Impact of pharmaceutical care on health outcomes in patients with COPD
Background: Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD.
Objective: The aim of the present study was to evaluate the impact of pharmaceutical care intervention, with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD.
Setting: Outpatient COPD Clinic at the Royal Medical Services Hospital.
Method: In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patients were followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life, medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS(®) software version 17 for statistical analysis. A P value of <0.05 was considered statistically significant.
Main outcome measure: The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures.
Results: A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P < 0.001), medication adherence (P < 0.05), medication beliefs (P < 0.01) and significant reduction in hospital admission rates (P < 0.05) in intervention patients when compared with control group patients at the end of the study.
Conclusion: The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD.