The Pharmaceutical Journal
Vol 269 No 7218 p472
5 October 2002

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JAMA (jama.ama-assn.org)

Mixed results for pharmaceutical care approach to the treatment of asthma

Pharmaceutical care provided by community pharmacists to patients with asthma or chronic obstructive pulmonary disease results in only slight improvements in lung function, an American study has revealed (JAMA 2002;288:1594).

Moreover, although the pharmacist intervention resulted in increased patient satisfaction, it led to an increase in the amount of breathing-related medical care sought.

Researchers at Indiana University conducted the research at 36 community pharmacies in Indianapolis. They enrolled 1,113 people with COPD or asthma to take part in the trial and randomised them to three study groups — an intervention group, in which pharmacists were trained to provide pharmaceutical care and given resources to help implement the programme, and two control groups, one in which patients received a peak flow meter and were instructed in its use, and a usual-care group.

The researchers had predicted that a pharmaceutical care programme would enhance patients' compliance with their asthma or COPD medication and would improve outcomes. Dr Morris Weinberger, professor of health policy and administration at the University of North Carolina, said: "What we were trying to do was to figure out a way to involve community pharmacists more actively in patient care, and so in the study we provided pharmacists with patient-specific information.

"We also gave them tools and training on how to use that information to communicate more effectively with patients when they filled prescriptions," he added.

The researchers found that after one year, patients in the pharmaceutical care group had better peak expiratory flow rates than the usual-care group but not the peak flow monitoring group. There was also no between-group differences in medication compliance and patients receiving pharmaceutical care were twice as likely to have a breathing-related hospital visit than those receiving usual care (14.6 per cent compared with 7.3 per cent). The researchers suggest that the increased visits may have resulted from patients associating their peak flow values with symptoms, which could have led to more care-seeking behaviour.

They note that pharmacists who had been trained to provide pharmaceutical care only viewed patient data (available through a password-protected study computer) on half the occasions that prescriptions were dispensed. And they documented their actions only 50 per cent of the time those data were viewed.

"We found that pharmacists were not able to incorporate the programme into their regular practices effectively," Dr Weinberger said. However, the researchers remain confident that pharmacists can improve outcomes for patients by providing pharmaceutical care. "We need to develop programmes that are more pragmatic for community pharmacists," he said.

In an accompanying editorial (ibid p1642), Dr Brian Strom and Dr Sean Hennessy of the University of Pennsylvania School of Medicine comment that assessments of pharmaceutical care are crucial, even when a programme intuitively makes sense. "If results in the intervention group had simply been examined as a before-and-after comparison, the conclusion would have been misleading."