Complex pharmaceutical care intervention in pulmonary care - Part A. The process and pharmacists' professional satisfaction

Objective: In the IPMP study (Interventions on the principle of Pulmonary Medication Profiles), tailored pharmaceutical care interventions were provided to pulmonary patients selected because of drug use that deviates from Dutch guidelines. The aims were to solve drug-related problems and to improve patients' drug use. This article describes the pharmaceutical care process tailored to the individual problems of patients in the intervention arm of a randomized controlled trial and defines the package of care. Methods: After a preliminary selection of the patients with the help of the algorithmic IPMP computer instrument, instructed Dutch community pharmacists had structured consultations with patients (aged 13-70 years) in the intervention arm to identify behaviour and specific problems with their medication. Based on this identification process, a tailored intervention was constructed that could comprise one or more of six pharmaceutical care modules. Modules were clustered in sets describing the complete programme of care provided to one patient. If necessary, pharmacists consulted the patients' physicians to improve the prescribed therapy. After the interventions, medication changes were evaluated with the patients. The prescribed medication and the refill rate were monitored in the pharmacy computer during 1 year. All activities and results were extensively monitored and documented. Main outcome measure: Process description, i.e. number of provided pharmaceutical care modules and medication changes. Pharmacists' satisfaction. Results: Tailored interventions were provided to 199 patients at risk of sub-optimal drug therapy. In all 813 pharmaceutical care modules were performed and documented, and clustered in four different programmes. In addition to education and motivation to adhere to prescribed medication for all 199 patients, a medication change was suggested in 124 cases. Patients and physicians agreed upon a change in 94 cases. Device change was agreed upon in 58 of 64 cases, often simultaneously with medication change. Pharmacists consulted physicians concerning 100 patients. Pharmacists reported satisfaction with the pharmaceutical care approach. Conclusion: Because of the extensive documentation, interventions could be described completely. Pharmacists observed a better drug use after educating patients or by solving their drug-related problems. In collaboration with physicians drug treatment could be improved