Pharmacist-led intervention study to improve drug therapy in asthma and COPD patients
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Background Pharmacists can play an important role in identifying and instructing pulmonary patients on their inhalation techniques in their patient contacts when dispensing inhalation medication. Pharmacy dispensing data can be used to identify inappropriate drug use in asthma and chronic obstructive pulmonary disease (COPD) patients. Recent studies found beneficial effects of pharmacy care services in improving drug adherence of pulmonary patients. However, large-scale and rigorous evaluations on pharmacist-led interventions in community care settings to enhance evidence-based drug treatment in patients with asthma and COPD seems to be lacking and results from studies on pharmacist-led interventions for pharmacotherapy improvements are inconsistent. This study evaluated the effectiveness of pharmacist-led interventions on suboptimal drug use patterns with asthma or COPD medication with substantial numbers of pharmacies and patients involved. Setting A prospective cohort study in a group of community pharmacies (intervention group) with a matched control group of Dutch community pharmacies was conducted between May 2011 and February 2012. Algorithms on 19 potential problems with asthma or COPD medication in a national dispensing database were used to signal patients to pharmacists of the intervention group (IG). Methods IG pharmacists selected patients for comprehensive care by a structured program. Changes in problems were measured during 10 months in selected and all users of asthma and COPD medication of IG pharmacies and in compared to a control pharmacies (CG) without the structured program. Primary outcome was reduction of oral high dosage corticosteroids or antibiotics (HDT). Secondary outcomes were changes in the persistence of 19 potential problems in the IG compared to CG. Results In the 107 IG pharmacies, 3,757 patients were selected for comprehensive care from totally 102,497 asthma or COPD patients and compared with 105,507 patients from 105 CG pharmacies. The mean number of HDT decreased in selected IG patients by an additional 0.54 (95 % CI 0.21–0.86) HDT treatments. From the problems with specific COPD and asthma medication, all problems decreased additionally to the CG within the total asthma or COPD population from the IG. Within the selected IG population the following problems decreased additionally for obsolete medication by 35 % (95 % CI 6–54 %), contra-indicated medication by 61 % (95 % CI 38–75 %) and lower use of powder inhalers in elderly patients by 29 % (95 % CI 13–42 %). Conclusion Community pharmacists actively providing comprehensive pharmacy care could improve effective treatment in asthma and COPD patients and thereby decrease the number of prescriptions for exacerbations for these patients.
KeywordsAsthma COPD Pharmaceutical care Pharmacist intervention study The Netherlands
The authors wish to thank the KNMP, SFK and GSK for their assistance to perform this study.
GSK developed the web-based tool and provided a fee of 50 Euro per included patient, with a maximum of 40 patients per asthma or COPD project. The analysis of all data done independent of GSK.
Conflicts of interest
Romy de Groot is employed by GSK. GSK contributed financially to the internship of Stefan Ottebros.
- 6.Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256–76.PubMedCrossRefGoogle Scholar
- 7.Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane database of systematic reviews (Online). 2000(3):CD000336.Google Scholar
- 15.McLean W, Gillis J, Waller R. The BC Community Pharmacy Asthma Study: a study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Can Respir J. 2003;10(4):195–202 Epub 2003/07/10.PubMedGoogle Scholar
- 16.Fischer LR, Scott LM, Boonstra DM, DeFor TA, Cooper S, Elkema MA, et al. Pharmaceutical care for patients with chronic conditions. J Am Pharm Assoc. 2000;40(2):174–80.Google Scholar
- 17.Herborg H, Soendergaard B, Froekjaer B, Fonnesbaek L, Jorgensen T, Hepler CD, et al. Improving drug therapy for patients with asthma–part 1: Patient outcomes. J Am Pharm Assoc. 2001;41(4):539–50.Google Scholar
- 25.Cheung KC dBJ. Apotheker in de WGBO. Praktijk, kennis en verwachtingen van apothekers en apothekersassistenten vóór opname van de apotheker in de WGBO.. 2012 [cited 2007]; Available from: http://www.knmp.nl/downloads/organisatie-regelgeving/organisatie-regelgeving-wet-en-regelgeving/definitief20rapport20wgbo20en20apotheekpraktijk20oktober202007.pdf.
- 26.Griens AMGF JJ, Kloon JDL, Lukaart JS, van der Vaart RJ. News and publications. Stichting Farmaceutische Kengetallen 2012; Available from: http://www.sfk.nl/english.
- 27.Smeele IJM vWC, van Schayck CP, van der Molen T, Thoonen B, Schermer T, Sachs APE, Muris JWM, Chavannes NH, Kolnaar BGM, Grol MH, Geijer RMM. Guideline for COPD treatment. Huisarts Wetenschap. 2007;50(8):18.Google Scholar
- 28.Geijer RMMCN, Muris JWM, Sachs APE, Schermer T, Smeele IJM, Thoonen B, Van der Molen T, van Schayck CP, van Weel C, Kolnaar BGM, Grol MH. Guideline asthma treatment for adults. Huisarts Wetenschap. 2007;50(11):15.Google Scholar
- 29.Statistics DAf. Level of urbanity. Available from: http://www.cbs.nl/nl-NL/menu/methoden/toelichtingen/alfabet/p/2009-platteland-toelichting.htm.
- 30.Methodology WHOCCfDS. Guidelines for ATC CLassification and DDD Assignment. 2013; Available from: http://www.whocc.no/filearchive/publications/1_2013guidelines.pdf.