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Release: Nov. 28, 2001

UI study finds automated health survey allows pharmacists to identify medication problems

IOWA CITY, Iowa -- Pharmacists often have access to the most up-to-date and complete information about patients' medications. In addition, pharmacists see patients regularly over the long term as people return to refill prescriptions. These facts mean that community pharmacists are ideally placed to ensure that patients get the most benefit from their drug treatment.

Taking advantage of this situation, University of Iowa College of Pharmacy researchers worked with Outcomes Pharmaceutical Health Care (a network of 12 community pharmacies in Iowa) and G.D. Searle (now Pharmacia Corporation) to find out whether on-the-spot health assessments could be used by pharmacists to identify and resolve patients' drug-related problems.

"Pharmacists have realized that they are in a unique position in the whole chain of health care provision to be able to identify those patients who might need more help with their medications," said Michael Ernst, Pharm. D., assistant professor (clinical) in the UI College of Pharmacy and a pharmacist in the UI Family Medicine Clinic. "We wanted to design a project, based in community pharmacies, to investigate how pharmacists can help patients get the best overall health benefit from their drug therapy."

The UI researchers and their colleagues conducted an observational study of patients who used community pharmacies to obtain medications for chronic musculoskeletal disorders such as arthritis. These patients often take multiple medications to treat these conditions. Taking several different medications at the same time can lead to adverse drug interactions, and many of the drugs prescribed for arthritis have side effects. For example, non steroidal anti-inflammatory drugs commonly used to treat pain can cause stomach problems. Therefore, these patients are at high risk of having drug-related problems.

Pharmacists at 12 eastern Iowa community pharmacies used a touch-screen survey to assess these patients' self-reported health status. Using this tool, the pharmacists were able to identify 926 drug-related problems in a population of 388 patients. This result confirms the assumption that the prevalence of drug-related problems is high for these patients.

The study also found that drug-related problems were associated with a decrease in physical health as reported by the patients. The pharmacists were able to resolve nearly 71 percent of these problems and, by the end of the yearlong study, participating patients reported an improvement in their physical well-being. Pharmacists often worked in tandem with physicians to resolve the problems.

Patty Kumbera, vice president of operations for Outcomes Pharmaceutical Health Care, outlined several questions that the study aimed to answer. For one, the researchers wanted to know if the community pharmacy setting is a good place to collect health-related quality of life information from patients.

"This information is not consistently collected anywhere else in the health care system," Kumbera said.

The team also wanted to know if patients were comfortable answering the survey's detailed questions. Finally, the study investigated whether pharmacists, armed with this level of patient information, could find and resolve drug therapy problems that they otherwise might not have uncovered.

"Although final results are still pending, it appears the answer was 'yes' to all three questions," Kumbera said.

The health assessment survey used in the study was based on a standardized, general health questionnaire designed to measure patients' physical and mental well-being. The survey also included specific questions designed to investigate medication side effects, patients' physical functioning and their use of health resources.

The touch-screen computer used to record the patients' answers provided a simple, easy-to-use tool for patients, many of whom had difficulty writing due to their arthritis.

Once the patients finished the survey, the computer software analyzed the responses. These results, along with the results from previous visits, were immediately available to the pharmacist, giving a picture of how each patient's health had changed over the preceding months. The pharmacists then used the information to monitor patients' progress and determine whether a problem had arisen or whether an intervention was helping.

One significant outcome of the study was the demonstration that arthritis pain is frequently under treated. Pharmacists used the survey information to recognize when a patient's medication dosage was too low to provide the maximum benefit. The pharmacist could then suggest additional over-the-counter medications or work with the prescribing physician to change a medication dosage.

Other strategies used by pharmacists seeking to resolve identified problems included educating patients about their drug therapies.

"This study highlights the benefit of using one pharmacy for a patient's needs," Ernst said. "When a pharmacy has access to information about all the medications a patient is using, then the pharmacist can sit down with the patient and pinpoint the things affecting their overall quality of life in terms of their medications. Patients should realize that their medications can have both good and bad outcomes, and their drug therapy can impact their quality of life."

In addition to Ernst and Kumbera, the research team included William Doucette, Ph.D., associate professor in the UI College of Pharmacy and Matthew Osterhaus, of Osterhaus Pharmacy in Maquoketa.

Seema Dedhiya, Jane Osterhaus, Ph.D., and Raymond Townsend, Pharm. D., all formerly with G. D.

Searle, also were part of the research team. The study was funded by G. D. Searle, now Pharmacia Corporation.

Outcomes Pharmaceutical Health Care is an organized network of advanced-practice pharmacies that is involved in disease state management programs, community-based research initiatives, and the overall advancement of patient care in the community pharmacy setting. For more information about Outcomes' programs and services visit their Web site at

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at