Effectiveness of Pharmacist Care for Patients With Reactive Airways Disease: A Randomized Controlled Trial

• Published in: JAMA : the journal of the American Medical Association 2002-10, Vol.288 (13), p.1594-1602
• Main Authors: Weinberger, Morris, Murray, Michael D, Marrero, David G, Brewer, Nancy, Lykens, Michael, Harris, Lisa E, Seshadri, Roopa, Caffrey, Helena, Roesner, J. Franklin, Smith, Faye, Newell, A. Jeffrey, Collins, Joyce C, McDonald, Clement J, Tierney, William M
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Care Facilities; Asthma - therapy; Biological and medical sciences; Clinical outcomes; Clinical trials; Emergencies; Female; Humans; Indiana; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Compliance; Patient education; Patient Satisfaction; Peak Expiratory Flow Rate; Pharmacies; Pharmacists; Pulmonary Disease, Chronic Obstructive - therapy; Respiratory diseases; Respiratory system; Sickness Impact Profile
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.288.13.1594

CONTEXT It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. OBJECTIVE To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. INTERVENTIONS The pharmaceutical care program (n = 447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates [PEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n = 363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n = 303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. MAIN OUTCOME MEASURES Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. RESULTS At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P = .02) but not than PEFR monitoring controls (P = .28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P