Clinical pharmacy-led disease and medicine management programme for patients with COPD
Clinical pharmacy-led disease and medicine management programme for patients with COPD
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DOI：
10.1111/j.1365-2125.2009.03493.x
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发表时间：
2009-10-01
影响因子：
3.4
通讯作者：
McElnay, James C.
中科院分区：
文献类型：
--
作者：
Khdour, Maher R.;Kidney, Joseph C.;McElnay, James C.
center dot The concept of self-management plans for patients with chronic obstructive pulmonary disease (COPD) is derived from their success in asthma management.center dot 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.center dot There is little published information on clinical pharmacist-led disease and patient self-management in the area of COPD care.WHAT THIS STUDY ADDScenter dot 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).center dot The intervention programme was tailored and individualized based on a preliminary assessment of individual patient needs.center dot Education about self-management in COPD patients should be explicit, tailored to individual needs, and on a continuous basis.AIMThe 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).METHODSOne 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.RESULTSOver 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.CONCLUSIONSThe clinical pharmacy-led management programme can improve adherence, reduce the need for hospital care in patients with COPD and improve aspects of their HRQoL.
