Impact of student pharmacist-delivered asthma education on child and caregiver knowledge

Promoting knowledge of metered dose inhaler (MDI) usage among pharmacy professional students through a mobile app

INTRODUCTION

Efficient asthma management necessitates optimal usage of metered-dose inhalers (MDIs). As future health professionals, pharmacy students are pivotal in disseminating accurate methodologies for MDI usage. Despite having hands-on experience, there is room to enhance their comprehension, highlighting the need for prompt patient educational interventions.

OBJECTIVE

This study aims to evaluate the effectiveness of a mobile app-assisted educational method in improving pharmacy students' understanding of MDI usage.

METHODS

A pre-experimental study was conducted from March to August 2021 with 45 participants enrolled in the Pharmacist Professional Study Program at the Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta. Using a one-group pretest-post-test design, the study measured the app's impact on students' knowledge and MDI usage skills.

RESULTS

The intervention significantly improved students' scores on a 9-step MDI usage checklist, with increases ranging from 0.10 to 0.50 across verbal and motor components. A Mann-Whitney U test validated these findings, showing a statistically significant p-value of 0.001.

CONCLUSION

The mobile app-assisted educational approach substantially enhanced pharmacy students' proficiency in MDI use. The significant rise in mean scores for the 9-step checklist, along with the notable p-value, supports the effectiveness of this intervention in healthcare education.

The role of community pharmacists as oral health advisors in the management of oral effects of asthma medications: an exploratory survey

OBJECTIVES

To investigate community pharmacists' attitudes, confidence, practice, knowledge, and barriers towards the management of oral side effects of asthma medications.

METHODS

A paper-based questionnaire was developed from previous research, trialled, and validated. Convenience sampling through web search was used to identify pharmacy practices across Cairns, Queensland, Australia. Practices were contacted by email and phone before hand-delivering and collecting questionnaires.

KEY FINDINGS

Thirty eight community pharmacist responses were descriptively analysed. Community pharmacists surveyed within the Cairns region feel that it is within their role to help manage the side effects of asthma medications. Many feel this is best conveyed during inhaler dispensing and instruction. Current advice is more prompted rather than preventative. Pharmacists routinely advise patients of mouth-rinsing following inhaler use, however the link to preventing side effects is not clearly communicated. Pharmacists are confident in recognizing and managing common side effects such as oral thrush and dry mouth, but fewer are aware of dental decay and gingivitis. Many identify a lack of guidelines as the largest barrier to providing preventive oral health advice.

CONCLUSIONS

Cairns community pharmacists already self-perceive their role in the management of oral side effects of asthma medications. Advice given to patients is practical but does not clearly convey the causative associations between asthma medications and their potential oral side effects. Patient education is prompted more by enquiry rather than a preventative approach. The development of standardized practice protocols and integration within undergraduate degrees or continuing education may benefit the community-pharmacist delivered care.

[Educational interventions in childhood asthma: A systematic review]

OBJECTIVE

To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management.

DESIGN

Systematic review based on the PRISMA recommendations.

DATA SOURCES

Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed.

STUDY SELECTION

Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0-18 years.

DATA EXTRACTION

Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs.

RESULTS

The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique.

CONCLUSIONS

The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.

Pharmacist intervention for pediatric asthma: A systematic literature review and logic model

BACKGROUND

Asthma is highly prevalent in children. Evidence about pharmacist-led interventions in the management of pediatric asthma is emerging.

OBJECTIVE

To summarize empirical evidence of pharmacist-led interventions for pediatric asthma patients, and to identify the components of a logic model, which can inform evidence-based pharmacy practice.

METHODS

PubMed, Web of Science, Embase Scopus, ScienceDirect, Medline and CNKI were searched. Studies concerning pharmacist-led interventions for pediatric asthma patients with an interventional design published between January 2013 and February 2023 were selected for analysis. Literature was searched and retrieved according to PRISMA guidelines. Components of pharmacist-led interventions were compiled into a logic model comprising input, activity, output, outcome and contextual factors.

