Development and evaluation of an innovative model of inter-professional education focused on asthma medication use

A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists

Objective. To provide optimal asthma care, community pharmacists must have advanced, contemporary knowledge, and the skills to translate that knowledge into practice. The development and evaluation of an innovative multi-mode education program to enhance pharmacists' clinical knowledge and practical skills is described.Methods. The online education modules were collaboratively developed alongside asthma and pharmacy organizations. The education program was comprised of five evidence-based education modules delivered online and a skills review conducted either in-person with real-time feedback (urban pharmacists) or via video upload and scheduled video-conference feedback (regional and remote pharmacists). A mixed methods approach was used to evaluate the feedback obtained from pharmacists to assess the content, efficacy, and applicability of the education.Results. Ninety-seven pharmacists opted into the program and successfully completed all education requirements. A larger proportion of pharmacists did not pass trial protocol-based education modules on their first attempts compared to the number that passed the asthma and medication knowledge-based modules. Prior to skills review, the proportion of pharmacists demonstrating device technique competency was suboptimal. Pharmacists rated the education modules highly in both quantitative and qualitative evaluations and reported that the program adequately prepared them to better deliver care to asthma patients.Conclusion. We developed, implemented, and evaluated a novel multi-mode asthma education program for community pharmacists that supports knowledge and practical skill development in this crucial area of patient care. The education program was well received by pharmacists. This form of education could be used more broadly in international collaborative trials.

A brief educational intervention can improve nursing students' knowledge of the human papillomavirus vaccine and readiness to counsel

Provider recommendation is a primary reason for patient uptake of the human papillomavirus (HPV) vaccine. Most provider-focused educational interventions are focused on physicians, even though nurses are also important sources of vaccine-related information for their patients. This study examined whether a HPV educational intervention could improve nursing students' HPV knowledge, beliefs, and comfort with counseling. The same lecture on HPV and HPV vaccination was given to both medical and nursing students. To determine the effects of the lecture, students were asked to complete identical pre- and post-lecture tests with questions on demographics, knowledge, attitudes, and comfort with counseling on the HPV vaccine. Pre- and post-lecture test scores were compared between nursing and medical students to assess whether there were differences in pre-lecture test scores and/or changes in post-lecture test scores. On the pre-lecture tests, fewer nursing students responded correctly to knowledge questions, indicated positive attitudes or comfort with counseling about the HPV vaccine compared to medical students. However, similar frequencies of nursing and medical students responded correctly to knowledge questions and indicated a positive attitude, as well as a high comfort level with counseling on the post-lecture tests. Study results show that integrating lectures in a nursing program curriculum could be a feasible way to increase students' HPV knowledge. Having health-care providers with similar levels of knowledge, attitudes, and comfort with counseling on HPV vaccination is ideal, as all share the responsibility of recommending the vaccine to patients.

Implementing a collaborative medicine and pharmacy educational activity in two countries

BACKGROUND

To promote better collaboration for patient care, interprofessional education (IPE) is required in many health professions courses. However, successful IPE implementation at scale can be challenging because of complicated logistics and competing priorities. Implementing across multiple geographies adds further complexity.

OBJECTIVE

This paper describes the implementation of a full cohort IPE activity for medical and pharmacy students delivered at both the Australian and Malaysian campuses of Monash University.

DESIGN

We designed a 150-minute, blended learning activity centred around asthma care for second-year medical and pharmacy students. Student perceptions were measured with a pre- and post-activity survey using the validated ten-item, three-factor, SPICE-R2 instrument. Analysis focused on differences between professions and countries.

RESULTS

All second-year medicine (N = 301 in Australia and N = 107 in Malaysia) and pharmacy students (N = 168 in Australia and N = 117 in Malaysia) participated in the learning activity. A total of 326/693 (47%) students participated in the associated research by completing both the pre- and post-activity surveys. The pre-activity survey showed significant differences in four items between medicine and pharmacy students in Australia and two items in Malaysia. Post-activity, we observed significant changes in 8/10 items when the two professions were combined. Specifically, we noted changes across the countries in perceptions of roles and responsibilities for collaborative practice and patient outcomes from collaborative practice.

