Table 18bSummary of adult self-monitoring, self-management, or patient education interventions provided by pharmacists

ReferenceStudy PurposeTarget PopulationStudy DesignType of InterventionResults
Barbanel et al.137 To evaluate whether a community pharmacist with basic asthma training could improve asthma control by providing self-management advice.23 adults aged 18–65 years with asthma living in inner city East London. Nint=12, Ncon=11.RCTIntervention patients received a 45–60 minute individual session from the pharmacist on asthma pathophysiology, recognition and avoidance of triggers, inhaler technique, self-management skills including symptom and PF monitoring, actions in response to worsening symptoms, accessing emergency care, and smoking cessation, if relevant. They received written self-management plans and weekly phone calls for the next 3 months to review plans and answer questions.3 months after the intervention, the symptom score increased in the control group and decreased in the intervention group (p<0.001).137
Cordina et al.159 To examine the effects of a community pharmacy-based education and monitoring program for patients with asthma on a range of patient-specific asthma management outcomes.152 patients over the age of 14 who received their asthma prescriptions at private pharmacies in Malta.CBAA comprehensive asthma education and monitoring program was instituted in private pharmacies in Malta for 12 months. The intervention pharmacists reviewed patients asthma symptoms, PF records, medication use, and when necessary suggested changes in treatment to the patient's physician.There was no significant difference between treatment and control groups in terms of PF measurement, self-reported inhaler use, days lost from work or school, or health related QOL. There were fewer self-reported hospitalizations for asthma among intervention patients (0/86) than among control patients (8/66) (p<0.002) but no other differences in health services utilization. The intervention patients were less likely to report nighttime wheezing and more likely to improve their inhaler technique than control patients. 159
Herborg et al.160 To evaluate the effects of the “Danish Therapeutic Outcomes Monitoring” program of increased pharmaceutical care on various outcome and process measures of asthma care.413 patients aged of 16–60 years old with moderate-to-severe asthma in Denmark cared for in 16 intervention and 15 control pharmacies. Nint=209, mean age: 38.8 yrs. Ncon=204, mean age: 42.4 yrsCBAThe program consists of 7 steps for establishing a patient-pharmacist-physician relationship, collecting patient data, identifying and analyzing drug therapy problems, outlining therapeutic goals, choosing individual intervention and monitoring plan, implementing monitoring and follow up, and documenting and reporting to physician and patient. The intervention required monthly sessions with pharmacists over 1 year.12 months after the intervention, the intervention group had fewer “sick days,” fewer physician visits (p<0.012), and improved asthma symptoms, inhaler technique (p<0.001), health-related QOL (p<0.05), and knowledge of asthma medications (p<0.031). There was no difference in PFs.160
Kelso et al.161, 162 To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education would improve outcomes in African-American adults with asthma.39 African-Americans aged ≥18 years with moderate to severe asthma with recent ED visits or hospitalizations for asthma in Memphis. A control group comparable for all demographic variables was identified via chart review at local hospitals. Ncon=18, Nint=21.CBAThe intervention subjects received 1-hour individual asthma education session from a pharmacist emphasizing environmental control and PF meter and inhaler use. Patients were also given the NIH National Asthma Education Program booklet, individualized inhaled corticosteroid prescriptions, albuterol to use “as needed,” and an emergency supply of prednisone. Patients were given PF meters and taught how to use their medications in relation to their PF. The intervention utilized the strategies of role-playing and the distribution of printed or audiovisual materials. Free access to an asthma clinic was provided and an appointment was scheduled within 1 week of their ED visit.At two years, the intervention group showed a significantly greater reduction in both ED visits (p<0.05) and (p<0.05) hospitalization compared to the control group.161
Knoell et al.163 To compare an education program provided by a pharmacist with treatment by a pulmonologist to pulmonologist treatment alone.100 asthma patients in Ohio Nint-pre=45, Age: 8.9% <25 yrs.; 82.2% 25–65 yrs.; 8.9% >/=65.Ncon-pre=55, Age: 14.5% <25 yrs.; 74.6% 25–65 yrs.;10.9% >/=65.CBAPharmacist developed and implemented individualized education/self-management programs. Within an outpatient specialty care setting, a pharmacist spent 30–60minutes with a patient during the first visit, and had at least one more meeting with the patient over the course of 45-day study. Pharmacist also conferred and coordinated care with a pulmonologist.The intervention group was more likely to have recorded a recent PF than control subjects. No differences in days missed from work, hospitalization, QOL, drug costs, or physician visits.163
Schulz et al.164 To determine if a pharmacy-based patient education intervention can improve measures of lung function, HRQOL and self-management in asthma patients.164 asthma patients in Hamburg. Nint=101 (34.6% M), mean age: 46.3 yrs., SD: 11.4. Ncon=63 (57.4% M), mean age: 45.9 yrs., SD: 12.5.CBAPharmacists and patients met at 6-week intervals for a total of 9 meetings in 12 months. The study pharmacists were trained to detect and teach patients about inhaler technique, adverse drug reactions, adherence, drug interactions, and the need for additional therapy.At 12 months post-intervention, there was no difference in FEV1 or physician rated asthma severity, although patient-rated asthma symptoms were improved in experimental subjects compared to controls. The intervention group had significantly higher overall QOL scores (p=0.02), but there was no difference between the groups in SF-36 mental summary score. 23% of the total population were current smokers and an additional 25% were ex-smokers. No change in smoking rates.164

Note: ED=emergency department; PF=peak flow; QOL=quality of life; CBA=controlled before-after trial.

From: 3, Results

Cover of Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 5: Asthma Care).
Technical Reviews, No. 9.5.
Bravata DM, Sundaram V, Lewis R, et al.

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