When does pharmaceutical care impact health outcomes? A comparison of community pharmacy-based studies of pharmaceutical care for patients with asthma

BACKGROUND: Pharmaceutical care (PC) as a philosophy of care and practice model is now > 14 years old. It is important to determine whether PC influences health outcomes. Such outcomes are best studied in specific disease states where variables are minimized and specific outcomes have been established. We analyzed 4 multi-site controlled studies that evaluated PC in community pharmacies for patients with asthma. Study results varied widely. OBJECTIVE: To understand factors contributing to positive outcomes from PC for asthma. METHODS: The 4 studies were compared on the basis of 10 aspects of their research design, as well as 10 elements of PC. Dr. McLean conducted the initial analysis, and his assessments were confirmed by Dr. MacKeigan. RESULTS: Important differences were found in the type of pharmacy where PC was delivered (chain vs independent), how pharmacies were selected (required vs volunteered), patient selection (on asthma medication Vs uncontrolled disease), pharmacist training (4-h workshop Vs certification over several weeks), the nature of PC protocol (computer reminders vs detailed care protocol), rigor of the protocol (intervention vs requirement to reach self-management), and the level of pharmacist adherence to the PC protocol (< 50% vs 90%). Differences were also found in study design. CONCLUSIONS: More favorable PC outcomes were associated with use of all elements of PC, independent pharmacies, pharmacist certification, a detailed PC protocol, targeting patients with uncontrolled asthma, and a practice system facilitating PC.