JAMA study looks at role of pharmacist in health care

October 01, 2002

Researchers at the Regenstrief Institute, the Indiana University School of Medicine and the Roudebush VA Medical Center studied over a thousand patients to determine whether having a pharmacist work closely with individuals with reactive airway diseases such as asthma improved health outcomes. The results of this study are published in the October 2 issue of the Journal of the American Medical Association. Patients with reactive airway diseases, costly and prevalent conditions, tend to visit the pharmacy with much more frequency than they visit their doctor?s office, and a pharmacist is often the last health professional whom patients see before taking their medication.

The study was conducted at 36 CVS stores in Central Indiana. The researchers divided the stores into three clusters of 12 stores. Stores in each cluster were matched for socioeconomic characteristics.

The first, or pharmaceutical care group of patients, filled its prescriptions 12 CVS stores in Central Indiana where the pharmacists were provided patient-specific clinical data including peak air flow rates, emergency department visits, hospitalization and medication compliance information for each of the patients randomized to the pharmacist intervention group. The pharmacists made no treatment decisions but did try to reinforce compliance with the physician?s prescribed treatment regimen. Patients in this group were taught how to measure their air flow with a simple to use device called a peak flow meter.

Members of the second group enrolled in the study had their prescriptions filled at another 12 CVS stores in Central Indiana. Members of this group, known as the peak flow monitoring group, also were trained to measure their air flow but did not receive any special assistance from the pharmacists filling their prescriptions.

Those in the third group had their prescriptions filled at yet another 12 CVS stores in Central Indiana. These individuals received the usual care given to anyone having a prescription filled at that store.

The researchers found that at the end of one year patients who were monitored by pharmacists had significantly better peak flow rates than the usual care group, but not the peak flow monitoring group.

Asthma patients in the pharmaceutical care group had more breathing-related emergency room or hospital visits than members of other groups. This may be an indication that the pharmacist, using all the information made available to them, advised the patients that they needed urgent medical attention, says study co-author Michael D. Murray, PharmD, MPH, a research scientist at the Regenstrief Institute, professor of pharmacy at Purdue University and adjunct professor of medicine at the IU School of Medicine.

The number of breathing-related emergency department or hospital visits by all patients (asthma and other chronic obstructive pulmonary diseases) in the pharmaceutical care group and the peak flow monitoring control group was twice as high as the number of visits by those in the usual care group. According to Dr. Murray this is presumably because those measuring their air flow knew when they needed assistance while those relying solely on symptoms did not.

Individuals who consented to participate in this study of pharmaceutical care were randomly assigned to one of three groups. Each cluster of pharmacies had similar socioeconomic characteristics. Those patients selected for the study filled at least 70% of their prescriptions at a single pharmacy.

The researchers are also conducting other studies on the role of the pharmacist in providing healthcare. "Pharmacists are trusted by the public, have a wealth of clinical knowledge, and most importantly are the last health professionals with whom a patient talks before taking his or her medication. Pharmacists may be the only persons who know all of the drugs a patient is taking, if that patient is seeing more than one physician. As electronic medical record systems expand, they will hopefully help doctors, pharmacists, and other clinicians to work closer together to help patients,? said William M. Tierney, MD, professor of medicine at the IU School of Medicine and Regenstrief Institute research scientist, the senior author of the JAMA study.
Authors of this new study published in JAMA are Morris Weinberger PhD, Michael D. Murray PharmD, David G. Marrero PhD, Nancy Brewer, Michael Lykens MD, Lisa E. Harris MD, Roopa Seshadri PhD, Helena Caffrey MS, J. Franklin Roesner MD, Faye Smith MS, A. Jeffrey Newell RPh, Joyce C. Collins RPh, Clement J. McDonald MD, and William M. Tierney MD.

The Agency for Healthcare Research and Quality and the Department of Veterans Affairs supported this study.

Indiana University

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