Clinical medication reviews in collaboration with general practitioners can have a positive effect on the Medication Appropriateness Index. However, pharmacist withdrawal from the study suggests that community pharmacy may not be an appropriate environment from which to expand clinical medication reviews in primary care.
INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are ongoing concerns to the health system. Poor inhaler technique results in less than optimal delivery of medicine to the lungs and consequent inadequate symptom control. AIM: This study aimed to assess inhaler technique amongst people with asthma and/or COPD. The secondary aims were to investigate who provided education on inhaler technique and whether age, gender or ethnicity was associated with poor inhaler technique. METHODS: People with asthma or COPD who presented to a community pharmacy with a prescription for a respiratory inhaler were invited to participate in the study. Participants completed a brief questionnaire and had their inhaler technique assessed against a standard checklist. RESULTS: There were 103 participants from 26 pharmacies, 86 with asthma and 17 with COPD. Just over half (52.5%) of the assessments indicated good inhaler technique, with 68% of people using the Turbuhaler having good technique compared to 53% for the pressurised metered dose inhaler (pMDI) with spacer and 47% for the pMDI alone. The majority of people (76%) received their initial inhaler technique instruction from their doctor. Over half of participants did not recall having their inhaler technique rechecked. DISCUSSION: After prescribing appropriate therapy, correct inhaler technique is a cornerstone of achieving adequate therapy. Rechecking inhaler technique is a gap in care that needs to be addressed from an interdisciplinary perspective. KEYWORDS: Asthma; chronic obstructive pulmonary disease; dry powder inhalers; metered dose inhalers; spacer inhalers
INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 4879 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family) were a resource for information and a support when independence was limited. Rongoa (traditional medicine) played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the Maori way. Medicines used for gout management were predominantly non-steroidal anti-inflammatory drugs, colchicine and prednisone, with allopurinol only playing a role late in the disease. Medications were often poorly understood and consequently improperly used. Relationships with health professionals were important, but cultural, financial and time barriers impaired access and understanding. Gout had a huge, negative impact on the lives of participants. CONCLUSION: The quality of lives of many people with gout could be improved by better understanding through educational campaigns for health professionals and the community. Culturally sensitive health care systems and a paradigm shift in gout management and early preventive treatment are needed. KEYWORDS: Drug therapy; ethnic groups; gout; health status disparities; primary health care; qualitative research
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