An evaluation of a multi-site community pharmacy–based chronic obstructive pulmonary disease support service

Abstract

Objectives Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition that can be effectively managed by smoking-cessation, optimising prescribed therapy and providing treatment to prevent chest infections from causing hospitalisation. The government agenda in the UK is for community pharmacists to become involved in chronic disease management, and COPD is one area where they are ideally located to provide a comprehensive service.This study aims to evaluate the effect of a community pharmacy-based COPD service on patient outcomes. Methods Patients in one UK location were recruited over a 10-week period to receive a community pharmacy-based COPD support service consisting of signposting to or provision of smoking-cessation service, therapy optimisation and recommendation to obtain a rescue pack containing steroid and antibiotic to prevent hospitalisation as a result of chest infection. Data were collected over a 6-month period for all recruited patients. Appropriate clinical outcomes, patient reported medication adherence, quality of life and National Health Service (NHS) resource utilisation were measured. Key findings Three hundred six patients accessed the service. Data to enable comparison before and after intervention was available for 137 patients. Significant improvements in patient reported adherence, utilisation of rescue packs, quality of life and a reduction in routine general practitioner (GP) visits were identified. The intervention cost was estimated to be off-set by reductions in the use of other NHS services (GP and accident and emergency visits and hospital admissions). Conclusions Results suggest that the service improved patient medicine taking behaviours and that it was cost-effective.

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

“…This is consistent with other studies which show that pharmacist-delivered interventions can lead to significant improvement in medications adherence in other diseases [30,31]. Two studies [23,25,26] in this review showed that the provided interventions were cost-effective in terms of reducing hospitalisation rate and severe exacerbation rate. There was a cost saving of £94.12 per patient (equivalent to €133) for six months in Wright et al [23] study in the UK and €227 per patient for one year in Tommelein et al [25,26] study in Belgium.…”

“…With respect to IT, the offered interventions were found to significantly reduce IT errors or even improve the choice of the inhaler [5, 23-25, 28, 29]. For MA, the review showed that CPs interventions resulted in improving adherence to inhaled medications which was statistically significant in the addressed studies [8,23,25]. This is consistent with other studies which show that pharmacist-delivered interventions can lead to significant improvement in medications adherence in other diseases [30,31].…”

“…Two studies [23,25,26] in this review showed that the provided interventions were cost-effective in terms of reducing hospitalisation rate and severe exacerbation rate. There was a cost saving of £94.12 per patient (equivalent to €133) for six months in Wright et al [23] study in the UK and €227 per patient for one year in Tommelein et al [25,26] study in Belgium. This highlights that IT and MA interventions provided by CPs are not only beneficial for patients but also for the healthcare system.…”

“…The mean cost-saving associated with the intervention was mainly due to the reduction in the use of NHS services notably hospital admissions. However, the results should be treated with some caution due to the before-and-after study design, the lack of a comparison control group (CG), and the fact that the intervention was conducted in winter period when COPD is expected to be worse in comparison to the pre-intervention period [23].…”

Knowledge, Attitudes and Preferences Among Spanish Community Pharmacists Regarding Inhaled Therapy (The Optim Pharmacy Study)

“…It has been shown that pharmaceutical care of patients with obstructive respiratory diseases improves medication adherence [24][25][26][27] and achieves a better use of inhalers [26,[28][29][30] and control of the disease [31,32]. In a randomized controlled study to investigate the effect of a simple educational intervention concerning DPI technique delivered by community pharmacists to patients with asthma, a simple educational intervention taking only 2.5 min and targeting inhaler technique was feasible for delivery by community pharmacists and resulted in improved clinical and humanistic outcomes for patients with asthma [33].…”