Clinical pharmacy‐led disease and medicine management programme for patients with COPD

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The concept of self‐management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management. • It is believed that selected people with COPD may benefit from the early intervention that comes from following self‐management plans, which may prevent a crisis and possibly the need for hospital admission. • There is little published information on clinical pharmacist‐led disease and patient self‐management in the area of COPD care. WHAT THIS STUDY ADDS • A structured education programme led by a clinical pharmacist for patients with COPD was associated with a reduction in both hospitalization and emergency department visits and an improvement in patients' adherence to treatment regimens and health‐related quality of life (excluding physical activity). • The intervention programme was tailored and individualized based on a preliminary assessment of individual patient needs. • Education about self‐management in COPD patients should be explicit, tailored to individual needs, and on a continuous basis. AIM The aim was to investigate the impact of a disease and medicine management programme, focusing on self‐management in patients with chronic obstructive pulmonary disease (COPD). METHODS One hundred and seventy‐three patients (mean age 67 years; 54% female) were recruited; 86 patients were randomly assigned to an intervention group and 87 to a usual care (control) group. Intervention patients received education on disease state, medications and breathing techniques. Patients were given booklets and a customized action plan (antibiotic and oral steroid to be initiated promptly by patients for exacerbations). Patients were followed up at 6 and 12 months during a scheduled visit. The St George's Respiratory Questionnaire (SGRQ), COPD Knowledge and Morisky adherence questionnaires were administered to all patients at baseline, 6 and 12 months. Outcome measures included hospital admissions, emergency department (ED) visits, health‐related quality of life (HRQoL) and medication adherence. RESULTS Over the 12‐month period in the intervention group, ED visits decreased by 50% (P= 0.02) and hospitalization by approximately 60% (P= 0.01). On the SGRQ, differences reached statistical significance on the symptom (−7.5; P= 0.04) and impact (−7.4; P= 0.03) subscales but not on the physical activity subscale. There was a significant difference between the intervention and usual care groups regarding knowledge scores (75.0 vs. 59.3; P= 0.001) and good adherence to medication (77.8% vs. 60.0%, P= 0.019). There was no significant difference regarding smoking between study groups. CONCLUSIONS The clinical pharmacy‐led management programme can improve adherence, reduce the need for hospital care in patients with COPD and improve aspects of their HRQoL.

Effect of Implementing an Educational Module About Inhaler Use on Severity of Dyspnea and Adherence to Inhalation Therapy Among Patients with Chronic Obstructive Pulmonary Disease

“…In the current study, it was noticed that the total knowledge score of study group was improved than control group post education by two weeks and one month. The result is in line with Khdour et al, (2009) and Jarab et al, (2012) who reported that the study group showed improvement of COPD knowledge when compared with control group [39,40]. Also El-Sayed et al, (2012) found a statistical improvement of total knowledge score among study group than control group post education [41].…”

Unravelling self-management for COPD

“…Two studies which have incorporated motivational interviewing into self-management interventions have both shown successful improvements in quality of life at 12 months. 10,12 The study by Khdour and colleagues 10 is of particular interest because it also demonstrated reduced health care utilisation, despite the intervention only requiring 1 h of supervision. The incorporation of psychological techniques into self-management programmes is certainly an area for further attention.…”

“…However, we have seen that some programmes with only minimal supervision have had significant impact on health care utilisation and health status. 10 Another consideration is that some of the extended programmes branded as 'self-management' actually exceed the level of support that many comprehensive pulmonary rehabilitation programmes offer. The COPE studies 7,9 provided individuals with up to twice weekly supervised exercise for up to a year, which surpasses the 6-8 weeks provided by many rehabilitation courses reported in the literature.…”

Safe and Effective Use of Medicines for Ethnic Minorities - A Pharmacist- Delivered Counseling Program That Improves Adherence

“…This may reflect a lower baseline concordance in the ethnic minority target group compared to patients with type 2 diabetes. Concordance is known to be a determinant of adherence, meaning that patient-provider communication has an effect on medication adherence, such that provider communication rated as more collaborative is associated with better medication adherence [31][32][33]. The improvements assessed by patients, pharmacists and social workers show the same tendencies for improvement in knowledge, adherence, confidence in medication taking and the ability to use the medicines correctly.…”