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Leonard SH, Chin-Yee I, Delport J, Crozier A, Abdulsatar F. Improving wound swab collection in paediatric patients: a quality improvement project. BMJ Open Qual 2023; 12:e002170. [PMID: 37612047 PMCID: PMC10450052 DOI: 10.1136/bmjoq-2022-002170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
Microbiology sample swabs may be unsuccessful or rejected for a variety of reasons. Typically, errors occur in the preanalytical phase of sample collection. Errors with collection, handling and transport can lead to the need to repeat specimen collection. Unsuccessful specimens contribute to delays in diagnosis, increased patient stress and increased healthcare costs. An audit of sample swabs from London Health Sciences Centre Children's Hospital from August through October 2021 yielded complete success rates of 100% for ear and eye culture swabs, 98.1% for methicillin-resistant Staphylococcus aureus swabs and 88.9% for wound swabs. This project aimed to improve wound swab success to 95% on the paediatric inpatient and paediatric emergency departments by May 2022.Stakeholders from paediatric clinical services including physicians, nurses and the laboratory medicine team at our centre were engaged to guide quality improvement interventions to improve specimen success rate. Based on feedback, we implemented visual aids to our electronic laboratory test information guide. Additionally, visual reminders of correct sample collection equipment were placed in high traffic areas for nursing staff.After the interventions were implemented, a three-month follow-up showed that wound swab success rate rose to 95.3%. This study achieved its aim of improving wound swab success rate to 95%. It adds to the growing pool of evidence that preanalytical phase intervention such as visual aids can increase swab success rates, in healthcare settings.
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Affiliation(s)
- Sean H Leonard
- Department of Paediatrics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Ian Chin-Yee
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Hematology, Western University, London, Ontario, Canada
| | - Johan Delport
- Department Medical Microbiology, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Abby Crozier
- Division of Microbiology, London Health Sciences Centre, London, Ontario, Canada
| | - Farah Abdulsatar
- Department of Paediatrics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Department of Paediatrics, London Health Sciences Centre, London, Ontario, Canada
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Bosnic-Anticevich S, Bender BG, Shuler MT, Hess M, Kocks JWH. Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2355-2364.e5. [PMID: 37146881 DOI: 10.1016/j.jaip.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/22/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights.
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Affiliation(s)
| | - Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Melinda T Shuler
- Quality Mangement, Eastern Band of Cherokee Indian, Tribal Option, Cherokee, NC
| | - Mike Hess
- Patient Outreach and Education, COPD Foundation, Miami, Fla
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands; Observational and Pragmatic Research Institute, Singapore; Groningen Research Institute Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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3
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Gul S, Rehman IU, Goh KW, Ali Z, Rahman AU, Khalil A, Shah I, Khan TM, Ming LC. Can Pharmacists' Counseling Improve the Use of Inhalers and Quality of Life? A Prospective "Pre" and "Post" Education Analysis in Mardan, Pakistan. J Asthma Allergy 2023; 16:679-687. [PMID: 37435420 PMCID: PMC10332412 DOI: 10.2147/jaa.s405943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/05/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Asthma is one of the common major non-communicable respiratory diseases, and is associated with a lower health-related quality of life (QOL). Poor inhalation is a significant contributing factor to poor control of asthma. Community pharmacist has a vital role to play in assisting patients and ultimately improving their asthma conditions through the use of inhalers. Aim This study aimed to assess the effectiveness of "pre" and "post" educational intervention by a community pharmacist within a community pharmacy on asthma patients' QOL, inhaler technique, and adherence to therapy during the endemic phase of COVID-19. Methods A "pre" and "post" interventional study was performed at a community pharmacy in the city of Mardan, Pakistan, in 2022 during the COVID-19 pandemic. Patients were divided into two groups, ie control and pharmacist-led education groups. After assigning patients to both groups, the baseline data were collected and followed for one month to compare the reduction in errors in the use of inhalers, QOL, and adherence to therapy. A paired sample t-test was performed, keeping a p-value <0.05 as statistical significance. Results A total of 60 patients were recruited, majority (58.3%) were females, and 28.3% were from the age group of 46-55 years old. A statistically significant difference was observed in the pre- and post-education QOL score among patients in the pharmacist-led education group, from a mean ± SD at pre-education of 40.23±10.03 to a mean±SD at post-education of 48.10±5.68. Similarly, a statistically significant difference was observed for the correct use of inhalers, ie MDIs and DPIs. Similarly, a statistically significant difference was observed in the adherence status between pre-education and post-education by pharmacists. Conclusion The findings of the study revealed a positive impact of community pharmacist-led education on QOL, inhaler technique, and adherence to therapy among patients with asthma.
