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Pharmacy-Assisted Health Care Backfires

Asthma, COPD patients happy, but likelier to end up in hospital

TUESDAY, Oct. 1, 2002 (HealthDayNews) -- A program designed to involve pharmacists in the health care of customers with certain respiratory illnesses did not have better outcomes than having the patients manage their own care.

The pharmacist-care program did lead to increased satisfaction among customers, but it also led to more medical visits, according to a study appearing in tomorrow's issue of the Journal of the American Medical Association.

"The original intent was to see if pharmacists in the community could use patient-specific information about customers to interact effectively with them and improve outcomes," explains Morris Weinberger, lead author of the study and a professor of health policy and administration at the University of North Carolina.

Breathing disorders such as asthma and chronic obstructive pulmonary disease (COPD) can be managed with drugs, but patients often have trouble following the prescribed regimen.

According to the study, pharmacies may be helpful because people often have several doctors but just one pharmacist, whom they're inclined to trust. The pharmacist is also the last health-care professional patients see before they take their medications.

To see if pharmacists could help compliance and therefore outcomes, the study authors conducted a randomized trial at 36 CVS community drugstores in Indianapolis. The trial enrolled 1,113 participants with asthma or active COPD, a condition usually associated with emphysema and chronic bronchitis.

The drugstores were divided into three groups of 12 stores each. One group followed the pharmacy care program, which involved training the pharmacist and using patient-care materials. Patients visiting the second group of pharmacies measured their own peak expiratory flow rate (PEFR), a gauge of exhalation and lung function, with peak flow meters at home. The third group did not receive peak flow meters or individualized care from the pharmacist.

After one year, patients in the pharmacy care group had similar PEFRs to those in the peak flow group and both were higher than patients in the usual-care component. "The results were that, basically, intervention looked a lot like the peak flow monitoring group," Weinberger says.

But the pharmacy-assisted patients were also 2.16 times likelier to end up in an emergency room or a doctor's office with a breathing-related problem than were those in the usual-care group.

The study also found that pharmacists accessed computerized data on patients only half the time, which Weinberger feels was not frequently enough. "We found that it was too clunky for the pharmacists. We need a simpler way. We have been working with CVS on how to do that more effectively."

It's not clear why those helped by a pharmacist landed in the hospital more often. Increased education may lead to seeking more medical care, postulates Dr. Marianne Frieri, director of the Allergy Immunology Program at Nassau University Medical Center in East Meadow, N.Y. "It's good that the patient has another person to interact with rather than just take a pill and go home. Maybe it's because when they had increased education they decided to go back to their doctor. It might be increased attention to their disease state."

Some experts feel the design of the study may have weeded out non-compliant patients, which resulted in the similar outcomes. "I'm not surprised that they didn't find much difference with pharmacy intervention," says Dr. Richard Honsinger. "They picked the most compliant patients anyway. If a pharmacy program is going to make a difference, it's probably going to make a difference in compliance." The study results reflected only those patients who had responded to questionnaires, not those who had not responded.

The larger question still remains: Should pharmacists assume a larger role in health care? "I still think the idea is how do we get pharmacists involved as members of the care team in an effective way," Weinberger says. "We've made a dent on that road, but we need to get them more engaged."

Others are not so sure.

"We have a limited health-care budget in the United States. We have more and more people getting into the health-care field who all want an income: We need to keep doing these studies to see if intervention is worth the money we put into it," Honsinger says. "We want to take care of people. We want them to do well, but we want to know that our money is being well spent."

What To Do

For information on a variety of respiratory conditions including asthma, visit the American Academy of Asthma, Allergy and Immunology. The National Heart, Lung and Blood Institute has a page devoted to COPD.

SOURCES: Richard W. Honsinger Jr., M.D., clinical professor, medicine, University of New Mexico, Albuquerque, N.M., and chairman, New Mexico Medicaid Advisory Committee; Morris Weinberger, Ph.D., professor, health policy and administration, University of North Carolina, Chapel Hill; Marianne Frieri, M.D., Ph.D., director, Allergy Immunology Program, Nassau University Medical Center, East Meadow, N.Y.; Oct. 2, 2002, Journal of the American Medical Association
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