Impact of pharmacist management on chronic obstructive pulmonary disease in a family medicine residency clinic

Abstract

Introduction

Studies support pharmacist intervention to improve adherence and reduce hospital admissions in the management of chronic obstructive pulmonary disease (COPD); however, evidence is lacking to assess pharmacist management on symptom improvement and disease control using COPD Assessment Test (CAT) scores in a primary care setting.

Objective

The purpose of this study was to assess the impact of pharmacist involvement in performing spirometry and therapeutic management of COPD on symptoms and inhaler use.

Methods

This was a prospective cohort study of patients with COPD at a family medicine residency clinic from January 2021 to November 2022. Patients included were 18 years of age or older, had a confirmed diagnosis of COPD with spirometry, and completed at least one COPD management visit with the pharmacist. Pharmacists performed spirometry, modified inhaler therapy, provided COPD and inhaler education, reviewed and ordered immunizations and labs, and provided tobacco cessation education and management if applicable. The primary outcome was the change in CAT scores from baseline to 3 months. The secondary outcome was the percentage of patients on guideline-directed inhaler therapy at 3 months compared with baseline.

Results

A total of 77 spirometry visits were completed by the pharmacist, with confirmed COPD in 49 patients who were managed by the pharmacist and included in the final analysis. At baseline, the average age was 66 years old, 53% were males, and only 6% had no smoking history. The mean CAT score improved by 5.0 points (p < 0.001) from baseline. At baseline, 45% were on guideline-directed therapy, which increased to 98% at final follow-up (p < 0.001).

Conclusion

This study assessed the impact of pharmacist-led spirometry and COPD management at a family medicine residency clinic. Based on the results, pharmacist involvement in COPD management resulted in an improvement in symptoms and increased use of guideline-directed inhaler therapy.