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Affiliation(s)
- Sumaira Gul
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Zahid Ali
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Aziz Ur Rahman
- Department of Urology, North West General Hospital and Research Center Peshawar, Peshawar, Pakistan
| | - Asad Khalil
- Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - Ismail Shah
- Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences Lahore, Lahore, Pakistan
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
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4
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Al-Kharouf MS, Abdeljalil MH, Obeidat NM, Oweidat KA, Awwad O. Video-based teach-to-goal intervention on inhaler technique on adults with asthma and COPD: A randomized controlled trial. PLoS One 2023; 18:e0286870. [PMID: 37294823 PMCID: PMC10256228 DOI: 10.1371/journal.pone.0286870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/17/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Incorrect use of inhalers is a problem associated with poor patient outcomes. Despite improvement in the technique after verbal educations, this deteriorates over-time requiring re-enforcement through different educative strategies. This study aimed to assess the impact of a novel video-based teach-to-goal (TTG) educational intervention on: mastery of inhaler technique, disease control, medication adherence and disease-related quality of life (QoL) over-time among asthma and COPD patients. METHODS This prospective, open-label, randomized controlled trial was registered in ClinicalTrials.gov: Identifier NCT05664347. After baseline assessment participants received either a verbal (control group) or a video-based (intervention group) TTG strategy. After 3-month the intervention was assessed for impact on the intended outcomes. Inhaler technique was assessed using standardized checklists, disease control using the Asthma control test and COPD assessment test respectively for asthma and COPD patients while adherence using the Morisky Green Levine scale. For QoL, the mini asthma quality of life questionnaire and the St. George respiratory questionnaire were used for asthmatic and COPD patients, respectively. Differences in outcomes between intervention-control groups were analyzed using either Chi-Square (X2)/Fisher Exact or Mann Whitney test. The impact of intervention on outcomes over-time was examined using either McNemar or Wilcoxon test. RESULTS At baseline, intervention (n = 51) and control (n = 52) groups had comparable demographic/clinical characteristics. At follow-up, inhaler technique improved among intervention group compared to control group (93.4% vs 67%) and to baseline (93.4% to 49.5%), (P<0.05). Similarly, medication adherence ameliorated among the intervention group in comparison to control group (88.2% to 61.5%) and to baseline (88.2% to 66.7%), (P<0.05). In regards to disease control, results showed an amelioration among the intervention group compared to baseline (35.3% to 54.9%) (P<0.05). QoL scores improved significantly among asthma patients (intervention group) at follow-up vs baseline. Better scores were also observed for COPD patients compared to controls, (P<0.05). CONCLUSION Video-based (TTG) was effective in enhancing inhaler technique over time as well as improving disease control, medication adherence, and QoL. TRIAL REGISTRATION ClinicalTrials.gov: NCT05664347. https://clinicaltrials.gov/ct2/show/NCT05664347.
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Affiliation(s)
- Mohammad Samer Al-Kharouf
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Mariam Hantash Abdeljalil
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Nathir M. Obeidat
- Faculty of Medicine, Department of Internal Medicine, The University of Jordan, Amman, Jordan
- Department of Respiratory and Sleep Medicine, Jordan University Hospital, Amman, Jordan
| | - Khaled Al Oweidat
- Faculty of Medicine, Department of Internal Medicine, The University of Jordan, Amman, Jordan
- Department of Respiratory and Sleep Medicine, Jordan University Hospital, Amman, Jordan
| | - Oriana Awwad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
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5
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Sedeh FB, Arvid Simon Henning M, Mortensen OS, Jemec GBE, Ibler KS. Communicating with patients through pictograms and pictures - a scoping review. J DERMATOL TREAT 2022; 33:2730-2737. [PMID: 35440279 DOI: 10.1080/09546634.2022.2068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundCommunication between patients and Health Care Workers (HCW) may on occasion be challenged by disparities in cultural background, age and educational level. Written educational material is commonly used to reduce the risk of miscommunication. However, literacy among patients may also differ and it is therefore speculated that the use of pictograms may improve patients' understanding and adherence.ObjectiveTo evaluate the scientific literature and investigate the effect and practical utility of pictograms in medical settings with focus on dermatological patients.Materials and methodsPubmed, EMBASE, and Cochrane Library were searched July 2021 for studies regarding use of pictograms in medical settings and dermatology.ResultsThe use of pictograms in dermatology is not well characterized, but studies in other fields of medicine report a positive effect of using pictograms in communication. Pictograms have a significant positive effect when presented alongside verbal or written explanations.ConclusionThe quality of the development process is important to ensure the utility of any pictogram. Involving the target population in the design and validation of the pictograms may be critical. In the validation process, testing of transparency and translucency may benefit from international recommendations.