RESULTS

The initial search retrieved 2291 records and 35 were included in the analysis. The main interventional activities included optimising medicines use and prevention and control of asthma. Commonly reported outputs were medication adherence, knowledge and inhaler technique. The main economic outcomes included cost of medication and hospitalization; clinical outcomes included Childhood Asthma Control Test/Asthma Control Test scores and lung function in FEV1% and PEF%; humanistic outcomes included patients' quality of life and satisfaction. Social, economic, political, and technological factors were identified as contextual factors.

CONCLUSION

The logic model summarized components of interventions evaluated in literature. It provides a blueprint for pharmacist-led management of pediatric asthma. Further research can focus on the pharmacists' role in a multidisciplinary healthcare professional team and transition of care in patient-centered management of pediatric asthma.

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Mothers’ knowledge about childhood asthma influences management practices and disease control, but validating knowledge/practice questionnaires is difficult due to the lack of a gold standard. We hypothesized that Latent Class Analysis (LCA) could help identify underlying mother profiles with similar knowledge/practices. A total of 438 mothers of asthmatic children answered a knowledge/practice questionnaire. Using answers to the knowledge/practice questionnaire as manifest variables, LCA identified two classes: Class 1, “poor knowledge” (33%); Class 2, “good knowledge” (67%). Classification accuracy was 0.96. Mothers in Class 2 were more likely to be aware of asthma-worsening factors and indicators of attacks. Mothers in Class 1 were more likely to prevent exposure to tobacco smoke (91.1% vs. 78.8%, p = 0.005). For attacks, mothers in Class 2 were more likely to go to the emergency department and follow the asthma action plan. Mothers in Class 2 more frequently had a high education level (79.5% vs. 65.2%, p = 0.004). Children in Class 2 more frequently had fully controlled asthma (36.7% vs. 25.9%, p = 0.015) and hospitalizations for attacks in the previous 12 months (24.2% vs. 10.7%, p = 0.003). LCA can help discover underlying mother profiles and plan targeted educational interventions.

Improved asthma outcomes among at-risk children in a pharmacist-led, interdisciplinary school-based health clinic: A pilot study of the CAReS program

BACKGROUND

Disparities in access to care and outcomes have been identified among children with asthma living in underserved communities. The Caring for Asthma in our Region's Schoolchildren program was established to reduce disparities by providing school-based, comprehensive asthma care by a pharmacist-led, interdisciplinary team to high-risk pediatric populations in the Greater Pittsburgh area.

OBJECTIVE

To investigate program impact on follow-up appointment attendance, delivery of guideline-based care, asthma control, asthma morbidity (emergency department [ED] visits, oral corticosteroid [OCS] requirement), and asthma-related knowledge and quality of life.

METHODS

The study enrolled 50 children with asthma from 6 elementary schools (September 2014-December 2017). Children completed 5 visits over a 3-month period. McNemar's test assessed improvement in guideline-based controller therapy use and reduced morbidity (ED visits or OCS requirement). Generalized estimating equation analyses determined the significance of monthly improvements in asthma control, asthma knowledge, and quality of life.

RESULTS

A 100% show rate was achieved in nearly all participants (92.0%). Most of the patients were African-American (56%). In children with persistent disease, only 21.4% were prescribed controller therapy at baseline, which improved to 78.5% upon enrollment (P < 0.05). Asthma control statistically significantly improved (P < 0.05), and a reduction in percentage of patients who required an ED visit or an OCS burst pre-to postintervention was also statistically significant (31.3% vs. 14.6%, P < 0.05). The goal of 100% treatment plan knowledge was achieved in 67% of caregivers within 1 month and increased from 6% to 60% in children over 3 months (P < 0.05). Asthma-related quality of life also improved statistically significantly pre-to postintervention (P < 0.05).

CONCLUSIONS

Disparities in asthma outcomes owing to inadequate access to health care can be addressed. Improved asthma control, asthma medication knowledge, quality of life, and reduced morbidity in high-risk pediatric patients are achievable as demonstrated by our study. Our findings support the feasibility and value of a pharmacist-led, interdisciplinary school-based health care delivery model in providing comprehensive asthma care to at-risk pediatric populations.

Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study

BACKGROUND

Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD).

METHODS

This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate.

RESULTS

Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%).

CONCLUSION

Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.

