Martha Brillant

Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community

Background: Despite national disease management plans, optimal asthma management remains a challenge in Australia. Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of best practice. The impact of the Pharmacy Asthma Care Program (PACP) on asthma control was assessed using a multi-site randomised intervention versus control repeated measures study design. Methods: Fifty Australian pharmacies were randomised into two groups: intervention pharmacies implemented the PACP (an ongoing cycle of assessment, goal setting, monitoring and review) to 191 patients over 6 months, while control pharmacies gave their usual care to 205 control patients. Both groups administered questionnaires and conducted spirometric testing at baseline and 6 months later. The main outcome measure was asthma severity/control status. Results: 186 of 205 control patients (91%) and 165 of 191 intervention patients (86%) completed the study. The intervention resulted in improved asthma control: patients receiving the intervention were 2.7 times more likely to improve from “severe” to “not severe” than control patients (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). The intervention also resulted in improved adherence to preventer medication (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03), decreased mean daily dose of reliever medication (difference −149.11 μg, 95% CI −283.87 to −14.36; p = 0.03), a shift in medication profile from reliever only to a combination of preventer, reliever with or without long-acting β agonist (OR 3.80, 95% CI 1.40 to 10.32; p = 0.01) and improved scores on risk of non-adherence (difference −0.44, 95% CI −0.69 to −0.18; p = 0.04), quality of life (difference −0.23, 95% CI −0.46 to 0.00; p = 0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01) and perceived control of asthma questionnaires (difference −1.39, 95% CI −2.44 to −0.35; p<0.01). No significant change in spirometric measures occurred in either group. Conclusions: A pharmacist-delivered asthma care programme based on national guidelines improves asthma control. The sustainability and implementation of the programme within the healthcare system remains to be investigated.

Pharmacists' views on involvement in pharmacy practice research: Strategies for facilitating participation

In order for community pharmacy practice to continue to evolve, pharmacy practice research on potential new services is essential. This requires the active participation of community pharmacists. At present the level of involvement of community pharmacists in pharmacy practice research is minimal. Objectives To ascertain the attitudes of a group of research-experienced community pharmacists towards participating in research; to investigate the barriers and facilitators to participation; to identify potential strategies to increase the involvement of community pharmacists in research. Methods A focus group was conducted with a purposive sample of 11 research-experienced community pharmacists. A pharmacist academic moderated the focus group using a semi-structured interview guide. The participants were asked about their attitudes towards research, previous involvement in research, barriers to their involvement and strategies to overcome these barriers. The session was audio-taped and notes were taken by an observer. Thematic analysis of the notes and audio-tape transcripts was conducted. Results Three themes emerged around pharmacists’ attitudes towards research: pharmacists’ perception of the purpose of research, pharmacists’ motivation for involvement in research, and pharmacists’ desired role in research. Barriers to research participation were grouped into four themes: pharmacists’ mindset, communication, infrastructure (time, money and staff), and skills/knowledge. Strategies to address each of these barriers were suggested. Conclusions Participants recognised the importance of research towards advancing their profession and this was a motivating factor for involvement in research. They perceived their role in research primarily as data collection. A series of practical strategies to overcome the barriers to participation were offered that researchers may wish to consider when promoting research outcomes and designing research projects.

Cost-effectiveness analysis of a pharmacy asthma care program in Australia

ObjectivesA pharmacy asthma care program in Australia, which included specific education on asthma and asthma medication, trigger factors, use of inhalers, and medication adherence, as well as goal setting and patient review aspects, assessed the impact of a community pharmacy asthma service on the severity of patients’ asthma over 6 months. Data from this study were used to estimate the cost effectiveness of the program.MethodsThe intervention population was compared with a control population and results at 6 months were included in a Markov model in order to estimate the cost effectiveness over 5 years from the perspective of the Australian healthcare system. The model had a cycle length of 6 months and included transition probabilities for switching between classes of severity of asthma, the costs of asthma treatment and program delivery, and utility values for a patient’s quality of life with asthma. Costs were Australian dollars (

Asthma service delivered in community pharmacy provides positive clinical and humanistic outcomes and is cost-effective

A), year 2006 values, and both costs and benefits were discounted at a rate of 5% per annum.ResultsOver the 5 years following an initial review, the program generated 0.131 additional quality-adjusted life-years (QALYs), at an additional net cost of

Student experiences of problem-based learning in pharmacy: conceptions of learning, approaches to learning and the integration of face-to-face and on-line activities

A623 if annual reviews were required to maintain asthma improvements (annual review scenario) or

Pharmacy diabetes care program: Analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy

A376 if annual reviews were not required (no annual review scenario), resulting in costs per QALY gained of

Factors influencing Australian community pharmacists' willingness to participate in research projects - an exploratory study

A4753 and

Pharmacy Asthma Care Program. Final Report.

A2869, respectively.ConclusionsThe program appears to be cost effective compared with no program, whether or not annual reviews were required to maintain improvements and under a range of other assumptions. Current evidence suggests that the pharmacy asthma care program should be implemented and funded for the treatment of adults with asthma in Australia.

outcomes for patients in the community Pharmacy Asthma Care Program (PACP) improves

Asthma is a chronic, episodic respiratory condition which is primarily managed in the community. Asthma management comprises several components, including asthma education. Traditionally, pharmacists have provided advice and education to patients on an individual basis. Several studies with a range of nonpharmacist educators have shown that providing asthma education in small groups can be effective in improving asthma outcomes and reducing asthmarelated health care utilisation. A group of Danish pharmacists (ISPW, Malta, 2004) demonstrated that group education regarding lipid-lowering agents is feasible, and feedback from patients was very positive. To date, no such small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated in Australia.