Perspectives of pharmacists about collaborative asthma care model in primary care

Bridging the continuity: Practice-enhancing publications about the ambulatory care medication-use process in 2021

PURPOSE

This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2021 that can impact ambulatory pharmacy practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement.

SUMMARY

A PubMed search was conducted in January 2022 for the year 2021 using targeted Medical Subject Headings keywords and the tables of contents of selected pharmacy journals were also searched, providing a total of 6,026 articles. A thorough review identified 86 potentially practice-enhancing articles: 10 for transitions of care, 9 for prescribing and collaborative practice, 20 for adherence, 17 for accessing care, 18 for monitoring and quality, and 12 for monitoring and medication therapy management. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

A qualitative study on asthma management experiences of Turkish community pharmacists

INTRODUCTION

Asthma is seen in more than 4 million people in Turkey. Numerous studies have shown the beneficial effects of pharmacist interventions on medication adherence and therapeutic outcomes. The aim of this study was to gain insight into the current situation by examining the experiences of Turkish community pharmacists in relation to the counseling and referral of asthma patients, the responsibilities of pharmacists and the recommendations made by pharmacists to improve asthma management.

METHODS

In this qualitative study, the constructivist-interpretivist paradigm was adopted. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study.

RESULTS

A total of 14 pharmacists engaged in semi-structured interviews conducted between June and August 2023. The wealth of information gathered during these interviews facilitated a meticulous thematic analysis, yielding four overarching themes: 1) Patient-related difficulties, 2) Communication with physicians, 3) Desired traits and responsibilities of pharmacists, 4) Pharmacists' expectations. Pharmacists placed significant emphasis on their challenges in allocating time to patients, primarily due to high workloads and limited collaboration with physicians.

CONCLUSION

Considering the workload and time limitations faced by pharmacists, a collaborative model involving pharmacists and physicians is seen as essential. Enhancing the collaboration between pharmacists and physicians, especially for chronic diseases, holds the potential to enhance public health outcomes while alleviating the workload of pharmacists.

A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Objective. To provide optimal asthma care, community pharmacists must have advanced, contemporary knowledge, and the skills to translate that knowledge into practice. The development and evaluation of an innovative multi-mode education program to enhance pharmacists' clinical knowledge and practical skills is described.Methods. The online education modules were collaboratively developed alongside asthma and pharmacy organizations. The education program was comprised of five evidence-based education modules delivered online and a skills review conducted either in-person with real-time feedback (urban pharmacists) or via video upload and scheduled video-conference feedback (regional and remote pharmacists). A mixed methods approach was used to evaluate the feedback obtained from pharmacists to assess the content, efficacy, and applicability of the education.Results. Ninety-seven pharmacists opted into the program and successfully completed all education requirements. A larger proportion of pharmacists did not pass trial protocol-based education modules on their first attempts compared to the number that passed the asthma and medication knowledge-based modules. Prior to skills review, the proportion of pharmacists demonstrating device technique competency was suboptimal. Pharmacists rated the education modules highly in both quantitative and qualitative evaluations and reported that the program adequately prepared them to better deliver care to asthma patients.Conclusion. We developed, implemented, and evaluated a novel multi-mode asthma education program for community pharmacists that supports knowledge and practical skill development in this crucial area of patient care. The education program was well received by pharmacists. This form of education could be used more broadly in international collaborative trials.

A Targeted Approach to Improve Asthma Control Using Community Pharmacists

Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice.

Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes.

Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data.

Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079).

Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.

Examining community pharmacists' intention to provide pharmacist-driven vaccination services: A structural equation modelling

BACKGROUND

The evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists' intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.

OBJECTIVE

Considering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the "Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)" by using the theory of planned behavior (TPB).

METHODS

Based on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.

RESULTS

In the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.

CONCLUSION

Results of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.

General practice pharmacists in Australia: A systematic review

Background

The inclusion of pharmacists into general practices in Australia has expanded in recent years. This systematic review aimed to synthesise the literature of qualitative and quantitative studies, and identify the knowledge gaps, related to pharmacists working in general practice in Australia.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EBSCOhost, EMBASE, and the Cochrane Library were searched from the inception of databases to January 2021. The search was focused on studies investigating general practice pharmacists in Australia. The quality of each study was appraised using the Mixed Method Appraisal Tool criteria. The narrative synthesis approach was utilised to describe data due to the heterogeneity among study designs and measures.

Results

Twenty-five studies were included in this review. General practice pharmacists engaged in various non-dispensing patient care services, with medication management reviews being the primary activity reported. General practice pharmacists’ characteristics and an environment with a willingness of collaboration were the notable influencing factors for successfully including pharmacists in general practices. Factors that posed a challenge to the adoption of general practice pharmacists were lack of funding and other resources, poorly defined roles, and absence of mentoring/training.

Conclusion

This review has summarised the characteristics, activities, benefits, barriers, and facilitators of including pharmacists in general practices in Australia. General practice pharmacists are well accepted by stakeholders, and they can engage in a range of patient-centred activities to benefit patients. There is a need for more robust research to explore the patient and economic outcomes related to clinical activities that a pharmacist can perform in general practice, as a foundation to developing an appropriate and sustainable funding model. The findings of this review will be beneficial for pharmacists, researchers, policymakers, and readers who wish to implement the role of general practice pharmacists in the future.

A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis

Background

Asthma is a common chronic disease worldwide affecting an estimated 300 million people. Pharmacists can play key roles to support optimal health outcomes for patients with asthma. Goffman's Dramaturgical Theory was used in this review to critically examine the literature describing the role of pharmacists in asthma services.

Objectives

The aim of this review is to identify factors that influence the role of pharmacists in asthma care services.

Methods

A systematic literature search was conducted of seven electronic databases including: CINAHL, Midline (Ovid), PubMed, Scopus, Web of science, Embase and PsycInfo.). The search was not restricted by language or date of publication. Studies were screened according to inclusion criteria which included much relate to pharmacists, asthma services and include qualitative findings. Data was extracted and thematically synthesised to create demographic, descriptive and analytical findings.

Results

Eighteen studies were included. The majority of studies were conducted in high income countries, with most of the studies conducted in Australia (n = 10). Semi-structured interview was used as a method for data collection in most studies (n = 11). Evidence indicated pharmacists engaged in asthma services positively and wanted to expand their roles in patient care. However, literature reported patients' attitudes and health-system factors such as remuneration, as well as inter-professional collaboration and expected low levels of knowledge and skills of pharmacists were barriers to implementation of pharmacy-led asthma care. Analytical findings suggest that pharmacists' involvement in asthma care services were influenced by patients' and healthcare professionals' expectations which were juxtaposed with pharmacists' own self-perceived identity.

Conclusions

This review demonstrates pharmacists self-identified as being capable and equipped with appropriate knowledge and skills, however the expectations of patients and other healthcare professionals prohibited their involvement in delivering asthma care services.