Community pharmacist counseling improves adherence and asthma control: a nationwide study

Abstract

Background: Pharmaceutical counseling (PC) interventions have been shown to improve adherence to controller medication and asthma control. However, the real-life impact of these PC interventions in difficult-to-control asthma patients remains unclear. We aimed to assess the effectiveness of PC interventions in real life using nationwide claims data.

Methods: Demographics and drugs use of patients who received ICS in 2017 with or without pharmaceutical counseling were retrieved from a Belgian claims database. Asthma-related drug use from 1 year before first ICS dispensing in 2017 (reference period) was compared with 1 year after. Outcomes were usage of inhaled corticosteroids (ICS) in defined daily doses (DDD), proportion of users of short-acting beta-agonist (SABA), antibiotics, oral corticosteroids (OCS), asthma biologicals and controller-to-total (CTT) ratio.

Results: The study population consisted of difficult-to-control asthma patients aged 5-40 years with at least the first interview within 90 days after first ICS dispensing (n = 1350). ICS usage increased significantly in the year after PC intervention compared with the reference period (+ 43.3 DDD/patient, p < 0.05). A nominal decrease was observed in the proportion of SABA (48.0 to 46.2%) and antibiotics (54.5 to 52.7%) after PC intervention compared with the reference period. CTT ratio significantly increased from 0.671 to 0.749 (p < 0.05). The proportion of biological users was nominally lower in the intervention group compared with a control group (n = 50,477) in the post-intervention time period (0.22% versus 0.30%).

Conclusions: This first nationwide study among difficult-to-control asthma patients suggests that community pharmacist counseling is effective in real life to improve controller adherence and asthma control.

Keywords: Adherence to therapy; Asthma clinical care; Asthma control; Asthma pharmacotherapy; Patient education and asthma.

Fig. 1

Example of data extraction. An example of how the BelPharData was extracted for a fictional patient receiving the first ICS dispensing in 2017 on February 1st, 2017 (= reference date). The asthma-related drug history 1 year before ICS dispensing (February 1st, 2016) was observed in comparison to the drug use exactly 12 months after the reference date

Fig. 2

Pharmaceutical counseling (PC) intervention protocol. *Step 2 in case PC is suggested by pharmacist or asked by patient

Fig. 3

Inhaled corticosteroids (ICS) usage pre- and post-intervention. Bar chart showing results of the primary analysis of ICS usage 1 year pre-intervention (light gray filled) and 1 year post-intervention (dark gray filled) in 5–40 year-old difficult-to-control asthma patients with at least one PC intervention in 2017

Fig. 4

Use of asthma-related drugs pre- and post-intervention. Bar charts showing the proportion of users of asthma-related drugs among difficult-to-control 5–40-year-old asthma patients who received at least one PC intervention in 2017 (n = 1350). The left bars represent the percentage (top) with number (bottom, italics) of short-acting beta-agonist (SABA) users pre-(light gray filled) to post-(dark gray filled) PC intervention, the middle bars the percentage antibiotic users and the right bars the percentage oral corticosteroid (OCS) users