Asthma is the most common chronic condition in children and represents one of the most common reasons for visiting a pediatrician. Despite improvements in knowledge and pharmacologic therapy, the prevalence of asthma has been increasing as has the morbidity and mortality from asthma. Asthma-related health services utilization and cost have been increasing. While studies suggest that asthma education programs may improve asthma knowledge and short-term outcomes, there have been no assessments of whether long-term health outcomes or costs are affected. Pharmaceutical care has the potential to improve patient adherence with asthma medications and to identify, resolve, and prevent drug-related problems. Additionally, pharmacists in community settings are in a unique position to provide accessible asthma patient education. We propose to assess the changes in disease control, functional status and cost associated with the introduction and delivery of a structured program of pharmaceutical care for pediatric and adolescent patients who have asthma. This randomized controlled trial will be conducted in the general community, including the Medicaid setting, and the health maintenance organization (HMO) setting in King County, Washington State. The primary aim of the study will be to demonstrate the effect of pharmacists' cognitive services on the health outcomes and cost of care of this patient population. A stratified random sample of 28 pharmacies will be selected and randomized to deliver either a structured pharmacist-based intervention or usual care. A sample of 400 chronic asthma patients ages 6 to 17 will be recruited in equal numbers from the intervention and control pharmacies. All study patients will receive baseline pulmonary function tests and other assessments. After a structured training program, intervention pharmacists will provide individualized asthma care assessment and patient education to study patients for up to one year following entry into the study. The primary outcomes will be the assessment of patient's pulmonary function, functional status, school attendance, and asthma-related health services utilization and cost. Information will be used to determine the cost- effectiveness of pharmaceutical care for pediatric asthma patients.
