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Turcotte C, Fénélon-Dimanche R, Lemière C, Beauchesne MF, Abou-Atmé B, Chabot I, Blais L. Development of a community pharmacy-based intervention for patients with uncontrolled asthma. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100167. [PMID: 36051610 PMCID: PMC9424560 DOI: 10.1016/j.rcsop.2022.100167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/09/2022] [Accepted: 08/05/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Caminati M, Vaia R, Furci F, Guarnieri G, Senna G. Uncontrolled Asthma: Unmet Needs in the Management of Patients. J Asthma Allergy 2021; 14:457-466. [PMID: 33976555 PMCID: PMC8104981 DOI: 10.2147/jaa.s260604] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
The recent scientific research has provided clinicians with the tools for substantially upgrading the standard of care in the field of bronchial asthma. Nevertheless, satisfactory asthma control still remains an unmet need worldwide. Identifying the major determinants of poor control in different asthma severity levels represents the first step towards the improvement of the overall patients' management. The present review aims to provide an overview of the main unmet needs in asthma control and of the potential tools for overcoming the issue. Implementing a personalized medicine approach is essential, not only in terms of pharmacological treatments, biologic drugs or sophisticated biomarkers. In fact, exploring the complex profile of each patient, from his inflammation phenotype to his preferences and expectations, may help in filling the gap between the big potential of currently available treatments and the overall unsatisfactory asthma control. Telemedicine and e-health technologies may provide a strategy to both optimize disease assessment on a regular basis and enhance patients' empowerment in managing their asthma. Increasing patients' awareness as well as the physicians' knowledge about asthma phenotypes and treatment options besides corticosteroid probably represent the key and more difficult goals of all the players involved in asthma management at every level.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - Rachele Vaia
- Department of Medicine, University of Verona, Verona, Italy
| | - Fabiana Furci
- Allergy Unit and Asthma Center, University of Verona and Verona University Hospital, Verona, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Unit, Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy.,Allergy Unit and Asthma Center, University of Verona and Verona University Hospital, Verona, Italy
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Caminati M, Cegolon L, Bacchini M, Segala N, Dama A, Bovo C, Olivieri B, Furci F, Senna G. The potential role of local pharmacies to assess asthma control: an Italian cross-sectional study. BMC Public Health 2021; 21:19. [PMID: 33402150 PMCID: PMC7784353 DOI: 10.1186/s12889-020-10080-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay between secondary and primary care services as an effective strategy to control the disease, community pharmacies’ are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies within the health district of the city of Verona (Veneto Region, North-Eastern Italy). Methods A call for participation was launched through the Pharmacists’ Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI). Results Fifty-seven community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) self-reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR = 0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT< 16 compared to those not taking medications regularly. Conclusions Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.
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Affiliation(s)
- M Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Treviso, Italy.
| | - M Bacchini
- Pharmacists' Association of Verona, Verona, Italy
| | - N Segala
- Pharmacists' Association of Verona, Verona, Italy
| | - A Dama
- Asthma Centre & Allergy Unit, Verona University Hospital, Verona, Italy
| | - C Bovo
- Medical Directorate, Verona University Hospital, Verona, Italy
| | - B Olivieri
- Residency Programme in Allergy & Clinical Immunology, Verona University Hospital, Verona, Italy
| | - F Furci
- Department of Clinical & Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - G Senna
- Department of Medicine, University of Verona, Verona, Italy
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Paoletti G, Keber E, Heffler E, Malipiero G, Baiardini I, Canonica GW, Giua C. Effect of an educational intervention delivered by pharmacists on adherence to treatment, disease control and lung function in patients with asthma. Respir Med 2020; 174:106199. [PMID: 33120195 DOI: 10.1016/j.rmed.2020.106199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lack of therapeutic adherence is a relevant problem in clinical practice and it can be assessed via validated tools such as the Test of Adherence to Inhalers (TAI). Education on the correct use of inhaler devices has been associated with improvement in adherence. Many studies highlighted the pivotal role of pharmacists in promoting therapeutic adherence in the management of respiratory diseases. OBJECTIVE To evaluate the effectiveness on adherence and clinical parameters of an educational intervention administered by clinical pharmacists (CPs) to patients with asthma on long-term inhalation therapy. METHODS A prospective comparative study involving 34 community pharmacies in Italy (23 intervention, 11 control). Enrolled subjects were evaluated for adherence to inhalation therapy by TAI, asthma control by "Asthma Control Test" (ACT), and lung function at baseline and after 2 months. The educational intervention at baseline was based on TAI results and administered by specifically trained pharmacists. RESULTS A total of 242 consecutive subjects (167 intervention, 75 control) were enrolled. There was a significant improvement in TAI score, ACT and lung function parameters (p-value<0.001) in the intervention group between baseline and the follow-up visit. Patients with baseline ACT≥20 maintained disease control more frequently in the intervention group compared to the control arm (95% vs 79.5%, p = 0.004). Conclusions through administration of TAI-driven educational interventions addressing both technical and psychological issues, trained CPs can help improve adherence to treatment and asthma control.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Enrico Keber
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - Ilaria Baiardini
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Corrado Giua
- Società Italiana Farmacia Clinica (SIFAC), Cagliari, Italy
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Graber ML, Grice GR, Ling LJ, Conway JM, Olson A. Pharmacy Education Needs to Address Diagnostic Safety. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7442. [PMID: 31507297 PMCID: PMC6718490 DOI: 10.5688/ajpe7442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/14/2019] [Indexed: 06/10/2023]
Abstract
The American Association of Colleges of Pharmacy, the Accreditation Council for Pharmacy Education, and the Center for the Advancement of Pharmacy Education frame patient safety from the perspective of medication management, which is also the current focus of pharmacy education and training. With the growing appreciation that diagnostic errors represent an urgent and actionable patient safety concern, the National Academy of Medicine has recommended diagnostic safety training for all health care professions. The Society to Improve Diagnosis in Medicine has worked with an interprofessional consensus group to identify a set of 12 key competencies necessary to achieve diagnostic quality and safety that focuses on individual, team-based, and system-related competencies. Much of this already exists in pharmacy education, but pharmacy training programs need to give graduates more guidance on how they contribute to the diagnostic process and the prevention and detection of diagnostic errors. We describe the current state of progress in this regard, and what steps are needed by training programs to provide content and assessment so that graduates achieve the requisite competencies. Governing and advisory bodies need to expand the expectations around patient safety to include diagnostic safety.