CONCLUSIONS

IPE across different professions and countries is feasible. Positive outcomes in role understanding and perceived patient outcomes are achievable through a context-sensitive, locally driven approach to implementation. Longitudinal experiences may be required to influence perceptions of teamwork and team-based care.

Perspectives of pharmacists about collaborative asthma care model in primary care

BACKGROUND

The newly recognized General Practice Pharmacist (GPP) model in Australia, where non-dispensing pharmacists work in collaboration with general practitioners (primary care physicians) within their general practice/clinics represent an efficient yet novel approach for the management of chronic diseases. In chronic conditions, such as asthma, these models can help achieve optimal health outcomes, given current gaps between guidelines and practice.

OBJECTIVE

The aim of this study was to elicit pharmacists' views and recommendations about pragmatic models of collaboration between GPPs and general practitioners in providing asthma management services in future service delivery models.

METHODS

Community pharmacists were recruited via convenience sampling and passive snowballing techniques. Qualitative, semi-structured, in-depth interviews were conducted. Recorded interviews were transcribed verbatim and analyzed utilizing NVivo® 11 software. Obtained data were content analyzed for emergent themes using the Braun and Clarke framework.

RESULTS

Twenty-five interviews were conducted. Asthma management challenges in current practice and the implementation practicality of asthma care GPP models comprised the two major emerging themes. Pharmacists' time and workload constraints and patients' reluctance to seek pharmacists' assistance to dispel misconceptions about asthma control were reported to be major barriers for the implementation of optimal asthma management services in community pharmacy. While a GPP dependent on several criteria. The development of specified channels for inter-professional communication for sharing of patient information and the willingness of stakeholders to accept and access such a model were reported. Funding and remuneration were considered critical factors by most participants. The professional self-autonomy of each healthcare professional involved in the GPP model was also highlighted as pertinent issue.

CONCLUSIONS

This study provides significant insights to create pragmatic scalable versions of a GPP care model that could facilitate better asthma care after key barriers and facilitators identified by participants are carefully addressed.

Play and Learn with Patients-Designing and Evaluating a Serious Game to Enhance Nurses' Inhaler Teaching Techniques: A Randomized Controlled Trial

Objective: To describe the development and evaluation of a nurse-patient interactive serious game in improving nurses' self-efficacy and performances in teaching the correct inhaler technique. Materials and Methods: The technology, pedagogy, and content knowledge (TPACK) framework was applied to guide the development of the serious game. The learning effectiveness of the serious game was evaluated through a randomized controlled trial that involved 46 registered nurses. Participants in the experimental group were asked to teach the inhaler technique to a standardized patient using the serious game as a teaching tool, whereas participants in the control group were asked to provide their own usual teaching to a standardized patient without the serious game. The performances of both groups were assessed based on their feedback to a standardized patient who made several errors while demonstrating the inhaler technique. Self-efficacy levels of teaching the inhaler technique were examined before and after the intervention. Results: A significantly higher number of participants from the experimental group obtained perfect performance scores than those in the control group (65.21% vs. 21.74%, χ^{2 =} 15.18, P < 0.01). The posttest self-efficacy mean scores for the experimental group improved significantly (P < 0.001) after the intervention, and significantly higher (P < 0.05) compared to the posttest mean scores of the control group. Conclusion: The study provided evidence on the effectiveness of a serious game in improving the self-efficacy and immediate postintervention performances of nurses teaching the inhaler technique. This game provides a practical and accessible learning tool to help nurses ensure effective patient education.

E-learning for self-management support: introducing blended learning for graduate students - a cohort study

BACKGROUND

E-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching).

METHODS

Graduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective.

RESULTS

The blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool.

CONCLUSIONS

In this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods.

Designing and developing a continuing interprofessional education model

BACKGROUND

Interprofessional education is considered as one of the approaches in educating learners in the health system that increases interprofessional collaboration and improves the quality of patient care.

PURPOSE

This study sought to design an interprofessional continuing education model.

METHODS

This study was conducted in three stages. In the first stage, a systematic review of literature and search of databases were conducted to identify the common models of interprofessional continuing education and to extract the elements used in these models. In the second stage, specialists in interprofessional continuing education were interviewed in relation to the features of elements derived from the first stage. In the third stage, the model of interprofessional continuing education was designed using the results of the first and second stages.

