Pharmacist intervention study, chronic obstructive pulmonary disease, COPD Assessment Test (CAT), primary care
Objective: To describe development and challenges of implementing a pharmacist-led chronic obstructive pulmonary disease (COPD) clinic in the primary care setting.
Methods: Starting in October 2014, patients scoring 10-30 on the COPD Assessment Test (CAT) were assigned to the intervention or control group. Intervention patients met with a pharmacist, who provided medication and lifestyle counseling and therapy recommendations to the patients’ primary provider per protocol. Control patients were encouraged to make an appointment with their primary provider for standard care. Two months following the initial CAT administration, the survey was administered again to both study groups by phone. The primary outcome was a comparison of change in CAT scores from baseline between the groups. Secondary outcomes included an analysis of medications, smoking status, vaccination status, hospital stays, visit attendance, and self-evaluation of disease progression.
Results: Of the 163 patients contacted, 29 were enrolled. Ninety-one percent of the patients screened with the CAT were eligible based on the CAT requirement with an average baseline CAT score of 18.75. The primary outcome, change in follow up CAT scores, were similar for intervention patients (n=18) versus control patients (n=11), +0.8 versus +0.7 respectively. Four of the intervention patients attended their clinic visit resulting in a 22% show rate.
Conclusion: Although our study was underpowered to detect between group differences, the elevated baseline CAT scores support the need for therapy optimization in patients with COPD. Pharmacists are well qualified to meet this need by providing medication counseling, smoking cessation, and therapy management. Additional randomized controlled studies are needed to support improved outcomes for patients with COPD when pharmacists are part of the clinical patient care team.
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