Abstract
Chronic obstructive pulmonary disease (COPD) represents a major cause of global morbidity and mortality, with suboptimal adherence to maintenance pharmacotherapy drastically increasing the risk of acute exacerbations and hospital admissions. Medication synchronization (MedSync) coupled with appointment-based clinical reviews has emerged as an innovative community pharmacy intervention, yet evidence from robust randomized trials in respiratory populations remains sparse. In this 12-month, parallel-group, cluster-randomized controlled trial, 24 community pharmacies were allocated (1:1) to deliver either an integrated MedSync service (intervention, n = 246 patients) or standard dispensing care (control, n = 238 patients) to adults with moderate-to-severe COPD. The intervention harmonized refill schedules to a single monthly appointment encompassing structured adherence assessments, inhaler technique validation, and proactive therapy reconciliation. The primary endpoint was the proportion of patients achieving optimal adherence, defined as a Proportion of Days Covered (PDC) ≥ 0.80 for maintenance inhaled medications. Secondary endpoints included all-cause emergency department visits, COPD-related hospital admissions, and severe exacerbation events. At 12 months, 78.5% of intervention patients achieved a PDC ≥ 0.80 compared to 53.4% in the control arm (adjusted odds ratio: 3.18; 95% CI: 2.14–4.72; p < 0.001). Furthermore, the intervention group experienced significantly fewer COPD-related emergency department presentations (rate ratio: 0.68; 95% CI: 0.51–0.91; p = 0.009) and severe exacerbations requiring hospitalization (rate ratio: 0.62; 95% CI: 0.44–0.88; p = 0.007). Community pharmacist-led medication synchronization substantially improves controller adherence and reduces acute healthcare utilization, demonstrating clear clinical utility for COPD management in ambulatory care.
