Background
Research and development in Danish pharmacies has in the 90'ies focused on the concept of pharmaceutical care. Pharmaceutical care is a continuous quality improvement function aimed at the drug use system. It focuses on inadequate managing of drug therapy, in particular failure to recognize and resolve drug related problems before they become morbidities. The hypothesis is that working with isolated factors is an inadequate approach to preventing drug related morbidities (therapeutic failure as well as adverse events). The overall purpose is to ensure optimal quality of life (clinical and psycho-social outcomes) for individual patients and health economic outcomes from the society perspective. All participants in the drug use system, including primary care actors such as GP's, pharmacists, nurses and the patients themselves are seen as essential resources.

Interventions
Two pharmacy based intervention projects have been carried out testing two different models of pharmaceutical care: a disease specific and a non-disease specific pharmacy based model. Both projects are part of multi-country European research programs.

1. Quality improvement of drug therapy for asthma patients in Denmark. The project ran for 12 months in 1994-95. It involved 500 asthma patients, 16 intervention and 15 control pharmacies in collaboration with 139 GP's. The patients had on average 10 encounters lasting 45 minutes.
2. Improving the well-being of elderly patients via community pharmacy based pharmaceutical care. The project ran for 18 months in 1997-98. It involved 524 patients receiving five or more drugs and aged >65 years. The patients had on average 6 encounters lasting 40 minutes.

In both projects the intervention consisted of individual counseling encounters where the pharmacist would monitor outcomes and drug related problems, provide individual action plans and patient education according to individual needs and wants, and if needed refer therapeutic problems to GPs.

Results
The asthma project showed beneficial effects on the following outcome measures: Asthma symptom status, days of sickness, quality of life, use of short acting Beta-agonists, use of inhaled Corticosteroids, knowledge and inhalation errors. Cost-effect ratios improved by a factor of five. Peak-flow and satisfaction did not show improvement relative to the control group.

The elderly project is currently being analyzed. Preliminary results show that intervention patients have significantly better quality of life and symptom scores, fewer problems with medicines, fewer contacts with GP's and decreased use of Benzoediazepines. Other indicators of drug use and knowledge, compliance and general satisfaction showed no difference between the groups. Satisfaction with information improved.

Conclusion
Comparing results from the two models it appears that the asthma model has worked as intended whereas the model for the elderly patients had less impact on drug therapy quality than anticipated.