Impact of a continuing education program on community pharmacists' interventions and asthma medication use: a pilot study

Role of community pharmacists in educating asthmatic patients: A multi-centered cross-sectional study in Ethiopia

Background:

Effective asthma management requires a multidisciplinary approach that includes; the physician, the patient, and the patient’s family.

Objectives:

The current study aimed to assess the roles played by community pharmacists toward asthma control together with the barriers hindering their practice and possible strategies to overcome those barriers.

Methods:

A multi-centered cross-sectional study was conducted. Data was collected using a structured, self-administered questionnaire adapted from previously conducted studies and customized to fit with the current study setup. The collected data was cleaned, coded, and entered into Statistical Package for Social Sciences (SPSS) version 21 for analysis. Descriptive analysis of the collected data was conducted and the results were presented using frequency tables and graphs.

Results:

A total of 122 community pharmacy professionals; 63 from Gondar, 26 from Bahir Dar, 15 from Debre Markos, 14 from Woldia, and 4 from Debre birhan participated in the study. About 96 (78.7%) of the participants reported that they teach their patients the basic facts about asthma. More than two-thirds of the participants 85 (69.7%) also reported that they were able to identify and manage the triggering factors of asthma for their patients. Lack of pharmacist time was reported by 78 (63.9%) of the study participants as a major reason for the inadequacy of the counseling service provided.

Conclusion:

It appears evident that there is a need for continuing professional education and pharmacists to receive additional training to improve their ability to go beyond identifying a problem and suggesting therapeutic options.

Community pharmacy interventions for health promotion: effects on professional practice and health outcomes

BACKGROUND

Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities.

OBJECTIVES

To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.

SEARCH METHODS

We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies.

SELECTION CRITERIA

We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only.

DATA COLLECTION AND ANALYSIS

We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations.

MAIN RESULTS

We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I² = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I² = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I²= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation.

AUTHORS' CONCLUSIONS

Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.

Effectiveness of a short training program for community pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study

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.

A multi-stakeholder perspective on asthma care in Canada: findings from a mixed methods needs assessment in the treatment and management of asthma in adults

Background

Although several aspects of asthma care have been identified as being sub-optimal in Canada, such as patient education, practice guideline adoption, and access to care, there remains a need to determine the extent to which these gaps remain, so as to investigate their underlying causes, and potential solutions.

Methods

An ethics-approved mixed methods educational needs assessment was conducted in four Canadian provinces (Alberta, British Columbia, Ontario, and Quebec), combining a qualitative phase (45-min semi-structured interviews with community-based healthcare providers and key stakeholders) and a quantitative phase (15-min survey, healthcare providers only).

Results

A total of 234 participants were included in the study, 44 in semi-structured interviews and 190 in the online survey. Five clinical areas were reported to be suboptimal by multiple categories of participants, and specific causes were identified for each. These areas included: Integration of guidelines into clinical practice, use of spirometry, individualisation of asthma devices to patient needs, emphasis on patient adherence and self-management, and clarity regarding roles and responsibilities of different members of the asthma healthcare team. Common causes for gaps in all these areas included suboptimal knowledge amongst healthcare providers, differing perceptions on the importance of certain interventions, and inadequate communication between healthcare providers.

Conclusions

This study provides a better understanding of the specific causes underlying common gaps and challenges in asthma care in Canada. This information can inform future continuing medical education, and help providers in community settings obtain access to adequate materials, resources, and training to support optimal care of adult patients with asthma.

A Systematic Review of the Effects of Continuing Education Programs on Providing Clinical Community Pharmacy Services

Objective. To summarize the effects of media methods used in continuing education (CE) programs on providing clinical community pharmacy services and the methods used to evaluate the effectiveness of these programs. Methods. A systematic review was performed using Medline, SciELO, and Scopus databases. The timeline of the search was 1990 to 2013. Searches were conducted in English, Portuguese, and Spanish. Results. Nineteen articles of 3990 were included. Fourteen studies used only one media method, and the live method (n=11) was the most frequent (alone or in combination). Only two studies found that the CE program was ineffective or partially effective; these studies used only the live method. Most studies used nonrobust, nonvalidated, and nonstandardized methods to measure effectiveness. The majority of studies focused on the effect of the CE program on modifying the knowledge and skills of the pharmacists. One study assessed the CE program's benefits to patients or clients. Conclusion. No evidence was obtained regarding which media methods are the most effective. Robust and validated methods, as well as assessment standardization, are required to clearly determine whether a particular media method is effective.

