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Published Online, 7 June 2005, www.theannals.com, DOI 10.1345/aph.1E474a.
 The Annals of Pharmacotherapy: Vol. 39, No. 7, pp. 1371. DOI 10.1345/aph.1E474a
© 2005 Harvey Whitney Books Company.
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Comment: when does pharmaceutical care impact health outcomes? A comparison of community pharmacy-based studies of pharmaceutical care for patients with asthma

Martin Schulz, PhD

Head, Center for Drug Information and Pharmacy Practice ABDA—Federal Union of German Associations of Pharmacists Jägerstrasse 49/50 10117 Berlin, Germany fax 49 30 40004 243 m.schulz{at}abda.aponet.de

Published Online, June 7, 2005. www.theannals.com, DOI 10.1345/aph.1E474a

TO THE EDITOR: I congratulate McLean and MacKeigan for their very interesting findings in comparing 4 different pharmaceutical care (PC) studies in community pharmacies for patients with asthma.1 They addressed the important question of whether some community pharmacy–based interventions have been proven more effective than others and whether "complete" PC has been applied. However, based on the principles of evidence-based medicine, it is likely that not all information regarding a complex study has been published in one article. This holds true, for example, for our study.2

Hence, before further conclusions are drawn, at least the following facts should be considered: (1) Besides the 13-hour initial training provided, all pharmacies were closely monitored by a pharmacist (PhD in pharmacology) based in Hamburg and employed for this study.2 This monitor visited all practice sites regularly to check for compliance with the entire study protocol and the documentation forms for PC, to minimize missing data, and to enhance the documentation of drug-related problems detected and solved (intervention group only). In addition, counseling on-site and via phone/fax was offered from the first day of recruitment until the end of the study. Therefore, assistance from a distant research center was limited to supervision and monitoring the monitor.

(2) Patient satisfaction with healthcare/PC and the pharmacist was evaluated in the intervention group and proved to be extremely high. So far, these data have been presented at meetings3 or nationally4 only. A comparison with the control group was considered inappropriate as these patients did not experience elements of PC (usual care).

(3) Additionally, we evaluated physicians' (emergency) visits, hospitalizations, and days off work/school without finding significant differences. This was mainly due to the mild to moderate severity of asthma within our cohort.

(4) We paid a small honorarium of 50 German Marks ({euro}25.60 or $34 US) to pharmacists and physicians, but not patients, in both groups based on data provision at baseline and after 6 and 12 months for each time-point and patient.

One of the most important elements in our study was the monitor. Visiting all practice sites regularly and offering counseling and advice contributed to favorable outcomes in our study.

References

  1. McLean WM, MacKeigan LD. When does pharmaceutical care impact health outcomes? A comparison of community pharmacy–based studies of pharmaceutical care for patients with asthma. Ann Pharmacother 2005;39: 625-31. DOI 10.1345/aph.1E474[Abstract/Free Full Text]
  2. Schulz M, Verheyen F, Mühlig S, Müller JM, Mühlbauer K, Knop-Schneickert E, et al. Pharmaceutical care services for asthma patients: a controlled intervention study. J Clin Pharmacol 2001;41:668-76.[Abstract]
  3. Schulz M, Mühlbauer K, Verheyen F, Knop-Schneickert E, Mühlig S, Petermann F, et al. Pharmaceutical care services for asthma patients (abstract). Eur J Clin Pharmacol 1999;55:A15.
  4. NN. Asthmastudie belegt Effizienz der Pharmazeutischen Betreuung.Pharm Ztg 1999;144:2877-81.



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