title: Effects of targeting disease and medication management interventions towards patients with COPD.
abstract: OBJECTIVE
  Suboptimal adherence in chronic obstructive pulmonary disease (COPD) patients is associated with decreased clinical and economic outcomes. Intervention programs, targeted at patients with suboptimal adherence and exacerbations, offer opportunities for cost-effective COPD care. We have aimed to assess the effects of the Medication Monitoring and Optimization (MeMO) targeted COPD intervention.
  
  
  METHODS
  Twenty community pharmacies participated in this 1 year real-world study with a pre-test/post-test design. Patients with a physician-confirmed COPD diagnosis, oral corticosteroid use, suboptimal adherence and Clinical COPD Questionnaire (CCQ) score ≥1 were selected by pharmacists. Pharmacy interventions included inhalation instruction, medication information and motivational interviewing regarding adherence and smoking cessation. Proposals for dose, medication and/or inhaler change and physical activity or diet recommendations were discussed with the general practitioner (GP), physiotherapist or dietician, when deemed relevant. Primary endpoint was the change in CCQ score. Secondary outcomes were adherence, exacerbations, healthcare utilization, quality of life (EQ-5D), modified Medical Research Council (mMRC) dyspnea score and cost-effectiveness.
  
  
  RESULTS
  Interventions were performed in 88 patients (mean age: 69; 52% male; mean CCQ: 2.10). The most often performed interventions were inhalation instruction (89%), medication education (98%) and adherence counseling (58%). Respectively 9%, 45% and 16% were referred to GP, physiotherapist or dietician. After 1 year, mean CCQ decrement was 0.12 and 38% showed a clinically relevant improvement. There was a significant decrease in exacerbations (-0.82) per patient per year. Adherence, mMRC and EQ-5D hardly changed. Per patient, annual medication costs were €26 higher, interventions cost €33, but total healthcare costs were €333 lower. The small sample size and lack of a control group were the main limitations.
  
  
  CONCLUSIONS
  By specifically targeting COPD patients with potential room for improvement, the MeMO COPD program has the potential to be an effective and cost-saving method for preventing exacerbations. However, no effects on quality of life have been observed. Larger studies are therefore recommended.
authors.affiliation: a a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.
authors.forename: J F M
authors.initials: JF
authors.lastname: van Boven
authors.affiliation: b b West-Pharmacy , Emmeloord , The Netherlands.|c c Health Base Foundation , Houten , The Netherlands.
authors.forename: A G G
authors.initials: AG
authors.lastname: Stuurman-Bieze
authors.affiliation: a a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.|c c Health Base Foundation , Houten , The Netherlands.
authors.forename: E G
authors.initials: EG
authors.lastname: Hiddink
authors.affiliation: a a Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.|d d Institute of Science in Healthy Ageing & health caRE (SHARE) , University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010594:Pharmacies; D010595:Pharmacists / Q000458:organization & administration; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D011788:Quality of Life
keywords: Adherence; COPD; Disease management; Medication management; Pharmaceutical care