Evaluation of the effectiveness of an Internet-based continuing education program on pharmacy-based minor ailment management: a randomized controlled clinical trial

ABSTRACT The aim of this work was to evaluate the effectiveness of an internet-based continuing education (CE) program on pharmacy-based minor ailment schemes (PMASs). A controlled randomized clinical trial was conducted in community pharmacies in Brazil. Community pharmacists (CPs) were enrolled in two groups: intervention (n = 61) and control (n = 60). CPs who were enrolled to the intervention group participated in an Internet-based CE program. CPs in the control group received no educational intervention. We evaluated participant perception, learning outcomes, and practice performance. Learner satisfaction with the CE program was high for every point evaluated (mean ± standard deviation = 4.2 ± 0.4). Posttest learner outcome scores and practice performance in the intervention group after the conclusion of the CE program significantly improved compared with pretest scores (p < 0.001) and were significantly better compared with the control group (p < 0.001). The present Internet-based CE program is a viable educational strategy for improving participant perception, learning outcomes, and practice performance in PMASs.

Long-acting beta2-adrenergic agonist in pediatric and adolescent asthma patients, 2003-2011

OBJECTIVES

To evaluate changes in the dispensing patterns of long-acting beta2-adrenergic agonist (LABA) in pediatric and adolescent asthma patients in relation to multiple Food and Drug Administration (FDA) regulatory activities from 2003 to 2011.

METHODS

We estimated LABA dispensing to pediatric asthma patients across three periods: 2003-2004 (after the first labeling change), 2005-2009 (after regulatory activities in 2005 and before 2010 LABA labeling change) and 2010-2011 (after 2010 LABA labeling change), using the IMS Health Plan Claims database. We estimated dispensing patterns over time for single-ingredient (SI) LABA and fixed-dose combination (FDC) of inhaled corticosteroid (ICS) and LABA (FDC-ICS/LABA). We also evaluated prior use of non-LABA asthma-control medication (ACM) before LABA initiation.

RESULTS

Of the 147 862 pediatric and adolescent asthma patients who initiated a LABA during the entire study period, the majority (96%) were FDC-ICS/LABA initiators. The proportion of SI-LABA among any LABA initiators was small and declined (9%, 4% and 2%, trend test p < 0.001) for the three periods. Among the patients who initiated, the proportions with prior use of an ACM (1-90 days prior) were 35%, 36% and 39% for the three periods.

CONCLUSIONS

The significant decline in the proportion of SI-LABA initiation over these years is consistent with FDA's recommendations. However, the favorable trend cannot be solely attributed to FDA activities as changes to clinical practice guidelines, and media publicity may have played a role. Investigating the reasons for the low ACM use before LABA initiation may inform approaches to further improve appropriate use of LABA in young asthma patients.

Asthma management and inhalation techniques among community pharmacists in 2009: a comparison with the 1999 survey

OBJECTIVE

In a 1999 survey, community pharmacists from the Alsace region of France had a reasonably good knowledge of asthma treatment and prevention, but their skill in the use of asthma inhalation devices left room for improvement. Since then, health authorities have encouraged the involvement of community pharmacists in patient care and education in order to improve asthma control. The aim of this study was to assess the change in the knowledge of asthma management and inhaler technique skills of community pharmacists in the same geographic area after a 10-year interval.

METHODS

In 2009, 86 randomly selected community pharmacists from the Alsace region answered a standardized questionnaire about their theoretical knowledge of and practical attitude toward asthma management and inhaled delivery systems, following which their skills in the use of four inhalation devices (pressurized metered-dose inhaler (pMDI) with/without a spacer, breath-actuated pMDI and dry powder inhaler (DPI)) were evaluated.

RESULTS

Very few pharmacists were required to manage an acute asthma exacerbation at the pharmacy, but all responded well by administering a short-acting inhaled β2-agonist. Theoretical knowledge of asthma management (criteria of severity of asthma exacerbation, guidelines and drugs triggering asthma exacerbations) was still average. Compared with 1999, they were twice as confident in demonstrating inhaler use, and their skills in using the pMDI, breath-actuated pMDI and DPI had improved significantly (p < 0.001).

CONCLUSIONS

Since 1999, pharmacists' skill in the use of inhalers has improved, but theoretical knowledge of asthma management is still average, pointing to the importance of continuing pharmaceutical education.

