Inter-professional education unveiling significant association between asthma knowledge and inhaler technique
Objectives: To explore whether an association exists between health care professionals’ (HCPs) asthma knowledge and inhaler technique demonstration skills.
Methods: HCPs’ asthma knowledge and inhaler technique demonstration skills were assessed at baseline at an inter-professional educational workshop focusing on asthma medication use. Asthma knowledge was assessed via a published questionnaire. Correct inhaler technique for the three inhalers, the Accuhaler, Turbuhaler and pressurized Metered Dose Inhaler (pMDI) was assessed using published checklists.
Results: Two hundred HCPs agreed to participate: 10 specialists (medical doctors specialized in respiratory diseases) (5%), 46 general practitioners (23%), 79 pharmacists (39%), 15 pharmacists’ assistants (8%), 40 nurses (20%) and 10 respiratory therapists (5%). Backwards stepwise multiple regression conducted to determine predictors of HCPs’ inhaler technique, showed that out of many independent variables (asthma knowledge score, profession, age, gender, place of work, years in practice and previous personal use of the study inhaler/s), asthma knowledge score was the only variable showing significant association with inhaler technique (R2=0.162, p<0.001).
Conclusion: This study revealed significant associations between asthma knowledge and inhaler technique scores for all HCPs. Providing inter-professional workshops for all HCPs involved integrating education on asthma knowledge and practice of inhaler technique skills are looked-for.
2. Abu-Ekteish F, Otoom S, Shehabi I. Prevalence of asthma in Jordan: comparison between Bedouins and urban schoolchildren using the International Study of Asthma and Allergies in Childhood phase III protocol. Allergy Asthma Proc. 2009;30(2):181-185. doi: 10.2500/aap.2009.30.3208
3. 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. doi: 10.4187/respcare.01205
4. British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2014; 69(Suppl 1):1-192.
5. National Heart Lung and Blood institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/02_sec1_intro.pdf (accessed 1 May 2014).
6. 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
7. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, Serra M, Scichilone N, Sestini P, Aliani M, Neri M; Gruppo Educazionale Associazione Italiana Pneumologi Ospedalieri. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930-938. doi: 10.1016/j.rmed.2011.01.005
8. Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns. 2008;72(1):26-33. doi: 10.1016/j.pec.2008.01.014
9. Bosnic-Anticevich SZ, Stuart M, Mackson J, Cvetkovski B, Sainsbury E, Armour C, Mavritsakis S, Mendrela G, Travers-Mason P, Williamson M. Development and evaluation of an innovative model of inter-professional education focused on asthma medication use. BMC Med Educ. 2014;14:72. doi: 10.1186/1472-6920-14-72
10. 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.
11. Bosnic-Anticevich SZ, Sinha H, So S, Reddel HK. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47(3):251-6. doi: 10.3109/02770900903580843
12. McCarty K, Rogers J. Inpatient asthma education program. Pediatr Nurs. 2012;38(5):257-262.
13. Lehr AR, McKinney ML, Gouin S, Blais JG, Pusic MV, Ducharme FM. Development and pretesting of an electronic learning module to train health care professionals on the use of the Pediatric Respiratory Assessment Measure to assess acute asthma severity. Can Respir J. 2013;20(6):435-441.
14. Adnan M, Karim S, Khan S, Al-Wabel NA. Comparative evaluation of metered-dose inhaler technique demonstration among community pharmacists in Al Qassim and Al-Ahsa region, Saudi-Arabia. Saudi Pharm J. 2015;23(2):138-142. doi: 10.1016/j.jsps.2014.06.007
15. Giner J, Roura P, Hernandez C, Torrejon M, Peiro M, Fernandez MJ, Lopez de Santa Maria E, Gimeno MA, Macian V, Tarragona E, Plaza V. Knowledge and Attitudes of Nurses in Spain about Inhaled Therapy: Results of a National Survey. J Aerosol Med Pulm Drug Deliv 2015, [Epub ahead of print].
16. Barthwal MS, Pethe MP. Study of asthma management practices among general practitioners and physicians in and around Pune city. J Indian Med Assoc. 2013;111(12):840-844.
17. De Tratto K, Gomez C, Ryan CJ, Bracken N, Steffen A, Corbridge SJ. Nurses' knowledge of inhaler technique in the inpatient hospital setting. Clin Nurse Spec. 2014;28(3):156-160. doi: 10.1097/NUR.0000000000000047
18. Hodges B, Inch C, Silver I. Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950-2000: a review. Am J Psychiatry. 2001;158(10):1579-1586.