Effect of an educational intervention on public knowledge, attitudes, and intended practices towards diabetes mellitus: A quasi-experimental study

AIM

To assess the impact of educational workshops on the knowledge, attitudes, and intended practices (KAP) of the general public towards diabetes in Jordan in terms of symptoms, risk factors, complications, and prevention.

METHODS

A pharmacist led educational intervention and Propensity score matching was carried out for a convenience sample to assess Jordanians pre- and post-knowledge, attitudes, and practices towards diabetes mellitus (DM) using a validated questionnaire.

RESULTS

Among the 357 invited participants, 335 attended the educational workshops (response rate 93.8%). Prior to intervention, participants showed an overall knowledge score of 16.03 ± 4.88. About half of the participants knew that a sedentary lifestyle is a risk factor for getting DM (n = 172, 51.3%). Following educational intervention, knowledge scores significantly improved to be 21.36 ± 2.11 (P value < .001). A similar finding was obtained for attitude scores, where mean attitude scores significantly improved from 2.74 ± 1.94 before intervention to 4.40 ± 1.87 following the workshop (P value < .001). As for the intended practices, the educational intervention improved the participants' intent to exercise, eat healthy foods, and do annual screening.

CONCLUSIONS

Participants' knowledge, attitudes, and intended practices improved following a trained pharmacy led educational intervention. These encouraging results highlight the need for continuous national educational interventions about diabetes provided by trained health care professionals such as pharmacists. Future studies are needed to evaluate the impact of improved knowledge and perceptions on actual long-term practice.

Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review

INTRODUCTION

Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma.

METHOD

An integrative review was conducted to review and appraise 80 studies.

RESULTS

Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology.

DISCUSSION

As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.

Healthcare Providers' Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases

PURPOSE

The purpose of this study was to identify healthcare providers' experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases.

DESIGN AND METHODS

A qualitative, descriptive design was used with 13 pediatric healthcare providers.

FINDINGS

Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support.

CONCLUSIONS

Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers.

PRACTICE IMPLICATIONS

The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.

Parental knowledge and attitudes regarding asthma in their children: Impact of an educational intervention in an Indian population

INTRODUCTION AND OBJECTIVES

Research shows positive effects of asthma education in improving parental knowledge, self-management skills, and reducing healthcare costs. Such studies are lacking in resource-limited countries. We studied the effectiveness of educational intervention in improving the knowledge and attitudes of parents/caregivers of asthmatic children.

METHODS

The study was conducted in the pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into the interventional group (A) receiving education module and control group (B). Parents' asthma knowledge and attitudes were assessed at baseline and 5 months postenrollment using 25-item questionnaire. Detailed demographic data, clinical data, and exacerbations during study were noted.

RESULTS

A total of 75 parents/guardians fulfilling inclusion criteria were analyzed (cases/group A: 37 and controls/group B: 38). 8.3 percent of parents/caregivers were illiterate. Around 36.9% of patients had a family history of allergy/asthma. Mean knowledge scores at follow-up were 12.24 and 9.89 for groups A and B, respectively (P < .05). Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma, and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude-based questions postintervention as compared with the nonintervention group (B). There was no statistically significant difference in asthma severity and control between the two groups at follow-up.

CONCLUSIONS

Small group education on asthma in parents/caregivers improves their knowledge and attitudes. Healthcare plans should invest in pediatric asthma education and identify key personnel/opportunities to impart the same in routine care.

Engaging student pharmacists to improve Hospital Consumer Assessment of Health Care Providers and Systems scores

INTRODUCTION

Student pharmacists have historically served in shadowing roles for their experiential training at our institution. However, engaging students through active learning assignments has the potential to benefit both the student and the institution. The purpose of this project was to evaluate the impact of student pharmacists on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) scores, a direct reflection of patient satisfaction within the hospital.

METHODS

In a four-month quality-improvement pilot project, student pharmacists were given active learning assignments directed at helping patients understand the purpose and side effects of their medications. Patients with hospital-initiated medications were provided with medication cards via student pharmacist-run counseling programs. The primary outcome was top response ("always") in medication-related HCAHPS scores. Secondary outcomes included scores on individual questions, number of medication education encounters, number of interventions, cost savings, and student feedback.