Didactic Lecture Versus Interactive Workshop for Continuing Pharmacy Education on Reproductive Health

Pharmacists are routinely providing reproductive health counseling in community pharmacies, but studies have revealed significant deficits in their competencies. Therefore, continuing pharmacy education (CPE) could be utilized as a valuable modality to upgrade pharmacists’ capabilities. A randomized controlled trial was designed to compare the efficacy of CPE meetings (lecture based vs. workshop based) on contraception and male sexual dysfunctions. Sixty pharmacists were recruited for each CPE meeting. Small group training using simulated patients was employed in the workshop-based CPE. Study outcomes were declarative/procedural knowledge, attitudes, and satisfaction of the participants. Data were collected pre-CPE, post-CPE, and 2 months afterward and were analyzed using repeated measure analysis of variance and Mann–Whitney U test. Results showed that lecture-based CPE was more successful in improving pharmacists’ knowledge post-CPE ( p < .001). In contrast, a significant decrease was observed in the lecture-based group at follow-up ( p = .002), whereas the workshop-based group maintained their knowledge over time ( p = 1.00). Knowledge scores of both groups were significantly higher at follow-up in comparison with pre-CPE ( p < .01). No significant differences were observed regarding satisfaction and attitudes scores between groups. In conclusion, an interactive workshop might not be superior to lecture-based training for improving pharmacists’ knowledge and attitudes in a 1-day CPE meeting.

Intervention research to enhance community pharmacists' cognitive services: a systematic review

BACKGROUND

Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery.

OBJECTIVES

To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas.

METHODS

Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies.

RESULTS

A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used.

CONCLUSIONS

There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized.

Development, validation and implementation of continuous professional development programmes for community pharmacists

In India, structured continuous professional development modules are not available to update the knowledge and skills of the practicing community pharmacists. A prospective study was designed to develop, validate and implement continuous professional development modules and to assess the impact of training programme on knowledge and skills of community pharmacists. Modules were developed by referring to standard texts and data bases and were validated for the content. The impact of training programme on pharmacists’ knowledge and skills was assessed using suitably designed pre and post training knowledge attitude and practice questionnaires, pre and post training questionnaires for individual continuous professional development training sessions, pre and post training patient counseling skill assessment, blood pressure measurement skill assessment and capillary blood glucose check-up skill assessment check-lists. Data was analyzed by applying suitable statistical methods using InStat version 3.01 statistical software. Fourty eight community pharmacists were enrolled in to the study. A statistically significant (P<0.05) improvement was observed in post training knowledge attitude and practice scores and in post training scores of individual training sessions. A statistically significant (P<0.05) improvement was also observed in post training scores of professional skills such as Patient counseling, capillary blood glucose recording and blood pressure measurement skills. The study findings conclude that continuous training updates the knowledge and skills in practicing the pharmaceutical care in their pharmacies.

Factors Influencing a Community Pharmacist's Interventions in Asthma Care

Background:

Little is known about current pharmacists' interventions related to drug counselling and monitoring in asthma, along with the barriers and facilitators to these, in the province of Quebec.

Objectives:

To identify and explore organizational, relational and professional factors that influence community pharmacists' interventions in asthma care and propose solutions to overcome the barriers to these interventions.

Methods:

In 2006, a survey and an invitation to participate in a focus group were sent to community pharmacists in Quebec. Three focus groups were held to discuss the results of the survey about community pharmacists' interventions in asthma and the factors influencing these interventions, along with solutions to identified barriers. Each focus group lasted for approximately 120 minutes and was moderated by 2 investigators.

Results:

Seventeen community pharmacists participated in the study. One focus group was held with pharmacy owners, 1 with salaried pharmacists who graduated before 1990 and 1 with salaried pharmacists who graduated after 1996. Owners and salaried pharmacists of different years of graduation generally made the same comments. Most pharmacists reported intervening with asthma patients, especially when initial prescriptions were filled. Lack of time and unclear definition of tasks were reported as barriers. Solutions were proposed to resolve barriers, such as clearly defining tasks and ensuring quick access to support materials for patient education and drug monitoring.

Conclusion:

Community pharmacists report intervening in asthma care mostly when patients fill their initial prescription. Several barriers to follow-up interventions were identified.

A model for continuing pharmacy education

OBJECTIVE

To develop and implement a continuing pharmacy education (CPE) program at Kaiser Permanente Colorado (KPCO) DESIGN: To address the continuing education needs of its diverse pharmacy staff, an internal continuing pharmacy education (CPE) program was developed. The pharmacy department became an accredited provider by the Accreditation Council for Pharmacy Education (ACPE). Live, interactive, and evidence-based CPE programs, presented by highly qualified internal staff members, utilized videoconferencing and a Web-based learning management system. Cross-accreditation of medical and pharmacy educational programs was offered to KPCO staff members.

