Community pharmacist counseling improves adherence and asthma control: a nationwide study

Community pharmacists' knowledge of, and role in, managing anticholinergic burden among patients with dementia in primary care: a cross-sectional survey study

BACKGROUND

Anticholinergic medications and associated anticholinergic burden can impair cognitive function and increase mortality rates in patients with dementia.

AIM

To explore community pharmacists' knowledge of anticholinergic burden and perceptions of their role in anticholinergic burden management amongst patients with dementia.

METHOD

A self-administered, postal questionnaire was distributed to all registered community pharmacies in Northern Ireland (n = 526) on two occasions (October and November 2022). The questionnaire comprised four sections: (1) demographics associated with pharmacists and pharmacies, (2) contact between community pharmacists and patients with dementia/their carers, and types of medication-related queries received by pharmacists, (3) understanding and knowledge about anticholinergic burden, and (4) community pharmacist role in management of anticholinergic burden in patients with dementia. Data were analysed descriptively using Stata v17.

RESULTS

A response rate of 15.2% (80/526) was achieved. Most contact was with patients with dementia/carers in their own homes. Community pharmacists lacked knowledge about anticholinergic burden in dementia, did not use any anticholinergic burden scales in their practice (n = 77, 96.3%), and rarely discussed anticholinergic burden with patients, carers (n = 60, 75.0%), or other healthcare professionals (n = 42, 52.5%). However, they were positive about their role in future interventions and saw value in managing anticholinergic burden in patients with dementia as part of a multidisciplinary primary healthcare team (n = 67; 83.3%).

CONCLUSION

Despite the low response rate, the study findings have highlighted community pharmacists' willingness to contribute to the management of anticholinergic burden in patients with dementia. Further research is required to understand how this can be achieved.

Current status of pharmacists in community pharmacies in China in the health management of chronic respiratory diseases

BACKGROUND

Effective management of chronic respiratory diseases (CRDs) is critical, and community pharmacists play a key role. This study evaluates pharmacists' knowledge, attitude, technology use and patient education in CRDs management across various regions in China.

METHODS

This cross-sectional study conducted a survey of pharmacists across nine provinces and two municipalities in China from January to September 2024, using a stratified convenience sampling method based on regional GDP. A total of 733 questionnaires were distributed through online platforms and pharmacy networks, yielding 699 valid responses, resulting in a response rate of 95.4%.

RESULTS

61.5% of pharmacists correctly answering 5 or fewer questions on knowledge-related topics. Additionally, 68.1% of the pharmacists demonstrated an accuracy rate of less than 50% in COPD-related questions, and 58.7% had an accuracy rate below 50% in asthma-related questions. Pharmacists in developed regions showed higher scores in knowledge, attitude, and patient education compared to those in underdeveloped areas (P < 0.05). Higher education and professional certifications were associated with better scores (P < 0.05). Frequent CRDs patient management and positive attitudes enhanced technology use, while longer working hours were linked to lower technology use and patient education scores (P < 0.05). Higher knowledge and attitude scores were significantly associated with better patient education (P < 0.05).

CONCLUSION

Community pharmacists display significant knowledge gaps in managing CRDs, particularly COPD and asthma. Developed regions, higher education, certification, and frequent CRDs management correlate with better scores. These findings highlight the need for ongoing education and improved working conditions to strengthen pharmacists' roles in CRDs management, aligning with the Healthy China initiative.

Improving asthma self-management education through inhaler labeling

Objective

Improper use and poor understanding of asthma medications can lead to poorly controlled asthma, emergency department visits, and hospitalizations for children with asthma. Pharmacists play a critical role in improving asthma medication adherence through education on asthma self-management. The use of color-coded labels applied at pharmacies to help patients differentiate between rescue and maintenance inhalers has not been explored.

Methods

Pharmacies were recruited to join a community pharmacy asthma coalition. Pharmacists provided patient education and labeled inhalers with two types of color-coded stickers. A red sticker labeled "RESCUE" was used for short-acting β-2 agonist medication inhalers. A green sticker labeled "USE EVERY DAY" was used for inhaled corticosteroids (ICS) or combination ICS/long-acting β-2 agonist medication inhalers.

Results

During the two years of the pilot program, 25 pharmacy locations participated. Pharmacies labeled over 6000 rescue and 9000 controller medications using color-coded labels. Over 1000 children and 7000 adults were served by the coalition.