RESULTS

Seven models were obtained. Five themes, including the subject of interprofessional continuing education, objectives, content, learning strategy, and evaluation strategies, were extracted from them. Specialists stated interprofessional collaboration, needs of community and learners, focus on patient, using interactive teaching methods, and feedback as the main features of these five themes.

CONCLUSION

The results of this study showed that providing a framework and model regulated in interprofessional continuing education programs can help design these programs.

An integrative review of e-learning in the delivery of self-management support training for health professionals

BACKGROUND

E-learning involves delivery of education through Information and Communication Technology (ITC) using a wide variety of instructional designs, including synchronous and asynchronous formats. It can be as effective as face-to-face training for many aspects of health professional training. There are, however, particular practices and skills needed in providing patient self-management support, such as partnering with patients in goal-setting, which may challenge conventional practice norms. E-learning for the delivery of self-management support (SMS) continuing education to existing health professionals is a relatively new and growing area with limited studies identifying features associated with best acquisition of skills in self-management support.

METHODS

An integrative literature review examined what is known about e-learning for self-management support. This review included both qualitative and quantitative studies that focused on e-learning provided to existing health professionals for their continuing professional development. Papers were limited to those published in English between 2006 and 2016. Content analysis was used to organize and focus and describe the findings.

RESULTS

The search returned 1505 articles, with most subsequently excluded based on their title or abstract. Fifty-two full text articles were obtained and checked, with 42 excluded because they did not meet the full criteria. Ten peer-reviewed articles were included in this review. Seven main themes emerged from the content analysis: participants and professions; time; package content; guiding theoretical framework; outcome measures; learning features or formats; and learning barriers. These themes revealed substantial heterogeneity in instructional design and other elements of e-learning applied to SMS, indicating that there is still much to understand about how best to deliver e-learning for SMS skills development.

CONCLUSIONS

Few e-learning approaches meet the need for high levels of interactivity, reflection, practice and application to practice for health professionals learning to deliver effective SMS. Findings suggest that the context of SMS for patients with chronic condition matters to how health professional training is delivered, to ensure partnership and person-centred care. Further creative approaches and their rigorous evaluation are needed to deliver completely online learning in this space. Blended learning that combines e-learning and face-to-face methods is suggested to support SMS skills development for health professionals.

ABCs of asthma inhaler and device training

BACKGROUND

The impact of poor adherence and medication administration is well documented, as are the difficulties with asthma inhaler and device usage. However, difficulties with these devices and inhalers continue to present significant challenges to many healthcare providers and patients.

METHODS

A systematic review of the published, peer-reviewed international literature was performed to identify likely teaching needs as well as available and recommended resources to address same.

RESULTS

Asthma inhaler and device use and educational needs vary as widely as do the types and severity of usage errors committed. Multiple interventions have been studied and found to be effective at improving both patient technique and overall asthma outcomes.

CONCLUSION

Providers must ensure that patient teaching is performed by suitably prepared staff members. Education should be device-specific, patient-centered, and repeated at frequent intervals. Providers must frequently reassess patient understanding and ability with regard to asthma inhalers and devices in order to maximize therapeutic outcomes.

Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: Effects on prescription filling and readmission

PURPOSE

The effects of dispensing inhalers to patients with chronic obstructive pulmonary disease (COPD) on hospital discharge were evaluated.

METHODS

Data were collected in 2011-12 for patients with COPD who had hospital orders for the study inhalers (preintervention group) and after implementation of the multidose medication dispensing on discharge (MMDD) service (2013-14) (postintervention group). The primary objective of this study was to assess inhaler adherence and readmission rates before and after MMDD implementation. Adherence was defined as filling the discharge prescription for the multidose inhaler at a Harris Health pharmacy within three days of discharge or having at least seven days of medication left in an inhaler from a previous prescription that was filled or refilled before hospital admission. All patients in the postintervention group were considered adherent, since every patient was given the remainder of his or her multidose inhaler when discharged.

