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House R, Kritikos V, Cvetkovski B, Rimmer J, Yan K, Cheong L, Bousquet J, Lourenco O, Bosnic-Anticevich S. The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy. Explor Res Clin Soc Pharm 2023; 12:100340. [PMID: 37869069 PMCID: PMC10585337 DOI: 10.1016/j.rcsop.2023.100340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR. Objectives To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy. Methods This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively. Results Six pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR. Conclusions While there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.
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Affiliation(s)
- Rachel House
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
| | - Janet Rimmer
- Macquarie University, Macquarie Park, NSW, Australia
- Thoracic Medicine, St Vincent's Private Hospital, Darlinghurst, Australia
| | - Kwok Yan
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lynn Cheong
- Discipline of Pharmacy, University of Canberra, Canberra, Australia
| | - Jean Bousquet
- MACVIA-France, Contre les Maladies Chroniques pour un Vieillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Olga Lourenco
- Faculty of Health Sciences and CICS—UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Glebe, NSW, Australia
- Macquarie University, Macquarie Park, NSW, Australia
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Alamyar S, Azzi E, Srour-Alphonse P, House R, Cvetkovski B, Kritikos V, Bosnic-Anticevich S. Uncovering the Burden of Rhinitis in Patients Purchasing Nonprescription Short-Acting β-Agonist (SABA) in the Community. Pharmacy (Basel) 2023; 11:115. [PMID: 37489346 PMCID: PMC10366934 DOI: 10.3390/pharmacy11040115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023] Open
Abstract
Asthma and rhinitis are common comorbidities that amplify the burden of each disease. They are both characterized by poor symptom control, low adherence to clinical management guidelines, and high levels of patient self-management. Therefore, this study aims to investigate the prevalence of self-reported rhinitis symptoms in people with asthma purchasing Short-Acting Beta Agonist (SABA) reliever medication from a community pharmacy and compare the medication-related behavioral characteristics among those who self-report rhinitis symptoms and those who do not. Data were analyzed from 333 people with asthma who visited one of eighteen community pharmacies in New South Wales from 2017-2018 to purchase SABA and completed a self-administered questionnaire. Participants who reported rhinitis symptoms (71%), compared to those who did not, were significantly more likely to have coexisting gastroesophageal reflux disease (GERD), overuse SABA, and experience side effects. They may have been prescribed daily preventer medication but forget to take it, and worry about its side effects. They were also more likely to experience moderate-to-severe rhinitis (74.0%), inaccurately perceive their asthma as well-controlled (50.0% self-determined vs. 14.8% clinical-guideline defined), and unlikely to use rhinitis medications (26.2%) or daily preventer medication (26.7%). These findings enhance our understanding of this cohort and allow us to identify interventions to improve patient outcomes.
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Affiliation(s)
- Sara Alamyar
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Elizabeth Azzi
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- GSK Australia, Pty., Ltd., Ermington, NSW 2115, Australia
| | - Pamela Srour-Alphonse
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rachel House
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Local Health District, Sydney, NSW 2050, Australia
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Retinasekharan S, Md Shukri N, Ismail AF, Abdullah B. Knowledge, Attitude, and Practice of Intranasal Corticosteroid in Allergic Rhinitis Patients: Development of a New Questionnaire. Healthcare (Basel) 2021; 10:healthcare10010008. [PMID: 35052171 PMCID: PMC8775375 DOI: 10.3390/healthcare10010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The knowledge gap and attitude of allergic rhinitis (AR) patients using intranasal corticosteroid (INCS) led to the poor outcome of their disease. We aimed to develop and validate a new questionnaire to assess the knowledge, attitude, and practice (KAP) of AR patients that can be used to assess and understand the factors affecting compliance of INCS. Methods: The questionnaire comprised development and validation stages. A self-administered questionnaire was developed after a comprehensive literature review. It was subjected to content and face validity before a revised final version was drafted. Exploratory factor analysis was used to assess the validity of the questionnaire. Cronbach’s alpha was used to verify internal consistency. Results: The development phase resulted in a questionnaire consisting of 14 items. Explanatory factor analysis revealed four factors associated with KAP. The four factors were extracted, and 12 items were kept. The factors were attitude domain with four items (factor 1), practice domain with four items (factor 2), and knowledge domain with four items (factor 3 has two items, and factor 4 has two items). The Cronbach’s alpha of the four factors ranged from 0.614 to 0.809. The final questionnaire consists of 3 domains with 12 items (the knowledge domain with four questions; the attitude domain with four questions; the practice domain with four questions) and was valid and reliable. Conclusions: The newly developed questionnaire has adequate validity and reliability. It is a useful tool to improve the treatment of AR patients by understanding the factors affecting their compliance.
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Affiliation(s)
- Senthilraj Retinasekharan
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.R.); (N.M.S.)
| | - Norasnieda Md Shukri
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.R.); (N.M.S.)
| | - Ahmad Filza Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (S.R.); (N.M.S.)
