Article Text

Download PDFPDF

Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider
  1. Michela Tinelli1,
  2. John White2 and
  3. Andrea Manfrin3
  1. 1 Personal Social Services Research Unit (PSSRU), The London School of Economics and Political Science, London, UK
  2. 2 York Teaching Hospital NHS Foundation Trust, York, UK
  3. 3 Sussex Pharmacy, School of Life Sciences, University of Sussex, Brighton, UK
  1. Correspondence to Michela Tinelli; m.tinelli{at}


Introduction A key priority in asthma management is achieving control. The Asthma Control Test (ACT) is a validated tool showing a numerical indicator which has the potential to provide a target to drive management. A novel pharmacist-led intervention recently evaluated and introduced in the Italian setting with a cluster randomised controlled trial (C-RCT) showed effectiveness and cost-effectiveness. This paper evaluates whether the intervention is successful in securing the minimally important difference (MID) in the ACT score and provides better health outcomes and economic savings.

Methods Clinical data were sourced from 816 adult patients with asthma participating in the C-RCT. The success of the intervention was measured looking at the proportion of patients reaching MID in the ACT score. Different levels of asthma control were grouped according to international guidelines and graded using the traffic light rating system. Asthma control levels were linked to economic (National Health Service (NHS) costs) and quality-adjusted life years outcomes using published data.

Results The median ACT score was 19 (partially controlled) at baseline, and 20 and 21 (controlled) at 3-month and 6-month-follow up, respectively (p<0.01). The percentage of patients reaching MID at 3 and 6 months was 15.8% (129) and 19.9% (162), respectively. The overall annual NHS cost savings per 1000 patients attached to the shift towards the MID target were equal to €346 012 at 3 months and increased to €425 483 at 6 months. Health utility gains were equal to 35.42 and 45.12 years in full health gained, respectively.

Discussion The pharmacist-led intervention secured the MID in the ACT score and provided better outcomes for both patients and providers.

  • quality-adjusted life years
  • asthma
  • cost effectiveness
  • patient reported outcome
  • community pharmacists

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Contributors AM developed the pharmacist-led intervention. MT and AM designed the framework of analysis and the multidimensional matrix. AM conducted the effectiveness analysis and MT the economic analysis. MT and AM drafted the manuscript. JW reviewed the output of the analysis, its applicability in the clinical setting and helped with the drafting of the manuscript, and reviewed the manuscript as well. All authors revised the manuscript for intellectual content, and read and approved the final manuscript. The researchers (MT and AM) had access to all data. MT acts as the guarantor for the results.

  • Funding The Italian Pharmacists’ Federation (FOFI) funded the C-RCT.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted according to the principles expressed in the Declaration of Helsinki. The study was approved by the University of Kent Faculty of Sciences Research Ethics Advisory Group for Human Participants on 18 February 2014 (reference no 0281314). Then it was approved by the Brescia Ethics Committee in Italy on 3 June 2014 (reference no 1710-Studio RE I-MUR), which also acted as the coordinating centre in Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data supporting the conclusions of this article can be found in the University of Kent Academic Repository (KAR).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.