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Guzenda W, Żabiński J, Plewka B, Byliniak M, Przymuszała P, Dąbrowiecki P, Michalak M, Waszyk-Nowaczyk M. Inhaler use technique course: an effective postgraduate training solution for pharmacists to enhance therapeutic outcomes as part of patient education. BMC MEDICAL EDUCATION 2024; 24:153. [PMID: 38374024 PMCID: PMC10875814 DOI: 10.1186/s12909-024-05129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patients with asthma and chronic obstructive pulmonary disease could benefit from education on using inhalers provided by pharmacists. However, pharmacists may have limited competencies, indicating the necessity to implement appropriate postgraduate courses. The study aimed to evaluate an inhaler use course for pharmacists, including its impact on participants' knowledge and satisfaction. METHODS The study involved 261 pharmacists from community pharmacies and was conducted between September 2019 and March 2021. A pre-post analysis of their knowledge of the topic was applied. Additionally, at the beginning of the course, participants were asked about their educational needs, and at the end, they completed a satisfaction survey. The preferred learning formats indicated by participants were interactive workshops and lectures. RESULTS As a result of the course, both their actual and self-assessed level of knowledge significantly increased. The percentage of correct answers in the test before the training was 24.4%, while after, it was 84.3% (p < 0.0001). Before the course, their average self-assessed level of knowledge was 52.0%, and after the training, it increased to 90.0% (p < 0.0001). Almost all respondents stated that the course met their expectations. They estimated their satisfaction at 94.0% and the usefulness of the provided information at 98.0%. CONCLUSIONS Improved preparation of pharmacists resulting from their participation in the course can contribute to providing more professional advice to patients, thereby positively influencing the pharmaceutical care process in community pharmacies.
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Affiliation(s)
- Weronika Guzenda
- Pharmacy Practice and Pharmaceutical Care Division, Chair and Department of Pharmaceutical Technology , Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806, Poznan, Poland.
| | - Jerzy Żabiński
- Department of Organic and Physical Chemistry, Medical University of Warsaw, 1 Banacha Street, 02-097, Warsaw, Poland
- Mazovian Pharmaceutical Chamber, 01-882, Żeromskiego 77/6 Street, Warsaw, Poland
| | - Beata Plewka
- Pharmacy Practice and Pharmaceutical Care Division, Chair and Department of Pharmaceutical Technology , Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806, Poznan, Poland
| | | | - Piotr Przymuszała
- Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60- 806, Poznan, Poland
| | - Piotr Dąbrowiecki
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 128 Szaserów Street, 04-141, Warsaw, Poland
| | - Michał Michalak
- Chair and Department of Computer Science and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-806, Poznan, Poland
| | - Magdalena Waszyk-Nowaczyk
- Pharmacy Practice and Pharmaceutical Care Division, Chair and Department of Pharmaceutical Technology , Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806, Poznan, Poland
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De Vos R, Hicks A, Lomax M, Mackenzie H, Fox L, Brown TP, Chauhan AJ. A systematic review of methods of scoring inhaler technique. Respir Med 2023; 219:107430. [PMID: 37890639 DOI: 10.1016/j.rmed.2023.107430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Many inhaler devices are currently used in clinical practice to deliver medication, with each inhaler device offering different benefits to overcome technique issues. Inhaler technique remains poor, contributing to reduced airway drug deposition and consequently poor disease control. Scoring inhaler technique has been used within research as an outcome measure of inhaler technique assessment, and this systematic review collates and evaluates these scoring methods. The review protocol was prospectively registered in PROSPERO (CRD42020218869). A total of 172 articles were screened with 77 included, and the results presented using narrative synthesis due to the heterogeneity of the study design and data. The most frequently used scoring method awarded one point per step in the inhaler technique checklist and was included in 59/77 (77%) of articles; however limited and varied guidance was provided for score interpretation. Other inhaler technique scoring methods included grading the final inhaler technique score, expressing the total score as a percentage/ratio, deducting points from the final score when errors were made, and weighting steps within the checklist depending on how crucial the step was. Vast heterogeneity in the number of steps and content in the inhaler technique checklists was observed across all device types (range 5-19 steps). Only 4/77 (5%) of the inhaler technique measures had undertaken fundamental steps required in the scale development process for use in real world practice. This review demonstrates the demand for a tool that measures inhaler technique and highlights the current unmet need for one that has undergone validation.
