Credentialed pharmacist-led home medicines reviews targeting treatable traits and their impact on health outcomes in people with chronic obstructive pulmonary disease: a pre- and post-intervention study.

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) should engage in self-management strategies targeting behavioural traits and lifestyle risk-factors for optimal outcomes.

Aim: To evaluate the impact of credentialed pharmacist-led home medicines review (HMR) targeting treatable traits (TTs) on health outcomes in COPD in primary care.

Method: A pre- and post-intervention study was nested within a cluster-randomised controlled trial. A total of 81 participants with COPD from 21 Australian general practices received an HMR with a credentialed pharmacist targeting TTs. Changes in health outcomes at 6 and 12 months from baseline were assessed.

Results: Ten TTs were assessed and targeted during the HMR. At baseline, no-one had a written action plan for managing exacerbations, and medication adherence was sub-optimal in 85% of patients. Additionally, 53% of participants demonstrated inadequate inhaler device technique, while 52% were current smokers. At 6-months follow-up, significant improvements were observed in health-related quality of life (St. George's Respiratory Questionnaire score = 34.6 versus 39.1 at baseline, p = 0.006), health status (COPD Assessment Test score = 12 versus 16, p = 0.002), anxiety (Hospital Anxiety and Depression Scale (HADS)-Anxiety score = 2.0 versus 5.0, p < 0.001), depression (HADS-Depression score = 1.0 versus 5.0, p < 0.001), self-reported smoking (47% versus 51.9%, p = 0.031) and treatment adherence (Tool for Adherence Behaviour Screening score = 12.5 versus 10.0, p = 0.002). At 12-months: health status, anxiety, depression, smoking abstinence and adherence to treatment, continued to show statistically significant improvements compared to baseline measurements.

Conclusion: HMRs targeting TTs improved health outcomes in people with COPD. Credentialed pharmacists in primary care can work alongside general practitioners to optimise COPD management.