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Adults with Asthma

British Columbia Pharmacy Asthma Study

Article Citation(s):
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. Canadian Respiratory Journal 2003;10:195-202.

Intervention Setting:
Pharmacists’ offices

Target Population:
Patients, primarily adults with uncontrolled asthma, of a group of British Columbia (BC) pharmacies belonging to the Health Outcome Pharmacies (HOP) cooperative

Program Description:
Twenty BC pharmacists from 18 pharmacies of the HOP cooperative who were trained in a “pharmaceutical care of asthma” course carried out this year-long intervention. The study aimed to demonstrate a significant difference in clinical, economic, and quality of life (QoL) outcomes in asthma patients who received enhanced pharmaceutical care compared with those who received usual care. A goal of the pharmaceutical care was to involve the patient in his/her therapy and provide sufficient support for self-management, which in turn would change the patients’ behaviors so that they would be able to control their asthma. Participating pharmacists were paid $75 for each patient enrolled in the usual-care group and $300 for each one enrolled in the intervention or enhanced care group.

Participants in both groups received an initial interview with the pharmacist to complete a symptom, drug utilization and knowledge assessment; review proper inhaler technique; and provide an opportunity to ask the pharmacist questions about asthma or the project. All patients were asked to complete a monthly Asthma Calendar Diary where they recorded their peak expiratory flow rate (PEFR), a twice-daily scale, medical visits, emergency or hospital visits, and lost school/work days. All participants also were administered a Pharmacy Client Survey near midpoint in the study. Finally, PEFRs were recorded at their first visit and at the end of the study period. Researchers conducted a second interview at the end of the study to assess symptoms, drug use, and knowledge. The extended-care group received education that included the basic concepts of the disease, medications, instruction on trigger identification and avoidance, and development of an asthma action plan. Peak flow meter use also was taught. This education was delivered individually on the basis of an initial assessment of the patient’s readiness for change and a reassessment at each appointment. The frequency of care for the extended-care group involved appointments of about an hour with the pharmacist in a private counseling area every 2–3 weeks for at least three appointments, then a follow-up appointment at least every 3 months for the remainder of the study. Patients could request additional appointments or could see the pharmacist intermittently for short sessions without an appointment. The frequency of care for usual-care group participants was determined by the patient’s needs for prescription refills.

Evaluation Design:
A randomized controlled study approach was used.

Sample Size:
The study included 225 patients.

Outcome Measures/Results:
Outcome measures included PEFRs, symptom scores, drug use changes, QoL measures, emergency visits and hospitalizations, doctor visits, and healthcare costs. Patients in the extended-care group experienced a 50% decrease in symptoms over the 12-month study period and PEFRs that were 11% higher than the usual-care group’s readings, a statistically significant difference. Only the extended-care group demonstrated a decrease in doses of B2-agonists, a decrease from an average of 3.96 to 1.94 doses per day. In the extended-care group, days off work decreased by approximately 0.6 days per month. The extended-care group experienced significantly greater improvement than the usual-care group in QoL measures. For the extended- care group, emergency visits decreased by 75%, and physician visits fell 75% from an average of 1.33 visits per month to 0.39 visits per month between first and last pharmacy visits. By contrast, the number of physician visits increased between the first and last dates in the usual-care group. Hospitalizations in either group did not change significantly. Average health-care costs per month totaled $351 for usual-care patients, compared with $150 for extended care patients.

Materials available:
“The HOP Asthma Disease State Module” materials are available from Care Mart Inc. Calgary Alberta c/o George Doherty (fax number 403-247-6812).

Community Pharmacy-based Asthma Program

Article Citation:
Schulz M, Verheyen F, Muhlig S, Muller JM, Muhlbauer K, Knop-Schneichert E, Petermann F, Bergmann KC. Pharmaceutical care services for asthma patients: A controlled intervention Study. Journal of Clinical Pharmacology 2001 41: 668-676.

Intervention Setting:
Forty-eight pharmacies in the city of Hamburg, Germany (population: 1.7 million)

Target Population:
Asthma patients aged 18–65 years who had been diagnosed with mild to severe asthma were targeted for the study.

Program Description:
The objective of the study was to improve self-management by improving compliance with medication use, health attitudes, and health behavior. Intervention pharmacists participated in a 13-hour training course to prepare them to conduct one-on-one meetings in counseling rooms with asthma patients at the participating pharmacies. Control pharmacies received an introduction to the study protocol only. Meetings between pharmacists and patients in the intervention group were scheduled at 6-week intervals for a total of 9 meetings in 12 months. During these sessions, pharmacists assisted and corrected patients’ inhalation techniques and detected and solved medication and health-related problems in cooperation with the patient and a physician. To improve self-management of their disease, study patients were instructed to use a provided peak flow meter and an asthma diary on a regular basis. The control group received traditional care. At baseline, after 6 months and after 12 months, quality of life (qol), self-efficacy, and asthma knowledge questionnaires were administered to all patients.

Evaluation Design:
The study employed a randomized control trial with repeated measures at 6 and 12 months. To monitor lung function forced expiratory volume at one second (FEV1) and peak flow (PEF) were measured. The percent change in FEV1 from baseline was used as a clinical outcome. PEF was measured at home and in the pharmacies. Inhalation technique was assessed using a seven-point checklist.

Sample Size:
Study participants included 161 patients served by 26 participating intervention pharmacies and 81 patients served by 22 control pharmacies.

Outcome Measures/Results:
Outcome measures included lung function, dyspnea and asthma severity, inhalation technique, asthma knowledge and self-efficacy, and quality of life. PEF values recorded in the morning by intervention patients remained unchanged, but evening values increased substantially. Intervention group patients perceived a substantial within-group improvement of asthma severity from 6–12 months that differed substantially from the control group at 12 months. Inhalation technique improved substantially in the intervention group. At 12 months, asthma knowledge in the intervention group was substantially improved. Self-efficacy was improved in the intervention group at 6 and 12 months. The mental summary scale on the qol survey improved substantially. All sub scales and the summary score in the qol questionnaire showed significant improvements.

Availability of Protocol/Materials:
The protocol and materials are not available for widespread distribution.

Case Study: