Impact of a pharmacist-led asthma clinic in a high-risk pediatric population at a federally qualified health center within a medically underserved area

Abstract

Background

There are few publications regarding pediatric asthma treatment at federally qualified health centers (FQHCs). FQHC patients are considered high risk with complex social determinants of health. This FQHC, located in a medically underserved area, has an established collaborative practice agreement for pharmacist-led management of pediatric asthma.

Objective

This study aimed to assess the asthma control of pediatric FQHC patients before and after pharmacist intervention.

Methods

This was a single-center, retrospective, observational cohort study. Patients were included if they had a current asthma diagnosis, were aged 4-21 years, and were an active patient of the FQHC. Patients were referred to the pharmacist-led asthma clinic to receive disease state, medication, and device education with guideline-directed asthma pharmacotherapy changes when needed. Patients and caregivers were surveyed using the age-appropriate Asthma Control Test (ACT) before the first asthma clinic appointment and at each follow-up visit. The primary end point was the change in ACT score from baseline to the most recent follow-up. Secondary end points included proportions of patients who achieved a clinically meaningful increase in ACT (a change of 2-3 points has been validated as a clinically meaningful difference), usage of systemic corticosteroids and emergent care, and patients converted to using the FQHC’s on-site pharmacy. Continuous end points were evaluated using paired t tests and categorical variables with Fisher’s exact tests.

Results

Thirteen patients were enrolled with an average age of 11.8 years and 4.4 years since asthma diagnosis. Pharmacist intervention showed a statistically significant improvement in the primary end point (mean ± SD ACT score increase 6.1 ± 3.1; P < 0.001). All patients had a clinically meaningful improvement in their asthma control. One patient (7.7%) sought emergent care with systemic corticosteroid usage. Among eligible patients, 4 of 5 (80%) were converted to using the FQHC’s on-site pharmacy.

Conclusion

Pharmacist intervention improved asthma control in high-risk pediatric patients within an FQHC.