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Pharmacist care and telephone peak flow monitoring can improve peak flow rates among patients with asthma and COPD

People who have asthma or chronic obstructive pulmonary disease (COPD) can prevent breathing crises by appropriate drug therapy. However, patients often find it difficult to follow prescribed drug regimens. A pharmacist care program in which the pharmacist monitors symptoms, provides medication counseling, helps resolve drug-related problems, and facilitates communication with the patient's doctors, may be able to enhance patients' adherence to therapy and outcomes.

A new study found that compared with usual care, pharmaceutical care significantly increased patients' peak expiratory flow rates (PEFRs), an indicator of breathing capacity, but such care provided little benefit over monthly calls for peak flow monitoring alone. However, implementation of the pharmacy care program was poor, perhaps due to pharmacists' limited time or lack of incentives. Pharmacists viewed patients' filled prescriptions by computer only half the time and documented their actions only 50 percent of the time they viewed those data, notes Morris Weinberger, Ph.D., of Indiana University.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09083), Dr. Weinberger and his colleagues provided participating pharmacists with weekly faxed reports of recent clinical data on 447 patients (PEFRs, emergency department visits, hospitalizations, and medication compliance), training, customized patient educational materials, and other resources. The PEFR monitoring control group (363 patients) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs; but PEFR data were not provided to the pharmacists. The 303 patients in the usual care group received neither peak flow meters nor instructions in their use, and were not asked about PEFR rates. At 12 months, pharmaceutical care patients had significantly higher peak flow rates than the usual care group but not higher than PEFR monitoring controls. There were no significant between-group differences in medication compliance or health-related quality of life.

See "Effectiveness of pharmacist care for patients with reactive airways disease," by Dr. Weinberger, Michael D. Murray, Pharm.D., David G. Marrero, Ph.D., and others, in the October 2, 2002, Journal of the American Medical Association 288(13), pp. 1594-1602.

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