19. American College of Clinical Pharmacy, Burke JM, Miller WA, Spencer AP, Crank CW, Adkins L, Bertch KE, Ragucci DP, Smith WE, Valley AW. Clinical pharmacist competencies. Pharmacotherapy. 2008;28(6):806-815. doi: 10.1592/phco.28.6.806
20. Casset A, Meunier-Spitz M, Rebotier P, Lefèvre H, Barth C, Heitz C, de Blay F. Asthma management and inhalation techniques among community pharmacists in 2009: a comparison with the 1999 survey. J Asthma. 2014;51(9):964-973. doi: 10.3109/02770903.2014.936446
21. Basheti IA, Qunaibi E A, Hamadi SA, Reddel HK. Inhaler technique training and health-care professionals: effective long-term solution for a current problem. Respir Care. 2014;59(11):1716-1725. doi: 10.4187/respcare.02671
22. Kritikos V, Krass I, Chan HS, Bosnic-Anticevich SZ. The validity and reliability of two asthma knowledge questionnaires. J Asthma. 2005;42(9):795-801.
23. Caffarella RS. Planning programs for adult learners. A practical guide for educators, trainers and staff developers. 2nd ed. San Francisco, CA: Jossey-Bass; 2002.
24. González Diaz SN, Cruz AA, González González AY, Félix Berumen JA, Weinmann AM. [Validation of a knowledge-questionnaire about asthma applied to teachers of elementary school of Monterrey, Mexico]. Rev Alerg Mex. 2010;57(2):44-49.
25. Delclos GL, Arif AA, Aday L, Carson A, Lai D, Lusk C, Stock T, Symanski E, Whitehead LW, Benavides FG, Antó JM. Validation of an asthma questionnaire for use in healthcare workers. Occup Environ Med. 2006;63(3):173-179.
26. Borges MC, Ferraz E, Pontes SM, Cetlin Ade C, Caldeira RD, Silva CS, Araújo AC, Vianna EO. Development and validation of an asthma knowledge questionnaire for use in Brazil. J Bras Pneumol. 2010;36(1):8-13.
27. Rodríguez Martínez C, Sossa MP. [Validation of an asthma knowledge questionnaire for use in parents or guardians of children with asthma]. Arch Bronconeumol. 2005;41(8):419-424.
28. Basheti IA, Obeidat NM, Ammari WG, Reddel HK. Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs. Int J Tuberc Lung Dis 2016; 20 (5): In Press.
29. Lareau SC, Hodder R. Teaching inhaler use in chronic obstructive pulmonary disease patients. J Am Acad Nurse Pract. 2012;24(2):113-120. doi: 10.1111/j.1745-7599.2011.00681.x
30. Basheti IA, Natsheh AI, Ammari WG, Khater S, Qunaibi EA, Bosnic-Anticevich SZ. Education on Correct Inhaler Technique in Pharmacy Schools: Barriers and Needs. Trop J Pharm Sci. 2015;14(4):1319-1326.
31. Basheti IA. The effect of using simulation for training pharmacy students on correct device technique. Am J Pharm Educ. 2014;78(10):177. doi: 10.5688/ajpe7810177
32. Nguyen YBN, Wainwright C, Basheti IA, Willis M, Bosnic-Anticevich SZ. Do Health Professionals on Respiratory Wards Know How to Use Inhalers? J Pharm Pract Res 2010;40(3):214-219. doi: 10.1002/j.2055-2335.2010.tb00541.x
33. Basheti IA, Bosnic-Anticevich SZ, Armour CL, Reddel HK. Checklists for powder inhaler technique: a review and recommendations. Respir Care. 2014;59(7):1140-1154. doi: 10.4187/respcare.02342
34. Melani AS, Zanchetta D, Barbato N, Sestini P, Cinti C, Canessa PA, Aiolfi S, Neri M; Associazione Italiana Pneumologi Ospedalieri Educational Group. Inhalation technique and variables associated with misuse of conventional metered-dose inhalers and newer dry powder inhalers in experienced adults. Ann Allergy Asthma Immunol. 2004;93(5):439-446.
35. Caffarella RS. Planning programs for adult learners. A practical guide for educators, trainers and staff developers. San Francisco: Jossey-Bass; 2002. ISBN: 978-0470770375
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.