Physician-Pharmacist Collaborative Management of Asthma in Primary Care

Abstract

Objective To determine if asthma control improves in patients who receive physician-pharmacist collaborative management (PPCM) during visits to primary care medical offices. Design Prospective pre-post study of patients who received the intervention in primary care offices for 9 months. The primary outcome was the sum of asthma-related emergency department (ED) visits and hospitalizations at 9 months before, 9 months during, and 9 months following the intervention. Events were analyzed using linear mixed effects regression. Secondary analysis was conducted for patients with uncontrolled asthma (Asthma Control Test [ACT]<20). Additional secondary outcomes included the ACT, the Asthma Quality of Life Questionnaire by Marks (AQLQ-M) scores, and medication changes. Intervention Pharmacists provided patients with an asthma self-management plan and education and made pharmacotherapy recommendations to physicians when appropriate. Results Of 126 patients, the number of emergency department (ED) visits and/or hospitalizations decreased 30% during the intervention (p=0.052) and then returned to pre-enrollment levels after the intervention was discontinued (p=0.83). Secondary analysis of patients with uncontrolled asthma at baseline (ACT<20), showed 37 ED visits and hospitalizations prior to the intervention, 21 during the intervention, and 33 after the intervention was discontinued (p=0.019). ACT and AQLQ-M scores improved during the intervention (ACT mean absolute increase of 2.11, AQLQ-M mean absolute decrease of 4.86, p<0.0001 respectively) and sustained a stable effect after discontinuation of the intervention. Inhaled corticosteroid use increased during the intervention (p=0.024). Conclusions The PPCM care model reduced asthma-related ED visits and hospitalizations and improved asthma control and quality of life. However, the primary outcome was not statistically significant for all patients. There was a significant reduction in ED visits and hospitalizations during the intervention for patients with uncontrolled asthma at baseline. Our findings support the need for further studies to investigate asthma outcomes achievable with the PPCM model.

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

“…6,7 The value of MTM has been established by increasing medication adherence, improving clinical outcomes, and leading to potential economic benefits. 8–14 For example, the Asheville project has shown that asthma patients achieved and maintained improvements in lung function and had asthma-related cost savings in health care after receiving MTM services. 13 In another study, pharmacists in collaboration with physicians in providing MTM services that resulted in reduced hospitalizations and emergency room visits and improved patient quality of life among patients with asthma.…”

“…13 In another study, pharmacists in collaboration with physicians in providing MTM services that resulted in reduced hospitalizations and emergency room visits and improved patient quality of life among patients with asthma. 14 …”

Summative Evaluation of Physician-Pharmacist Collaboration Management

“…The primary outcome of the asthma arm in the usual care BP group was the sum of asthma-related emergency department (ED) visits and hospitalizations in three periods: 9 months before intervention, 9 months during, and 9 months after the intervention. Of the 126 patients in the asthma arm, the number of ED visits and/or hospitalizations decreased 30% during the intervention (p=0.052) and returned to preenrollment levels after the intervention was discontinued (p=0.83) [17].…”

“…To our knowledge none have evaluated barriers and facilitators in a large, randomized, multihealth system clinical trial. The results from both the BP and asthma interventions from the CAPTION Trial have recently been published [17,18]. Not only was the intervention shown to improve blood pressure control, it was also shown to be cost effective considering both cost of medications and pharmacist and physician time [19].…”

Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma

“…Face‐to‐face pharmacist interventions clearly increase patient adherence to asthma controller therapy . The effectiveness of pharmacy‐based education, counselling and monitoring of drug adherence to reduce hospitalisations and improve disease control has been demonstrated in several conditions, including asthma . Led by Australia, Finland and the Netherlands, there is currently a global movement to expand pharmacist's professional activities beyond drug dispensing and monitoring, towards acting as case managers coordinating asthma care .…”