Assessment of pharmaceutical care outcomes on the patients with chronic obstructive pulmonary disease attending community hospital in Thailand
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Abstract
Background : Chronic obstructive pulmonary disease (COPD) is health problem that increase in prevalence. As COPD is not fully reversible airway obstructive disease, the multidisciplinary team intervene follow GOLD guideline to achieve clinical outcome. Paknum-Chumphon hospital initiated an ambulatory COPD clinic run by physicians, pharmacists and nurses. Its pharmaceutical care impacts remained unassessed. Objective: This study aimed to evaluate the impacts of pharmaceutical care on patients’ medication outcomes (inhaler techniques scores and drug related problems, DRPs) and clinical outcomes (PEFR, FEV1, COPD Assessment Test (CAT) scores and dyspnea scores). Subjects and Methods: The pretest-posttest one-group study was carried out in outpatients of Paknum-Chumphon Hospital from October 1, 2010 to December 31, 2011. Adult patients diagnosed with definite COPD were included in the study and those attending the COPD clinic less than six months afterwards were excluded. All patients were assessed by two pharmacists and nurses for medication and clinical outcomes before receiving pharmacists' interventions that embraced advice on COPD, medicine, inhaler techniques and lifestyle modification. At 6 months they were reassessed for the same COPD outcomes. Relevant data were gathered and analyzed using a paired t-test and χ2 test with the significance level determined at α= 0.05. Results: A total of 80 patients were assessed and 12 were excluded. The majority of patients were male (67.5%) with the mean age of 65.2 years (SD=13.3). The average COPD duration was 6.3 years (SD=2.8). After the counseling interventions, patients' inhaler technique scores significantly increased from 83.0% to 93.4% (p=0.001). A significant reduction in the number of DRPs was detected after the interventions (p=0.001). Most DRPs before the interventions were ‘improper drug selection’ (37.1%), but after that were ‘failure to receive drugs’ (8.1%). Patients’ PEFR (55.8% vs 61.9%, p=0.001) and CAT scores (23.2 vs 15.9, p=0.001) were significantly improved. An insignificant improvement were found in FEV1 (60.4% vs 67.4%), targeted dyspnea score 0-1 (83.8% vs 95.0%) and combined assessment of COPD type A and B (52.5% vs 58.8%). Conclusions: Pharmaceutical care provided by pharmacist in the multidisciplinary COPD team for COPD patients could improve patients’ inhaler techniques, reduce drug-related problems and enable them to achieve the desired therapeutic outcomes of COPD management.
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References
Beauchesne M-F, Bercier D, Baker FJ, et al. Community pharmacy-based medication assessment program for asthma and chronic obstructive pulmonary disease. Can Pharmaceut J 2012; 154, 2: 70-71.
Bereznicki BJ. Improving the management of asthma and chronic obstructive pulmonary disease. Available at http://eprints.utas.edu.au/12415/ Accessed April 05, 2012.
Boonsawat Wachara. Chronic obstructive pulmonary disease. In Sunee Lerdsinudom, editor. Pharmaceutical Care in Asthma, Allergic Rhinitis and COPD. Bangkok: Klungnan¬awidhaya; 2010; 118-126.
Celli BR, Thomas NE, Andreson JA, et al. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease Result from the TORCH study. Am J Respir Crit Care Med 2008; vol 178: 332-338.
COPD Assessment Test (CAT). Available at http://www.catestonline.org/english/index_Thai. htm. Accessed April 05 , 2012.
Doherty D, Belfer MH, Brunton SA, et al. Chronic obstructive pulmonary disease concensus recommendation for early diagnosis and treatment. Journal of Family Practice 2006; Nov: S1-S8.
Escamilla R and Julia B. Role of community phar¬macists in chronic obstructive pulmonary disease management (COPD). J Pharm Clin 2012; vol 31, No 1, March: 51-60.
Foster JA, Yawn BP, Mazier A, et al. Enhancing COPD management in primary care set¬tings. MedGenMed 2007; 9(3): 24.
George J, Kong DCM, Thoman R, et al. Factors associated with medication nonadherence in patient with COPD. Chest 2005; 128(5): 3198-3204.
Glaab T, Vogelmeier C and Buhl R. Outcome measure in chronic obstructive pulmonary disease (COPD): strengths and limitations. Respiratory Research 2010; 11:79.
