Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office
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Keywords
Abstract
Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians office
Methods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceutical interventions. Abnormal spirometry was identified as an obstructive and/or restrictive defect.
Results: Sixty-five patients with a primary diagnosis of cough, shortness of breath, or diagnosis of asthma or chronic obstructive pulmonary disease were referred to the spirometry clinic for evaluation. A total of 51 (32 patients with normal spirometry, 19 abnormal spirometry) completed their scheduled appointment. Calculated lung age was lower in normal spirometry (58.1; SD=20 yrs) than abnormal spirometry (78.2; SD=7.5 yrs, p<0.001). Smoking pack years was also lower in normal spirometry (14.4; SD=10.7 yrs) than abnormal spirometry (32.7; SD=19.5 yrs, p=0.004). Resting oxygen saturation of the arterial blood (SaO2) was higher in normal spirometry than abnormal spirometry (98.1% vs 96.5%, p=0.016). Mean change in the forced expiratory volume in one second (FEV1) after administration of bronchodilator was greater in patients with abnormal spirometry compared with normal spirometry (10.9% vs 4.1%, p<0.001). Spirometry testing assisted in addition, discontinuation or altering pulmonary drug regimens in 41/51 patients (80%) and the need for further diagnostic testing or physician referral in 14/51 patients (27.4%).
Conclusion: Implementation of a pharmacist-driven spirometry clinic is a value-added service that can be integrated with other clinical pharmacy services within the ambulatory care setting. Further studies are needed to determine the role of pharmacists in performing spirometry testing and measuring performance outcomes of the pulmonary patient.
Keywords: Pharmacists. Point-of-Care Systems. Spirometry. United States.
References
2. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma 2007. Available from http://www.nhlbi.nih.gov/guidelines/asthma/ (Accessed September 22, 2011).
3. Crapo RO. Pulmonary Function Testing. N Engl J Med. 1994;331(1):25-30.
4. Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schünemann H, Wedzicha W, MacDonald R, Shekelle P; American College of Physicians; American College of Chest Physicians; American Thoracic Society; European Respiratory Society. Diagnosis and management of stable chronic obstructive pulmonary disease: A clinical practice guideline update from the Am College of Physicians, Am. College of Chest Physicians, Am. Thoracic Society, and Eur. Respiratory Society. Ann Intern Med. 2011;155(3):179-191.
5. Castillo D, Guayta R, Giner J, Burgos, F, Capdevila C, Soriano JB, Barau M, Casan P, FARMAEPOC group. COPD case findings by spirometry in high-risk customers of urban community pharmacies: A pilot study. Respir Med. 2009;103(6):839-45.
6. Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932-946.
7. Burton MA, Burton DL, Simpson MD, Gissing PM, Bowman SL. Respiratory function testing: The impact of respiratory scientists on the training and support of primary health care providers. Respirology. 2004;9:260-264.
8. Fletcher C, Peto R. The natural history of chronic airflow obstruction. BMJ. 1977;1(6077):1645-1648.
9. American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med. 1995;152:1107-1136.
10. Barreiro T, Perillo I. An approach to interpreting spirometry. Am Fam Physician. 2004;69:1107-1114.
11. Cawley MJ, Pacitti R, Keenan D. Reaping the rewards of a pharmacist-run spirometry clinic. Pharmacy Purchasing and Product. 2010;7(12):24-26.
12. Johannigmn MJ, Leifheit M, Bellman N, Pierce T, Marriot A, Bishop C. Medication therapy management and condition care services in a community-based employer setting. Am J Health Syst Pharm. 2010;16:1362-1367.
13. Cooper T, Taber D, Mazur J. Implementation of a collaborative drug therapy management service for inpatients receiving direct thrombin inhibitors. Am J Health Syst Pharm. 2009;14:1297-1303.
14. Wong MD, Manley RT, Stettin G, Chen W, Salmun LM. Intervention to reduce unnecessary dispensing of short-acting {beta}- agonists in patients with asthma. Ann Pharmacother. 2010;4:623-629.
15. Bounthavong M, Christopher ML, Mendes MA, Foster EB, Johns ST, Lim L, Rubin LM, Patel JJ, Stewart AG. Measuring patient satisfaction in the pharmacy specialty immunization clinic: a pharmacist-run Immunization Clinic at the Veterans Affairs San Diego Healthcare System. Int J Pharm Pract. 2010;2:100-107.
16. Baggarly SA, Jenkins TL, Biglane GC, Smith GW, Smith CM, Blaylock BL. Implementing a Referral to Telephone Tobacco Cessation Services in Louisiana Community Pharmacies: A Pilot Study. Ann Pharmacother. 2010;44(9):1395-1402.
17. Bunting BA, Cranor CW. The Ashville project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46:133-147.
18. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, Brusselle G. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008;31(4):790-799.
19. Weinberger M, Murray MD, Marrero DG, Brewer N, Lykens M, Harris LE, Seshadri R, Caffrey H, Roesner JF, Smith F, Newell AJ, Collins JC, McDonald CJ, Tierney WM. Effectiveness of pharmacist care for patients with reactive airways disease. JAMA. 2002;288:1594-1602.
20. Deane K, Stevermer JJ. Help smokers quit: Tell them their “lung age”. J Family Pract. 2008;57:584-586.
21. Jacka M, Cheng A, McAlister F. Do history, physical, and spirometry predict pulmonary complications? Canadian J Anesth. 2002;49:A96.
22. Dales RE, Vandemheen KL, Clinch J, Aaron SD. Spirometry in the primary care setting. Influence on clinical diagnosis and management of airflow obstruction. Chest. 2005;128:2443-2447.
23. Mann RP, Zaiken K. Management of chronic obstructive pulmonary disease by pharmacists in an internal medicine department. Am J Health-Syst Pharm. 2009;66:890-893.
24. Bluml BM. White paper on expanding role of pharmacists in chronic obstructive pulmonary disease. J Am Pharm Assoc. 2011;51:203-211.
25. American Association for Respiratory Care clinical practice guideline: Spirometry. Respir Care. 1996;41:629-636.
26. The American College of Chest Physicians. Available from http://www.chestnet.org/accp/events/copd-what-really-works. (Accessed September 26, 2011).
27. Jarrold I, Morrell J, Huntly K, Eiser N. An on-line survey of clinicians on distinguishing between COPD and asthma. Presented in abstract format. European Respiratory Society 19th Annual Congress. Abstract 4561.
28. Beebe M, Dalton JA, Espronceda M, Evans D, Glenn R. CPT 2007 professional edition. Chicago, IL: American Medical Association, 2007;400.
29. Diamond E. Pulmonary function and exercise testing. In: Manaker S, ed. Appropriate coding for critical care services and pulmonary medicine 2007. New Berlin, WI: Northbrook, 2007:161-175.
30. Lange NE, Mulholland M, Kreider ME. Spirometry. Chest. 2009;136:608-614.
31. MacIntyre NR, Foss C. Pulmonary function testing: Coding and Billing Issues. Respir Care. 2003;48:786-790.