The impact of pharmacist-managed clinic on medication adherence and health-related quality of life in patients with COPD: a randomized controlled study
Abstract:IntroductionCOPD is rapidly becoming one of the most challenging health problems worldwide, which is characterized by not fully reversible airflow limitation. Although a lot of treatment medications have been delivered, the treatment goals of COPD are often not achieved. Furthermore, few well-designed randomized controlled trials in the People’s Republic of China have been reported to evaluate the impact of pharmacist-managed clinic (PMC) on medication adherence and health-related quality of life in patients w… Show more
“…A prospective randomised controlled trial assessed the impact of pharmacist-managed clinic (similar to the HMMR service) on medication adherence in COPD patients. [27] The Table 3 Changes in the medication nonadherence frequencies as a result of intervention n (%) in both study groups study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist. [27] Many strategies are found to improve patient's adherence.…”
Section: Discussionmentioning
confidence: 91%
“…[27] The Table 3 Changes in the medication nonadherence frequencies as a result of intervention n (%) in both study groups study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist. [27] Many strategies are found to improve patient's adherence. Providing patient home visits is an important strategy required by some patients for adherence to be optimised.…”
Section: Discussionmentioning
confidence: 91%
“…showed that 24% of the patients became highly adherent and 68% reached medium adherence reflecting on the positive role of the pharmacist and the value of the MMR service. A prospective randomised controlled trial assessed the impact of pharmacist‐managed clinic (similar to the HMMR service) on medication adherence in COPD patients . The study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist …”
Objectives
This study was designed to evaluate the impact of Home Medication Management Review (HMMR) on self‐reported adherence, and to explore the effect of different patient factors on their medication adherence.
Method
Consecutive patients from outpatient clinics who were eligible for the study were recruited and randomly distributed into two groups. Patients in both groups were visited at home by the clinical pharmacist at baseline. For the intervention group only, the pharmacist delivered counselling regarding self‐reported adherence. After identifying treatment‐related problems (TRPs), the pharmacist sent a letter to the patients’ physician with certain recommendations (intervention group only). Both groups were reassessed for adherence after 3 months from baseline to measure the difference between the two groups.
Key findings
A total of 97 participants were included. Mean ages for the intervention and control groups were 63.13 and 58.39 respectively. The majority of patients were women. The study revealed significant association with the number of TRPs, and level of adherence in the intervention group at follow‐up (R2 = 0.348, P < 0.001). Adherence score for patients diagnosed with hypertension, diabetes and other chronic conditions indicates that more than 70% of the participants have ‘medium adherence score’ in comparison with <10% having ‘high adherence’ at baseline. Three months postbaseline, 33% of patients in the intervention group were found to have high adherence compared to 14% in the control group. Adherence score significantly decreases in ‘low scores of adherence’ and increases in ‘high scores of adherence’ (P < 0.001) at follow‐up in the intervention group. No significate association between adherence and patient factors was found.
Conclusion
HMMR service has resulted in significant improvements in patients’ adherence when compared to control group patients who did not receive the service. Besides receiving the service, no other patient factors played a role in patients’ improvement in adherence.
“…A prospective randomised controlled trial assessed the impact of pharmacist-managed clinic (similar to the HMMR service) on medication adherence in COPD patients. [27] The Table 3 Changes in the medication nonadherence frequencies as a result of intervention n (%) in both study groups study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist. [27] Many strategies are found to improve patient's adherence.…”
Section: Discussionmentioning
confidence: 91%
“…[27] The Table 3 Changes in the medication nonadherence frequencies as a result of intervention n (%) in both study groups study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist. [27] Many strategies are found to improve patient's adherence. Providing patient home visits is an important strategy required by some patients for adherence to be optimised.…”
Section: Discussionmentioning
confidence: 91%
“…showed that 24% of the patients became highly adherent and 68% reached medium adherence reflecting on the positive role of the pharmacist and the value of the MMR service. A prospective randomised controlled trial assessed the impact of pharmacist‐managed clinic (similar to the HMMR service) on medication adherence in COPD patients . The study showed a significantly greater improvement in medication adherence compared with baseline and to the control group, which was still found after 12 months, attributed to the service received from the clinical pharmacist …”
Objectives
This study was designed to evaluate the impact of Home Medication Management Review (HMMR) on self‐reported adherence, and to explore the effect of different patient factors on their medication adherence.
Method
Consecutive patients from outpatient clinics who were eligible for the study were recruited and randomly distributed into two groups. Patients in both groups were visited at home by the clinical pharmacist at baseline. For the intervention group only, the pharmacist delivered counselling regarding self‐reported adherence. After identifying treatment‐related problems (TRPs), the pharmacist sent a letter to the patients’ physician with certain recommendations (intervention group only). Both groups were reassessed for adherence after 3 months from baseline to measure the difference between the two groups.
