Pharmacists' training to improve inhaler technique of patients with COPD in Vietnam

Abstract

BackgroundIncorrect use of inhalers is very common and subsequently leads to poor control of COPD. Among health care providers, pharmacists are in the best position to educate patients about the correct use of inhaler devices.ObjectiveThe objective of this study was to evaluate the impact of pharmacist-led training on the improvement of inhaler technique for COPD patients in Vietnam.Patients and methodsFor this pre- and post-intervention study, standardized checklists of correct use of metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) were used to evaluate the inhaler technique. A scoring system (maximum score =8) was applied before and after training to guarantee assessment uniformity among pharmacists. Three methods including “face-to-face training”, “teach-back” and “technique reminder label” were used. After the baseline evaluation (T0), the inhaler technique was reassessed after 1 month (T1), 3 months (T2), 6 months (T3) and 12 months (T4).ResultsA total of 211 COPD patients participated in the study. Before the training, a high rate of errors was recorded. After the training, the percentage of patients using MDIs and DPIs perfectly increased significantly (p<0.05). The mean technique score for MDIs and DPIs improved from 6.0 (T0) to 7.5 (T3) and 6.9 (T4) and 6.7 (T0) to 7.6 (T3) and 7.2 (T4), respectively (p<0.05). The average training time was 6 minutes (T0) and 3 minutes (T3), respectively.ConclusionPharmacist-led comprehensive inhaler technique intervention program using an unbiased and simple scoring system can significantly improve the inhaler techniques in COPD patients. Our results indicated a 3-month period as the optimal time period between training and retraining for maintaining the correct inhaler technique. The training would be highly feasible and suitable for implementing in the clinical setting. Our model of pharmacist-led training should be considered as an effective solution for managing COPD patients and better utilization of health care human resources, especially in a developing country like Vietnam.

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

“…Community pharmacists are particularly situated to regularly check inhaler technique when patients drop off new inhaler prescriptions or pick up refills. Pharmacist interventions can help to improve the inhaler technique of asthma and COPD patients [14,26,27]. Furthermore, patients trust and attempt to follow the pharmacist's inhaler technique instructions [28].…”

“…Furthermore, patients trust and attempt to follow the pharmacist's inhaler technique instructions [28]. The patient's inhaler technique declines over time and thus, regular checks and counseling is required to ensure therapeutic stability [27]. The Global Initiative for Chronic Obstructive Lung Disease-(GOLD) and Global Initiative for Asthma (GINA) guidelines stipulate that inhaler technique needs to be assessed regularly, but do not offer a suggested time frame for re-evaluation [29,30].…”

“…The Global Initiative for Chronic Obstructive Lung Disease-(GOLD) and Global Initiative for Asthma (GINA) guidelines stipulate that inhaler technique needs to be assessed regularly, but do not offer a suggested time frame for re-evaluation [29,30]. One study suggested that pharmacists should conduct inhaler checks every three months to verify proper inhaler technique [27]. However, it is unknown how often pharmacists check inhaler technique in real-life community pharmacy practice.…”

Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD

“…Previous studies have indicated that implementation of inhaler training achieves a measurable improvement in inhaler technique [ 27 , 28 , 29 ].…”

Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease

“… 41-43 Pharmacist-led interventions significantly improve inhaler technique in patients with COPD and supplement physician-based education. 15 , 44 In a large single-intervention study of patients with a diagnosis of asthma or COPD ( n = 757), inhalation technique was assessed by a CP at baseline and after 4 to 6 weeks of intervention using a 21-item checklist. Pharmacist-led training reduced the number of patients making 1 or more errors while performing inhalation technique from 597 patients (78.9%) to 214 (28.3%).…”