COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates

Abstract

Purpose: To evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities. Patients and Methods: Forty "host" pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two "consultant" pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient's general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student's t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data. Results: Nine "host" pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the "consultant" pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership. Conclusion:In this pilot study, the specialized pharmacy-based COPD care model delivered by "consultant" pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model's effectiveness in a larger population as well as when measured against standard care.

Patient and Health Care Provider Perspectives on Potential Preventability of Hospital Admission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Qualitative Study

“… 31 As van der Molen et al propose in their literature review, pharmacists can assist patients with disease management by providing advice and education regarding dosage, inhaler technique, treatment expectations, and the importance of adherence, as well as by supporting self-management. 32 Pharmacists and pulmonologists must share awareness and consult with one another about these elements. In the present study, one pulmonologist assumed that their patient was adherent to medication therapy because iterated requests for the medication were sent by the pharmacy.…”

COPD inhaler therapy: A path to success

“…6,7 Intervention by a pharmacist correlates with a significant reduction in number of exacerba-tions; an increased likelihood that the patient has a COPD care plan and has received the pneumococcal vaccine; and an improvement in the mean health-related quality of life. 11,12 In primary care practices that lack robust multidisciplinary resources, we recommend a The peak inspiratory flow rate affects the location of drug deposition and disaggregation and aerosolization of dry powders; it is therefore a consideration when selecting a delivery device for a given patient. 8,9 Continue use of a long-acting bronchodilator during exacerbations, when feasible.…”

Plan de Intervención Comunitaria para el manejo de la EPOC estable: protocolo de coordinación asistencial y derivación entre farmacias comunitarias y centros de salud

“…Entonces, el farmacéutico puede realizar una serie de intervenciones como ofrecer consejo breve y servicio de cesación, así como educación sanitaria, enseñar el manejo del dispositivo inhalado, chequear la técnica inhalatoria correcta y la adecuación del inhalador al paciente, detectar una falta de adherencia terapéutica o hacer un seguimiento de la enfermedad en cuanto a empeoramiento de la disnea y/o aparición de exacerbaciones (10). La intervención de farmacéuticos comunitarios puede mejorar los resultados en salud, incluyendo un aumento de la adherencia terapéutica (11) y una optimización del uso de los inhaladores, lo que se traduciría en un mejor control de la enfermedad (12).…”