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Affiliation(s)
- Mark L Graber
- The Society to Improve Diagnosis in Medicine, Plymouth, Massachusetts
| | | | - Louis J Ling
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jeannine M Conway
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Andrew Olson
- University of Minnesota Medical School, Minneapolis, Minnesota
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Dokbua S, Dilokthornsakul P, Chaiyakunapruk N, Saini B, Krass I, Dhippayom T. Effects of an Asthma Self-Management Support Service Provided by Community Pharmacists: A Systematic Review and Meta-Analysis. J Manag Care Spec Pharm 2018; 24:1184-1196. [PMID: 30362920 PMCID: PMC10397854 DOI: 10.18553/jmcp.2018.24.11.1184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current evidence of the effects of pharmacy services on asthma outcomes are not conclusive, since most pharmacy services comprise a variety of interventions. OBJECTIVE To assess the effect of a service containing self-management support delivered by community pharmacists to patients with asthma. METHODS A systematic search was performed in the following databases from inception to January 2017: PubMed, Embase, Cochrane Library's Central Register of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, International Pharmaceutical Abstracts, and PsycInfo. Original studies were selected if they met the following criteria: (a) provided by community pharmacists; (b) the intervention service included the essential components of asthma self-management; (c) included a usual care group; and (d) measured control/severity of asthma symptoms, health-related quality of life (HRQOL), or medication adherence. RESULTS Of the 639 articles screened, 12 studies involving 2,121 asthma patients were included. Six studies were randomized trials, and the other 6 were nonrandomized trials. Patients with asthma who received a self-management support service by community pharmacists had better symptom control/lower severity compared with those receiving usual care (standardized mean difference [SMD] = 0.46; 95% CI = 0.09-0.82) with high heterogeneity (I2=82.6%; P = 0.000). The overall improvement in HRQOL and medication adherence among patients in the asthma self-management support group was greater than for those in the usual care group with SMD of 0.23 (95% CI = 0.12-0.34) and 0.44 (95% CI = 0.27-0.61), respectively. Evidence of heterogeneity was not observed in these 2 outcomes. CONCLUSIONS Self-management support service provided by community pharmacists can help improve symptom control, quality of life, and medication adherence in patients with asthma. DISCLOSURES This study received financial support from Naresuan University's Faculty of Pharmaceutical Sciences Research Fund. Two authors, Saini and Krass, have studies that were included in this review. However, they were not involved in the processes that could bias outcomes of the present study, that is, quality assessment and meta-analysis. The remaining authors have declared no conflicts of interest.
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Affiliation(s)
- Suthasinee Dokbua
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of Pharmacy, University of Wisconsin, Madison; and Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Selangor
| | - Bandana Saini
- Faculty of Pharmacy, the University of Sydney, Australia
| | - Ines Krass
- Faculty of Pharmacy, the University of Sydney, Australia
| | - Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Nguyen TS, Nguyen TLH, Pham TTV, Cao TBT, Nguyen VK, Hua S, Li SC. Effectiveness of a short training program for community pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study. Respir Med 2018; 144:50-60. [PMID: 30366584 DOI: 10.1016/j.rmed.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/26/2018] [Accepted: 10/06/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Community pharmacists can make significant contributions and be an indispensable member in the asthma therapy chain. The present study aimed to investigate the current knowledge level of Vietnamese community pharmacists in asthma counselling and the impact of a short training program on asthma knowledge and practice. METHOD 300 community pharmacists participated in the study. A knowledge questionnaire about asthma medications and a standardized inhaler checklist were designed to evaluate their knowledge before and after a 4-h training program. Six to eight weeks later, 10 simulated patients were sent to the community pharmacies to evaluate the pharmacists' knowledge and practice. RESULTS The training program significantly improved the asthma knowledge score of pharmacists from 5.3 to 17.2 out of a maximum score of 20 (p < 0.001). After the training, the percentage of pharmacists performing correctly inhaler devices increased significantly (0% vs.∼50%, p < 0.001). In the simulated patient study, pharmacists who attended the training demonstrated better asthma knowledge with higher scores (5.4 vs 1.7 out of a maximum score of 7.0, p < 0.001), as well as much better inhaler technique scores (6.1 vs 4.3, out of a maximum score of 8, p < 0.001). These pharmacists achieved higher scores in all aspects encompassing distinguishing controllers and relievers, counselling correctly about adherence, and common side effects. CONCLUSION Our results revealed significant knowledge deficiency about asthma among Vietnamese community pharmacists. However, a short training program was effective in upskilling the pharmacists to effectively counsel asthmatic patients about the management of their condition and medications.
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Affiliation(s)
- Tu-Son Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | | | - Thi Thuy Van Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | - Thi Bich Thao Cao
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia.
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Buss VH, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. J Pharm Policy Pract 2018. [DOI: 10.1186/s40545-018-0149-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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