title: Physician-pharmacist collaborative management of asthma in primary care.
abstract: OBJECTIVE
  To determine if asthma control improves in patients who receive physician-pharmacist collaborative management (PPCM) during visits to primary care medical offices.
  
  
  METHODS
  Prospective pre-post study of patients who received the intervention in primary care offices for 9 months. The primary outcome was the sum of asthma-related emergency department (ED) visits and hospitalizations at 9 months before, 9 months during, and 9 months after the intervention. Events were analyzed using linear mixed-effects regression. Secondary analysis was conducted for patients with uncontrolled asthma (Asthma Control Test [ACT] less than 20). Additional secondary outcomes included the ACT, the Asthma Quality of Life Questionnaire by Marks (AQLQ-M) scores, and medication changes.
  
  
  METHODS
  Pharmacists provided patients with an asthma self-management plan and education and made pharmacotherapy recommendations to physicians when appropriate.
  
  
  RESULTS
  Of 126 patients, the number of emergency department (ED) visits and/or hospitalizations decreased 30% during the intervention (p=0.052) and then returned to preenrollment levels after the intervention was discontinued (p=0.83). Secondary analysis of patients with uncontrolled asthma at baseline (ACT less than 20), showed 37 ED visits and hospitalizations before the intervention, 21 during the intervention, and 33 after the intervention was discontinued (p=0.019). ACT and AQLQ-M scores improved during the intervention (ACT mean absolute increase of 2.11, AQLQ-M mean absolute decrease of 4.86, p<0.0001) and sustained a stable effect after discontinuation of the intervention. Inhaled corticosteroid use increased during the intervention (p=0.024).
  
  
  CONCLUSIONS
  The PPCM care model reduced asthma-related ED visits and hospitalizations and improved asthma control and quality of life. However, the primary outcome was not statistically significant for all patients. There was a significant reduction in ED visits and hospitalizations during the intervention for patients with uncontrolled asthma at baseline. Our findings support the need for further studies to investigate asthma outcomes achievable with the PPCM model.
authors.affiliation: Department of Pharmacy Practice & Science, University of Iowa College of Pharmacy, Iowa City, Iowa; Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
authors.forename: Tyler H
authors.initials: TH
authors.lastname: Gums
authors.forename: Barry L
authors.initials: BL
authors.lastname: Carter
authors.forename: Gary
authors.initials: G
authors.lastname: Milavetz
authors.forename: Lucinda
authors.initials: L
authors.lastname: Buys
authors.forename: Kurt
authors.initials: K
authors.lastname: Rosenkrans
authors.forename: Liz
authors.initials: L
authors.lastname: Uribe
authors.forename: Christopher
authors.initials: C
authors.lastname: Coffey
authors.forename: Eric J
authors.initials: EJ
authors.lastname: MacLaughlin
authors.forename: Rodney B
authors.initials: RB
authors.lastname: Young
authors.forename: Adrienne Z
authors.initials: AZ
authors.lastname: Ables
authors.forename: Nima
authors.initials: N
authors.lastname: Patel-Shori
authors.forename: Angela
authors.initials: A
authors.lastname: Wisniewski
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D003299:Cooperative Behavior; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D010819:Physician's Role; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
keywords: asthma; collaboration; pharmacist; team-based care