A non-randomised controlled pilot study of clinical pharmacist collaborative intervention for community dwelling patients with COPD

Abstract

UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician. Comparator group-patients were drawn from another hospital out-patient clinic. Main outcomes were exacerbations during 4-months of follow-up and respiratory hospitalisations (number and duration) after 1 year. In the intervention group, 86 patients received a median of three home visits; 87 received usual care (UC). At baseline, patients in the intervention group were similar to those in UC in terms of respiratory hospitalisations although slightly younger, more likely to receive specific maintenance antibiotics/Prednisolone and to have had exacerbations. Sixty-two (72.1%) of the intervention group received dose changes; 45 (52.3%) had medicines stopped/started and 21 (24.4%) received an expedited review at the specialist respiratory consultant clinic; 46 (53.5%) were referred to other healthcare services. Over one-third were referred for bone scans and 11% received additional investigations. At follow-up, 54 (63.5%) of intervention group participants had an exacerbation compared with 75 (86.2%) in the UC group (p = 0.001); fewer had respiratory hospitalisations (39 (45.3%) vs. 66 (76.7%); p < 0.001). Hospitalisations were shorter in the intervention group. Pharmacist-consultant care for community dwelling patients with COPD, changed clinical management and improved outcomes. A randomised controlled trial would establish causality.

Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study

“…Outcome measures in this study were relevant, built on previous work, inexpensive to collect, objectively assessed, and reproducible. Surrogate end points could be assessed in subsequent trials, however unlike patients recruited in previous trials of patients recruited because of a single condition, [37][38][39] people experiencing homelessness have multiple complex health and social care needs meaning outcomes are more diverse. Subsequent pilot work on the PHOE-NIx intervention could evaluate patient reported outcomes, or effectiveness using health state utilities (for a future cost utility analysis) e.g.…”

<p>Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model</p>

“…10 Existing studies on collaborative COPD care models focused mainly on clinical pharmacists. 6,51 Considering the importance of continuity of care in improving COPD patient outcomes (including a reduction in all-cause mortality 52 ), a collaborative care model with guided practice protocols should be developed to integrate community pharmacists into the ongoing therapeutic support for COPD patients and to promote the understanding of and respect for pharmacists' potential to contribute, and most importantly, to guide good practice among pharmacists. 5,[53][54][55] To expand and consolidate the role of community pharmacists in managing COPD, it is important to demonstrate the added value of pharmacists' interventions on the overall disease management and the clinical outcome of the patients.…”

Clinical pharmacists in chronic care

“…It is plausible that repeated pharmacist intervention to ensure optimal pharmacotherapy and minimize adverse effects, with a direct link to a consultant respiratory physician, and the patient's GP, may lead to improved outcomes. 142 The interventions identified focused on key areas of asthma and COPD management and support including: assessment of current symptoms; assessment and rectification of inhaler technique; identification of medication-related problems; medication adherence; provision of written and oral education materials; smoking cessation. 143 Osteoporosis Worldwide, it is estimated that 1 in 3 women above the age of 50 will experience osteoporotic fractures, as well as 1 in 5 men.…”