Are Sudanese community pharmacists capable to prescribe and demonstrate asthma inhaler devices to patrons? A mystery patient study
Although community pharmacists have become more involved in the care of asthma patients, several studies have assessed pharmacists’ ability to illustrate appropriately inhalation technique of different asthma devices. Many studies addressed inappropriate use of asthma devices by patients and pharmacists, in addition to its clinical, humanistic and economic burden.
Objective: To evaluate community pharmacists’ practical knowledge and skills of demonstrating proper inhalation technique of asthma inhaler devices available in Sudan.
Method: Three hundred community pharmacies located around the three major hospitals in the capital city (Khartoum) and four other provinces were approached, and four asthma devices were assessed: Metered-dose inhaler (MDI) (n=105), MDI with Spacer (n=83), Turbuhaler (n=61), and Diskus (n=51). Investigator (a pharmacist) acted as a mystery patient. He selected one device and asked the serving pharmacist to demonstrate how to use the device. Investigator completed a checklist of 9 steps of inhaler device use immediately after leaving the pharmacy. Essential steps derived from published literature were pre-specified for each device. Five evaluation categories were accordingly formulated as follows: optimal technique, adequate technique, poor technique, totally unfamiliar with the device, and does not know.
Results: More than half of the pharmacists approached with metered dose inhaler did not know how to use optimal technique (ie all steps correct) all through. A third poorly demonstrated the technique, and only one pharmacist was categorized as being able to demonstrate an “optimal technique”. The majority of pharmacists approached with spacing chamber and dry powder inhalers (Turbuhaler and Diskus) either did not know proper technique or were totally unfamiliar with the devices.
Conclusion: The majority of community pharmacists, who were expected to educate asthma patients on their dispensed inhalers, lack the basic knowledge of proper use of commonly dispensed asthma inhaler devices.
2. Dizdar EA, Civelek E, Sekerel BE. Community pharmacists’ perception of asthma: a national survey in Turkey. Pharm World Sci. 2007;29(3):199-204.
3. Global Initiative for Asthma. Global Burden of Asthma. http://www.ginasthma.com (Accessed March 8, 2005).
4. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J. 2002;19(2):246-251.
5. Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurized aerosol for patients with poor inhaler technique. Thorax. 1991;46(10):712-716.
6. Lindgren S, Bake B, Larsson S. Clinical consequences of inadequate inhalation technique in asthma therapy. Eur J Respir Dis. 1987;70(2):93-98.
7. Mangiapane S, Schulz M, Mühlig S, Ihle P, Schubert I, Waldmann HC. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother. 2005;39(11):1817-1822.
8. Hämmerlein A, Müller U, Schulz M. Pharmacist-led intervention study to improve inhalation technique in asthma and COPD patients. J Eval Clin Pract. 2011 Feb;17(1):61-70.
9. Saini B, LeMay K, Emmerton L, Krass I, Smith L, Bosnic-Anticevich S, Stewart K, Burton D, Armour C. Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained. Patient Educ Couns. 2011;83(3):295-302.
10. Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: feasibility and acceptability of training by pharmacists. Respir Med. 2011;105(12):1815-1822.
11. Emmerton L, Shaw J, Kheir N. Asthma management by New Zealand pharmacists: apharmaceutical care demonstration project. J Clin Pharm Ther. 2003;8(5):395-402.
12. Närhi U, Airaksinen M, Enlund H. Pharmacists solving problems in asthmamanagement-experiences from a one year intervention program in Finland. Int J Pharm Pract. 2002;10(1):55-59.
13. Hanania NA, Wittman R, Kesten S, Chapman KR. Medical personnel’s knowledge of and ability to use inhaling devices: metered-dose inhalers, spacing chambers, and breath-actuated dry powder inhalers. Chest. 1994;105(1):111-116.
14. Watson MC, Skelton JR, Bond CM, Croft P, Wiskin CM, Grimshaw JM, Mollison J. Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting. Pharm World Sci. 2004;26(1):32-37.
15. Smith IJ, Parry-Billings M. The inhalers of the future? A review of dry powder devices on the market today. Pulm Pharmacol Ther. 2003;16(2):79-95.
16. Lenney J, Innes JA, Crompton GK. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI. Respir Med. 2000;94(5):496-500.
17. Madden J, Quick J, Ross-Degnan D, Kafle K. Undercover careseekers: simulated clients in the study of health provider behaviour in developing countries. Soc Sci Med. 1997;45(10):1465-1482.
18. Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med. 2003;16(3):249-254.
19. Frew AJ, MacFarlane JTM. Are medical staffs any better at using inhalers than patients? Thorax 1982;37:780.
20. Kesten S, Zive K, Chapman KR. Pharmacist knowledge and ability to use inhaled medication delivery systems. Chest. 1993;104(6):1737-1742.
21. Mickle TR, Self TH, Farr GE, Bess DT, Tsiu SJ, Caldwell FL. Evaluation of pharmacists' practice in patient education when dispensing a metered-dose inhaler. DICP. 1990;24(10):927-930.
22. Hounkpati A, Glakar CA, Gbadamassi AG, Adjoh K, Balogou KA, Tidjani O. Attitudes of private pharmacists in the management of asthma patients in Lomé. Int J Tuberc Lung Dis. 2007;11(3):344-349.
23. Basheti IA, Qunaibi E, Bosnic-Anticevich SZ, Armour CL, Khater S, Omar M, Reddel HK. User Error With Diskus and Turbuhaler by Asthma Patients and Pharmacists in Jordan and Australia. Respir Care. 2011;56(12):1916-1923.
24. Basheti IA, Armour CL, Reddel HK, Bosnic-Anticevich SZ. Long-Term Maintenance of Pharmacists’ Inhaler Technique Demonstration Skills. Am J Pharm Educ. 2009;73(2):32.
25. Raynor DK, Savage I, Knapp P, Henley J. We are the experts: people with asthma talk about their medicine information needs. Patient Educ Couns. 2004;53(2):167-174.
26. Kritikos VS, Reddel HK, Bosnic-Anticevich SZ. Pharmacists' perceptions of their role in asthma management and barriers to the provision of asthma services. Int J Pharm Pract. 2010;18(4):209-216.
27. Khassawneh BY, Al-Ali MK, Alzoubi KH, Batarseh MZ, Al-Safi SA, Sharara AM, Alnasr HM. Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers. Respir Care. 2008;53(3):324-328.
28. Rönmark E, Jögi R, Lindqvist A, Haugen T, Meren M, Loit HM, Sairanen U, Sandahl A, Lundbäck B. Correct use of three powder inhalers: comparison between Diskus, Turbuhaler, and Easyhaler. J Asthma. 2005;42(3):173-178.
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