Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial

Abstract

AIMSFew well-designed randomized controlled trials have been conducted regarding the impact of community pharmacist interventions on pharmacotherapeutic monitoring of patients with chronic obstructive pulmonary disease (COPD). We assessed the effectiveness of a pharmaceutical care programme for patients with COPD. METHODSThe pharmaceutical care for patients with COPD (PHARMACOP) trial is a single-blind 3 month randomized controlled trial, conducted in 170 community pharmacies in Belgium, enrolling patients prescribed daily COPD medication, aged ≥50 years and with a smoking history of ≥10 pack-years. A computer-generated randomization sequence allocated patients to an intervention group (n = 371), receiving protocol-defined pharmacist care, or a control group (n = 363), receiving usual pharmacist care (1:1 ratio, stratified by centre). Interventions focusing on inhalation technique and adherence to maintenance therapy were carried out at start of the trial and at 1 month follow-up. Primary outcomes were inhalation technique and medication adherence. Secondary outcomes were exacerbation rate, dyspnoea, COPD-specific and generic health status and smoking behaviour. RESULTSFrom December 2010 to April 2011, 734 patients were enrolled. Forty-two patients (5.7%) were lost to follow-up. At the end of the trial, inhalation score [mean estimated difference (Δ),13.5%; 95% confidence interval (CI), 10.8-16.1; P < 0.0001] and medication adherence (Δ, 8.51%; 95% CI,; P < 0.0001) were significantly higher in the intervention group compared with the control group. In the intervention group, a significantly lower hospitalization rate was observed (9 vs. 35; rate ratio, 0.28; 95% CI, 0.12-0.64; P = 0.003). No other significant between-group differences were observed. CONCLUSIONSPragmatic pharmacist care programmes improve the pharmacotherapeutic regimen in patients with COPD and could reduce hospitalization rates.

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

“…Interestingly, the study of Tommelein et al [25] evaluated the hypothesis stated above. It was the first randomised controlled trial (RCT) to address the impact of CPs' intervention on IT and MA as primary outcomes in COPD patients in Belgium.…”

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].…”

“…This study concludes that Pharmacists need more appropriate continuing education programs that can translate into improved pediatric asthma self-management practices and thus improved asthma outcomes in children. In fact, these and many other studies have addressed the effects of education and assessment by community pharmacists of patients with asthma or COPD by community pharmacists [15,26,[30][31][32][33][45][46][47], including children with asthma [58] and elderly subjects [59]. Moreover, in community pharmacies from different countries several initiatives to improve inhaler use have been implemented, such as the Australian Inhaler Technique Labels [50], the Pharmacy Asthma Management Service (PAMS) [53], and the Danish Inhaler Technique Assessment Service (ITAS) [60].…”

Patient Care Indicator: Degenerative-Nondegenerative Patients and Compounded-Non-Compounded Prescription in One of Community Pharmacy in Bandung

“…Penampilan kerja merupakan aktivitas pelayanan kefarmasian yang dapat dilakukan di fasilitas kesehatan masyarakat. Menurut Tommelein et al (2014), program pelayanan kefarmasian yang dilakukan di suatu fasilitas kesehatan masyarakat terhadap pasien dengan suatu penyakit tertentu dapat memberikan efek peningkatan terhadap hasil terapi pasien. 7 Hanya saja, seringkali terdapat beberapa faktor yang menjadi penghambat dilakukannya praktik pelayanan ini.…”

“…Menurut Tommelein et al (2014), program pelayanan kefarmasian yang dilakukan di suatu fasilitas kesehatan masyarakat terhadap pasien dengan suatu penyakit tertentu dapat memberikan efek peningkatan terhadap hasil terapi pasien. 7 Hanya saja, seringkali terdapat beberapa faktor yang menjadi penghambat dilakukannya praktik pelayanan ini. Menurut Mehralian et al (2014), penghalang yang dapat memengaruhi praktik pelayanan kefarmasiant adalah kurangnya kemampuan dari apoteker, serta regulasi dan lingkungan yang tidak sesuai.…”