raised levels, with total cholesterol being 8.6 mmol/L and triglycerides 6.2 mmol/L. After the patient was shown these results, he re-commenced rosuvastatin (Crestor®). It was hoped that he would return for future consultations and blood tests. In this case, the NP was able to educate the patient on the importance of his medication, by explaining his test results and reasoning why those values had increased, which proved to be beneficial advice for the patient. After being admitted to hospital, possibly with chest pain or a myocardial infarction, Mr Z was encouraged to change his lifestyle, with the assistance of the NP. In a period of two months, his systolic blood pressure had risen from 140/100 to 153/78. In the space of one month, effective lifestyle changes allowed for his blood pressure to reduce to 112/54. The NP described him as an extremely motivated individual; he would come into the pharmacy more frequently than his hospital visits. The major change he incorporated into his life was increasing his physical activity by cycling. After his emergency visit to the pharmacy, he also undertook smoking cessation with the support of the NP.