Conclusion

Color-coded asthma medication labels can be successfully utilized by pharmacies. This low-cost tool provides vital information regarding the proper use of asthma medications.

Innovation

The color-coded labeling of asthma medications is a novel innovation that can be successfully used by pharmacists to improve asthma self-management education.

Pharmacist roles in the Medication Use Process: Qualitative analysis of stakeholder perceptions

BACKGROUND

Pharmacist roles in the Medication Use Process (MUP) have advanced along with new healthcare delivery models and interprofessional collaborative practice. It is unclear whether stakeholder perceptions of pharmacist roles have evolved simultaneously.

OBJECTIVES

Examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP.

METHODS

This institutional review board-approved study used a cross-sectional design with Qualtrics panels of patients, pharmacists, and physicians. Role Theory was used as a framework to develop 12-item surveys to study pharmacist role perceptions in the MUP: prescribing, transcribing, dispensing, administration, and monitoring. Content analysis was performed on the responses to open-ended questions.

RESULTS

From 1004 patients, a total of 7217 comments were obtained on 9 questions (740-1004 comments), resulting in an average of 802 comments per question or 0.8 comments per question per respondent (CQR). Similarly, 1620 comments from 205 pharmacists on 11 questions (121-205 comments) averaged 0.72 CQR; and 1561 comments from 200 physicians on 11 questions (136-200 comments) equated to 0.74 CQR. Content analysis revealed recurring themes across the stakeholders: "pharmacists," "physicians," "insurance," "technology," "collaboration," "time," "communication," and "patient's responsibility." Some role congruence was seen regarding pharmacist roles by all 3 stakeholders; noting pharmacist roles in improving all steps of the MUP, except transcribing. Pharmacists highlighted professional challenges such as staffing issues, burnout, and competing demands; which were not acknowledged by patients and physicians indicating the need to increase awareness.

CONCLUSION

This study showed increased visibility and awareness of pharmacist roles in the MUP by all stakeholders, compared to previous research showing pharmacist roles limited to dispensing. Known barriers to pharmacy practice such as lack of provider status and reimbursement were not reported by any of the stakeholders in this study. There is a need to continuously inform stakeholders about pharmacists' expanding roles in the MUP through advocacy and marketing.

The Association Between Short-Acting β2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia

INTRODUCTION

In Australia, short-acting β2-agonists (SABA) are available both over the counter (OTC) and on prescription. This ease of access may impact SABA use in the Australian population. Our aim was to assess patterns and outcome associations of prescribed, acquired OTC and reported use of SABA by Australians with asthma.

METHODS

This was a cross-sectional study, using data derived from primary care electronic medical records (EMRs) and patient completed questionnaires within Optimum Patient Care Research Database Australia (OPCRDA). A total of 720 individuals aged ≥ 12 years with an asthma diagnosis in their EMRs and receiving asthma therapy were included. The annual number of SABA inhalers authorised on prescription, acquired OTC and reported, and the association with self-reported exacerbations and asthma control were investigated.

RESULTS

92.9% (n = 380/409) of individuals issued with SABA prescription were authorised ≥ 3 inhalers annually, although this differed from self-reported usage. Of individuals reporting SABA use (n = 546) in the last 12 months, 37.0% reported using ≥ 3 inhalers. These patients who reported SABA overuse experienced 2.52 (95% confidence interval [CI] 1.73-3.70) times more severe exacerbations and were 4.51 times (95% CI 3.13-6.55) more likely to have poor asthma control than those who reported using 1-2 SABA inhalers. Patients who did not receive SABA on prescription (43.2%; n = 311/720) also experienced 2.71 (95% CI 1.07-7.26) times more severe exacerbations than those prescribed 1-2 inhalers. Of these patients, 38.9% reported using OTC SABA and other prescription medications, 26.4% reported using SABA OTC as their only asthma medication, 13.2% were prescribed other therapies but not SABA OTC and 14.5% were not using any medication.

CONCLUSION

Both self-reported SABA overuse and zero SABA prescriptions were associated with poor asthma outcomes. The disconnect between prescribing authorisation, OTC availability and actual use, make it difficult for clinicians to quantify SABA use.

Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study

Purpose

The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm.

Patients and Methods

We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot.

Results

At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up.

Conclusion

The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.