Adherence enhancement for patients with asthma in community pharmacy practice: tools development and pharmacists’ feedback

Improving Asthma Management: Patient–Pharmacist Partnership Program in Enhancing Therapy Adherence

Community pharmacist interventions can assist in improving adherence in patients with asthma. The objective of the study was to assess the feasibility of patient-centered counseling using the developed asthma-specific tools to identify barriers to adherence and identify their preliminary effect on adherence barrier score and asthma control. Adult patients with persistent asthma were invited to participate in a 3-month pre–post intervention study involving community pharmacist-provided patient-centered counseling. Bivariate analyses were conducted to determine whether there were changes in outcomes from the pre to post period. Of 36 recruited patients, 17 completed both pre and post surveys. At baseline, patients had a mean ACT score of 15.1 ± 3.5, with 94% having uncontrolled asthma, and an average of 4.2 ± 2.5 reported barriers. The following barriers were most common: not having an Asthma Action Plan (52.9%), use of inhaler more or less often than prescribed (47.1%) and forgetfulness (41.2%). The ACT score increased by 2.7 ± 5.4, which was not statistically significant; however, it might be clinically significant. Two barrier scores improved as a result of the intervention. Preliminary evidence on the feasibility of identifying and addressing patient-specific barriers to adherence delivered by pharmacists showed that it has the potential to resolve barriers and improve asthma outcomes.

Qualitative Investigation of Community Pharmacy Immunization Enhancement Program Implementation

Background: Despite widely available nonseasonal immunization services in community pharmacies, actual pharmacist-administered vaccines are not yet optimal. A flexible choice multicomponent intervention, the “We Immunize” program, was implemented in Alabama and California community pharmacies, with the goal to enhance pneumococcal and zoster immunization delivery. Limited research has been done to qualitatively understand factors influencing immunization service expansion. Objective: Explore pharmacist perceptions of the We Immunize program in terms of its acceptability, impact, and real-world feasibility, and pharmacist-perceived facilitators and barriers influencing success in immunization delivery enhancement. Methods: This practice-focused qualitative research used semistructured telephone interviews with 14 pharmacists at the completion of the 6-month intervention. Results: Major program implementation facilitators were technician inclusion, workflow changes, training and feedback, goal setting, and enhanced personal selling and marketing activities. Multiple pharmacies increased the number of delivered pneumococcal and zoster immunizations, and increased revenue. Many pharmacists felt professional image, knowledge, skills, roles, and personal satisfaction were enhanced, as were technician knowledge, skills, and roles. Program flexibility, along with multiple perceived benefits, increases the potential for success. Conclusions: The We Immunize program appears to have been viewed positively by participating pharmacists and was seen as having a beneficial impact on immunization delivery in the community pharmacies in which it was implemented.

Examination of Barriers to Medication Adherence, Asthma Management, and Control Among Community Pharmacy Patients With Asthma

OBJECTIVE

To describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics.

METHODS

Previously developed asthma-specific tool was pilot tested on a convenience sample of adult patients with persistent asthma. The following data were collected via patient survey: demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics. Descriptive and inferential statistics were used to address the study objective.

RESULTS

The patients (N = 93) were 45.4 (17.2) years of age, and 66.7% were female. The majority had poor (68.8%) adherence, with 61.3% of patients having controlled asthma. There was no significant association between adherence and asthma control. The mean number of barriers for good and poor adherence groups differed significantly: 2.0 ± 1.1 and 5.4 ± 2.4, respectively (P < .0001). Having an asthma action plan (AAP) was the only asthma management characteristic significantly related to adherence. The majority of patients with poor adherence did not have an AAP (76.6%), whereas 81.5% of patients with good adherence did have an AAP (P < 0.0001).

CONCLUSIONS

The use of this survey tool confirmed presence of asthma-specific barriers, thus using this specialized approach may lead to more effective, targeted counseling in community pharmacy settings.