Pharmacists as the delivery channel for adherence support in asthma

Non-adherence to inhaled corticosteroids remains a key challenge in asthma care in the United Kingdom (UK) – it increases healthcare costs, morbidity, and mortality. The growing pressure on UK primary care increased interest in pharmacists as a potential delivery channel for adherence support. However, research on UK pharmacist-led adherence support for asthma is limited. // This thesis addresses the gap in the literature by examining the effectiveness of previous pharmacist-led interventions in improving adherence in adults with asthma (systematic review/meta-analysis, 11 studies), exploring the perspectives of UK pharmacists (online questionnaire, n = 127) and adults with asthma (qualitative study, n = 17) on pharmacist-led adherence support for asthma, and assessing the feasibility and acceptability of a new pharmacist-led adherence support intervention delivered to adults with asthma in general practice (before-and-after study, n = 31). // Previous pharmacist-led interventions significantly improved adherence in adults with asthma (d = 0.49, 95% CI 0.35 – 0.64, p < 0.0001), with effective interventions addressing the ability and motivation to adhere to medication. UK pharmacists reported feeling most confident in and focusing mostly on patient education as adherence support (i.e. ability-related processes). Adults with asthma used their trust in other healthcare professionals (e.g. general practitioners) to gauge their trust in pharmacists. While they were open to pharmacist-led support due to gaps in existing asthma care, they were also concerned about pharmacist competency and role overlap with other healthcare professionals. The new pharmacist-led adherence intervention delivered in general practice demonstrated high acceptability among pharmacists and adults with asthma, but further work is needed to improve the feasibility of the study design. // This research suggests that pharmacist-led adherence support is worth exploring further. With additional adherence-focused support/training for pharmacists and public awareness of pharmacist-led care, UK pharmacists may be able to make a valuable contribution to asthma care

Acceptability of a theory-based adherence intervention for adults with asthma - a person-based approach

OBJECTIVE: Nonadherence to inhaled corticosteroids contributes to poor asthma control. This study evaluated two different theory-based intervention approaches to address nonadherence in adults with asthma using a person-based, qualitative approach to investigate comprehensibility, coherence and acceptability. METHODS: The two intervention approaches addressed treatment beliefs and misconceptions in asthma, aiming to provide a common-sense rationale for medication adherence. Approach one reframed asthma using a concept of balance, the second approach was more traditional presenting medical consequences of nonadherence. We ran three focus group interviews involving 19 adults with asthma to investigate patient acceptability of the intervention approaches and their influence on perceptions of asthma and medication. RESULTS: Approach one was perceived as novel compared to current practice, logical and easily understandable. Its use of non-medical jargon was perceived as representing information more positively, moving away from stigmatizing people with asthma. Approach two was perceived as not sufficiently novel, not applicable to everyone’s illness experience and triggering fear. CONCLUSIONS: Patient feedback allowed us to refine our intervention strategy prior to running costly feasibility trials. Patient-based approaches for intervention planning may facilitate implementation and acceptability of interventions in practice