Effectiveness of pharmacist care for patients with reactive airways disease: A randomized controlled trial

Morris Weinberger, Michael D. Murray, David G. Marrero, Nancy Brewer, Michael Lykens, Lisa E. Harris, Roopa Seshadri, Helena Caffrey, J. Franklin Roesner, Faye Smith, A. Jeffrey Newell, Joyce C. Collins, Clement J. McDonald, William M. Tierney

Research output: Contribution to journalArticle

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Abstract

Context: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. Objective: To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). Design, Setting, and Participants: Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. Interventions: The pharmaceutical care program (n=447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates rPEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n=363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n=303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. Main Outcome Measures: Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. Results: At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P=.02) but not than PEFR monitoring controls (P=.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P=.03) and the PEFR monitoring group (P=.001) and were more satisfied with their health care than the usual care group at 6 months only (P=.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. Conclusions: This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.

Original languageEnglish (US)
Pages (from-to)1594-1602
Number of pages9
JournalJournal of the American Medical Association
Volume288
Issue number13
DOIs
StatePublished - Oct 2 2002

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Peak Expiratory Flow Rate
Pharmacists
Pharmaceutical Services
Patient Care
Randomized Controlled Trials
Medication Adherence
Hospital Emergency Service
Respiration
Asthma
Patient Satisfaction
Chronic Obstructive Pulmonary Disease
Quality of Life
Control Groups
Hospitalization
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Interviews
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

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Effectiveness of pharmacist care for patients with reactive airways disease : A randomized controlled trial. / Weinberger, Morris; Murray, Michael D.; Marrero, David G.; Brewer, Nancy; Lykens, Michael; Harris, Lisa E.; Seshadri, Roopa; Caffrey, Helena; Franklin Roesner, J.; Smith, Faye; Jeffrey Newell, A.; Collins, Joyce C.; McDonald, Clement J.; Tierney, William M.

In: Journal of the American Medical Association, Vol. 288, No. 13, 02.10.2002, p. 1594-1602.

Research output: Contribution to journalArticle

Weinberger, M, Murray, MD, Marrero, DG, Brewer, N, Lykens, M, Harris, LE, Seshadri, R, Caffrey, H, Franklin Roesner, J, Smith, F, Jeffrey Newell, A, Collins, JC, McDonald, CJ & Tierney, WM 2002, 'Effectiveness of pharmacist care for patients with reactive airways disease: A randomized controlled trial', Journal of the American Medical Association, vol. 288, no. 13, pp. 1594-1602. https://doi.org/10.1001/jama.288.13.1594
Weinberger, Morris ; Murray, Michael D. ; Marrero, David G. ; Brewer, Nancy ; Lykens, Michael ; Harris, Lisa E. ; Seshadri, Roopa ; Caffrey, Helena ; Franklin Roesner, J. ; Smith, Faye ; Jeffrey Newell, A. ; Collins, Joyce C. ; McDonald, Clement J. ; Tierney, William M. / Effectiveness of pharmacist care for patients with reactive airways disease : A randomized controlled trial. In: Journal of the American Medical Association. 2002 ; Vol. 288, No. 13. pp. 1594-1602.
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abstract = "Context: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. Objective: To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). Design, Setting, and Participants: Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1{\%}) participants at 6 months and 898 (80.7{\%}) at 12 months. Interventions: The pharmaceutical care program (n=447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates rPEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n=363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n=303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. Main Outcome Measures: Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. Results: At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P=.02) but not than PEFR monitoring controls (P=.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95{\%} confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P=.03) and the PEFR monitoring group (P=.001) and were more satisfied with their health care than the usual care group at 6 months only (P=.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. Conclusions: This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.",
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T1 - Effectiveness of pharmacist care for patients with reactive airways disease

T2 - A randomized controlled trial

AU - Weinberger, Morris

AU - Murray, Michael D.

AU - Marrero, David G.

AU - Brewer, Nancy

AU - Lykens, Michael

AU - Harris, Lisa E.

AU - Seshadri, Roopa

AU - Caffrey, Helena

AU - Franklin Roesner, J.

AU - Smith, Faye

AU - Jeffrey Newell, A.

AU - Collins, Joyce C.

AU - McDonald, Clement J.

AU - Tierney, William M.

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N2 - Context: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. Objective: To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). Design, Setting, and Participants: Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. Interventions: The pharmaceutical care program (n=447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates rPEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n=363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n=303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. Main Outcome Measures: Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. Results: At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P=.02) but not than PEFR monitoring controls (P=.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P=.03) and the PEFR monitoring group (P=.001) and were more satisfied with their health care than the usual care group at 6 months only (P=.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. Conclusions: This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.

AB - Context: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. Objective: To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). Design, Setting, and Participants: Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. Interventions: The pharmaceutical care program (n=447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates rPEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n=363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n=303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. Main Outcome Measures: Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. Results: At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P=.02) but not than PEFR monitoring controls (P=.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P=.03) and the PEFR monitoring group (P=.001) and were more satisfied with their health care than the usual care group at 6 months only (P=.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. Conclusions: This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.

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