Morris Weinberger study on pharmaceutical care among asthma patients
The pharmacy profession is still smarting from a just-published study, which found that pharmacy interventions, while they improved patient satisfaction, were also associated with more hospital visits and higher costs.
In an interview with Drug Topics, the principal investigator, Morris Weinberger, Ph.D., acknowledged that the results were "disappointing," but he pointed out, "I don't think we've shown that pharmaceutical care doesn't work." Rather, he said, the right incentives and systems must be in place in busy practices before the value of pharmacy interventions could be demonstrated.
The study, which was funded by the Agency for Healthcare Research & Quality, involved 1,113 asthma patients from 36 CVS pharmacies who were divided into three groups. One group received the usual care, the second group was given a peak flow meter and instructions on how to use it, while the third group was served by pharmacists who were trained to provide pharmaceutical care. At the end of the study, the researchers found that, contrary to their hypothesis, patients in the two intervention groups reported more emergency room visits than did those in the control group.
What went wrong? The study was conducted several years ago, when technology was not as sophisticated as it is today, explained Weinberger, who is a professor of health policy and administration at the University of North Carolina at Chapel Hill. The pharmacists had to use a separate computer to take part in the study, which made things very "cumbersome" for them. This study computer was "not by choice, but by necessity," he said, and it led to "interventions not being delivered as intended."
In a presentation before the American Pharmaceutical Association annual meeting back in 1998 (Drug Topics, April 20, 1998), Weinberger had related two other computer issues his study had to deal with. He said when his study began, it was to have involved Revco stores, but CVS acquired Revco and changed its computer system, so the study had to adjust accordingly. Then, CVS got into hot water over its use of a third party to remind patients about refills, potentially compromising patient confidentiality. So Weinberger had to get patient consent before he could review the data. This is another reason why the researchers went with a study computer.
Is the study a setback for pharmacy? While the results are not positive, Weinberger said, "I'm not sure the mail-order folks can make hay out of this. If interventions were delivered completely, we would have far different results."
If a future study is undertaken, Weinberger said, the researchers must be more sensitive to the demands of busy pharmacists by using technicians, an integrated pharmacy computer, and other measures. He added that he is talking with CVS and trying to solicit funding for another study.
"I remain committed to trying to demonstrate that pharmacists need to be involved as a part of the healthcare team," Weinberger declared. The challenge in the next iteration is to figure out how to build systems that are more pragmatic for pharmacists, he concluded.
The study was published in the Oct. 2 issue of the Journal of the American Medical Association.
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