Relative exposure to controller therapy and asthma exacerbations: a validation study in community pharmacies.

PURPOSE: "Controllers-to-total asthma drug" ratios computed from claims data identify asthmatics at risk of exacerbations. Direct link of ratios to data obtained from patients, such as control and recent outcomes, would facilitate their interpretation. We studied the relationship between R1 ratio (inhaled corticosteroids (ICS)/total anti-asthma drug ratio) and the Asthma Control Test. Comparisons were also conducted for secondary outcomes (asthma-related hospital contacts, monthly medical contacts, use of oral corticosteroids, and perception of disease burden). Results with R1 ratio were compared with those obtained with a second ratio, "ICS-plus-leukotriene receptor antagonist/total asthma drug" (R2 = ICS + leukotriene receptor antagonist/total anti-asthma drugs). METHODS: A survey was conducted in community pharmacies. Patients visiting with a prescription of anti-asthma drug and ≥12 months of drug dispensing recorded in the pharmacy were consecutively recruited. Dispensing data were linked to patient-reported outcomes. Asthma control and secondary outcomes were compared for both ratios between low-controller-ratio (R < 50%) and high-controller-ratio groups (R ≥ 50%), after excluding null values. RESULTS: Of the 919 eligible patients (mean age 37 years, 55% women), 90.2% and 92.4% had non-null values for R1 and R2, respectively. Compared with the low-controller-ratio groups, adjusted risks of being uncontrolled were significantly lower in the high-controller-ratio groups (RR = 0.64, 95%CI [0.54, 0.77] and RR = 0.57, 95%CI [0.47, 0.70], for R1 and R2 ratios, respectively). Likewise, fewer patients with secondary outcomes were observed in the high-controller-ratio groups, for both ratios. CONCLUSION: Asthma was better controlled among patients with high controller ratios, along with fewer asthma-related outcomes, for both R1 and R2 ratios. This confirms the utility of asthma/drug ratios in identifying patients at risk of exacerbations, notably in claims data.

[Migraine or headache management: a pharmacy survey]. / Prise en charge de la migraine: enquête en pharmacie.

AIM: To describe the characteristics and the management of migraine. METHOD: Data on headaches, drug consumption and life habits of 762 patients were collected using questionnaires and pharmacy records. RESULTS: The migraine attack was characterized by a severe pain for more than 80% of the patients. The frequency was more than 2 attacks a week in 16% of the cases. Eighty four per cent of the patients had triptans and 45% had a long-term migraine treatment. Nonspecific analgesics were prescribed for 55%. The frequency of over-consumption of treatments of migraine attacks was 46%. CONCLUSION: The management of migraine still remains inadequate. The pharmacist could contribute to its improvement.

Correlates of quality of life of pre-obese and obese patients: a pharmacy-based cross-sectional survey.

BACKGROUND: The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies. METHODS: A convenience sample of patients with a Body Mass Index > or = 28 kg/m(2) were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension. RESULTS: QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index > or = 35 kg/m(2) was significantly associated with poorer QOL scores on physical, relational and psychological dimensions. CONCLUSION: Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.

Factors influencing dispensing of psychotropic medications to patients with asthma: a community pharmacy-based survey.

BACKGROUND: To our knowledge, the use of psychotropic medications (antidepressant, anxiolytic, and hypnotic agents) in patients with asthma has not been extensively explored. OBJECTIVE: To identify factors associated with the use of these medications in patients with asthma. METHODS: Regular customers (aged 18-50 years) of 348 pharmacies in 9 French regions were consecutively recruited from November 2003 to June 2004. Patients with a prescription for an asthma medication were included. Patients completed a questionnaire, complemented by the computerized records of their therapy dispensed in the past 12 months. Asthma control was measured with the Asthma Control Test. RESULTS: Among 886 patients (mean age, 37.4 years; 55.0% female), during the 12 months before the survey, the proportions who received at least 1 U of anxiolytic, antidepressant, and hypnotic agents were 25.6%, 13.7%, and 13.0%, respectively. Higher dispensing levels of antidepressant, anxiolytic, and hypnotic agents were observed with decreasing asthma control (P < .001 for each drug class). Other correlates of receiving any of these classes included older age, female sex, smoking status, and dispensing of antireflux treatment (P < .001 for all). These results were confirmed in multivariate analyses. CONCLUSIONS: Psychotropic drugs were commonly dispensed to patients with asthma, and correlates of receiving these drugs were identified in this population. The high use of psychotropic medication, particularly in patients with poorly controlled asthma, is of concern.

Dispensing of antibiotics, antitussives and mucolytics to asthma patients: a pharmacy-based observational survey.

