Effects of a pharmacist-initiated outreach program on controller medication use and asthma control in non-adherent asthmatics

Purpose: To evaluate the impact of a new program in which primary care clinical pharmacists (PCCPs) in an ambulatory care setting outreached to patients with persistent asthma.

Methods: This retrospective chart review included non-COPD patients aged five to sixty-five with a diagnosis of persistent asthma who received PCCP outreach between September 12^th, 2011 and January 31^st, 2012. Inclusion criteria consisted of overutilization of albuterol; lack of/non-adherence to an inhaled corticosteroid (ICS); same-day/ER visit for asthma exacerbation in the past three months; or oral corticosteroid (OCS) prescription for asthma exacerbation filled in the past three months. To determine the outreach program’s effectiveness, medication refills for albuterol and ICS three months before and after outreach were evaluated. Improvement in asthma control was assessed by comparing quantity of OCS prescriptions utilized for acute asthma exacerbation three months before and after outreach and change in Asthma Control Test (ACT) scores between initial outreach and follow-up approximately one month later.

Results: 266 patient charts were evaluated, of which 106 patients received PCCP outreach. Of these, 78 met inclusion criteria. Ninety days following outreach, 46% (36/78) had filled an ICS. 32% (25/78) filled an ICS who had not filled one in the last ninety days. The average ICS day supply per patient ninety days before and after outreach increased significantly from 12.69 days to 39.71 days (p<0.0001). The number of albuterol canisters per patient ninety days before and after outreach also increased significantly from 1.37 canisters to 1.88 canisters (p=0.0141). The average ACT score increased significantly from 15.6981 to 19.4906 (p<0.0001). The percentage of patients with controlled asthma (ACT score ≥20) increased significantly from 21.67% to 68.3% (p<0.0001).

Conclusion: Clinical pharmacist outreach not only improved ICS adherence but also led to clinically significant increases in ACT scores and the percentage of patients achieving ACT-defined asthma control.