An exploration of clinical interventions provided by pharmacists within a complex asthma service
Background: Pharmacists in Australia are accessible health care professionals, and their provision of clinical pharmacy interventions in a range of areas has been proven to improve patient outcomes. Individual clinical pharmacy interventions in the area of asthma management have been very successful. An understanding of the nature of these interventions will inform future pharmacy services. What we do not know is when pharmacists provide a complex asthma service, what elements of that service (interventions) they choose to deliver.
Objective: To explore the scope and frequency of asthma-related clinical interventions provided by pharmacists to patients in an evidence-based complex asthma service.
Methods: Pharmacists from 4 states/territories of Australia were trained in asthma management. People with asthma had 3 or 4 visits to the pharmacy. Guided by a structured patient file, the pharmacist assessed the patient’s asthma and management and provided interventions where and when considered appropriate, based on their clinical decision making skills. The interventions were recorded in a checklist in the patient file. They were then analysed descriptively and thematically.
Results: Pharmacists provided 22,909 clinical pharmacy interventions over the service to 570 patients (398 of whom completed the service). The most frequently delivered interventions were in the themes ‘Education on asthma’, ‘Addressing trigger factors’, ‘Medications – safe and effective use’ and ‘Explore patient perspectives’. The patients had a high and ongoing need for interventions. Pharmacists selected interventions based on their assessment of perceived need then revisited and reinforced these interventions.
Conclusion: Pharmacists identified a number of areas in which patients required interventions to assist with their asthma management. Many of these were perceived to require continuing reinforcement over the duration of the service. Pharmacists were able to use their clinical judgement to assess patients and provide clinical pharmacy interventions across a range of asthma management needs.
2. Benrimoj S, Langford J, Berry G, Collins D, Lauchlan R, Stewart K, Ward PR. Clinical significance of clinical interventions in community pharmacy: a randomised trial of the effect of education and a professional allowance. Int J Pharm Pract. 2003;11(2):81-87.
3. Williams K, Emmerton L, Taylor R, Werner J, Benrimoj S. Non-prescription medicines and Australian community pharmacy interventions: rates and clinical significance. Int J Pharm Pract. 2011;19(3):156-165. doi: 10.1111/j.2042-7174.2010.00091.x
4. Williams M, Peterson G, Tenni P, Bindoff I, Stafford A. DOCUMENT: a system for classifying drug-related problems in community pharmacy. Int J Clin Pharm. 2012;34(1):43-52. doi: 10.1007/s11096-011-9583-1
5. Young S, Bishop L, Conway A. Interventions performed by community pharmacists in once Canadian province: a cross-sectinal study. Ther Clin Risk Manag. 2012;8:415-421. doi: 10.2147/TCRM.S37581
6. Pottegård A, Hallas J, Søndergaard J. Pharmaceutical interventions on prescription problems in a Danish pharmacy setting. Int J Clin Pharm. 2011;33(6):1019-1027. doi: 10.1007/s11096-011-9580-4
7. Stafford A, Bindoff I, Tenni P, Peterson G, Doran C. A methodological framework for estimating the clinical and economic value of community pharmacists' clinical interventions using expert opinion. J Clin Pharm Ther. 2012;37(4):378-385. doi: 10.1111/j.1365-2710.2011.01322.x
8. Benrimoj S, Langford J, Berry G, Colins D, Lauchlan R, Stewart K, Aristides M, Dobson M. Economic impact of increased clinical intervention rates in community pharmacy. A randomised trial of the effect of education and a professional allowance. Pharmacoeconomics. 2000;18(5):459-468.
9. Rupp M. Value of community pharmacists' interventions to correct prescribing errors. Ann Pharmacother. 1992;26(12):1580-1584.
10. Williams M, Peterson G, Tenni P, Bindoff I, Curtain C, Hughes J, Bereznicki LR, Jackson SL, Kong DC, Hughes JD. Drug-related problems detected in Australian Community Pharmacies: The PROMISe Trial. Ann Pharmacother. 2011 Sp;45(9):1067-1076. doi: 10.1345/aph.1Q138
11. Australian Government Department of Health. 5th Community Pharmacy Agreement. Pharmacy Practice Incentives. Available at: http://5cpa.com.au/programs/pharmacy-practice-incentives/ (Accessed 31 October 2014).
