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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR24

Pharmaceutical care of asthma patients in a New Zealand community pharmacy setting

By J. P. Shaw,* L. Emmerton, N. A. Kheir, P. A. Barron, G. Becket and N. A. Smith

Introduction Despite worldwide interest in pharmaceutical care (PC) practice, its uptake by community pharmacists has been hindered by a number of barriers to implementation, including lack of time, absence of demand, inadequate remuneration, insufficient training, and poor documentation systems.3
The aim of this study was to assess a community pharmacy-based PC service as a novel model of practice, taking account of these barriers. A secondary objective addressed patient-related outcomes of the service. Asthma was used as the disease model for demonstration purposes.

Methods After ethics committee approval, pharmacists in five community pharmacies in southern New Zealand received training to provide the service. In consultation with local general practitioners, 20 asthma patients per pharmacy were entered in cohorts of five, twice per year over the two-year study period, with approximately monthly pharmacist-patient consultations. Baseline measurements were taken for one to five months prior to entry.
The PC service comprised creation of a patient record, identification of medication-related problems (MRPs) using a classification system modified from Strand et al,4 and development of strategies to resolve MRPs and monitor outcomes. Documentation and recording systems were designed specifically for the study. Data collected included peak flow diaries, asthma symptoms, medication usage, sick days, medical interventions and quality of life. Payment for the service was provided by the government health funding authority on a trial basis. An acceptability survey was administered to participants, and pharmacists were interviewed concerning their perceptions.

Focal points

  • The implementation of pharmaceutical care practice has been hindered by a number of identifiable barriers
  • Using asthma as the disease model, a group of community pharmacists in New Zealand implemented a novel pharmaceutical care service
  • Pharmacists were able to identify medication-related problems and implement strategies to resolve them
  • Improvements in asthma management and quality of life were achieved in the majority of patients
  • Both pharmacists and patients supported the continuation of the service but patients would be reluctant to pay for it directly

Results One hundred patients (51 males, 49 females) were enrolled into the study, with 34 aged under 17 years. The great majority (91) were of New Zealand European descent, with nine Maori. In total, 431 MRPs were identified (average 4.3 per patient). Of these, 285 (66.1 per cent) were compliance-related, 83 (19.2 per cent) concerned choice or dose of medication, 46 (10.7 per cent) choice of dosage form, and 11 (2.6 per cent) development of adverse reactions/interactions. Interventions included revision of the asthma action plan for 72 patients, referral to the general medical practitioner for 49, and intensive medication counselling for all 100.
There was a trend for reduced bronchodilator medication, improved symptom control, and improved peak-flow readings in the majority of patients, although about one-third showed little or no improvement. There were significant improvements in both adults' (P<0.01) and children's (P<0.05) mean quality of life scores as measured by the asthma quality of life questionnaire (AQLQ).5 Both patients and pharmacists expressed satisfaction with the service and would support its continuation. Most patients would resist having to pay for such services directly, believing they should be publicly funded.

Discussion The pharmacists responded positively to the implementation of the new service, and made a number of changes in their practices to accommodate the study requirements. The patients received the service particularly well, with the majority indicating their asthma had improved following consultations. However, most would be reluctant to have to pay for PC services directly in the future.
Examination of the patients' clinical records indicated that pharmacists are capable of identifying asthma management problems in the community and can establish appropriate goals and support systems. Most patients demonstrated some improvement in their clinical data, particularly in reduction of symptoms. Those who did not improve may be resistant to any management plans. The quality of life assessment indicated good improvement, and good correlation with the clinical data.
This study has provided evidence to support the further development of pharmaceutical care practice in New Zealand community pharmacy.

*Department of pharmacy, University of Auckland, Auckland, New Zealand; school of pharmacy, University of Otago, Dunedin, New Zealand

References

1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-42.
2. Tomechko MA, Strand LM, Morley PC, Cipolle RJ. Q and A from the pharmaceutical care project in Minnesota. Am Pharm 1995; NS35:30-9.
3. McDonough RP, Rovers JP, Currie JD, Hagel H, Vallandingham J, Sobotka J. Obstacles to the implementation of pharmaceutical care in the practice setting. J Am Pharm Assoc 1998;38:87-95.
4. Strand LM, Cipolle RJ, Morley PC, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP Ann Pharmacother 1990;24:1093-1097.
5. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992;47:76-83