A non-randomised controlled pilot study of clinical pharmacist collaborative intervention for community dwelling patients with COPD

Hunt, V., Anderson, D., Lowrie, R., Montgomery Sardar, C. , Ballantyne, S., Bryson, G., Kyle, J. and Hanlon, P. (2018) A non-randomised controlled pilot study of clinical pharmacist collaborative intervention for community dwelling patients with COPD. npj Primary Care Respiratory Medicine, 28(1), 38. (doi: 10.1038/s41533-018-0105-7) (PMID:30305634) (PMCID:PMC6180130)

Abstract

UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician. Comparator group-patients were drawn from another hospital out-patient clinic. Main outcomes were exacerbations during 4-months of follow-up and respiratory hospitalisations (number and duration) after 1 year. In the intervention group, 86 patients received a median of three home visits; 87 received usual care (UC). At baseline, patients in the intervention group were similar to those in UC in terms of respiratory hospitalisations although slightly younger, more likely to receive specific maintenance antibiotics/Prednisolone and to have had exacerbations. Sixty-two (72.1%) of the intervention group received dose changes; 45 (52.3%) had medicines stopped/started and 21 (24.4%) received an expedited review at the specialist respiratory consultant clinic; 46 (53.5%) were referred to other healthcare services. Over one-third were referred for bone scans and 11% received additional investigations. At follow-up, 54 (63.5%) of intervention group participants had an exacerbation compared with 75 (86.2%) in the UC group (p = 0.001); fewer had respiratory hospitalisations (39 (45.3%) vs. 66 (76.7%); p < 0.001). Hospitalisations were shorter in the intervention group. Pharmacist-consultant care for community dwelling patients with COPD, changed clinical management and improved outcomes. A randomised controlled trial would establish causality.

• Item Type: Articles
• Additional Information: The study was funded from within NHS Greater Glasgow and Clyde Pharmacy and Prescribing Support Unit, Health Services Research Department.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Montgomery Sardar, Dr Colette and Kyle, Dr John and Lowrie, Dr Richard and Hanlon, Dr Peter
• Authors: Hunt, V., Anderson, D., Lowrie, R., Montgomery Sardar, C., Ballantyne, S., Bryson, G., Kyle, J., and Hanlon, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: npj Primary Care Respiratory Medicine
• Publisher: Nature Publishing Group
• ISSN: 2055-1010
• ISSN (Online): 2055-1010
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in npj Primary Care Respiratory Medicine 28(1):38
• Publisher Policy: Reproduced under a Creative Commons License