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.

Conclusion:

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.

Keywords: :

• Adherence
• COPD
• Disease management
• Medication management
• Pharmaceutical care

Transparency

Declaration of funding

For the implementation of the study the authors’ institution (University of Groningen) received an unrestricted educational grant from AstraZeneca Ltd. The views and opinions expressed here are those of the authors only.

Declaration of financial/other relationships

M.J.P. has disclosed that he has received travel grants, stipendiums and honoraria from various pharmaceutical companies including those potentially interested in this work. J.F.M.v.B., A.G.G.S.-B. and E.G.H. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank all the participating pharmacists and other primary care healthcare professionals for their participation. The authors thank Stefan Vegter and Dieke van Leusen for proofreading the manuscript.