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Affiliation(s)
- Ruth De Vos
- Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, School of Sport, Health and Exercise Science, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK.
| | - Alexander Hicks
- Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK
| | - Mitch Lomax
- University of Portsmouth, School of Sport, Health and Exercise Science, UK
| | | | - Lauren Fox
- Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, UK
| | - Thomas P Brown
- Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK
| | - A J Chauhan
- Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, Faculty of Science and Health, UK
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3
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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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Bao LK, Khoa ND, Chi LTK, Anh NT. Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study. J Clin Med 2023; 12:4420. [PMID: 37445455 PMCID: PMC10342446 DOI: 10.3390/jcm12134420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. METHODS We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes. RESULTS 18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely "holding breath for about five seconds or as long as comfortable" and "breathing out gently," were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1-25.5, p = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3-20.1, p = 0.017) were associated with increased odds of using the inhaler correctly. CONCLUSIONS Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD.
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Affiliation(s)
- Le Khac Bao
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Dang Khoa
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Le Thi Kim Chi
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Tuan Anh
- Department of Respiratory, University Medical Center Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
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O'Mahony E, Kenny J, Hayde J, Dalton K. Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge. Int J Clin Pharm 2023:10.1007/s11096-023-01558-0. [PMID: 37093415 PMCID: PMC10124684 DOI: 10.1007/s11096-023-01558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pharmacists can use teach-back to improve patients' understanding of medication; however, the evidence of its impact on patient outcomes is inconsistent. From the literature, there is no standardised way to provide pharmacist-delivered medication counselling at hospital discharge, with limited reporting on training. AIM To develop a standardised medication counselling procedure using teach-back at hospital discharge, and to evaluate feedback from patients and pharmacists on this initiative. METHOD A standardised intervention procedure was developed. Participating pharmacists (n = 9) were trained on teach-back via an online education module and watching a demonstration video created by the researchers. Pharmacists provided patients with discharge medication counselling utilising teach-back and a patient-friendly list of medication changes to take home. To obtain feedback, patients were surveyed within seven days of discharge via telephone and pharmacists answered an anonymous survey online. RESULTS Thirty-two patients (mean age: 57 years; range: 19-91) were counselled on a mean 2.94 medications/patient with the mean counselling time as 23.6 min/patient. All patients responded to the survey, whereby 93.7% had increased confidence regarding medication knowledge and were satisfied with the counselling and the information provided. All pharmacist survey respondents (n = 8) agreed they were given adequate training and that teach-back was feasible to apply in practice. CONCLUSION This is the first study to evaluate patients' views on pharmacist-provided teach-back medication counselling. With positive patient outcomes, a standardised procedure, and a comprehensive description of the training, this study can inform the development of discharge medication counselling utilising teach-back going forward.
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Affiliation(s)
- E O'Mahony
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Kenny
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Hayde
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - K Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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Gong Y, Chen Q, Zhang Y. The Role of the Clinical Pharmacist on the Health Outcomes of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). Int J Chron Obstruct Pulmon Dis 2022; 17:1863-1870. [PMID: 35996393 PMCID: PMC9391938 DOI: 10.2147/copd.s370532] [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: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical pharmacists play a significant role in clinical practice, but their work in the clinical pathway (CP) of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains undefined. Methods This prospective study included patients who met the discharge criteria during hospitalization at the department of respiratory medicine of the Second Affiliated Hospital of Fujian Medical University from March to December 2017 (no pharmacists involved) and from March 2018 to January 2019 (pharmacists involved). The adverse drug reaction (ADR) reporting rate, the average DDD number of antibacterial drugs, the per capita cost of pharmaceutical services, and the benefit-cost ratio (B/C) were analyzed. Results and Discussion Eighty participants were enrolled during the traditional period and eighty-five participants during the clinical pharmacist period. The average hospital stays (9.2±0.4 vs 10.7±0.6 days, P=0.032), the total cost of hospitalization expenses (¥ 14,058±826 vs ¥ 18,765±1434, P=0.004), the total cost of drugs (¥ 5717±449 vs ¥ 8002±755, P=0.004), and cost of antimicrobial drugs (¥ 3639±379 vs ¥ 5636±641, P=0.007) were all lower in the clinical pharmacist group than in the traditional group. The B/C was 10.38 and 5.05 in the total cost of hospitalization expenses and the total cost of drugs, respectively. The clinical pharmacists’ participation was independently associated with the total cost of hospitalization expenses (β=−0.201, 95% confidence interval: −0.390, −0.055, P=0.010). What is New and Conclusion The participation of the clinical pharmacist in implementing an AECOPD CP significantly reduces patients’ hospitalization days, the total cost of hospitalization expenses, and antibiotic use and improves the B/C of AECOPD management. The clinical pharmacists’ participation was independently associated with the total hospitalization expenses.
