Involving Community Pharmacies in Improving Asthma Outcomes in an Urban Pediatric Population

IMPACT DC has been funded by the National Association of Chain Drug Stores Foundation
(NACDSF) to undertake a project regarding coordination between the existing IMPACT DC Asthma
Clinic and certain community pharmacies in Northwest, Northeast, and Southeast DC that
provide patients with asthma medications, devices, and education.

This is a single blind prospective randomized clinical trial in which eligible patients with
asthma aged 12m to 12y, inclusive, seen in the current IMPACT DC Asthma Clinic and
prescribed ICS as controller medications is randomized to either "usual pharmacy care" or
"enhanced pharmacy care." The IMPACT DC Asthma Clinic is an ED-based follow-up clinic that
has been shown to improve outcomes. (1)

Outcomes will be assessed by blinded and structured patient phone interview at 1, 3, and 6
months.

Patients randomized to usual pharmacy care will fill prescriptions by their usual preferred
method, whereas patients randomized to enhanced pharmacy care will have these same
prescriptions electronically transmitted to specifically trained pharmacists at one of the
participating community pharmacies. Both "usual pharmacy care" and "enhanced pharmacy care"
will be provided within all participating pharmacy sites.

Community pharmacies located in five zip codes in Northeast and Southeast DC with the
highest absolute numbers of pediatric ED asthma visits to hospital in the District (20019,
20020, 20032, 20002, 20011) will be selected for the program based on their geographic
distribution and ability to meet programmatic expectations. Pharmacies will receive
electronically transmitted, faxed or verbal prescriptions from the IMPACT DC Asthma Clinic
staff for patients identified as study participants in the intervention group.

Pharmacists will then provide real-time, targeted education around the purpose and use of
the new and refilled ICS medications to study participants and their families at each point
of contact, including rationale for their use, device teaching, dosage review, and
importance of compliance. Families randomized to "enhanced care" will also be contacted
monthly by phone and mail with reminders to fill their controller medications prescriptions
and to seek ongoing longitudinal asthma care with their primary care providers.

(1) Teach SJ, Crain EF, Quint DM, Hylan ML, Joseph JG. Improved Asthma Outcomes in a High
Morbidity Pediatric Population: Results of an Emergency Department-based Randomized Clinical
Trial. Archives of Pediatric and Adolescent Medicine. 2006;160:535-541.

Inclusion Criteria:

- Inclusion criteria include:

1. age between 12 months and 12 years, inclusive;

2. prior physician-diagnosed asthma;

3. prescription of an inhaled corticosteroid during the IMPACT DC Asthma Clinic
visit,

4. a parent/guardian available for interview;

5. residence in one of the 5 zip codes in Washington, DC with the highest absolute
numbers for asthma visits to the Emergency Department at Childrens National
Medical Center (20019, 20020, 20032, 20002, 20011), and

6. insurance that covers at least part of the cost of medications.

Exclusion Criteria:

- Exclusion criteria include:

1. significant medical co-morbidities affecting the cardiorespiratory system;

2. enrollment in another asthma research study;

3. unavailability for telephone follow-up; or

4. primary language other than English.