Asthma management remains a significant public health challenge, despite national guidelines and disease management strategies. Community pharmacists are uniquely positioned to play a crucial role in improving asthma care delivery and ensuring adherence to best practice standards. The Pharmacy Asthma Care Program (PACP) is an innovative approach designed to optimize asthma control through community pharmacies. A comprehensive study investigated the effectiveness of PACP in enhancing asthma management outcomes.
This multi-site, randomized controlled study evaluated the impact of PACP on asthma control. Fifty pharmacies across Australia were randomly assigned to either the intervention or control group. In the intervention group, pharmacists implemented PACP with 191 patients over a six-month period. PACP involves a structured cycle of patient assessment, collaborative goal setting, consistent monitoring, and regular review of asthma management plans. The control group, consisting of 205 patients, received their usual standard of pharmacy care. Both groups underwent assessments at the beginning of the study and after six months, including questionnaires and spirometry tests, to measure changes in asthma severity and control.
The results of the study demonstrated a clear benefit of the Pharmacy Asthma Care Program. A significant improvement in asthma control was observed in the intervention group. Patients in the PACP group were 2.7 times more likely to experience an improvement from a “severe” asthma status to a “not severe” status compared to patients receiving usual care (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). This substantial improvement highlights the effectiveness of pharmacist-led interventions in managing severe asthma cases.
Beyond overall asthma control, the PACP intervention led to several other positive outcomes. Patient adherence to preventative asthma medication significantly improved in the intervention group (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03). Improved adherence to preventer medication is crucial for long-term asthma management and reducing exacerbations. Furthermore, patients in the PACP group experienced a decrease in their average daily use of reliever medication (difference -149.11 microg, 95% CI -283.87 to -14.36; p=0.03). Reduced reliance on reliever medication suggests better underlying asthma control.
The study also revealed a positive shift in patients’ medication profiles. The intervention group showed a significant change from using reliever medication alone to a combination therapy approach, including preventer medication, with or without long-acting beta-agonists (OR 3.80, 95% CI 1.40 to 10.32; p=0.01). This shift towards guideline-recommended combination therapy is indicative of improved asthma management strategies being implemented through PACP. In addition, the PACP intervention resulted in improved patient-reported outcomes. Scores related to the risk of non-adherence (difference -0.44, 95% CI -0.69 to -0.18; p=0.04), quality of life (difference -0.23, 95% CI -0.46 to 0.00; p=0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01), and perceived control of asthma (difference -1.39, 95% CI -2.44 to -0.35; p<0.01) all showed significant improvement in the intervention group. These findings underscore the holistic benefits of PACP, extending beyond clinical measures to enhance patients’ understanding and perception of their asthma management. Interestingly, spirometry measurements did not show significant changes in either group, suggesting that the improvements were more related to symptom control and medication management rather than lung function itself over the study period.
In conclusion, this study provides compelling evidence for the effectiveness of pharmacist-delivered asthma care programs, specifically PACP, in improving asthma control and related patient outcomes. The implementation of PACP, grounded in national asthma guidelines, leads to significant enhancements in asthma management. Further research is needed to investigate the long-term sustainability and broader implementation of PACP within diverse healthcare systems to maximize its impact on public health.