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Affiliation(s)
- Yanqing Gong
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China.,Department of Pharmacy, Gaoxin Branch of the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qiying Chen
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Yin Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
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Imamoglu D, Yilmaz Z, Koruk I. Comparison of the knowledge and skill levels of pharmacists and pharmacy technicians on the implementation of inhaler drug-delivery devices: a cross-sectional study in Şanlıurfa, Turkey. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gracia G, Ruiz VR, Martínez B, Grande-Ratti MF, Mayer GF. Eficacia de una intervención educativa en el manejo de un dispositivo de inhalación entre profesionales de enfermería de un servicio de urgencias. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gracia G, Ruiz VR, Martínez B, Grande-Ratti MF, Mayer GF. Efficacy of an educational intervention in the management of an inhalation device among nursing professionals of an emergency department. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:279-283. [PMID: 35533982 DOI: 10.1016/j.enfcle.2022.04.004] [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: 08/08/2021] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the most frequent errors of the inhalation technique (main topic for the pharmacological treatment of exacerbations of asthma and/or chronic obstructive pulmonary disease) in the nursing staff of an emergency department, and to evaluate the efficacy of an educational intervention. METHODS Prospective quasi-experimental study, carried out in a hospital in Argentina during 2019. For the evaluation of the nursing staff, the steps of the Separ-Alat Consensus were used. The educational intervention consisted of oral explanation and visual demonstration of the inhalation technique. Paired data analysis was performed, and absolute and relative frequencies were calculated with their respective 95% confidence intervals. RESULTS A consecutive sample of 72 nurses was included, of which 95.83% (95%CI 88.30-99.13) made at least one error in the baseline assessment. The most frequent errors were the lack of indication to the patient to exhale prior to inhalation (83.72%), forgetting to remove the air chamber and repeat the steps before the second dose (81.40%). After immediate evaluation after receiving the educational intervention, 74.42% (95%CI 58.83-86.49) corrected the technique. However, at one month, 53.49% (23/43; 95%CI 37.66-68.86) performed the technique correctly. CONCLUSIONS The educational intervention could be effective in correcting errors in this practice, although its effects tend to fade over time. Therefore, we consider periodic and systematic education relevant to maintain a correct inhalation technique among professionals.
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Affiliation(s)
- Guadalupe Gracia
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vanesa Romina Ruiz
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Bernardo Martínez
- Central de Emergencias de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Florencia Grande-Ratti
- Central de Emergencias de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Germán Federico Mayer
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kebede AT, Trapnes E, Lea M, Abrahamsen B, Mathiesen L. Effect of pharmacist-led inhaler technique assessment service on readmissions in hospitalized COPD patients: a randomized, controlled pilot study. BMC Pulm Med 2022; 22:210. [PMID: 35624509 PMCID: PMC9145163 DOI: 10.1186/s12890-022-02004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the effect of pharmacist-led inhaler technique assessment service on readmissions and CAT-score in hospitalized COPD patients. Furthermore, to provide an effect estimate for sample size calculations for future studies and to gain experience on the feasibility of such studies. METHODS A randomized controlled pilot study. Patients were randomized 1:1 to intervention or standard care. The primary endpoint was the difference in time to first readmission after hospital discharge between the treatment groups. RESULTS There was no statistically significant effect on the time to readmission (median 41 days in the intervention group (19 patients) and 95 days in the control group (20 patients), HR 1.74, 95% CI 0.81-3.75, p = 0.16). There was no statistically significant difference between the groups in CAT-score 2 months after discharge, median scores being 25.5 and 24 in the intervention and the control group, respectively (p = 0.29). There was, however, a reduction of 3.5 units in CAT-score from baseline to 2 months after discharge in the intervention group, compared to no change in the control group. CONCLUSION Pharmacist-led inhaler technique training had no effect on time to readmission or CAT-score. Future studies in larger populations should consider focusing on patients with less severe COPD, exploring CAT-score as a primary endpoint, consider stratifying for important baseline variables and evaluate the acceptability of the intervention. TRIAL REGISTRATION Date of registration 01/10/2018. CLINICALTRIALS gov identifier: NCT03691324.
