Jeannette Y. Wick, RPh, MBA, FASCP
Medication use improved in COPD and asthma patients whose community pharmacists intervened to address a range of potential problems.
No matter how many times pharmacists educate patients about inhalers, additional counseling and technique review is critical. Patients forget how to use their inhalers, slip into sloppy technique, or become non-adherent to necessary medication. Encouraging words from pharmacists can improve adherence. In addition, pharmacist review of patients’ drug profiles often identifies inappropriate drug use in asthma and chronic obstructive pulmonary disease (COPD) patients.
published in the December 2013 issue of the International Journal of Clinical Pharmacy
underscores these points. The researchers noted that large-scale, rigorous evaluations of pharmacist-led interventions in asthma and COPD patients in community care settings are scarce—and those that are available have produced inconsistent results. The researchers sought to provide additional information.
The researchers conducted a prospective cohort study in Dutch community pharmacies between May 2011 and February 2012. They matched an intervention group of pharmacies with a control group based on prescription volume, the number of pharmacists employed, and location (urban vs. rural). They provided algorithms to pharmacists in the intervention group to address 19 potential problems with asthma or COPD medication use. Some items of interest included overuse of short acting beta-agonists, suboptimal maintenance therapy with long acting beta-agonists, suboptimal co-medication, inappropriate inhalation technique or use of inappropriate inhalation devices, and poor adherence.
The researchers notified pharmacists in the intervention group of potential suboptimal medication therapy after identifying high-risk patients in a national dispensing database. Pharmacists in the intervention group provided pharmaceutical care according to structured protocols, while pharmacists in the control group provided usual care.
The researchers measured changes in the persistence of the 19 potential problems with asthma or COPD medication use in both intervention groups and control pharmacies. The study’s primary outcome was reduction of oral high dosage corticosteroids or antibiotics (HDT), which indicate poor disease control.
In the 107 pharmacies in the intervention group, pharmacists provided comprehensive care to 3757 asthma or COPD patients who had been identified as high-risk out of a total of 102,497 asthma or COPD patients. In the 105 pharmacies in the control group, 105,507 asthma or COPD patients were identified.
Pharmacists in the intervention group successfully decreased the mean number of HDT treatments in selected patients by 0.54 treatment courses. They were also able to decrease the incidence of all 19 monitored problems in the overall asthma or COPD population. Specifically, obsolete medication decreased by 35%, contra-indicated medication fell by 61%, and use of powder inhalers by elderly patients was reduced by 29%.
This large, community-based study demonstrates the impact that pharmacists can have through counseling patients about specific problems. In particular, active intervention can improve treatment and decrease the number of prescriptions for exacerbations for asthma and COPD patients.
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.