Community pharmacist program improves COPD care

Nov 5 2013

By Sara Freeman, medwireNews Reporter

Patients with chronic obstructive pulmonary disease (COPD) who receive a community pharmacist-based intervention have improved inhalation technique and medication adherence, show the results of a randomized trial.

Findings from the PHARMAceutical Care for COPD (PHARMACOP) study, published in the British Journal of Clinical Pharmacology, also suggest that the pharmacist-led approach may reduce the rate of severe exacerbations.

The PHARMACOP trial was a single-blind study involving 170 community pharmacies and 734 individuals with COPD who were aged at least 50 years and had a smoking history of at least 10 pack years. Just over half (n=371) of the patients were randomly assigned to receive protocol-defined pharmacist care and 363 to usual pharmacist care.

The patients in the intervention group received two one-on-one counselling sessions; these included education about COPD and their medication, instruction on how to use their prescribed inhalers, and discussion on self-management, smoking cessation, and adherence.

At the start of the trial, 15.6% of patients in the intervention group and 11.6% in the control group performed major errors when demonstrating how they would use their device. This included failing to remove the cap, load the device correctly, or to inhale quickly or deeply enough, all of which were automatically given a score of 0%.

At a 1-month follow-up visit, however, significantly fewer patients in the intervention group scored 0% for their inhalation technique (1.2 vs 4.6%). Improvement in the control group was due to major errors being corrected for ethical reasons, according to the study protocol, note authors Eline Tommelein (Ghent University, Belgium) and colleagues.

Furthermore, the percentage of patients with a 100% score for their inhalation technique improved to a greater extent in the intervention group, from 22.4% at the start of the trial to 68.5% at 1 month (16.5 vs 32.9%, respectively, for controls).

The percentage of patients who were adherent to their medication at a 3-month follow-up visit was also higher if patients had been assigned to the intervention rather than to the control group (78.1 vs 62.5%).

The estimated annual severe exacerbation rate was 0.27 in the intervention group and 0.61 in the control group, with a 72% reduction in the estimated annual hospitalization rate in the intervention compared with control arms.

However, there were no significant differences between the groups in terms of the moderate exacerbation rate, level of dyspnea, COPD-specific and generic health status measures, or change in smoking behavior.

“Pragmatic pharmacist care programs improve the pharmacotherapeutic regime in patients with COPD and could reduce hospitalization rates,” Tommelein et al conclude. “This trial should encourage community pharmacists to engage in COPD care aiming to sustain an effective and safe pharmacotherapeutic treatment in patients with COPD.”

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