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Affiliation(s)
- Adyam Tesfamariam Kebede
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Elin Trapnes
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - Marianne Lea
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Bjørg Abrahamsen
- Chief Physician at the Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
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Johnson BR, Franks AS, Bullock LN, Dennis DL, Heidel RE, Self TH. Pharmacist‐Led
Inhaler Training for Nurses on an Acute Care Pulmonary Unit. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Blake R. Johnson
- University of Tennessee Medical Center Knoxville Tennessee
- University of Georgia College of Pharmacy, Athens, Georgia (Dr. Johnson was a resident at UT Medical Center at the time of this study.)
| | - Andrea S. Franks
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
- University of Tennessee Graduate School of Medicine Knoxville Tennessee
| | - Laura N. Bullock
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - Danielle L. Dennis
- University of Tennessee Medical Center Knoxville Tennessee
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
| | - R. Eric Heidel
- University of Tennessee Health Science Center College of Pharmacy Memphis/Knoxville Tennessee
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Sulku J, Janson C, Melhus H, Ställberg B, Bröms K, Högman M, Lisspers K, Malinovschi A, Nielsen EI. Changes in critical inhaler technique errors in inhaled COPD treatment – A one-year follow-up study in Sweden. Respir Med 2022; 197:106849. [DOI: 10.1016/j.rmed.2022.106849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
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13
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Hudd TR. Emerging role of pharmacists in managing patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2021; 77:1625-1630. [PMID: 32699897 PMCID: PMC7499078 DOI: 10.1093/ajhp/zxaa216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Timothy R Hudd
- Department of Pharmacy Practice, MCPHS University, Boston, MA
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14
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Kim JS, Hashweh N, Li H, Choudhary S, Santosh S, Charbek E. Effectiveness of one-on-one coaching in improving pressurized metered dose inhaler (pMDI) technique among COPD patients: a prospective clinical study. BMC Pulm Med 2021; 21:266. [PMID: 34399721 PMCID: PMC8365924 DOI: 10.1186/s12890-021-01627-y] [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: 03/25/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incorrect use of inhalers among asthma and COPD patients is very prevalent. Yet, no single intervention is considered standard of care. We aimed to conduct a COPD-specific investigation of active one-on-one coaching as the educational intervention to improve pressurized metered dose inhaler (pMDI) technique and COPD symptoms management. METHODS COPD patients who have pMDI in their treatment regimen were enrolled in this prospective study using the Global Initiative for Chronic Obstructive Lung Disease criteria. After rapid cognitive screen, inhaler technique was assessed and an active one-on-one coaching was provided utilizing the 12-step American Thoracic Society instructions. Patients' inhaler technique was assessed and scored again at their regular follow-up visits. RESULTS One hundred and one patients participated in the study. The percentage of pMDI misuse decreased from 43.5% pre-teaching to 12.9% post-teaching (binomial test p value < 0.001). The mean number of errors decreased from 3.1 errors pre-teaching to 1.7 errors post-teaching (paired t-test p value < 0.001). The number needed to treat was 3.3 patients to prevent one misuse. Patients with an impaired cognitive function were more likely to have inhaler misuse in general and less likely to improve their technique when provided training. CONCLUSIONS This study reveals that many COPD patients have incorrect pMDI techniques that can be improved with a short training in the clinic. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Jin Sun Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA.
