Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly

Bouwmeester, Carla; Kraft, Jacqueline; Bungay, Kathleen M.

doi:10.1016/j.rmed.2015.07.013

Cited by 34 publications

(29 citation statements)

References 18 publications

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“…Only a few reports have addressed the management of the elderly population with asthma (10,110). It is widely accepted that asthma is often undertreated in older patients (111)(112)(113), likely due to multiple factors (Table 3), including incomplete understanding of pathophysiology and most appropriate age-related therapy, decreased asthma self-management with aging, misdiagnosis of AIE, poor access to health care, comorbidities, medication costs, fear of corticosteroid use, and poor medication delivery technique (114)(115)(116)(117). The appropriate management of any chronic disease in the elderly, including asthma, should include multidimensional assessment (MDA) of physical, psychological, cognitive, and social factors that may impact successful treatment.…”

Section: Update On Strategies To Manage the Elderly Patient With Asthmamentioning

confidence: 99%

An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly

et al. 2016

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Asthma in the elderly (>65 yr old) is common and associated with higher morbidity and mortality than asthma in younger patients. The poor outcomes in this group are due, in part, to underdiagnosis and undertreatment. There are a variety of factors related to aging itself that affect the presentation of asthma in the elderly and influence diagnosis and management. Structural changes in the aging lung superimposed on structural changes due to asthma itself can worsen the disease and physiologic function. Changes in the aging immune system influence the cellular composition and function in asthmatic airways. These processes and differences from younger individuals with asthma are not well understood. Phenotypes of asthma in the elderly have not been clearly delineated, but it is likely that age of onset and overlap with chronic obstructive pulmonary disease impact disease characteristics. Physiologic tests and biomarkers used to diagnose and follow asthma in the elderly are generally similar to testing in younger individuals; however, whether they should be modified in aging has not been established. Confounding influences, such as comorbidities (increasing the risk of polypharmacy), impaired cognition and motor skills, psychosocial effects of aging, and age-related adverse effects of medications, impact both diagnosis and treatment of asthma in the elderly. Future efforts to understand asthma in the elderly must include geriatric-specific methodology to diagnose, characterize, monitor, and treat their disease.

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Section: Update On Strategies To Manage the Elderly Patient With Asthmamentioning

confidence: 99%

An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly

et al. 2016

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“…However, much of the information may get lost during the complicated hospital discharge or in the first medical consultation when the patient was diagnosed and prescribed. 7 Several studies show that patients often display incorrect inhalation techniques just a few days after being taught them. 6 …”

Section: Introductionmentioning

confidence: 99%

Identification of inhaler technique errors with a routine procedure in Portuguese community pharmacy

Castel‐Branco¹,

Fontes²,

Figueiredo³

2017

Pharm Pract (Granada)

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Background:A correct selection of drugs prescribed, but also the choice of the appropriate inhaler device, is crucial for the control of respiratory diseases.Objective:To evaluate the inhaler technique and identify potential errors of patients when treated with inhalers by testing a routinary procedure to be implemented in any community pharmacy.Methods:Adults with asthma/COPD and under inhalation therapy were invited to demonstrate how they use their inhalers. After direct observation it was registered whether all the sequential steps included in the summary of product characteristics (SmPC) were performed.Results:The study involved 67 patients from 4 community pharmacies (Portugal central region): 34 (50.7%) males, 65.4 (SD=18.28) years old, 42 (62.7%) with COPD, and 23 (34.3%) using more than one inhaler. The 67 patients used 95 inhalers, comprising: 57 (60.0%) multiple dose DPI (dry powder inhalers), 18 (18.9%) single dose DPI, 16 (16.8%) pMDI (pressurized metered dose inhalers), 2 (2.1%) pMDI+spacer and 2 (2.1%) SMI (soft mist inhalers). No errors were made only by 9 (13.4%) patients. In the 75 DPIs techniques, the most frequent errors were ‘no previous forced expiration’ (46=61.3%) and ‘no 10s apnea after inhalation’ (51=68.0%); in the 16 pMDIs techniques common errors were ‘lack of hand-lung coordination’ (7=43.8 %), ‘no previous forced exhalation’ (8=50.0%) and ‘no apnea after inhalation’ (10=62.5%). After inhaling from 56 devices containing corticosteroids, 34 (60.7%) of the patients did not wash their mouth.Conclusion:The study demonstrated the possibility of performing this procedure routinely in Portuguese community pharmacies and also its utility, since 58 (87%) of patients had at least one error during the inhalers use.

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“…Nevertheless, this study's sample of questions was roughly four times larger than the prior studies assessing general or drug-specific information needs of PCOA [1,9]. While larger samples are desirable, we believe that our sample size provides meaningful results given the number of pharmacists (23) and prescribers (102) involved in this study. Third, manually documented encounters are recorded through the lens of the documenting pharmacist.…”

Section: Discussionmentioning

confidence: 94%

“…At a minimum, the pharmacy must dispense both prescription and over-the-counter medications for PACE participants [19]. Currently, regulations do not require pharmacists to be part of the IDT [19], but many PACE organizations contractually collaborate with one or more pharmacists as part of their care model [21][22][23].…”

Section: Setting and Contextmentioning

confidence: 99%

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

Bankes¹,

Schamp²,

Knowlton³

et al. 2020

Pharmacy

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Little is known about the types of drug information inquiries (DIIs) prescribers caring for older adults ask pharmacists during routine practice. The objective of this research was to analyze the types of DIIs prescribing clinicians of Programs of All-Inclusive Care for the Elderly (PACE) made to clinical pharmacists during routine patient care. This was a retrospective analysis of documented pharmacists’ encounters with PACE prescribers between March through December, 2018. DIIs were classified using a developed taxonomy that describes prescribers’ motivations for consulting with pharmacists and their drug information needs. Prescribers made 414 DIIs during the study period. Medication safety concerns motivated the majority of prescribers’ inquiries (223, 53.9%). Inquiries received frequently involved modifying drug therapy (94, 22.7%), identifying or resolving adverse drug events (75, 18.1%), selecting or adjusting doses (61, 14.7%), selecting new drug therapies (57, 13.8%), and identifying or resolving drug interactions (52, 12.6%). Central nervous system medications (e.g., antidepressants and opioids), were involved in 38.6% (n = 160) of all DIIs. When answering DIIs, pharmacists made 389 recommendations. Start alternative medications (18.0%), start new medications (16.7%), and change doses (12.1%) were the most frequent recommendations rendered. Prescribers implemented at least 79.3% (n = 268) of recommendations based on pharmacy records (n = 338 verifiable recommendations). During clinical practice, PACE prescribers commonly ask pharmacists a variety of DIIs, largely related to medication safety concerns. In response to these DIIs, pharmacists provide medication management recommendations, which are largely implemented by prescribers.

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Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly

Cited by 34 publications

References 18 publications

An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly

An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly

Identification of inhaler technique errors with a routine procedure in Portuguese community pharmacy

Prescriber-Initiated Engagement of Pharmacists for Information and Intervention in Programs of All-Inclusive Care for the Elderly

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