A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Serhal, Sarah; Saini, Bandana; Bosnic‐Anticevich, Sinthia; Krass, Ines; Emmerton, Lynne; Bereznicki, Bonnie; Bereznicki, Lre; Weier, Naomi; Mitchell, Bernadette; Wilson, Frances; Bawa, Zeeta; Wright, Bronwen; Wilson, Kiara; Segrott, Rebecca; Gomez, Marsha; Armour, Carol

doi:10.5688/ajpe8633

Cited by 4 publications

(12 citation statements)

References 19 publications

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“…An earlier study had included an active referral to a GP for every asthma patient who did not have a current asthma action plan at baseline ( Serhal et al, 2021 ). In the current study, this was not a recommendation until the final visit in both arms.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to implementation, pharmacists in the PAS arm were required to pass both theoretical and skills-based training for assurance of the advanced clinical knowledge and skills required to deliver the PAS and compliance with the trial protocol ( Serhal et al, 2021 ). Details of the education program have been published ( Serhal et al, 2021 ). Pharmacists in the comparator arm required protocol training only.…”

Section: Methodsmentioning

confidence: 99%

“…Upon completion of required training, pharmacies in both arms were asked to recruit a minimum of seven patients each. The sample size was based on feasibility established in previous studies, to account for predicted pharmacy and patient withdrawal rates, and the numbers required to show statistically significant change in asthma control ( Saini et al, 2011 ; Serhal et al, 2021 ).…”

Section: Methodsmentioning

confidence: 99%

“…Research within Australia and elsewhere over the past two decades has demonstrated that structured pharmacy-based, pharmacist-delivered, patient-centered asthma management services can cost-effectively improve a range of patient outcomes ( Saini et al, 2004 ; Gordois et al, 2007 ; Armour et al, 2013 ; Serhal et al, 2021 ). Despite demonstrated success in research, for a variety of reasons, including intervention complexity and the time required, these service models have unsuccessfully transitioned past novel interventions to become routinely embedded within community pharmacy practice.…”

Section: Introductionmentioning

confidence: 99%

“…In response to feedback from pharmacists in earlier trials ( Armour et al, 2007 ; Gordois et al, 2007 ; Armour et al, 2013 ) and to increase accessibility of evidence-based interventions to asthma patients within the Australian community, a trial was designed to implement a streamlined and technologically supported Pharmacy Asthma Service (PAS). A new method of training was offered, which allowed pharmacists the flexibility to refine their knowledge and skills at a pace and time that suited their professional schedules ( Serhal et al, 2021 ). Additionally, the service design aimed to reduce the cognitive and time burden on pharmacists by incorporating a novel, trial-specific, data collection software ( Emmerton et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

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A Targeted Approach to Improve Asthma Control Using Community Pharmacists

et al. 2021

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Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice.Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes.Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data.Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079).Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Targeted Approach to Improve Asthma Control Using Community Pharmacists

et al. 2021

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Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review

Serhal

Krass

Emmerton

et al. 2022

npj Prim. Care Respir. Med.

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Uptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers (consulted their GP on pharmacist’s advice) or action avoiders (did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients (n = 148) received a GP referral, of whom 78% (n = 115) were action takers, and 44% (n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers. Action takers were more likely to have an asthma action plan (P = 0.001) at month 12, and had significantly more GP visits during the trial period (P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.

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Improving Asthma Management: Patient–Pharmacist Partnership Program in Enhancing Therapy Adherence

et al. 2022

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Community pharmacist interventions can assist in improving adherence in patients with asthma. The objective of the study was to assess the feasibility of patient-centered counseling using the developed asthma-specific tools to identify barriers to adherence and identify their preliminary effect on adherence barrier score and asthma control. Adult patients with persistent asthma were invited to participate in a 3-month pre–post intervention study involving community pharmacist-provided patient-centered counseling. Bivariate analyses were conducted to determine whether there were changes in outcomes from the pre to post period. Of 36 recruited patients, 17 completed both pre and post surveys. At baseline, patients had a mean ACT score of 15.1 ± 3.5, with 94% having uncontrolled asthma, and an average of 4.2 ± 2.5 reported barriers. The following barriers were most common: not having an Asthma Action Plan (52.9%), use of inhaler more or less often than prescribed (47.1%) and forgetfulness (41.2%). The ACT score increased by 2.7 ± 5.4, which was not statistically significant; however, it might be clinically significant. Two barrier scores improved as a result of the intervention. Preliminary evidence on the feasibility of identifying and addressing patient-specific barriers to adherence delivered by pharmacists showed that it has the potential to resolve barriers and improve asthma outcomes.

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A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Cited by 4 publications

References 19 publications

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review

Improving Asthma Management: Patient–Pharmacist Partnership Program in Enhancing Therapy Adherence

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