(taken from abstract). Using reactive airways disease (RAD) as a model, the applicants propose to develop algorithms, materials, and an educational program to facilitate pharmaceutical care. They propose to conduct a randomized, controlled trial. They will provide developed materials and patient-specific clinical information, displayed on their computer workstations, when filling prescriptions. The patient educational materials will be printed and videotaped. Clinical information will come from the patients' electronic medical records stored in a network linking six hospitals, 24 free-standing clinics and neighborhood health centers, and a pharmacy chain filling half the prescriptions in Central Indiana. The clinical information displayed will include peak expiratory flow rates (PEFRs), evidence of recent hospitalizations or emergency room visits for respiratory disease, and an indicator of medication compliance calculated from the timing of refills. The sites for this trial will be 20 drugstores in central Indianapolis (10 randomized to intervention status, 10 to control status) located near the six computer-linked hospitals. Adult patients with RAD who fill most of their drugs at one of the study drugstores and use one of the six hospitals for acute care will be recruited by a letter from the drugstore chain. There will be one intervention group of 460 patients (who will also be given peak flow meters) and two control groups: 460 patients also given a peak flow meter and 460 patients without meters to control for a possible effect of the peak flow meters themselves. Those patients who agree to participate will be interviewed in their homes at baseline, 6, and 12 months. The following clinical information will be obtained during the in-home interviews and from monthly telephone calls to supplement data in their computer records: recent exacerbations of respiratory disease, medication compliance, and PEFR. Comorbidity information and the following outcome data will also be obtained during the in-home interviews: health-related quality of life (HRQOL), satisfaction with their health care, and satisfaction with their pharmacists and pharmacy. Pharmacists' job satisfaction and attitudes toward pharmaceutical care will also be assessed. Each patient will be followed for 1 year during which the effectiveness and cost-effectiveness of the intervention will be measured on patient outcomes that include PEFR, acute exacerbations of respiratory disease, medication compliance, and HRQOL.
| Tierney, William M; Roesner, J Franklin; Seshadri, Roopa et al. (2004) Assessing symptoms and peak expiratory flow rate as predictors of asthma exacerbations. J Gen Intern Med 19:237-42 |
| Hanlon, J T; Schmader, K E; Ruby, C M et al. (2001) Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 49:200-9 |
| Zhou, X H; Li, C; Gao, S et al. (2001) Methods for testing equality of means of health care costs in a paired design study. Stat Med 20:1703-20 |