RESULTS

There were 482 medication education encounters. The top response for all medication-related HCAHPS scores improved by 14% (49% to 63%). Top response regarding medication indication increased 23% (63% to 86%). There were 552 interventions accepted, projecting a savings of $135,658. The top score on student evaluations of the practice site increased 20% (69% to 89%).

CONCLUSIONS

Student pharmacists can have a meaningful impact on medication-related HCAHPS scores. Additionally, student pharmacists benefit from active learning opportunities by providing and improving patient care leading to a more meaningful experience.

Questions and reported medication problems from pediatric patients and caregivers after intervention

PURPOSE

The effectiveness of an asthma question prompt list with video intervention to increase question-asking during pediatric office visits among youth who reported medication problems was evaluated.

METHODS

English- or Spanish-speaking youth age 11-17 years with persistent asthma and their caregivers were enrolled from 4 pediatric clinics in a randomized controlled trial. Youth were randomized to intervention or usual care groups. Youth in the intervention group watched an educational video with their caregivers on an iPad. The youth then received a 1-page asthma question prompt list to complete before their visits. The audio of all baseline medical visits was recorded. Youth were interviewed and caregivers completed questionnaires at baseline and 6 months later.

RESULTS

A total of 40 providers and 359 of their patients participated. Youth who reported at least 1 medication problem who were in the intervention group were significantly more likely to ask 1 or more questions about medications during their visits than youth in the usual care group (odds ratio = 3.1, 95% confidence interval = 2.0, 4.1). Seventy-four percent of youth and 71% caregivers who reported the youth had problems using asthma medications at baseline still reported 1 or more problems 6 months later.

CONCLUSION

Among youth who reported 1 or more problems with using their asthma medications, the intervention significantly increased youth question-asking. Many youth- and caregiver-reported problems with using asthma medications persisted over time.

Effectiveness of providing health education to caregivers of hospitalized children with asthma for the prevention of recurrent attacks: a quasi-randomized trial

Objective: To determine the effectiveness of health education intervention for caregivers of children with asthma, focused on preventing recurrent attacks and improving knowledge.Methods: A quasi-randomized trial of 177 caregivers of asthmatic children was conducted in government hospitals in a district of Sri Lanka. At the time of discharge from the hospital, a health education booklet was prepared and given to the caregivers in the intervention group, along with individual explanation and discussion. The caregivers' knowledge of asthma and preventive practices was assessed. The primary outcome was the proportion of children with recurrent attacks of asthma who needed doctor visits during the three month post discharge period. The intention-to-treat principle was applied for data analysis.Results: In comparison to the control group, the intervention group had a 76% significant reduction in visits to the doctor for recurrent attacks (95% CI:45%-90%) and a 75% significant reduction in hospital admissions required for asthmatic children (95% CI:16%-93%) at the end of three months of intervention. The mean score of knowledge of asthma in the intervention group was 1.73 units higher at three months (p < 0.01) and 1.47 units higher at six months (p < 0.01) than the control group. The mean score of preventive practices for asthma in the intervention group was 1.25 units higher at three months (p = 0.02) and 1.15 units higher at six months (p < 0.01) versus the control group.Conclusion: Health education intervention significantly decreased doctor and hospital visits at three months. In addition, caregiver knowledge of asthma and preventive practices also improved.Trial Registration Number: SLCTR/2010/007.

Student pharmacists provide tobacco use prevention education to elementary school children: A pilot experience

BACKGROUND AND PURPOSE

The purpose of this article is to describe a service learning experience involving tobacco prevention education and to measure the education's effect on the learners' knowledge of tobacco products.

EDUCATIONAL ACTIVITY AND SETTING

Student pharmacists planned and presented a 40-min tobacco prevention education program using the Tar Wars curriculum to fourth and fifth grade students at three suburban elementary schools in Western Massachusetts. Mean scores on a five-question assessment given to school age children before and after the presentation were compared. A total of 206 elementary school students in ten classrooms participated.

FINDINGS

The average survey score increased from 1.87 on the pre-survey to 3.72 out of a maximum of five on the post-survey (P<0.01).