Key findings
A total of 97 participants were included. Mean ages for the intervention and control groups were 63.13 and 58.39 respectively. The majority of patients were women. The study revealed significant association with the number of TRPs, and level of adherence in the intervention group at follow‐up (R2 = 0.348, P < 0.001). Adherence score for patients diagnosed with hypertension, diabetes and other chronic conditions indicates that more than 70% of the participants have ‘medium adherence score’ in comparison with <10% having ‘high adherence’ at baseline. Three months postbaseline, 33% of patients in the intervention group were found to have high adherence compared to 14% in the control group. Adherence score significantly decreases in ‘low scores of adherence’ and increases in ‘high scores of adherence’ (P < 0.001) at follow‐up in the intervention group. No significate association between adherence and patient factors was found.
Conclusion
HMMR service has resulted in significant improvements in patients’ adherence when compared to control group patients who did not receive the service. Besides receiving the service, no other patient factors played a role in patients’ improvement in adherence.
“…The reasons for exclusion were as follows: not asthma or COPD patients, not a RCT, not pharmacist-led, no usual care control group, no outcome of interest and others. We included 13 studies 29-41 , 10 studies [29][30][31][33][34][35][36][37]40,41 reported medication adherence, 3 studies 30,33,34 could not be included in quantitative analysis because of the lack of available original data; 7 studies [31][32][33][34][38][39][40] reported inhalation technique, 3 studies 33,38,39 could not be included in quantitative analysis because of the lack of dichotomous data. The process of article selection is presented in Figure 1.…”
Section: Included Studies and Study Characteristicsmentioning
Objective
In patients with asthma and chronic obstructive pulmonary disease (COPD), disease control is still suboptimal—incorrect inhalation technique and medication non‐adherence are two important reasons for this outcome. Pharmacists' interventions have been shown to have a positive effect on the clinical outcomes of asthma and COPD. Quantitative assessment of the efficacy of pharmacist‐led interventions, mainly on inhalation techniques and medication adherence, is needed. Evidence for different interventions is not totally conclusive, and no results of theory‐based adherence promotion interventions for asthma and COPD have been published. The objective of our study is to evaluate the effect of pharmacist‐led interventions on asthma and COPD management, focusing mainly on inhalation technique and medication adherence, and whether the content of interventions (categorized based on Information‐Motivation‐Behavioural skills (IMB) model) affects the effectiveness and whether the IMB model is worthy of clinical promotion and application in adults with asthma or COPD.
Methods
The PubMed, EMBASE, The Cochrane Library, Web of Science and http://ClinicalTrials.gov databases were searched for randomized controlled trials that involved pharmacist‐led interventions among patients with asthma or COPD. We used database‐specific vocabulary (eg, Medical Subject Headings) and free text terms expanding from ‘asthma’, ‘COPD’ and ‘pharmacist’ to identify relevant articles. Two reviewers independently selected the studies, assessed the risk of bias and extracted the data. The meta‐analysis was performed in Review Manager 5.3 provided by the Cochrane Collaboration. PROSPERO registration number: CRD42019144793.
Results and discussion
Thirteen studies were eligible for qualitative analysis, and 12 studies were included in the meta‐analysis. Pharmacist‐led interventions showed a positive effect on medication adherence (1.34 [95% CI 1.18‐1.53], P < .0001) and inhalation technique (1.85 [95% CI 1.57‐2.17], P < .00001) in COPD and asthma patients. In the subgroup meta‐analysis, significant medication adherence improvement was found only in COPD patients (1.41 [1.24‐1.61], P < .0001). The subgroup meta‐analysis also noted that interventions that included all three Information‐Motivation‐Behavioural skills (IMB) constructs had a significant improvement in medication adherence (1.41 [1.24‐1.61], P < .0001). Subgroup meta‐analysis conducted between different diseases, different intervention contents, and different measure tools did not significantly change the heterogeneity.
What is new and conclusion
Pharmacist‐led interventions can improve inhalation technique in adult asthma and COPD patients. Significant improvement in medication adherence was found only in COPD patients. The effect among asthmatic patients requires further study. Interventions based on the IMB model may be worthy of clinical promotion and application. More future research is needed to establish solid evidence base for effective interventions and uniform measurem...
“…It is the second most common reason for emergency hospital admission.According to WHO, COPD has become the fourth leading cause of mortality in the US. It is estimated to become the fifth leading cause of disease burden in 2020 [128]. In 2015 alone, the death toll due to asthma was 383,000 globally [129].…”
Pharmacy practice has changed significantly lately. The professionals have the chance to contribute straightforwardly to patient consideration so as to lessen morbimortality identified with medication use, promoting wellbeing and preventing diseases. Healthcare organizations worldwide are under substantial pressure from increasing patient demand. Unfortunately, a cure is not always possible particularly in this era of chronic complications, and the role of physicians has become limited to controlling and palliating symptoms.The increasing population of patients with longterm conditions are associated with high levels of morbidity, healthcare costs and GP workloads. Clinical pharmacy took over an aspect of medical care that had been partially abandoned by physicians. Overburdened by patient loads and the explosion of new drugs, physicians turned to pharmacists more and more for drug information, especially within institutional settings. Once relegated to counting and pouring, pharmacists headed institutional reviews of drug utilization and served as consultants to all types of health-care facilities. In addition, when clinical pharmacists are active members of the
care team, they enhance proficiency by: Providing critical input on medicine use and dosing. Working with patients to solve problems with their medications and improve compliance.
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