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Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider

Michela Tinelli, John White and Andrea Manfrin
BMJ Open Respir Res 2018;5:e000322
doi: 10.1136/bmjresp-2018-000322

By 2025, an estimated 400 million people worldwide will be suffering from asthma, with a cost of €72 billion annually to the 28 countries of the European Union.

The long-term goals of asthma management, according to the Global Initiative for Asthma (GINA), are to achieve good symptom control and to minimise the risk of exacerbation, and therefore a key priority is the development of a simple and effective intervention for improving asthma control.

A previous cluster randomised controlled trial (C-RCT) in Italy (n=1263) has previously measured the effectiveness and cost-effectiveness of an innovative pharmacist-led intervention. Its primary outcome was asthma control, as assessed using the Asthma Control Test (ACT) score (ACT ≥20 representing good control) and its secondary outcomes were (1) the number of active ingredients, (2) adherence and (3) cost-effectiveness compared with usual care. The key results showed that firstly the intervention was effective: the median score was 19 before the intervention, 20 at three months post-intervention and 21 at six months post-intervention; and secondly the intervention was cost-effective – the probability of the intervention being more cost-effective than usual care was 100% at nine months.

The aim of Tinelli et al.’s study was to measure the impact of this intervention on the minimally important difference (MID) in asthma control, i.e. looking at the proportion of patients reaching a three-point improvement in the ACT score. It also looked at the benefits of reaching clinical MID in terms of health outcomes for the patient and economic savings for the healthcare provider. For this study, a subset of the former study was used (n=816).

In demonstrating a MID in the ACT, an improvement in patients’ health outcomes and a reduction of costs to the NHS, the pharmacist-led intervention explored in this study promotes a shift in the approach to good asthma control.

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