Global Initiative for Chronic Obstructive Lung Disease pocket guide to COPD diagnosis, management, and Prevention Revision 2011. Available at http://www.goldcopd.org/guideline. Accessed April 05 , 2012.
Gourley GA, Portner TS, Gourley DR, et al. Hu¬manistic outcomes in the hypertension and COPD arms of multicenter outcomes study. APhA /JAPhA (Washington D.C.:1996) 1998; 38(5): 586-97.
Hammerlein A, Muller U and Schulz M. Pharmacist-led intervention study to improve inhalation technique in asthma and COPD. J Eval Clin Pract 2011; Feb, 17(1): 61-70.
Jarab AS, AlQudah SG, Khdour M, et al. Impact of pharmaceutical care on health outcomes in patient with COPD. Int J Clin Pharm 2012; vol 34, number 1, Feb, 53-62.
Jones P, Harding G, Wiklund I, et al. Improving the process and outcome of care in COPD: development of a standardized assess¬ment tool. Prim Care Respir J 2009; 18(3): 208-215.
Jones P. St.George’s university of London. St.George’s respiratory questionnaire for COPD patient (SGRQ-C) Manual. Available at http://www.ncbi.nlm.nih.gov/pubmed Accessed April 05 , 2012.
Jones R and Ostrem A. Optimising pharmacological maintenance treatment for COPD in primary care. Primary Care Respiratory Journal 2011; 20(1): 33-45.
McGivney MS, Meyer SM, Duncan-Hewitt W, et al. Medication therapy management: Its relationship to patient counseling, disease management, and pharmaceutical care. JAPhA 2007; vol 47, number 5/ September- October: 620-628.
Mehuys E, Boussery K, Adriaens E, et al. COPD management in primary care: an observa¬tional, community pharmacist-based study. Ann Pharmacother 2010; 44(2): 257-266.
Mohangoo AD, Van der Linden MW, Schellevis FG, et al. Prevalence estimates of asthma or COPD from a health interview survey and from general practitioner registration: what is difference? Eur J Public Health 2005; vol 16, number 1: 101-105.
Molen TV, Clinical COPD Questionare. Available at http://www.ccq.nl Accessed April 06 , 2012.
Mortaz E, Masjedi MR and Rahman I. Outcome of smoking cessation on airway remodeling and pulmonary inflammation in COPD pa¬tients. Tanaffos 2011; 10(3): 7-11.
National Heart, Lung and Blood Institute World Health Organization. Global initiative for chronic obstructive lung disease revised 2011. National Heart, Lung and Blood Institute, 2011.
Pauwels RA, Lofdahl C-G, Laitinen LA, et al. Long termtreatment with budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999; June 24: 1948-1953.
Rukwanawong Achara. Drug related problem and outcome of problem solving in COPD out patient Nakornping hospital. Available at http://eoffice.pharmacy.cmu.ac.th/mis/stu¬dent Accessed April 05 ,
Stallberg B, Nokela M, Ehrs P-O, et al. Validation of the clinical COPD questionnaire (CCQ) in primary care. HQLO 2009; 7:26.
Tietze KJ. and Dlugosz C.K. COPD 2009: An update for pharmacist. Pharmacy today 2009 ; Nov : 50-60.
Valro C, Monteagudo M, Llagostera M, et al. Evaluation of a combined strategy directed towards health-care professionals and pa¬tients with chronic obstructive pulmonary disease (COPD): Information and health education feedback for improving clinical mornitoring and quality-of-life. Public Health 2009;9:442.
Vesbo J, Anderson W, Coxson HO, et al. Evaluation of COPD longitudinally to identify predictive surrogate end-points (ECLIPSE). Eur Respir J 2008; 31: 869-873.
Wan CT., FCCP; and Tze PN . CPD in Asia where east meets west. Chest 2008;133/2/517- 527.
Weinberger M, Murray MD, Marrero DG, et al. JAMA 2002; October 2, vol 288, No.13(Reprinted): 1594-1602.
Westwood M, Bourbeau J, Jones PW, et al. Re¬lationship between FEV1 change and patient-reported outcomes in randomized trials of inhaled bronchodilators for COPD: a systematic review. Respiratory Research 2011; 12:40.
World Health Organization. Chronic obstructive pulmonary disease (COPD), Fact sheet N°315, November 2011. Available at http://www.who.int/mediacentre/factsheets Ac¬cessed April 05 , 2012.