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Physician–Pharmacist Collaborative Management of Asthma in Primary Care

Authors

  • Tyler H. Gums,

    Corresponding author
    1. Department of Pharmacy Practice & Science, University of Iowa College of Pharmacy, Iowa City, Iowa
    2. Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
    • Address for correspondence: Tyler Harris Gums, Family Medicine Research Fellow, College of Pharmacy, University of Iowa, 115 South Grand Avenue, S533 PHAR, Iowa City, IA 52242-1112; e-mail: tyler-gums@uiowa.edu.

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  • Barry L. Carter,

    1. Department of Pharmacy Practice & Science, University of Iowa College of Pharmacy, Iowa City, Iowa
    2. Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
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  • Gary Milavetz,

    1. Department of Pharmacy Practice & Science, University of Iowa College of Pharmacy, Iowa City, Iowa
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  • Lucinda Buys,

    1. Department of Pharmacy Practice & Science, University of Iowa College of Pharmacy, Iowa City, Iowa
    2. Siouxland Medical Education Foundation, Inc., Sioux City, Iowa
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  • Kurt Rosenkrans,

    1. Family Health Care of Siouxland, Inc., Sioux City, Iowa
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  • Liz Uribe,

    1. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
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  • Christopher Coffey,

    1. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
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  • Eric J. MacLaughlin,

    1. Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, Texas
    2. Department of Family and Community Medicine, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas
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  • Rodney B. Young,

    1. Department of Family and Community Medicine, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas
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  • Adrienne Z. Ables,

    1. Edward Via College of Osteopathic Medicine-Carolinas Campus, Spartanburg, South Carolina
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  • Nima Patel-Shori,

    1. Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania
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  • Angela Wisniewski

    1. Department of Family Medicine, University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
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  • Supported by National Heart, Lung, and Blood Institute grants RO1HL091841 and RO1HL091843.
  • Poster at the American Society of Health-System Pharmacists ASHP Midyear Conference. Orlando, Florida. Poster Number: 5-228. December 10, 2013. Poster at the University of Iowa Health Science Research Week. Iowa City, Iowa. Poster Number 123. April 23, 2014.

Abstract

Objective

To determine if asthma control improves in patients who receive physician–pharmacist collaborative management (PPCM) during visits to primary care medical offices.

Design

Prospective pre–post study of patients who received the intervention in primary care offices for 9 months. The primary outcome was the sum of asthma-related emergency department (ED) visits and hospitalizations at 9 months before, 9 months during, and 9 months after the intervention. Events were analyzed using linear mixed-effects regression. Secondary analysis was conducted for patients with uncontrolled asthma (Asthma Control Test [ACT] less than 20). Additional secondary outcomes included the ACT, the Asthma Quality of Life Questionnaire by Marks (AQLQ-M) scores, and medication changes.

Intervention

Pharmacists provided patients with an asthma self-management plan and education and made pharmacotherapy recommendations to physicians when appropriate.

Results

Of 126 patients, the number of emergency department (ED) visits and/or hospitalizations decreased 30% during the intervention (p=0.052) and then returned to preenrollment levels after the intervention was discontinued (p=0.83). Secondary analysis of patients with uncontrolled asthma at baseline (ACT less than 20), showed 37 ED visits and hospitalizations before the intervention, 21 during the intervention, and 33 after the intervention was discontinued (p=0.019). ACT and AQLQ-M scores improved during the intervention (ACT mean absolute increase of 2.11, AQLQ-M mean absolute decrease of 4.86, p<0.0001) and sustained a stable effect after discontinuation of the intervention. Inhaled corticosteroid use increased during the intervention (p=0.024).

Conclusions

The PPCM care model reduced asthma-related ED visits and hospitalizations and improved asthma control and quality of life. However, the primary outcome was not statistically significant for all patients. There was a significant reduction in ED visits and hospitalizations during the intervention for patients with uncontrolled asthma at baseline. Our findings support the need for further studies to investigate asthma outcomes achievable with the PPCM model.

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