Nixon Bianca, Axtell Sandra
Department of Pharmacy, Cleveland Clinic Hillcrest Primary Care, Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA.
J Pharm Technol. 2024 Aug;40(4):178-185. doi: 10.1177/87551225241258873. Epub 2024 Jun 12.
Poor inhaler technique can worsen respiratory disease. An Aerosol Inhalation Monitor (AIM) may provide insight into a patient's capability of utilizing inhaled medications. The purpose of this quality assessment was to determine if the addition of the Vitalograph AIM device by ambulatory care pharmacists within an outpatient primary care clinic improves patient's disease control through changes in pharmacotherapy. This was a retrospective, longitudinal, quality assessment review. Pharmacists met with patients for initial and follow-up appointments. A chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) or Asthma Control Test (ACT) and AIM assessment were performed and pharmacotherapy was subsequently adjusted. The primary endpoint was the change in initial to last recorded ACT and CAT score and was analyzed by Wilcoxon sign-rank test. Twenty asthma and 17 COPD patients were included; 13 asthma and 13 COPD patients were included in the primary and secondary endpoint analysis. Initial median (interquartile range [IQR]) ACT score was 17 (14-23), first follow-up was 20 (18-24), and last recorded score was 22 (18-23). Initial median (IQR) CAT score was 17 (12-22), first follow-up score was 14 (6-20), and last recorded score was 11 (6-19). There was no statistical difference between initial CAT or ACT to first follow-up or last recorded CAT or ACT. Most patients continued their current inhaler regimen. This review demonstrates the positive effect pharmacists can have on respiratory disease management. The improvement in ACT and CAT scores suggests a positive, clinically significant outcome. Future research should evaluate pharmacist's effect on asthma and COPD readmission rates.
吸入器使用技术不佳会使呼吸系统疾病恶化。气溶胶吸入监测仪（AIM）或许能深入了解患者使用吸入药物的能力。本质量评估的目的是确定门诊初级保健诊所的门诊护理药剂师添加维托拉夫AIM设备是否能通过调整药物治疗来改善患者的疾病控制情况。这是一项回顾性、纵向的质量评估审查。药剂师与患者进行初次和随访预约。进行慢性阻塞性肺疾病（COPD）评估测试（CAT）或哮喘控制测试（ACT）以及AIM评估，随后调整药物治疗。主要终点是首次记录到最后记录的ACT和CAT分数的变化，并通过威尔科克森符号秩检验进行分析。纳入了20名哮喘患者和17名COPD患者；13名哮喘患者和13名COPD患者纳入了主要和次要终点分析。初始ACT中位数（四分位间距[IQR]）分数为17（14 - 23），首次随访为20（18 - 24），最后记录的分数为22（18 - 23）。初始CAT中位数（IQR）分数为17（12 - 22），首次随访分数为14（6 - 20），最后记录的分数为11（6 - 19）。初始CAT或ACT与首次随访或最后记录的CAT或ACT之间无统计学差异。大多数患者继续使用当前的吸入器治疗方案。本综述表明药剂师在呼吸系统疾病管理中可发挥积极作用。ACT和CAT分数的改善表明有积极的、具有临床意义的结果。未来的研究应评估药剂师对哮喘和COPD再入院率的影响。
