Public Release: 

Surprise: Pharmacists' care program boosted patients' satisfaction, but also hospital, ER visits

University of North Carolina at Chapel Hill

(Embargoed) CHAPEL HILL -- Even well-intentioned programs designed to help pharmacists improve patients' health don't always work as planned, according to a new study in the Journal of the American Medical Association.

The study, published in the Oct. 2 issue, showed that a specially created program for patients with breathing-related illnesses improved their lung function only slightly. On the other hand, the effort resulted in more, not fewer, visits to emergency rooms and hospitals.

Researchers at Indiana University and Veterans Affairs hospitals conducted the research at 36 cooperating CVS community drug stores in Indianapolis.

Lead author Dr. Morris Weinberger, now Vergil N. Slee professor of health policy and administration at the University of North Carolina at Chapel Hill School of Public Health, and colleagues carried out a randomized, controlled trial from July 1998 to December 1999. They enrolled 1,113 people with chronic obstructive pulmonary disease or asthma, divided the drug stores they patronized into three groups and assessed the patients, including their lung function, at six and again at 12 months.

Although the effort significantly boosted how satisfied patients were with their pharmacists, which was good, the modest effect on their medical conditions and quality of life was disappointing, he said.

"What we were trying to do was to figure out a way to involve community pharmacists more actively in patient care, and so in the study we provided pharmacists with patient-specific information," Weinberger said. "We also gave them tools and training on how to use that information to communicate more effectively with patients when they filled prescriptions.

"Basically, we found that pharmacists weren't able to incorporate the program into their regular practices effectively," he said.

Weinberger and his colleagues, including Drs. Michael Murray and William Tierney of the Regenstrief Institute for Health Care and Indiana University School of Medicine, believe they and others need to figure out how to involve pharmacists in patient care more effectively.

"Pharmacists really are in a good position to become more involved since they are such important members of the health-care team," Weinberger said. "The public trusts them, they are usually the last professionals patients see before taking medications, and they may be the only ones who know all the drugs people are taking, especially if they have more than one doctor.

"We need to develop programs that are more pragmatic for community pharmacists," he said. "We are excited that CVS, which has been so supportive of our research, is interested in continuing our partnership to address this important issue."

Why patients involved in the program sought more care was unclear, Weinberger said. It may be that those extra visits were appropriate.

"My guess is that pharmacists recommended more often that the asthma patients needed see a doctor between scheduled visits, and so the patients followed that suggestion," he said.

In an accompanying editorial Drs. Brian L. Strom and Sean Hennessy of the University of Pennsylvania School of Medicine praised the research because it represented a rigorous examination of such an important and difficult issue.

"This study provides two important lessons," they wrote. "First, despite a well-designed pharmaceutical care program and extensive implementation effort, patients did not appear to benefit clinically. The second lesson is that rigorous scientific study of commonly used or apparently promising interventions in routine patient care is needed."

Such assessments are crucial, even when a program intuitively makes sense, they wrote. If results in the intervention group had simply been examined as a before-and-after comparison, the conclusion would have been misleading indication of the apparent effectiveness of the program when, in fact, it was ineffective.

"Furthermore, like clinical care, such interventions can have adverse effects of their own," they said. "In this study, the intervention resulted in an apparent increase in health services utilization, rather than the expected reduction."

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The U.S. Agency for Healthcare Research and Quality and the Department of Veterans Affairs' Health Services Research and Development Service supported the research.

Note: To reach Weinberger, call (919) 966-7385. He will be gone Sept. 30-Oct. 1 but will check for messages often and return calls.

News Services Contact: David Williamson, (919) 962-8596
School of Public Health Contact: Lisa Katz, (919) 966-7467

By DAVID WILLIAMSON
UNC News Services

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