DISCUSSION AND SUMMARY

Student pharmacists provided tobacco prevention education to three suburban elementary schools. The children demonstrated an increase in short-term knowledge regarding tobacco use. Tobacco prevention is a unique co-curricular opportunity for student pharmacists to get involved in their community.

The school as a health promoter for children with asthma: The purpose of an education programme

BACKGROUND

Not only is asthma one of the leading causes of hospitalisation in children under 15 years and one of the main reasons for primary care outpatient visits, it also accounts for 13 million lost days of school annually, which can affect children's learning, integration at school and overall academic achievements.

MATERIAL AND METHODS

This review article highlights the important role of the school in helping children and adolescents to control and manage their asthma through integrated and coordinated actions of health professionals, school staff, family, and the community.

RESULTS

We recommended key elements for a multidisciplinary team asthma school programme that can be replicated and implemented especially in developing countries where children and adolescents are in a more disadvantaged environment.

CONCLUSION

This multidisciplinary asthma school intervention when demonstrated with efficacy can be applied in the context of the real world, where many children and families who need care the most currently do not receive it.

Feasibility of a worksheet for facilitating self-management in children with asthma

BACKGROUND

Few tools exist to facilitate recommended self-management support for children with asthma. We sought to examine the feasibility, acceptance and preliminary results of a novel worksheet designed to provide such support for children and their caregivers presenting for asthma care.

METHODS

A 12-topic asthma worksheet was modeled on currently available self-management tools and based on the behavior change theory and motivational interviewing techniques. Children 1-18 years old with asthma and their caregivers were recruited from an allergy clinic and an inpatient ward to pilot test the worksheet by choosing three topics, generating self-management goals for each topic and assessing their self-efficacy for behavior change. Physician documentation of the visit was reviewed for comparison. Telephone follow up of self-management goals occurred 1 week after the visit.

RESULTS

Forty-one of 46 eligible subjects agreed to participate (89%). Average completion time was 5:47 min (range 3:30-13:00). Most of them (98%) found the worksheet easy to understand, with minor modifications suggested. Topics most commonly selected were distinct from topics documented by physicians in the subsequent encounter (p < 0.01). Subjects generated 121 total self-management goals; 93% were at least "moderately confident" they could meet the goals. All 15 subjects reached by phone (37%) had achieved at least one goal at follow-up.

CONCLUSIONS

A worksheet designed for self-management support of children is brief, feasible and acceptable in the clinical environment. This tool captures unique patient-centered preferences for behavior change, and shows promise for facilitating goal-setting and self-management education in the routine clinical care of pediatric asthma.

Exploring youth and caregiver preferences for asthma education video content

OBJECTIVE

This study examines (1) whether youth and their caregivers have different preferences for asthma education video topics and (2) if education topic preferences vary by youth and caregiver sociodemographic characteristics.

METHODS

Youth (n = 83) ages 7-17 years with persistent asthma and their caregivers were recruited at two pediatric practices in North Carolina. Sociodemographic information and youth and caregiver preferences for nine asthma video education topics were collected during in-person interviews. Bonferroni-corrected Chi-square or McNemar tests (α = 0.0056) were used to compare youth and caregivers differences in topic preferences and topic preferences by youth and caregiver sociodemographic characteristics, including gender, race, ethnicity, and age.

RESULTS

Youth were primarily male (52%) and from low-income families (74%; caregiver annual income less than $30,000) and many were Hispanic (45%). Youth and parents expressed the most interest in the following two topics: "how to deal with triggers" (90% and 95%, respectively) and "how to keep asthma under control" (87% and 96%, respectively). Caregivers and children were discordant for two topics: "the difference between a rescue and controller medicine" and "how to [help your child] talk to your [his/her] friends about asthma." No differences were found between youth and caregiver sociodemographic characteristics and video topic preferences.

CONCLUSIONS

Youth with persistent asthma and their caregivers differed in their asthma education topic preferences, but preferences did not vary by caregiver or youth sociodemographic characteristics. Studies examining the effectiveness of interventions tailored to differences in educational preferences of youth with asthma and their caregivers are needed.