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ASTHMA

Community Pharmacy-Based Pharmaceutical Care for Asthma Patients

At time of writing, Research Associate, Center for Drug Information and Pharmacy Practice, ABDA—Federal Union of German Associations of Pharmacists, Berlin, Germany

Martin Schulz, PhD

Head, Center for Drug Information and Pharmacy Practice, ABDA; Adjunct Professor, Department of Pharmacology, Johann Wolfgang Goethe-University, Frankfurt at Main, Germany

Stephan Mühlig, PhD

Professor, Institute of Clinical Psychology, Technical University of Chemnitz, Germany

Peter Ihle, MD

Senior Research Associate, Primary Health Care Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, Germany

Ingrid Schubert, PhD

Head, Primary Health Care Research Group, Department of Child and Adolescent Psychiatry, University of Cologne

Hans-Christian Waldmann, PhD

Biostatistician and Head, MSB Statistical Consulting, Bremen, Germany

Reprints: Dr. Schulz, Center for Drug Information and Pharmacy Practice (ZAPP), ABDA—Federal Union of German Associations of Pharmacists, Jaegerstrasse 49/50, 10117 Berlin, Germany, fax 49 30/40004 243, M.Schulz{at}abda.aponet.de

BACKGROUND: Despite significant progress in asthma drug therapy in recent years, there has been no major change in asthma morbidity and mortality. It is still important to determine whether pharmaceutical care (PC) influences health outcomes.

OBJECTIVE: To evaluate the effectiveness of PC with regard to clinical, humanistic, and economic outcomes in adults with asthma.

METHODS: An intervention study was conducted over 12 months. At baseline, 39 community/retail pharmacies, 84 primary care physicians (general practitioners, internal specialists, chest physicians), and 183 patients (aged 18-65 y) diagnosed with asthma were included. To evaluate economic outcomes, 2 German statutory health insurance funds provided 2 years of claims data for their insured patients (n = 55). A 1:10 matching was carried out to compare the data of this intervention subgroup with those of a control group (n = 550).

RESULTS: Significant improvements were found for all humanistic outcomes (eg, asthma-specific quality of life, self-efficacy, knowledge, medication adherence). In addition, asthma severity, self-reported symptoms, peak expiratory flow, and patients' inhalation technique improved. Increases in forced expiratory volume in 1 second and vital capacity were not significant over time. Evaluation of the insurance claims data revealed a shift toward better adherence to evidence-based therapy.

CONCLUSIONS: The study shows that PC for people with asthma has a positive impact on humanistic and, to some extent, on clinical outcomes. To determine potential economic benefits, future research should focus on patients with more severe asthma.

Key Words: asthma, community pharmacy, pharmaceutical care, pharmacy practice

Published Online, October 11, 2005. www.theannals.com, DOI 10.1345/aph.1G180

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