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

Abstract

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.

Clinical inertia in asthma

“…For example, in a study conducted on patients with maternal asthma, patient education, including inhalation instruction and the use of an electronic spirometer by a pharmacist, resulted in a significant reduction in ACQ scores in the intervention group compared with a control group 68 . Similarly, an Australian study of a pharmacist-led pharmacy asthma service intervention for patients with poorly controlled asthma that addressed adherence, inhalation techniques, and allergic rhinitis showed that asthma treatment was reviewed in approximately half of the patients who consulted a general practitioner based on the pharmacist’s suggestion 69 . Other studies have found that nurse-led interventions by so-called “asthma nurses” increased knowledge of inhaled medications 70 and decreased the rate of acute exacerbations 71 .…”