12. Krass I, Hebing R, Mitchell B, Hughes J, Peterson G, Song Y, Stewart K, Armour CL. Diabetes management in an Australian primary care population. J Clin Pharm Ther. 2011;36(6):664-672. doi: 10.1111/j.1365-2710.2010.01221.x
13. Armour CL, Reddel HK, LeMay KS, Saini B, Smith LD, Bosnic-Anticevich SZ, Song YJ, Alles MC, Burton DL, Emmerton L, Stewart K, Krass I. Feasibility and effectiveness of an evidence-based asthma service in Australian community pharmacies: a pragmatic cluster randomised trial. J Asthma. 2013;50(3):302-309. doi: 10.3109/02770903.2012.754463
14. Global Initiative for Asthma. GINA Report. Global Strategy for Asthma Management and Prevention, Available at http://www.ginasthma.org (Accessed: 31 October 2014).
15. Armour CL, Lemay K, Saini B, Reddel HK, Bosnic-Anticevich SZ, Smith LD, Burton D, Song YJ, Alles MC, Stewart K, Emmerton L, Krass I. Using the community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma. 2011;48(9):914-922. doi: 10.3109/02770903.2011.615431
16. Fathima M, Naik-Panvelkar P, Saini B, Armour CL. The role of community pharmacists in screening and subsequent management of chronic respiratory diseases: a systematic review. Pharm Pract (Granada). 2013;11(4):228-245.
17. Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-1538.
18. Barbanel D, Eldridge S, Griffiths C. Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax. 2003;58(10):851-854.
19. Clifford S, Barber N, Elliott R, Hartley E, Horne R. Patient-centred advice is effective in improving adherence to medicines. Pharm World Sci. 2006;28(3):165-170.
20. Bereznicki B, Peterson G, Jackson S, Walters H, Fitamaurice K, Gee P. Data-mining of medication records to improve asthma mangement. Med J Aust. 2008;189(1):21-25.
21. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, Brusselle G. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008;31(4):790-799.
22. Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L, Stewart K. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62(6):496-502.
23. Mangiapane S, Schulz M, Mühling S, Ihle P, Schubert I, Waldmann H-C. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother. 2005;39(11):1817-1822.
24. McLean W, Gillis J, Waller R. The BC community pharmacy asthma study: a study of clinical, economic and holistic outcomes influences by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Can Respir J. 2003;10(4):195-202.
25. García-Cárdenas V, Sabater-Hernández D, Kenny P, Martínez- Martínez F, Faus MJ, Benrimoj SI. Effect of a pharmacist intervention on asthma control. A cluster randomised trial. Respir Med. 2013;107(9):1346-1355. doi: 10.1016/j.rmed.2013.05.014
26. Saini B, Smith L, Armour C, Krass I. An educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Educ. 2006;70(5):118.
27. National Asthma Council Australia. Australian Asthma Handbook. Version 1.0 National Asthma Council Australia, Melbourne. Available at: http://www.asthmahandbook.org.au (Accessed: 31 October 2014).
28. LeMay KS, Armour CL, Reddel HK. Performance of a brief asthma control screening tool in community pharmacy: a cross-sectional and prospective longitudinal analysis. Prim Care Respir J. 2014;23(1):79-84. doi: 10.4104/pcrj.2014.00011
29. Naik-Panvelkar P, Saini B, LeMay KS, Emmerton LM, Stewart K, Burton DL, Bosnic-Anticevich SZ, Krass I, Smith LD, Armour CL. A pharmacy asthma service achieves a change in patient responses from increased awareness to taking responsibility for their asthma. Int J Pharm Pract. 2014 [Epub ahead of print]. DOI: 10.1111/ijpp.12134
30. Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: feasibility and acceptability of training by pharmacists. Respir Med. 2011;105(12):1815-1822. doi: 10.1016/j.rmed.2011.07.004
31. Gibson P, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004;59(2):94-99.
32. Kahawati C, Smith L, Armour CL. Goal setting by people with asthma - what do they want? Aust Pharm. 2008;27(8):674-678.
33. Australian Government Department of Health. Chronic Disease. [updated 26 September 2012]; Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/chronic (Accessed 31 October 2014).
34. Emmerton LM, Smith L, LeMay KS, Krass I, Saini B, Bosnic-Anticevich SZ, Reddel HK, Burton DL, Stewart K, Armour CL. Experiences of comunity pharmacists involved in the delivery of a specialist asthma service in Australia. BMC Health Serv Res. 2012;12:164. doi: 10.1186/1472-6963-12-164
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