Do Face-to-Face Training and Telephonic Reminder Improve Dry Powder Inhaler Technique in Patients with COPD?

Abstract

Introduction. Current modes of instruction on inhaler technique are inadequate. We aimed to evaluate the value of face-to-face training and telephonic reminder (FFTTR) for improving Rotahaler technique in experienced patients with COPD. Materials and Methods. A single group pre-/postinterventional study was conducted at Chitwan Medical College Teaching Hospital, Nepal. We assessed the Rotahaler technique of thirty consecutive patients using Rotahaler device for more than one year. Patients with incorrect technique (n = 20) were instructed and trained by a pharmacist. Telephonic reminder was used to reinstruct patients on the correct technique on weekly basis for two weeks and technique was reassessed after 4 weeks of their first training. Descriptive statistics including Wilcoxon Signed Rank test were applied. Results. The mean age was 66.06 ± 10.6. Of 30 patients, 10 (33.3%) performed Rotahaler technique correctly at baseline and were excluded from FFTTR intervention. FFTTR corrected the technique in 18 (90%) patients and the median (IQR) score increased from 6 (5-6) to 8 (8-8) (p < 0.001). The most incorrect steps were “breathe out gently but not towards the inhaler mouthpiece” (16, 80%) and “hold breath for about 10 seconds” (18, 90%) at baseline which improved after intervention. Conclusion. FFTTR approach markedly improved Rotahaler technique in patients with COPD.

Incorrect inhaler techniques in Western India: still a common problem

“…A study conducted by Poudel RS et al aimed to evaluate the value of face-toface training and telephonic reminder for improving rotahaler technique in experienced patients with COPD and found that at baseline assessment most of the patients (16, 80%) failed to breathe out gently before inhalation and hold breath for 10 seconds after inhalation (18, 90%). 25 Souza ML et al in their study observed that among patients using Aerolizer inhalers, 55 patients (54.5%) did not exhale properly before inhaling the medication. 18 Using metered-dose inhalers, 49 patients (73.1%) did not keep the inhaler at a correct distance from their lips, 41 (61.2%) did not exhale properly before inhaling the medication, 28 (41.8%) did not shake the inhaler before use, and 23 (34.3%) did not exhale slowly during the procedure.…”

Perception of patients towards the role of pharmacist: a cross-sectional study from selected three hospitals in Central Nepal

“…This might be due to the fact that Nepalese pharmacy professionals working in some hospital pharmacies are known to include various patient-focused services such as counselling and education, prescription auditing, medicine information, training on special devices and telepharmacy. [15][16][17]27,28] Similarly, community pharmacy professionals have also been engaged in several services such as patient counselling, blood pressure monitoring, medication record keeping, first-aid treatment and vaccination. [9,26,46] Initiation of such services might change patients' perception of pharmacist as a businessman to healthcare service provider in future.…”

“…[50] Studies in Nepal [19] and Ethiopia [51] suggest a need of CPE and training for pharmacists which may improve the perception of other healthcare professionals towards pharmacists. The expectations of patients towards the role of pharmacist are increasing; thus, widening the pharmacy services such as incorporation of new technologies in the care of patients [28,52] together with development of interpersonal skills is required to improve patient satisfaction and perception towards the pharmacist. [53,54] Our study is probably the first one in Nepal to assess the perception of patients towards pharmacists and factors affecting their choice of pharmacy and will definitely add value to existing literature.…”

“…Despite this scenario, the pharmacists in Nepal have been working in pharmaceutical industries, academia, hospitals and community pharmacies . Literature also demonstrates that Nepalese pharmacists are also providing patient‐oriented services such as pharmaceutical interventions in prescription errors and inhaler technique . Pharmacists are progressively working on enhancing their role towards patients care by playing vital role in improving patient safety, management of drug therapy, improving medication adherence .…”

“…[6] Literature also demonstrates that Nepalese pharmacists are also providing patientoriented services such as pharmaceutical interventions in prescription errors [27] and inhaler technique. [16,27,28] Pharmacists are progressively working on enhancing their role towards patients care by playing vital role in improving patient safety, management of drug therapy, improving medication adherence. [29] Patients should have good perception towards the pharmacists for effective delivery of pharmaceutical services, but results show that this is not happening well in the Nepalese pharmacy practice context.…”