Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
International Programs: Canada (cont’d)
The British Columbia Pharmacy Asthma Study
Pharmaceutical Outcomes Research Unit, Ottawa Hospital
K1H 8L6 Canada
William McLean, PharmD
The British Columbia Community Pharmacy Asthma Study examined the failures and recommendations of past studies and introduced a new milieu for asthma care - the community pharmacy. The study incorporated a care protocol with the important ingredients of asthma education on medications, triggers, self-monitoring and an asthma action plan. Emphasis was put on pharmacies taking responsibility for outcomes, assessment of patients' readiness to change and tailoring education to that readiness, compliance monitoring and physician consultation to achieve asthma prescribing guidelines.
Thirty-three pharmacists in British Columbia, specially trained and certified in asthma care, agreed to participate in a study in which experienced pharmacists would have asthma patients (7-65 years old) allocated to enhanced (pharmaceutical) care (EC) or usual care (UC). Six hundred thirty-one patients provided consent, of which 225 in EC or UC were analyzed for all outcomes. Patients were followed for one year.
Before the intervention began the pharmacist assessed the participants' readiness to change following the Stages of Change theory. Participants in the EC group received instruction from a pharmacist on basic concepts of asthma, medications, trigger identification and avoidance, development of an asthma action plan, and use of a peak flow meter. Participants met with the pharmacist at the community pharmacy in a private counseling area for one-hour every two to three weeks for at least three appointments, and then followed-up at least every three months for one year.
The EC group had a significant impact (significant between group differences) on the following health outcomes: peak expiratory flow rate, symptoms, beta-agonist utilization, quality of life, and unscheduled (sick) office and emergency room visits. The EC group also had a positive impact on knowledge scores. EC group also had less than half the direct health care costs of the UC group.
Specially trained community pharmacists in Canada, using a pharmaceutical care-based protocol, can produce impressive improvements in clinical, economic and humanistic outcome measures in patients with asthma.
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