| | - Nader Hashweh
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA
| | - Hannah Li
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA
| | - Salik Choudhary
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA
| | - Sadashiv Santosh
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA
| | - Edward Charbek
- Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, 3635 Vista Ave, Saint Louis, MO, 63110, USA
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Petite SE, Hess MW, Wachtel H. The Role of the Pharmacist in Inhaler Selection and Education in Chronic Obstructive Pulmonary Disease. J Pharm Technol 2021; 37:95-106. [PMID: 34752567 PMCID: PMC7953076 DOI: 10.1177/8755122520937649] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To review the role of pharmacists in educating and monitoring patients with chronic obstructive pulmonary disease (COPD) on inhalation technique. Data Sources: A PubMed search (January 2000 to May 2020) was performed using the following keywords and associated medical subject headings: adherence, chronic obstructive pulmonary disease/COPD, education, inhaler, pharmacist, and technique. Study Selection and Data Extraction: The search was conducted to identify English language articles highlighting the importance of correct inhaler technique in COPD management and benefits of pharmacist inhaler training such as improved adherence, quality of life (QoL), and disease control. Randomized controlled trials, retrospective studies, observational studies, systematic reviews, and meta-analysis reporting pharmacist training were included. Data Synthesis: This review summarizes that incorrect inhaler use negatively affects treatment outcomes, prognosis, and QoL. Pharmacists are in a unique position to educate and monitor patients with COPD on optimal inhaler technique and an individualized, multifactorial approach to COPD management involving pharmacists could provide cost-effective patient care and improve adherence and minimize inhaler misuse. Several strategies used by pharmacists can optimize patient inhaler use, such as face-to-face technique demonstrations, the "teach-back" method, telemonitoring, instructional videos, or informational leaflets. An individualized action plan involving education and regular monitoring of inhaler use further enhances optimal adherence and disease management. Conclusions: As pharmacists are easily accessible to both patients and health care providers, they are ideally placed to play an important role in the enhancement of education on, and continuous assessment of, optimal inhaler technique, thereby improving adherence, disease control, and QoL.
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Affiliation(s)
| | - Michael W. Hess
- WMed Health, Western Michigan University, Kalamazoo, MI, USA
| | - Herbert Wachtel
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
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Volerman A, Kan K, Carpenter D, Press VG. Strategies for Improving Inhalation Technique in Children: A Narrative Review. Patient Prefer Adherence 2021; 15:665-675. [PMID: 33824582 PMCID: PMC8018416 DOI: 10.2147/ppa.s267053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. Given the significant consequences of improper inhaler use in children, the goal of this review is to comprehensively describe existing and potential solutions to improve inhaler technique. Because children move through various settings, including clinical practices, schools, pharmacies, and homes, in their daily routine, there is great opportunity to teach and reinforce proper inhaler technique across settings. Within each setting, in-person and technology-based interventions have shown promise to improve technique. These solutions need to be more broadly adopted to deliver tailored education with support for provider training, team-based care, communication structures, and reimbursement. Such solutions hold the potential to improve inhaler use among children, with potential for decreasing morbidity and costs.
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Affiliation(s)
- Anna Volerman
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Advanced General Pediatrics Division, Department of Pediatrics, Chicago, IL, USA
| | - Delesha Carpenter
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
| | - Valerie G Press
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
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Shersher V, Haines TP, Sturgiss L, Weller C, Williams C. Definitions and use of the teach-back method in healthcare consultations with patients: A systematic review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2021; 104:118-129. [PMID: 32798080 DOI: 10.1016/j.pec.2020.07.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To review and synthesise definitions of the teach-back method in the literature. The second aim is to synthesise the barriers, facilitators and perceptions of teach-back use in healthcare consultations with patients. METHODS A systematic review and thematic synthesis following Braun and Clarke's method. RESULTS The primary search found 1429 citations and the secondary search added 221 citations. Screening identified 66 citations eligible for data extraction. We contrasted and synthesised operational definitions of the teach-back method. The synthesis generated seven themes related to healthcare provider (HCP) and patient perceptions of teach-back (effectiveness, stigma and time-related perceptions), the universal application of teach-back, patient health outcomes and healthcare provider training. DISCUSSION Operational definitions of the teach-back method varied in the literature and contained implied steps. HCPs and patient perceptions of teach-back operated as both enablers and barriers to its use. HCPs training programs for the teach-back method were identified as beneficial for altering HCPs perceptions about the method and increased its use with patients. PRACTICE IMPLICATIONS Standardising operational definitions of the teach-back method can support replicability of research and enhance HCPs communication skills training programs. HCPs training on teach-back use can support the increased use of the technique with broader patient populations.
