Characterization of pharmacists’ interventions in asthma management: A systematic review

© 2018 American Pharmacists Association® Objective: Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the “amount of program delivered,” and core components of the intervention provided by pharmacists in asthma management. Data sources: A literature search was conducted in December 2016 using PubMed. Study selection: A 2-stage approach was used. At the first stage, systematic reviews of pharmacists’ interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. Data extraction: The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions’ core components. Results: Thirty-one studies were included. In most of the studies, the pharmacist–patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists’ interventions were the provision of drug information and patient counseling (n = 27). Pharmacists’ interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. Conclusion: Pharmacists’ interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists’ interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their implementation in practice. (Registration number CRD42016029181.

A drop-in clinic for patients with poorly-controlled diabetes: a community pharmacy feasibility study

Background Preparatory work suggests that there may be a role for the pharmacist in managing sub-optimal medication adherence and dose titration of prescribed medicines in patients with type 2 diabetes. Patients have reported that they are receptive towards pharmacists becoming involved in their care providing that this is integrated into the care received from their medical practice. Objective To determine whether a community pharmacy diabetes drop-in clinic is feasible and acceptable to patients with poorly controlled type 2 diabetes. Setting Five community pharmacies in Norfolk, UK. Method Poorly controlled patients, as defined by a national General Practitioner incentive scheme, were invited to participate in the study by a letter posted by their medical practice. One four-hour, pharmacist clinic, where participants were able to "drop-in", was conducted in five pharmacies every week for four to six weeks. Questionnaires before and after the consultation were used to determine the clinic's effect on satisfaction with, and beliefs about, medicines and adherence along with participant satisfaction. Pharmacists had the opportunity to provide feedback via "debrief" interviews. Main outcome measure As a feasibility study, a combination of outcomes were explored including informationsatisfaction and adherence. Results Thirty-three (9.6%) of the 342 patients with type 2 diabetes posted letters were recruited from four pharmacies. Follow-up questionnaire completion rate was 88%. The clinic demonstrated little change in the parameters measured over three months. All of the participants rated their general impression of the service as good or very good and all would be happy to recommend the service to others with diabetes. Sixteen participants (59%) stated that it would make them more likely to consult their pharmacist in the future. Pharmacists enjoyed providing the service as it allowed them to interact more formally, and for longer, with patients. Conclusion This research has demonstrated that a community pharmacy drop-in clinic is feasible and likely to be acceptable to both patients and pharmacists; however, cost effectiveness of such a service should be explored in future studies. Further thought should also be given to how this service can complement that provided by a nurse in the medical practice and how the pharmacist can provide additional benefit to the NHS