Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider

The relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention

RATIONALE, AIMS AND OBJECTIVES

This study aimed to investigate the relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention using structural equation modelling (SEM). SEM is a group of statistical techniques used in different disciplines to model latent variables and evaluate theories.

METHODS

A validated questionnaire was used to gather patient views on a pharmacist-led intervention. A conceptual model was developed to test the statistical significance of the relationship between patient understanding and satisfaction, the pharmacist's role and patient understanding, the pharmacist's role and patient satisfaction. In addition, the study evaluated the model's in-sample and out-of-sample predictive power. The analysis tested fours hypotheses (H): 1) There was no significant relationship between patient understanding and patient satisfaction; 2) There was no significant relationship between the pharmacist's role and patient understanding; 3) There was no significant relationship between the pharmacist's role and patient satisfaction; 4) The in-sample and out-of-sample predictive power of the model. Data were analysed using Smart-PLS software version 3.2.8.

RESULTS

Two hundred and forty-six patients returned the questionnaire. Construct reliability, validity (Cronbach's alpha〉0.70, ⍴A>0.70, ⍴C>0.70), average extracted variance (AVE〉0.50) and discriminant validity (HTMT<0.85) were confirmed. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. Path coefficients and effect sizes suggested that the pharmacist's role played a significant part in patient understanding (H2, β=0.650, f² =0.730, p<0.001), which then influenced patient satisfaction (H1, β=0.474, f² =0.222, p<0.001). The in-sample and out-of-sample predictive powers were moderate.

CONCLUSIONS

Patient satisfaction is becoming an integral component in healthcare provision and evaluation of healthcare quality. The results support using structural equation modelling to assess the link between the pharmacist's role and patient understanding and satisfaction when delivering cost-effective pharmacist-led interventions.

Response to Omalizumab as an Add-On Therapy in the Treatment of Allergic Asthma in Adult Chinese Patients-A Retrospective Study

(a) Background: Omalizumab is an anti-IgE humanized monoclonal antibody marketed in China for the conventional treatment of poorly controlled moderate-to-severe allergic asthma. Numerous clinical trials have demonstrated the effectiveness of omalizumab, but the data from studies in actual clinical treatment are still relatively limited. (b) Methods: Thirty-two patients with moderate-to-severe allergic asthma treated with omalizumab on the basis of ICS-LABA (inhaled corticosteroids/long-acting beta2-agonist) were selected. Clinical characteristics before and after treatment were collected to analyze the relationship between changes in serum total IgE levels and peripheral blood EOS (eosinophil) levels, FEV1 (forced expiratory volume in 1 second), PEF (peak expiratory flow), OCS (oral glucocorticoid) dosage, ATC (asthma control test) score, and the number of acute exacerbations and the treatment response, in order to observe the efficacy of omalizumab in addition to primary therapy, and to investigate whether baseline clinical characteristics such as serum total IgE and EOS levels could predict a treatment response. (c) Results: Using the ACT score as an evaluation, 68.75% of patients benefited from omalizumab treatment at the end of 16 weeks. The response group has a reduction in OCS dosage (p-values of 0.026 and 0.039), a significant reduction in ACT scores (both p < 0.001), and a reduction in the number of acute exacerbations (p = 0.034 and 0.025, respectively) after omalizumab treatment. The binary logistics analysis of factors affecting the effectiveness of omalizumab in the treatment of allergic asthma were total serum IgE and the presence of comorbidities (p-values of 0.039 and 0.046, respectively). (d) Conclusions: Combining omalizumab with ICS-LABA for 16 weeks significantly improves asthma symptoms in Chinese adults and can be used as an add-on treatment. In addition, high serum IgE levels and the presence of comorbidities were predictors of its therapeutic efficacy.

A retrospective evaluation of the effectiveness of a targeted medicines use review service in improving asthma and COPD control provided by community pharmacists in England

Objective

Medicines Use Reviews (MUR) may benefit asthma and chronic obstructive pulmonary disease (COPD) control. The present study evaluates the effect of respiratory-targeted MUR-plus (MUR+) services delivered by community pharmacists on disease control.

Methods

A retrospective analysis of MUR+ data in the PharmOutcomes database was conducted. All patients receiving respiratory-targeted MUR+ in Milton Keynes were included. Changes in asthma control test (ACT) and COPD assessment test (CAT) scores were analysed.

Key findings

A total of 191 asthma and 81 COPD patients received MUR+. Asthma and COPD control improved as shown by the increase in mean ACT [+1.2 (95% CI, 0.6–1.8)] and decrease in mean CAT [−0.2 (95% CI, −1.4 to 1.0)]. Baseline ACT, smoking cessation, absence of change in drug therapy, patient education, healthcare professional referral, device training and baseline ACT score ≤19 were associated with change in ACT, but only smoking cessation was related to CAT change. A multivariable regression model comprising the aforementioned variables explained 19% of the variance in ACT change (P &lt; 0.001). Only baseline ACT was associated with ACT change (beta = −0.34, P &lt; 0.01). Baseline CAT, absence of change in drug therapy, smoking cessation and baseline CAT score &gt;20 accounted for 12% of the variance in changes in CAT (P = 0.046). No variable was significantly associated with CAT change.

Conclusions

Respiratory-targeted MUR+ service by community pharmacists was associated with improvements in asthma control among patients with poorer baseline ACT, but not in patients with COPD. Several potentially modifiable factors such as education were associated with changes in control.

Economic evaluation of home medication review by community pharmacists (HMR-CP) for patients with type 2 diabetes mellitus (T2DM)

OBJECTIVE

Home medication review (HMR) programs could minimise patients' health-related costs and burdens, thereby enhancing the quality of life and well-being. The aim of this economic evaluation is to determine if home medication review by community pharmacists (HMR-CP) for patients with type 2 diabetes mellitus (T2DM) is a cost-effective intervention from the Malaysian healthcare provider perspective.

METHODS

The economic evaluation was conducted alongside the randomised controlled trial (RCT) to estimate the intermediate cost-effectiveness of HMR-CP for patients with T2DM. A Markov model was then constructed to project the lifetime cost-effectiveness data beyond the RCT. The primary outcomes for the economic evaluation were HbA_1c and quality-adjusted life-years (QALYs).

RESULTS

The intervention and health services costs throughout the 6-month HMR-CP trial were RM121.45 (USD28.64) [95%CI: RM115.89 to 127.08 (USD27.33-29.97)] per participant. At a 6-month follow-up, a significant reduction in HbA_1c of 0.902% (95% CI: 0.388% to 1.412%) was noted in the HMR-CP group compared to the control group. The ICER of HMR-CP intervention versus standard care was RM178.82 (USD 42.17) [95%CI: RM86.77-364.03 (USD20.46-85.86)] per reduction of HbA_1c. HMR-CP intervention [RM12,764.82 (USD3010.57)] was associated with an incremental cost of RM83.34 (USD19.66) over control group [RM12,682.95 (USD2,991.26)] with an additional of 0.07 QALY gained. The ICER associated with HMR-CP intervention was RM1,190.57 (USD280.79) per QALY gained, which was below the ICER threshold in Malaysia, indicating that HMR-CP was a cost-effective option.

CONCLUSION

HMR-CP was a cost-effective intervention that had significantly reduced the HbA_1c among the T2DM patients, although associated with higher mean total costs per participant.