Pharmacist Involvement in Improving Asthma Outcomes in Various Healthcare Settings: 1997 to Present

Abstract

OBJECTIVE To evaluate pharmacists’ impact on asthma management outcomes in various healthcare settings on the basis of updated guidelines set by the National Heart, Lung, and Blood Institute (NHLBI). DATA SOURCES A search of MEDLINE (1997–April 2008) and International Pharmaceutical Abstracts (1997–April 2008) was conducted using the MeSH terms asthma, community pharmacy services, pharmacists, pharmacies, clinic, hospital, disease state management, medication therapy management, emergency department, and community. STUDY SELECTION AND DATA EXTRACTION Articles were included if pharmacists participated in the intervention and the report measured outcomes of asthma as defined by symptoms, pulmonary function, asthma severity, quality of life (QOL), or healthcare utilization. DATA SYNTHESIS Since January 1997, a substantial number of studies have been published examining pharmacists’ impact on asthma clinical outcomes. Twenty-five studies were included in this review: 15 were conducted in community pharmacies, 5 in ambulatory clinics, 2 in an in-patient hospital setting, and 3 as various community initiatives. The studies varied in the type of intervention provided and outcomes measured. The most common outcome in community pharmacies was pulmonary function measures, in which all but one trial found improvements. Half of the community pharmacy trials found improvements in asthma severity, 75% found improvements in healthcare utilization, and although some trials found improvements in QOL, 2 trials found decreases in QOL. Ambulatory clinics reported improvements in asthma symptoms and pulmonary function and decreased healthcare utilization. Most trials in the ambulatory care setting reported decreases in QOL postintervention. Trials in the hospital setting most often reported decreases in healthcare utilization. Limitations of the studies, however, included varying definitions of asthma control, methodologies used in the studies, and the lack of long-term follow-up. CONCLUSIONS Future study designs may require larger sample size and measure outcomes that better assess disease severity in asthma, such as impairment and risk domains. This review supports the National Heart, Lung, and Blood Institutes of the National Institutes of Health Expert Panel Report 3 guidelines in recognizing pharmacists as accessible healthcare practitioners who, via patient education and medication management, may help patients with asthma attain better control of their disease state.