RESULTS

Data from 620 patients (412 in the preintervention group, 208 in the postintervention group) were collected. During the preintervention time period, 88 of 412 patients were readmitted within 30 days compared with 18 of 208 patients during the postintervention period (p < 0.001). The intervention was associated with a significant reduction in 30-day readmissions (p = 0.0016) and 60-day readmissions (p = 0.0056).

CONCLUSION

A targeted pharmacy program to provide COPD patients being discharged from the hospital with the multidose inhalers they had used during hospitalization was associated with improved medication adherence, as measured by prescription filling behavior, and reduced rates of 30- and 60-day hospital readmissions.

Inter-professional education unveiling significant association between asthma knowledge and inhaler technique

Objectives:

To explore whether an association exists between health care professionals’ (HCPs) asthma knowledge and inhaler technique demonstration skills.

Methods:

HCPs’ asthma knowledge and inhaler technique demonstration skills were assessed at baseline at an inter-professional educational workshop focusing on asthma medication use. Asthma knowledge was assessed via a published questionnaire. Correct inhaler technique for the three inhalers, the Accuhaler, Turbuhaler and pressurized Metered Dose Inhaler (pMDI) was assessed using published checklists.

Results:

Two hundred HCPs agreed to participate: 10 specialists (medical doctors specialized in respiratory diseases) (5%), 46 general practitioners (23%), 79 pharmacists (39%), 15 pharmacists’ assistants (8%), 40 nurses (20%) and 10 respiratory therapists (5%). Backwards stepwise multiple regression conducted to determine predictors of HCPs’ inhaler technique, showed that out of many independent variables (asthma knowledge score, profession, age, gender, place of work, years in practice and previous personal use of the study inhaler/s), asthma knowledge score was the only variable showing significant association with inhaler technique (R²=0.162, p<0.001).

Conclusion:

This study revealed significant associations between asthma knowledge and inhaler technique scores for all HCPs. Providing inter-professional workshops for all HCPs involved integrating education on asthma knowledge and practice of inhaler technique skills are looked-for.

Informal learning processes in support of clinical service delivery in a service-oriented community pharmacy

The evolving health care system necessitates pharmacy organizations' adjustments by delivering new services and establishing inter-organizational relationships. One approach supporting pharmacy organizations in making changes may be informal learning by technicians, pharmacists, and pharmacy owners. Informal learning is characterized by a four-step cycle including intent to learn, action, feedback, and reflection. This framework helps explain individual and organizational factors that influence learning processes within an organization as well as the individual and organizational outcomes of those learning processes. A case study of an Iowa independent community pharmacy with years of experience in offering patient care services was made. Nine semi-structured interviews with pharmacy personnel revealed initial evidence in support of the informal learning model in practice. Future research could investigate more fully the informal learning model in delivery of patient care services in community pharmacies.

The ability of people with intellectual disability to use inhalers--an exploratory mixed methods study

OBJECTIVE

This aim of this study was to assess inhaler technique of people with intellectual disability (ID), and evaluate the effectiveness of teaching with respect to their individual ability to adopt correct technique.

METHODS

Seventeen people with ID were recruited through existing networks of general practitioners and disability support organisations. Inhaler technique was assessed using validated checklists and placebo devices, followed by provision of individualised training. The educational interaction between participant and researcher was captured via video recording and analysed qualitatively.

RESULTS

Seventeen people with ID participated; females comprised 65%. At baseline, no participants correctly used any device. Pressurised metered dose inhalers, with or without accessory devices, were the most poorly used devices. Inhalation steps were poorly performed across all devices. Following training, the proportions of assessed participants that were able to master inhaler technique were 100% of Accuhaler users, 40% of Turbuhaler users, 25% of pressurised metered dose inhaler users and 0% of Handihaler users. Barriers identified included poor comprehension of breathing processes, the lack of attentiveness and poor dexterity. Facilitators for educator delivery of inhaler technique education included the use of analogies and being patient.

CONCLUSIONS

This is the first study to examine inhaler technique mastery in people with ID. Results show that with education that addresses the unique patient barriers inherent in this group, some individuals can be trained to mastery. Structured modules of inhaler technique training tailored for people with ID, but which can be individualised, are recommended.

Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers

OBJECTIVE

To address the problems about correct use of inhaler devices, adherence to inhaler corticosteroid treatment and the effects of these problems on the control of asthma.

