September 5, 2012

Pharmacists on the Front Lines of Osteoarthritis Care

Vancouver—Nearly 27 million Americans over the age of 25 have some form of osteoarthritis (OA), but a substantial number of cases are never diagnosed or treated. To remedy that, Canadian researchers enlisted the help of the most accessible health provider for most arthritis sufferers—the community pharmacist.

The study focused on knee osteoarthritis, which occurs in 10% of men and 13% of women over the age of 59, and was published recently in Arthritis Care & Research, a journal of the American College of Rheumatology. It looked at a collaborative approach to managing knee OA involving pharmacists, physiotherapists, and primary care physicians to improve quality of care, patient function, pain control, and quality of life.

"Many cases of knee OA go undiagnosed and patients often do not receive timely care to relieve pain, improve function and prevent disability," said lead author Carlo Marra, PharmD, PhD, a director with the Collaboration for Outcomes Research and Evaluation and a professor of pharmaceutical sciences at the University of British Columbia in Vancouver. "Our study investigates a multidisciplinary intervention that involves pharmacists in the identification and patient care for those with knee OA."

The authors said they included pharmacists in the study because “many chronic diseases are being managed in partnership with pharmacists who help with the identification of patients not seeking physician attention and improve medication management. We hypothesized that knee OA could benefit from collaborative care as well.”

Sites included in the randomized, controlled trial were 14 pharmacies that provided interventional therapy and 18 pharmacies that offered usual care. Two or more pharmacists at each location enrolled participants 50 or older who said they had experienced knee pain or stiffness on most days of the last month. Other study criteria included having a body mass index (BMI) greater than 25, lack of participation in a formal exercise program in the previous six months, and difficulty with activities due to knee pain.

The 73 participants in the intervention group filled out questionnaires, communicated with a primary care physician, and received pain medication management and physical therapy. Those in the control group were only given an educational pamphlet.

After both 3 months and 6 months, participants receiving interventions significantly improved in terms of overall pain and function compared to those receiving usual care.

The overall quality indicator pass rate was significantly higher for those in the intervention arm compared to the control arm—a difference of 45.2%, 95% CI (34.5, 55.9), P < 0.0001. Positive trends also were seen with pain control, overall function, exercise participation, patient knowledge, and weight management. For the control group, the only quality indicators higher than the intervention group were the use of assistive devices and reliance on pharmacologic therapy.

"Our findings suggest that pharmacists can effectively initiate interventions that address the gaps in OA patient care,” Marra said. “With the rise in OA, collaborative care presents a novel approach in prevent and treating those with knee OA."

U.S. Pharmacist Social Connect