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Optimizing Adherence to Therapy for Hypercholesterolemia


Approaches to counseling patients with high cholesterol levels on goals of therapy and the role of lifestyle changes as prevention against cardiovascular events

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP: That’s excellent. Everyone has some type of pharmacist or clinical pharmacist embedded in your practices. Jen, you have the luxury to spend a little more time with your patients. When we think about the treatment options out there, something you always start with is around dietary and lifestyle modifications. If you can, walk us through what you tell them on that first visit. The patient has high cholesterol: what do you walk them through? It’s not, “You can’t eat anything.” What’s your approach?

Jennifer Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP: Just to piggyback a little on what Joyce was talking about with communication, 1 of the most important parts of that communication is to be able to listen, and reflective listening. When you meet with a patient, you need to ask them, “What’s important to you?” What goals do they have? We can’t just put everything we want. As Bob [Busch] brought up, in the end, we’re going to have 7 pills. We all know this, but we’re not going to overload everything. We have to listen to what their goals are.

When we talk about lifestyle changes, we have to be cognizant of the limitations we have. It’s easy to say, “Go to the gym.” But not everyone can afford a gym membership. Not everyone has access to go swimming every day. We have to hear, what do you do for purposeful exercise? What can you do that might increase that? Listen to them, and have them solve their own problems; you can push them along a little. Do you do your own food shopping? Can you walk up and down the aisles? What can we do to help them? We have to be able to listen. Then we have to hear about food and have that conversation. What’s the problem? Are they grazing all day? Are they making good choices? Do they even understand? Speaking of diabetes, are they understanding the role of carbohydrates and fats and protein? In terms of lipids and diabetes and practices, are they having the right fish, lean meats, and so forth? Can they afford them? We have to work within cultural issues as well in terms of food. We have to be able to listen. You can’t go in and say, “You can’t eat any of these things anymore. You can’t do this anymore. No, no, no, no, no, no.” We can’t be finger wagging. We have to help them do their own problem-solving when it comes to lifestyle changes.

Joyce Ross, MSN, RNC, CRNP, CS, FNLA, FPCNA: Can I jump in quickly? What you’re saying is important, Jen. I also ask the patient is, “What food can you not live without?” Everybody has a favorite, whether it’s a comfort food, a cultural food, something they’d have a very hard time giving up. That’s when we start talking saying, “You can have it, but maybe cut down a little.” You have a conversation about, “What do you need? What’s your goal? Are you interested in making changes?” How about the rest of the family? Are they going to be supportive? That’s the other part: the rest of the family.

Dhiren Patel, PharmD, CDCES, BC-ADM, BCACP: Those are all great points. Keeping the patient at the center of that is the most important piece. It makes a lot of sense.

Transcript edited for clarity.

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