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Affiliation(s)
- Violetta Shersher
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia
| | - Liz Sturgiss
- Department of General Practice, School of Primary and Allied Healthcare, Monash University, VIC, 3168, Australia
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, VIC, 3004, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia
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Amini S, Ghasemi A, Solduzian M, Rahimi B, Heidari K, Hadjibabaie M, Kargar M. Is Inhaler Technique Associated with Quality of Life in Patients with Chronic Obstructive Pulmonary Disease? Curr Ther Res Clin Exp 2020; 93:100608. [PMID: 33296446 PMCID: PMC7691547 DOI: 10.1016/j.curtheres.2020.100608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
The study showed a high prevalence of incorrect technique among patients with COPD. There is an association between inhaler technique (>30% error) and lower quality of life in these patients.
Background Inhalers are the mainstay of treatment for patients suffering from chronic obstructive pulmonary disease. However, incorrect inhaler technique is a considerable challenge. Objective We aimed to evaluate inhaler technique and its association with quality of life in a sample of patients with chronic obstructive pulmonary disease. Methods This cross-sectional study included patients with confirmed chronic obstructive pulmonary disease who were prescribed at least 1 inhaler medication on a regular basis. Patients were recruited from the outpatient pulmonary clinic of a hospital in Tehran. Inhaler technique was assessed according to a validated checklist. Patients’ quality of life was evaluated using Chronic Obstructive Pulmonary Disease Assessment Test. Results One hundred seventy-five patients with mean (SD) age of 59.0 (10.1) years were included. Patients’ devices were 192 (62.3%) pressurized metered-dose inhalers (including pressurized metered-dose inhalers plus spacer) and 116 (37.7%) dry powder inhalers. Unfortunately, only 2.86% of patients used their inhalers completely correct. The highest rate of errors was committed by patients who used metered-dose inhalers plus spacer. Patients with a higher educational degree had significantly lower rate of errors on average (P = 0.001). The most frequent errors made by patients using pressurized metered-dose inhalers or Turbuhaler was priming the inhaler before the first administration in 90.6% and 78.3% of patients, respectively. Chronic Obstructive Pulmonary Disease Assessment Test scores in patients using different inhaler devices were not significantly different. However, in patients with lower quality of life, significantly more patients had poor inhaler technique (P = 0.0001). Conclusions There is still considerable need for interventions to optimize inhaler technique. We also noted that appropriate inhaler technique is associated with better quality of life. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)
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Affiliation(s)
- Shahideh Amini
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Ghasemi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Solduzian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Heidari
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Kargar
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
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Giner J, Villarnovo Cerrillo M, Aboín Sierra J, Casas Herrero L, Patino O, Plaza V. Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD. Eur Clin Respir J 2020; 8:1833411. [PMID: 33144930 PMCID: PMC7581282 DOI: 10.1080/20018525.2020.1833411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/02/2020] [Indexed: 11/14/2022] Open
Abstract
While poor inhaler technique in asthma and chronic obstructive pulmonary disease (COPD) can compromise the effectiveness of inhaled medications, identifying and quantifying these errors may suggest ways to improve inhalation technique and patient outcomes. The objective of this international, multicentre care improvement programme was to investigate errors in inhaler use (handling errors and inhalation errors) made by patients in handling two dry powder inhalers; DuoResp® Spiromax® and Symbicort® Turbuhaler®. Patients with asthma or COPD aged between 18 and 80 years attending the allergology/pneumology departments of 14 hospitals in Spain and Portugal were included. All assessments were performed during one regular scheduled visit to the study clinic. Among 161 eligible patients (138 with asthma; 23 with COPD), inhalation errors were the most common type of error, with no significant difference between devices in overall total error rate, handling error rate or inhalation error rate. Significantly fewer total errors per patient (1.4 vs. 1.9; p < 0.001) and handling errors per patient (0.5 vs. 0.8; p < 0.001) were observed with DuoResp® Spiromax® compared with Symbicort® Turbuhaler®. The mean number of attempts for patients using DuoResp® Spiromax® to perform two correct procedures was 1.9 (0.6) compared with 2.1 (0.9) attempts for patients using Symbicort® Turbuhaler® (p = 0.016). Compared with Symbicort® Turbuhaler®, DuoResp® Spiromax® was found to be easy to learn how to use (p < 0.001), easy to prepare (p < 0.001), easy to use (p < 0.001), comfortable in terms of weight and size (p = 0.001), and patients felt that they were using the device correctly (p < 0.001). Overall, 79.5% of patients stated that they preferred DuoResp® Spiromax® as their first option over Symbicort® Turbuhaler®. The findings of this study may be useful in developing effective inhaler training programmes and thus improve outcomes in asthma and COPD.