BACKGROUND: Antibiotics, antitussives and mucolytics are commonly used in asthma, despite limited evidence for their effectiveness. The correlates of use for these medication classes in asthma were identified. METHODS: Asthma patients aged 18-50 who were regular customers of pharmacies were included in an observational study. Patients completed a questionnaire, which was complemented by computerised pharmacy records of previously dispensed medications. Users of each drug class were compared to non-users in terms of demographics, asthma characteristics and management. RESULTS: Among 886 patients (mean age: 37; 55% females), 63.2%, 55.8% and 27.2%, respectively, were users of antibiotics, mucolytics and antitussives during the previous 12 months. In multivariate analysis, dispensing of >2 units of oral corticosteroids was the major correlate of receiving antibiotics (OR=5.47; 95% CI=[3.00-9.97]), mucolytics (OR=3.93; 95% CI=[2.38-6.50]) and antitussives (OR=1.86; 95% CI=[1.18-2.94]). Compared to well-controlled patients, the probability of receiving antibiotics was significantly higher for poorly controlled patients (OR=2.01; 95% CI=[1.28-3.15]). CONCLUSIONS: Our results suggest that these drugs are mainly used during asthma exacerbations. A better understanding of the use of co-medication in asthma is required.

Asthmatic patients' poor awareness of inadequate disease control: a pharmacy-based survey.

BACKGROUND: Many asthmatic patients fail to perceive their level of disease control. OBJECTIVE: To investigate whether patients' ability to identify asthma control varied with personal characteristics or factors related to disease management. METHODS: Asthmatic patients were consecutively recruited at 348 pharmacies. They completed a questionnaire (regarding personal characteristics and asthma management) linked to pharmacies records of dispensed medications. The Asthma Control Test questionnaire includes 4 dimensions of asthma control (activity limitations, dyspnea, nocturnal awakenings, and rescue medication use) and assesses patients' perception of control ("How would you rate your asthma control during the past 14 days?"). Analyses were restricted to patients with inadequate control. Patients' perception of control was compared across the other dimensions of the questionnaire. The correlates of patients' failure to perceive inadequate asthma control were investigated. RESULTS: Seven hundred eighteen (68.5%) of the 1,048 patients with inadequate asthma control and documented perception of control considered themselves to be "completely" or "well" controlled. Patients' perception of control did not vary with each dimension of inadequate control. High rates of failure to perceive poor control were observed in patients with at least weekly dyspneas (60%) or nocturnal symptoms (60%). Failure to perceive inadequate control was more likely in patients aged 41 to 50 years (odds ratio, 1.51; 95% confidence interval, 1.05-2.15). No significant effect of factors related to asthma management was observed. CONCLUSIONS: Patients with most uncontrolled asthma have difficulty in properly perceiving their level of disease control regardless of their personal characteristics or disease management. The reasons for this poor perception should be investigated. Education programs should be created that focus on knowledge of asthma miscontrol criteria.

Influence of patients' characteristics and disease management on asthma control.

BACKGROUND: Although asthma control is a major outcome in disease management, little is known about its determinants. OBJECTIVES: We sought to study the relationships between asthma control and patient characteristics or asthma management. METHODS: Asthmatic patients (age 18-50 years) who were regular customers of pharmacies and had a prescription for an antiasthma medication were recruited consecutively. Patients completed a questionnaire, which was complemented by computerized pharmacy records of previously dispensed medications. Asthma control (adequate/inadequate) was assessed with the Asthma Control Test. Determinants of asthma control were identified by means of multivariate logistic regression analysis. RESULTS: The mean age of the 1351 patients included was 36.8 years (SD, 9.8), and 55.8% were women. A minority of patients were considered to have had their symptoms adequately controlled. Smoking, female sex, and a body mass index of greater than 30 kg/m2 were all independent determinants of inadequate control. Compared with patients receiving inhaled corticosteroid monotherapy, those who were dispensed fixed combinations of inhaled corticosteroids and long-acting beta-agonists presented with a significantly lower risk of inadequate asthma control (odds ratio, 0.58; 95% CI, 0.35-0.96). CONCLUSION: Asthma control varied according to both the patients' characteristics and therapy. CLINICAL IMPLICATIONS: Our results strongly support the need to improve asthma control, especially in primary care and in women. A regular use of fixed controller combinations, helping patients to quit smoking, or addressing weight issues might contribute to improvement in asthma control.

Economic impact of pharmacists' interventions with nonsteroidal antiinflammatory drugs.

OBJECTIVE: To estimate the economic impact of community pharmacists' interventions following the detection of problems related to nonsteroidal antiinflammatory drugs (NSAIDs), whether in a prescription or self-medication format. The evaluation focused on the gastroduodenal adverse events that could be avoided and the subsequent savings of healthcare resources spent on treating these adverse effects. METHODS: A previous study conducted during a 12-week period in 924 French community pharmacies provided the number of interventions for drug-related problems concerning NSAIDs. A simulation model was constructed to compare 2 strategies: a systematic pharmacist's intervention and the absence of intervention. The base-case patient was assumed to have been taking an NSAID for 3 months. The model's inputs were extracted from medical literature and from an institutional medical database. RESULTS: In this study, 608 interventions were the results of NSAID-related problems. All of these interventions reduced the risk of gastrointestinal adverse events and avoided a total cost of 37 300. CONCLUSIONS: This model indicates that the dispensing of NSAIDs by pharmacists and related pharmaceutical care activities have a positive impact by reducing the number of gastrointestinal complications. The model quantifies the costs thus avoided. It also underlines the necessity of effective collaboration between the prescriber and the pharmacist if optimal patient management is to be achieved.