The added value of a

pharmacist in identifying drug-

related needs of patients in an
adult ambulatory cystic fibrosis
clinic
Sabrina Chan, Elizabeth Tullis, Daniel Cortes
2013 North American Cystic Fibrosis Conference
October 17-19, 2013
2
Study Rationale
Large body of literature evaluating pharmacists role in
ambulatory clinics
Examples of outcomes measured:
Hospitalization rates
Improvement in laboratory results e.g. blood pressure,
warfarin monitoring
Patient/clinician satisfaction with pharmacists interventions

The added value of a pharmacist in an adult CF
ambulatory clinic has not been studied
3
Research objectives
1) To compare the number, types, and clinical significance
of drug therapy problems (DTPs) identified by the
pharmacist (RPh) and standard of care (SOC) in an adult
ambulatory CF clinic

2) To quantify RPh recommendations and classify patient
care services provided by RPh
4
Standard clinic visit vs. study visit
Patient
Nurse
SOC:
Respirologist or
Nurse Practitioner
Respiratory therapist
Dietician
Physiotherapist
etc.
Study Patient
Nurse
SOC
Respiratory therapist
Dietician
Physiotherapist
etc.
RPh
5
Methods
Documented:
1)DTP identified
2)DTP type
3)Self-rated DTP clinical significance:
minor, moderate, major
RPh/SOC discussion
Patient
Nurse
SOC
RPh
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Drug Therapy Problem (DTP)
Undesirable event experienced by a patient which
involves or is suspected to involve drug therapy
Types of DTPs:
1) Unnecessary drug therapy
2) Additional drug therapy required
3) Ineffective drug
4) Dose too low
5) Dose too high
6) Adverse drug reaction
7) Noncompliance / nonadherence


DTP Clinical Significance:
Major DTPs requiring interventions
that prevent detrimental effect
Moderate DTPs requiring
interventions leading to moderate
benefit to patient
Minor DTPs requiring interventions
assumed to have little clinical
importance for the patient



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Examples of CF-related DTPs
Drug-therapy problem (DTP) DTP Type
Clinical
significance
Patient exhibiting signs and symptoms
of a pulmonary exacerbation !
requires IV antibiotics
Additional drug
therapy required
Major
Patient takes tobramycin 160mg
inhaled once daily instead of twice
daily
Nonadherence Moderate
Patient experiencing mild constipation
secondary to iron supplementation
Adverse drug
reaction
Minor
8
Results
Pharmacist recommendations: 57 (79% acceptance rate)
N=20 Pharmacist Standard of Care
DTPs
identified /
patient
Total DTPs (p=0.002)
4.0 2.38 1.7 1.87
Excluding same DTPs identified by both groups (p=0.001)
3.05 1.9 0.75 1.5
DTP Types
Additional drug required (31%)
Adverse drug reactions (25%)
Additional drug required (47%)
Adverse drug reactions (24%)
Clinical
significance
No significant association between clinical significance ratings and RPh/
SOC.
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Discussion
Different types of issues identified by both groups
Distinct roles for pharmacist and SOC clinicians within the
clinic
High acceptance rate of pharmacists recommendations
Generalizability of findings
Limitations
Small sample size
Hawthorne effect
Clinical significance classification had poor inter-rater
reliability
Disease outcomes (i.e. FEV1) not measured
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Conclusions
Pharmacists can add value to an adult ambulatory CF
clinic by:
identifying additional drug therapy problems
collaborating with the clinic team
providing expertise with drug-related clinical activities

Future direction:
identify, prioritize who may benefit most from pharmacist
assessment