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Affiliation(s)
- Jordi Giner
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau. Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Department of Medicine, Barcelona, Spain
| | | | | | | | | | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau. Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Department of Medicine, Barcelona, Spain
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Zolezzi M, Abdallah O, Sankaralingam S. Development and Evaluation of an Educational Program for Community Pharmacists on Cardiovascular Risk Assessment. Risk Manag Healthc Policy 2020; 13:623-632. [PMID: 32607030 PMCID: PMC7319523 DOI: 10.2147/rmhp.s231075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/06/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Cardiovascular disease (CVD) risk assessment is an important strategy for the prevention of CVD. Pharmacists play an important role in CVD risk assessment and management (CVDRAM). Our previous study identified gaps in knowledge among community pharmacists for the provision of CVDRAM services as assessed through patient simulation. Therefore, our objectives were: a) to develop and evaluate an educational program on CVD risk assessment for community pharmacists, b) to assess the knowledge and skills of participating pharmacists in assessing and managing CVD risk before and after enrolling in the educational program and c) to explore pharmacists’ satisfaction and perceived effectiveness of the educational program. Methods Using a blended learning instructional approach, the educational program for a subset of 25 community pharmacists recruited from our previous study consisted of two face-to-face workshops, and an online 5-module course on CVD risk factors such as hyperlipidemia, hypertension, diabetes, obesity, and smoking cessation based on principles of adult learning. A repeated measures study design was utilized by measuring participants’ knowledge on pre- and post-questionnaires and an objective structured clinical examination (OSCE) at the conclusion of the educational program was also used to assess its impact on the knowledge and skills of community pharmacists in the provision of CVD risk assessment and management (CVDRAM) services. The knowledge questionnaire was completed by 23 pharmacists while the OSCE was completed by 8 pharmacists. In addition, a survey assessed the pharmacists’ level of satisfaction with the educational program. Results At the conclusion of the educational program, the participating pharmacists achieved knowledge and skills for the provision of CVDRAM services. Knowledge scores in relation to CVDRAM significantly improved after the educational program [out of a maximum of 20 points, the median (interquartile range) = 9 (7–9) at pre- vs 12 (12–13) at post-educational program], p<0.001. On the OSCE, the median (interquartile range) scores for Stations 1 and 2 were 66 (63–71) and 71 (67–76), respectively. Out of the 21 pharmacists that completed the satisfaction survey, 71% were very satisfied and 29% were satisfied with the educational program. Conclusion The educational program improved pharmacists’ knowledge and skills for the provision of CVDRAM services.
