title: Effect of a network system for providing proper inhalation technique by community pharmacists on clinical outcomes in COPD patients.
abstract: BACKGROUND
  Nonadherence to inhalation therapy is very common in patients with chronic obstructive pulmonary disease (COPD). Few data are available to support the role of community pharmacists in optimizing inhalation therapy in COPD patients. Since 2007, the Kitano Hospital and the Kita-ku Pharmaceutical Association have provided a network system for delivering correct inhalation techniques through certified community pharmacists. The effects of this network system on clinical outcomes in COPD patients were examined.
  
  
  METHODS
  A total of 88 consecutive outpatients with COPD at baseline and 82 of those 4 years later were recruited from the respiratory clinic of Kitano Hospital Medical Research Institute. Measurements included the frequency of COPD exacerbations, patients' adherence to inhalation therapy using a five-point Likert scale questionnaire, and patients' health status both prior to this system and 4 years later.
  
  
  RESULTS
  Usable information was obtained from 55 patients with COPD at baseline, and from 51 patients 4 years later. Compared with baseline values, a significant decrease was observed in the frequency of COPD exacerbations (1.5 ± 1.6 versus 0.8 ± 1.4 times/year, P = 0.017). Adherence to the inhalation regimen increased significantly (4.1 ± 0.7 versus 4.4 ± 0.8, P = 0.024), but health status was unchanged. At 4 years, of 51 COPD patients, 39 (76%) patients who visited the certified pharmacies showed significantly higher medication adherence than those who did not (4.6 ± 0.6 versus 3.9 ± 1.0, P = 0.022).
  
  
  CONCLUSIONS
  The network system may improve COPD control and adherence to inhalation regimens.
authors.affiliation: Respiratory Disease Center, Kitano-Hospital, the Tazuke Kofukai Medical Research Institute, Osaka, Japan. m-takemura@kitano-hp.or.jp
authors.forename: Masaya
authors.initials: M
authors.lastname: Takemura
authors.forename: Katsumi
authors.initials: K
authors.lastname: Mitsui
authors.forename: Masako
authors.initials: M
authors.lastname: Ido
authors.forename: Masataka
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Misuzu
authors.initials: M
authors.lastname: Koyama
authors.forename: Daiki
authors.initials: D
authors.lastname: Inoue
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Takamatsu
authors.forename: Ryo
authors.initials: R
authors.lastname: Itotani
authors.forename: Manabu
authors.initials: M
authors.lastname: Ishitoko
authors.forename: Shinko
authors.initials: S
authors.lastname: Suzuki
authors.forename: Kensaku
authors.initials: K
authors.lastname: Aihara
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuramoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kagioka
authors.forename: Motonari
authors.initials: M
authors.lastname: Fukui
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003194:Computer-Assisted Instruction; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D010353:Patient Education as Topic; D010595:Pharmacists / Q000592:standards; D024382:Professional Role; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D058996:Quality Improvement; D011788:Quality of Life; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000193:education / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; adherence; community pharmacist; exacerbation; quality of life