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Affiliation(s)
| | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Heine M, Lategan F, Erasmus M, Lombaard CM, Mc Carthy N, Olivier J, van Niekerk M, Hanekom S. Health education interventions to promote health literacy in adults with selected non-communicable diseases living in low-to-middle income countries: A systematic review and meta-analysis. J Eval Clin Pract 2021; 27:1417-1428. [PMID: 33749092 DOI: 10.1111/jep.13554] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 12/17/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Health illiteracy is an important contributor to the burden of non-communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs. The objective of this systematic review was to evaluate the effectiveness of health literacy interventions on health literacy in the management of patients with selected NCDs living in low-to-middle income countries (LMIC). METHODS Seven electronic databases were searched (October 29, 2020) for RCTs aimed at improving health literacy in adults with NCDs in LMICs. Eligible NCDs included those pertaining to cancer, cardiovascular disease (CVD), chronic respiratory disease (CRD) or Diabetes. Studies were included that explicitly focussed on improving health literacy, and reported comprehensive measures of health literacy, or components thereof (ie, knowledge, attitude or behaviour). Random-effect meta-analyses were conducted for continuous outcome measures (Hedges-g). RESULTS The completed search yielded 2573 unique results of which 53 unique studies met the inclusion criteria. Studies included patients with cancer (n = 1, 2%), CRD (n = 8, 15%), CVD (n = 11, 21%) or Diabetes (n = 33, 62%). A significant (P < .01) summary effect was found for disease knowledge (SES = 1.27 [n = 23, 95%CI = 1.05-1.49]), attitude (SES = 1.17 [n = 20, 95%CI = 0.88-1.47]), and behaviour (SES = 1.20 [n = 31, 95%CI = 0.94-1.46]). CONCLUSIONS These results support the conclusion that there is compelling evidence, in particular, for patients with Diabetes, that health-literacy interventions are effective in promoting disease knowledge, attitude and behaviour across four chronic conditions that drive the burden of NCDs.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frandene Lategan
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Misha Erasmus
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chris-Mari Lombaard
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nina Mc Carthy
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeandri Olivier
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marnus van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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7
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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Almomani BA, Al-Qawasmeh BS, Al-Shatnawi SF, Awad S, Alzoubi SA. Predictors of proper inhaler technique and asthma control in pediatric patients with asthma. Pediatr Pulmonol 2021; 56:866-874. [PMID: 33497530 DOI: 10.1002/ppul.25263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/12/2020] [Accepted: 01/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Improper use of asthma inhalers is one of the potential factors of poor asthma control among children. This study aimed to assess the proper handling of asthma inhalers and asthma control in addition to factors influencing them among pediatric patients who self-administer their inhalers. METHODS A cross-sectional study was conducted in Jordan from February 2019 to February 2020. All eligible pediatric patients with asthma attending outpatient settings were approached. The inhalation technique was assessed according to a standard checklist, and asthma control was assessed using the Asthma Control Test. RESULTS A total of 150 patients were included in this study. A metered dose inhaler (MDI) was the most commonly used inhaler device (89.4%) which was used appropriately by only 13.4% of participants. Whereas, appropriate use of Turbohaler and Diskus was reported by 38.5% and 28.9%, respectively. The higher level of parental knowledge was associated with higher number of correct MDI steps (OR = 1.066; 95% CI = 1.010-1.125; p = .020) and less reported errors in critical steps (OR = 0.949; 95% CI = 0.900-0.999; p = .047). Higher level of both parental education and pediatric average stigma score (less stigmatized) were associated with better asthma control ([OR = 5.181; 95% CI = 1.238-21.677; p = .024], [OR = 2.825; 95% CI = 1.420-5.619; p = .003], respectively). CONCLUSION Continuous education on appropriate inhaler self-administration for asthmatic children is highly recommended. Clinical pharmacists play a major role toward improving the administration of inhalers through patient training and counseling.
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Affiliation(s)
- Basima A Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Batool S Al-Qawasmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah F Al-Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah Awad
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sirin A Alzoubi
- Department of Pediatrics, Princess Rahma Teaching Hospital, Irbid, Jordan
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9
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To Develop Health Education Tools for Nasogastric Tube Home Caring Through Participatory Action Research. Healthcare (Basel) 2020; 8:healthcare8030261. [PMID: 32785085 PMCID: PMC7551600 DOI: 10.3390/healthcare8030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
Medical institutions provide guidance on caring skills for home caregivers. Oral teaching is combined with graphical tools in a method that has been proved to be an effective way of quickly mastering home caring skills and promotes effective learning for home caregivers. The graphic design and operation contents of this method are constantly revised through interviews and observations, and by carrying out home care application graphics it forms a spiral structure of Plan-Do-Study-Act (PDSA) participatory action research (PAR). In the three cycles of the operation of PDSA PAR, the designers accurately create graphics of the caring details based on the nurses' demonstrations and develop health education tools that are suitable to provide continuous assistance and services in real-life situations. PAR combined with PDSA, in each of the three cycles of the operation-design personnel, medical personnel and home caregiver personnel, respectively-as the lead roles, guide the planning decisions for PAR. This study is a reference for the improvement and development of medical graphics for health education tools to improve accuracy.