ASSESSMENT

Annual needs assessments were conducted to ensure the provision of relevant educational topics and to assess learning needs. To demonstrate outcomes of the CPE programs, 2 methods were utilized: objective effectiveness assessment and knowledge acquisition assessment. This program met the objectives for CPE activities a large majority of the time (usually over 90%), demonstrated statistically significant (p < 0.05) improvement in knowledge from before to after the CPE activity in 11 of 13 questions asked, and minimized the cost to acquire CPE credit for both the pharmacy department and its staff members.

CONCLUSION

The KPCO continuing pharmacy education program has developed a high quality and cost-favorable system that has resulted in significant improvements in attendee knowledge.

Physician-pharmacist collaborative care for dyslipidemia patients: knowledge and skills of community pharmacists

INTRODUCTION

In a physician-pharmacist collaborative-care (PPCC) intervention, community pharmacists were responsible for initiating lipid-lowering pharmacotherapy and adjusting the medication dosage. They attended a 1-day interactive workshop supported by a treatment protocol and clinical and communication tools. Afterwards, changes in pharmacists' knowledge, their skills, and their satisfaction with the workshop were evaluated.

METHODS

In a descriptive study nested in a clinical trial, pharmacists assigned to the PPCC intervention (n = 58) completed a knowledge questionnaire before and after the workshop. Their theoretical skills were evaluated with the use of a vignette approach (n = 58) after the workshop and their practical skills were assessed by direct observation with study patients (n = 28).

RESULTS

The mean (SD) overall knowledge score was 45.8% (12.1%) before the workshop; it increased significantly to 89.3% (8.3%) afterwards (mean difference: 43.5%; 95% CI: 40.3%-46.7%). All the pharmacists had an overall theoretical-skill score of at least 80%, the minimum required to apply the PPCC in the trial. From 92.9% to 100% of the pharmacists' interventions with study patients complied with the treatment protocol.

DISCUSSION

In primary care, a short continuing-education program based on a specific treatment protocol and clinical tools is necessary and probably sufficient to prepare pharmacists to provide advanced pharmaceutical care.

Community pharmacists' interventions in asthma care: a descriptive study

BACKGROUND

Factors influencing community pharmacists' interventions have been identified, but little information is available regarding these factors in asthma care.

OBJECTIVE

To describe the type and frequency of pharmacists' asthma care interventions and to identify factors influencing those interventions.

METHODS

A pretested, self-administered questionnaire was mailed to all community pharmacists registered with the Ordre des pharmaciens du Québec in 2006. The form included questions about the pharmacists' interventions in asthma care in the community setting (21 questions), factors influencing the provision of those interventions (13 questions), and the responders' characteristics (17 questions).

RESULTS

A total of 4587 questionnaires were sent; 917 pharmacists returned the questionnaires (response rate 20%), and 877 were eligible for analysis. Overall, community pharmacists who completed the questionnaire appeared to intervene frequently when the initial prescription for asthma medication was filled. About 98% of responders reported providing verbal information always or often on new asthma medication prescriptions. Furthermore, checking for overuse of rescue medication and underuse of maintenance therapy always or often was reported by 91% and 85.8% of responders, respectively. Other interventions at follow-up were not as frequently reported. For example, only 8.4% of pharmacists reported reassessing inhalation technique always or often. Lack of time was reported to be an important barrier to the type and frequency of intervention, while interest on the part of the patient appeared to be a significant facilitator. About 99% of pharmacists agreed with the statement that they have an important role in asthma care.

CONCLUSIONS

Community pharmacists appear to intervene with patients with asthma mostly at the initiation of treatment, but some interventions at follow-up are not frequently done, which could be attributed to organizational factors.

Asthma education in primary healthcare settings

PURPOSE OF REVIEW

Patient education is an essential component of asthma management. The current paradigm of asthma education has moved away from the 'information-transfer' programmes that characterized earlier approaches and that were shown to be largely ineffective, to approaches that promote self-management education. In this article, we review the most recent research studies that discuss the impact of self-management education on health outcomes for asthma patients in the primary care setting.

RECENT FINDINGS

Although there are several recent examples of asthma education practices in primary healthcare, they are mostly with community-based pharmacists and largely confined to adults. Further research is clearly required especially in relation to children and adolescents. A key aspect of optimizing asthma self-management education for patients is the need for more effective training interventions for primary care providers, and structural and organizational reform based on good evidence.

SUMMARY

Health outcomes may be improved if there is greater consistency between the various different primary healthcare providers who manage children and families with asthma. There may be value in extending the concept of multidisciplinary care to include partnerships with community groups and organizations to ensure that asthma educational messages are reinforced across a variety of settings.