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Improving pediatric asthma outcomes in the community setting: does pharmaceutical care make a difference?
Andy Stergachis1, Jacqueline S Gardner, Mary T Anderson
1Department of Pharmacy, University of Washington, Seattle 98105, USA. andy@formularyresources.com
Insights
A structured pharmaceutical care program did not improve asthma control or health outcomes in pediatric patients. Pharmacist intervention showed no significant benefits in disease control, functional status, or healthcare utilization.
Area of Science:
- Clinical Pharmacy
- Pediatric Pulmonology
- Health Services Research
Background:
- Asthma is a chronic respiratory disease affecting millions of children and adolescents.
- Effective disease management is crucial for improving quality of life and reducing healthcare costs.
- Pharmaceutical care interventions aim to optimize medication use and patient outcomes.
Purpose of the Study:
- To evaluate the impact of a structured pharmaceutical care program on pediatric asthma patients.
- To assess changes in disease control, functional status, and healthcare utilization.
- To determine the effectiveness of pharmacist-led asthma management in community settings.
Main Methods:
- Randomized controlled trial involving 330 children (6-17 years) with moderate-to-severe asthma.
- Intervention group received structured pharmaceutical care from trained pharmacists for up to 1 year.
- Primary outcomes included pulmonary function (peak expiratory flow rate, spirometry); secondary outcomes were functional status and healthcare service use.
Main Results:
- The pharmaceutical care intervention demonstrated no significant improvement in pulmonary function, functional status, or quality of life.
- No differences were observed in asthma management, patient satisfaction, or use of anti-inflammatory medications.
- Healthcare utilization, including medical visits and school days missed, did not differ between intervention and usual care groups.
Conclusions:
- A structured pharmaceutical care program did not significantly impact health or healthcare use outcomes in pediatric asthma patients.
- The intervention's limited effect may be due to insufficient impact on pharmacist behavior or low compliance.
- Patient and practice-related obstacles may have hindered the intervention's success in community pharmacy settings.
Objective:
To assess the effect of a structured program of pharmaceutical care on changes in disease control, functional status, and health services utilization for pediatric and adolescent patients with moderate-to-severe asthma.
Design:
Randomized, controlled trial.
Setting:
Community and clinic pharmacies (14 intervention and 18 usual care pharmacies) in western Washington State.
Patients:
Three hundred thirty children, aged 6 to 17 years, with asthma.
Intervention:
Structured training for the intervention group pharmacists to provide individualized asthma management services during patient-pharmacist encounters for up to 1 year following the patient's enrollment into the study.
Main Outcome Measures:
The primary outcome measure was change in pulmonary function as measured by peak expiratory flow rate and spirometry. Secondary outcome measures included changes in functional status and use of asthma-related health care services.
Results:
The intervention had no significant effect on the health or health services use outcomes of study subjects. When compared with the usual care group, there was no evidence that patients from the intervention group experienced improvements in pulmonary function, functional status, quality of life, asthma management, or satisfaction with care. In addition, there were no differences between groups in use of anti-inflammatory medications, total or asthma-related medical care utilization, or total or asthma-related school days lost.
Conclusion:
This pharmaceutical care intervention had no significant effect on the health or health services use outcomes of pediatric patients with asthma. The intervention may not have been powerful enough to significantly affect pharmacists' behaviors and asthma patients' outcomes in community pharmacy settings, and there is evidence that the pharmacists' compliance with the study protocol was low due, in part, to patient- and practice-related obstacles.