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Abstract
Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients’ concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.
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Affiliation(s)
- Mary B Bridgeman
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, 5751Rutgers, The State University of New Jersey, NJ, USA
| | - Lori A Wilken
- Pharmacy Practice, 14681University of Illinois at Chicago College of Pharmacy, IL, USA
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11
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Jia X, Zhou S, Luo D, Zhao X, Zhou Y, Cui YM. Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: A systematic review and meta-analysis. J Clin Pharm Ther 2020; 45:904-917. [PMID: 32107837 DOI: 10.1111/jcpt.13126] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/09/2020] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In patients with asthma and chronic obstructive pulmonary disease (COPD), disease control is still suboptimal-incorrect inhalation technique and medication non-adherence are two important reasons for this outcome. Pharmacists' interventions have been shown to have a positive effect on the clinical outcomes of asthma and COPD. Quantitative assessment of the efficacy of pharmacist-led interventions, mainly on inhalation techniques and medication adherence, is needed. Evidence for different interventions is not totally conclusive, and no results of theory-based adherence promotion interventions for asthma and COPD have been published. The objective of our study is to evaluate the effect of pharmacist-led interventions on asthma and COPD management, focusing mainly on inhalation technique and medication adherence, and whether the content of interventions (categorized based on Information-Motivation-Behavioural skills (IMB) model) affects the effectiveness and whether the IMB model is worthy of clinical promotion and application in adults with asthma or COPD. METHODS The PubMed, EMBASE, The Cochrane Library, Web of Science and ClinicalTrials.gov databases were searched for randomized controlled trials that involved pharmacist-led interventions among patients with asthma or COPD. We used database-specific vocabulary (eg, Medical Subject Headings) and free text terms expanding from 'asthma', 'COPD' and 'pharmacist' to identify relevant articles. Two reviewers independently selected the studies, assessed the risk of bias and extracted the data. The meta-analysis was performed in Review Manager 5.3 provided by the Cochrane Collaboration. PROSPERO registration number: CRD42019144793. RESULTS AND DISCUSSION Thirteen studies were eligible for qualitative analysis, and 12 studies were included in the meta-analysis. Pharmacist-led interventions showed a positive effect on medication adherence (1.34 [95% CI 1.18-1.53], P < .0001) and inhalation technique (1.85 [95% CI 1.57-2.17], P < .00001) in COPD and asthma patients. In the subgroup meta-analysis, significant medication adherence improvement was found only in COPD patients (1.41 [1.24-1.61], P < .0001). The subgroup meta-analysis also noted that interventions that included all three Information-Motivation-Behavioural skills (IMB) constructs had a significant improvement in medication adherence (1.41 [1.24-1.61], P < .0001). Subgroup meta-analysis conducted between different diseases, different intervention contents, and different measure tools did not significantly change the heterogeneity. WHAT IS NEW AND CONCLUSION Pharmacist-led interventions can improve inhalation technique in adult asthma and COPD patients. Significant improvement in medication adherence was found only in COPD patients. The effect among asthmatic patients requires further study. Interventions based on the IMB model may be worthy of clinical promotion and application. More future research is needed to establish solid evidence base for effective interventions and uniform measurement of medication adherence.
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Affiliation(s)
- Xiaona Jia
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Daohuang Luo
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Xia Zhao
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Yi-Min Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
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Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors. PHARMACY 2020; 8:pharmacy8010006. [PMID: 31935995 DOI: 10.3390/pharmacy8010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Inhaled medications are critical in the pharmaceutical management of respiratory conditions, however, the majority of patients demonstrate at least one critical error when using an inhaler. Since community pharmacists can be instrumental in addressing this care gap, we aimed to determine the rate and type of critical inhaler errors in community pharmacy settings, elucidate the factors contributing to inhaler technique errors, and identify instances when community pharmacists check proper inhaler use. Fourth year pharmacy students on community practice placement (n = 53) identified 200 patients where at least one error was observed in 78% of participants when demonstrating inhaler technique. Prevalent errors of the users were associated with metered dose inhaler (MDI) (55.6%), Ellipta® (88.3%), and Discus® (86.7%) devices. Overall, the mean number of errors was 1.09. Possession of more than one inhaler, use of rescue inhaler, and poor control of asthma were found to be significant predictors of having at least one critical error. In all participating pharmacies, inhaler technique is mainly checked on patient request (93.0%) and for all new inhalers (79.0%).
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Comment on "A novel approach of using educational pharmaceutical pictogram for improving inhaler techniques in patients with asthma". Respir Med 2018; 145:241-242. [PMID: 30266530 DOI: 10.1016/j.rmed.2018.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 11/21/2022]
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