- Correspondence: or
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Abstract
We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - B N Landis
- Department of Otorhinolaryngology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Hopkins
- Department of Otorhinolaryngology, Guy's Hospital, London, UK
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - A R Sedaghat
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Liva GA, Karatzanis AD, Prokopakis EP. Review of Rhinitis: Classification, Types, Pathophysiology. J Clin Med 2021; 10:jcm10143183. [PMID: 34300349 PMCID: PMC8303640 DOI: 10.3390/jcm10143183] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification because a combined (mixed) phenotype exists in many individuals and different endotypes of rhinitis subgroups are overlapping. Due to the variety of pathophysiologic mechanisms (endotypes) and clinical symptoms (phenotypes), it is difficult to develop clear guidelines for diagnosis and treatment. This study aims to review the types of allergic and non-allergic rhinitis, providing a thorough analysis of the pathophysiological background, diagnostic approach, and main treatment options.
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Canonica GW, Klimek L, Acaster S, Dollner R, Kaulsay R, Lo SH, Price DB, Scadding GK, Valovirta E, Zieglmayer P. Burden of allergic rhinitis and impact of MP-AzeFlu from the patient perspective: pan European patient survey. Curr Med Res Opin 2021; 37:1259-1272. [PMID: 33840316 DOI: 10.1080/03007995.2021.1911973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aims of this survey were to (1) assess the burden of allergic rhinitis (AR) from the patient perspective, (2) investigate MP-AzeFlu use in real life and its impact on patients' lives and (3) explore factors associated with treatment satisfaction. METHODS A cross-sectional, quantitative, online, questionnaire-based survey was conducted in seven European countries (March-June 2019). Questions explored AR burden and treatment satisfaction. Satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication 9-item (TSQM-9; max score = 100). Participants (aged ≥18 years) had a doctor/healthcare provider confirmed AR diagnosis and used MP-AzeFlu within the last year. RESULTS Pre-MP-AzeFlu treatment, participants (n = 1004) reported an average of 3.3 (SD:3.5) doctor visits/year, 8.1 (SD:11.0) days/year absenteeism and 15.8 (SD:18.9) days/year presenteeism due to AR. Only 48% of participants used MP-AzeFlu twice/day as recommended. Post-MP-AzeFlu 57% of participants reported better QoL, 47% reported fewer doctor visits and 52% discontinued polypharmacy. Absenteeism and presenteeism were reduced by 2.5 (SD 10.0) and 7.3 (SD:16.0) days/year, respectively. 70% of participants were more/much more satisfied with MP-AzeFlu versus previous AR treatment(s), and ≥70% were satisfied/extremely satisfied with its ability to prevent/treat AR, relieve symptoms and with its onset of action. Mean global, effectiveness and convenience TSQM-9 scores were 70.0 (SD:19.8), 68.3 (SD:21.6) and 72.7 (SD:20.4), respectively. Treatment satisfaction and effectiveness were significantly improved when MP-AzeFlu was taken as recommended. CONCLUSIONS The impact of AR on patients' lives remains high. Real-life use of MP-AzeFlu reduces that impact and is associated with a high level of effectiveness, convenience and global satisfaction.
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Affiliation(s)
- G Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ludger Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | | | - Ralph Dollner
- Division of Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Ranbir Kaulsay
- Beacon Hospital and Bon Secours Hospital, Dublin, Ireland
| | | | - David B Price
- Optimum Patient Care, Cambridge, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Petra Zieglmayer
- Power Project GmbH, Vienna Challenge Chamber, Vienna, Austria
- Karl Landsteiner University, Krems, Austria
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Bousquet J, Farrell J, Illario M. Aligning the Good Practice MASK With the Objectives of the European Innovation Partnership on Active and Healthy Ageing. Allergy Asthma Immunol Res 2020; 12:238-258. [PMID: 32009320 PMCID: PMC6997284 DOI: 10.4168/aair.2020.12.2.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022]
Abstract
The reference sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) were renewed in 2019. The DG Santé good practice Mobile Airways Sentinel networK was reviewed to meet the objectives of the EIP on AHA. It included 1) Management of care process, 2) Blueprint of digital transformation, 3) EIP on AHA, innovation to market, 4) Community for monitoring and assessment framework, 5) Political, organizational, technological and financial readiness, 6) Contributing to European co-operation and transferability, 7) Delivering evidence of impact against the triple win approach, 8) Contribution to the European Digital Transformation of Health and Care and 9) scale of demonstration and deployment of innovation.
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Affiliation(s)
- J Bousquet
- CHU Arnaud de Villeneuve, Montpellier, France.,MACVIA-France, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France.,UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - J Farrell
- LANUA International Healthcare Consultancy, Belfast, Northern Ireland, UK
| | - M Illario
- Division for Health Innovation, Campania Region.,Federico II University Hospital Naples (R&D and DISMET) Naples, Italy
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