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Affiliation(s)
- Monica Zolezzi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar
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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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Topal E, Arga M, Özmen H, Doğru M, Alataş C, Muştu EB, Çeliksoy MH. Effects of modifying visual inhaler spacer usage instructions on correct usage rate of untrained users. Int Forum Allergy Rhinol 2019; 10:69-74. [DOI: 10.1002/alr.22440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Erdem Topal
- Pediatric Allergy and Immunology DepartmentFaculty of MedicineInonu University Malatya Turkey
| | - Mustafa Arga
- Pediatric Allergy and Immunology DepartmentFaculty of Medicineİstanbul Medeniyet University İstanbul Turkey
| | - Hakan Özmen
- Department of PediatricsBakırköy Sadi Konuk Education and Research Hospital İstanbul Turkey
| | - Mahmut Doğru
- Pediatric Allergy and Immunology DepartmentZeynep Kamil Education and Research Hospital İstanbul Turkey
| | - Cem Alataş
- Pediatric Allergy and Immunology DepartmentFaculty of MedicineInonu University Malatya Turkey
| | - Elif Büşra Muştu
- Pediatric Allergy and Immunology DepartmentFaculty of Medicineİstanbul Medeniyet University İstanbul Turkey
| | - Mehmet Halil Çeliksoy
- Pediatric Allergy and Immunology DepartmentGOP Taksim Education and Research Hospital İstanbul Turkey
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Impact of pharmaceutical care in the improvement of medication adherence and quality of life for COPD patients in Vietnam. Respir Med 2019; 153:31-37. [PMID: 31136931 DOI: 10.1016/j.rmed.2019.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Medication adherence is an important factor in the management of chronic obstructive pulmonary disease (COPD). However, the rate of non-adherence to medications is high in COPD and is associated with worsened clinical outcomes and health-related quality of life for patients. OBJECTIVES Our study aimed to evaluate the impact of a pharmaceutical care program led by pharmacists in the improvement of medication adherence and quality of life for COPD patients in Vietnam. METHODS A pre- and post-intervention study was conducted over 12 months. Pharmacists provided brief counselling which focused on the role of COPD medications and the importance of adherence. Morisky Medication Adherence Scale was used to evaluate patients' adherence. Quality of life was assessed using the EQ-5D-5L questionnaire and clinical outcomes were evaluated by symptom scores. These outcomes were reassessed at baseline (T0), after 3 months (T1), 6 months (T2) and 12 months (T3). RESULTS Study participants consisted of 211 COPD patients (mean age: 66.6 ± 8.2 years). The percentage of patients with good adherence significantly increased from 37.4% to 53.2% (p < 0.001) after the program. Mean medication adherence scores improved from 6.7 (T0) to 7.4 (T2) and 7.4 (T3) (p < 0.001). EQ-5D-5L index values also increased from 0.47 (T0) to 0.59 (T3) (p < 0.001). There was no significant change in symptom scores across the duration of the study. CONCLUSIONS Medication adherence and quality of life of COPD patients improved considerably after implementation of a pharmaceutical care program, thus supporting a vital role for pharmacists alongside physicians in the management of COPD.
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Nguyen TS, Nguyen TLH, Pham TTV, Cao TBT, Nguyen VK, Hua S, Li SC. Effectiveness of a short training program for community pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study. Respir Med 2018; 144:50-60. [PMID: 30366584 DOI: 10.1016/j.rmed.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/26/2018] [Accepted: 10/06/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Community pharmacists can make significant contributions and be an indispensable member in the asthma therapy chain. The present study aimed to investigate the current knowledge level of Vietnamese community pharmacists in asthma counselling and the impact of a short training program on asthma knowledge and practice. METHOD 300 community pharmacists participated in the study. A knowledge questionnaire about asthma medications and a standardized inhaler checklist were designed to evaluate their knowledge before and after a 4-h training program. Six to eight weeks later, 10 simulated patients were sent to the community pharmacies to evaluate the pharmacists' knowledge and practice. RESULTS The training program significantly improved the asthma knowledge score of pharmacists from 5.3 to 17.2 out of a maximum score of 20 (p < 0.001). After the training, the percentage of pharmacists performing correctly inhaler devices increased significantly (0% vs.∼50%, p < 0.001). In the simulated patient study, pharmacists who attended the training demonstrated better asthma knowledge with higher scores (5.4 vs 1.7 out of a maximum score of 7.0, p < 0.001), as well as much better inhaler technique scores (6.1 vs 4.3, out of a maximum score of 8, p < 0.001). These pharmacists achieved higher scores in all aspects encompassing distinguishing controllers and relievers, counselling correctly about adherence, and common side effects. CONCLUSION Our results revealed significant knowledge deficiency about asthma among Vietnamese community pharmacists. However, a short training program was effective in upskilling the pharmacists to effectively counsel asthmatic patients about the management of their condition and medications.
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Affiliation(s)
- Tu-Son Nguyen
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | | | - Thi Thuy Van Pham
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | - Thi Bich Thao Cao
- Department of Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Viet Nam
| | | | - Susan Hua
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Australia.
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