METHODS

Children with asthma were evaluated for the correct use of inhaler devices and adherence to therapy using a questionnaire. Effect of these on control of asthma was defined.

RESULTS

A hundred and seventy-one patients and/or their families were interviewed. The mean age was 8.29 ± 4.65 years (1-19) and 62.6% were male. Metered dose inhaler (MDI) with spacer was used by 119 (69.5%) patients and 52 (30.5%) used dry powder inhalers (DPIs). The devices were used correctly by 68.1% of patients using MDI and 34.6% of patients using DPI (p < 0.001). The most common improper step was "breathe in from the spacer 5-6 times or 10 s" for MDI (24.4%) and "exhale to residual volume" for DPI (51.9%). Frequency of correct use was higher in patients trained 3 times (p < 0.001). Asthma was controlled more frequently among correct users (p < 0.001). Partial or poor adherence was showed 22.8% of patients. Patients with mothers who had lower educational status had higher frequency of incorrect use of inhaler device (p = 0.007).

CONCLUSION

It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique. Especially children whose mothers had low education level and patients using DPI should be evaluated more carefully.

Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study

BACKGROUND

Feedback is a critical component of any educational intervention. When it comes to feedback associated with inhaler technique education, there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique.

AIMS

This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time.

METHODS

A parallel-group, repeated-measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback (Group 1) was compared with a combination of qualitative and quantitative visual feedback (Group 2). The impact of these two interventions on inhaler technique maintenance was evaluated. Community pharmacists were randomly allocated to recruit people with asthma who were using a dry powder inhaler. At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 (1 month later).

RESULTS

Both educational interventions resulted in an increase in the proportion of patients with correct inhaler technique: from 4% to 51% in Group 1 and from 6% to 83% in Group 2 (Pearson's Chi-Squared, P=0.03, n=49, and Pearson's Chi-Squared, P=0.01, n=48, respectively). The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 (n=97, P=0.02, Pearson's Chi-Square test).

CONCLUSIONS

The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time.

PACE: Pharmacists use the power of communication in paediatric asthma

BACKGROUND

Paediatric asthma is a public health burden in Australia despite the availability of national asthma guidelines. Community pharmacy interventions focusing on paediatric asthma are scarce. Practitioner Asthma Communication and Education (PACE) is an evidence-based program, developed in the USA for general practice physicians, aimed at addressing the issues of poor clinician-patient communication in the management of paediatric asthma. This program has been shown to improve paediatric asthma management practices of general practitioners in the USA and Australia. The development of a PACE program for community pharmacists will fill a void in the current armamentarium for pharmacist-patient care.

OBJECTIVES

To adapt the educational program, PACE, to the community pharmacy setting. To test the feasibility of the new program for pharmacy and to explore its potential impact on pharmacists' communication skills and asthma related practices.

SETTING

Community pharmacies located within the Sydney metropolitan.

METHOD

The PACE framework was reviewed by the research team and amended in order to ensure its relevance within the pharmacy context, thereby developing PACE for Pharmacy. Forty-four pharmacists were recruited and trained in small groups in the PACE for Pharmacy workshops. Pharmacists' satisfaction and acceptability of the workshops, confidence in using communication strategies pre- and post-workshop and self-reported behaviour change post workshop were evaluated.

MAIN OUTCOME MEASURE

Pharmacist self-reported changes in communication and teaching behaviours during a paediatric asthma consultation.

RESULTS

All 44 pharmacists attended both workshops, completed pre- and post-workshop questionnaires and provided feedback on the workshops (100 % retention). The participants reported a high level of satisfaction and valued the interactive nature of the workshops. Following the PACE for Pharmacy program, pharmacists reported significantly higher levels in using the communication strategies, confidence in their application and their helpfulness. Pharmacists checked for written asthma self-management plan possession and inhaler device technique more regularly, and provided verbal instructions more frequently to paediatric asthma patients/carers at the initiation of a new medication.

CONCLUSION

This study provides preliminary evidence that the PACE program can be translated into community pharmacy. PACE for Pharmacy positively affected self-reported communication and education behaviours of pharmacists. The high response rate shows that pharmacists are eager to expand on their clinical role in primary healthcare.