Asthma
Loren Bonner
Pharmacist-delivered asthma management services could reposition the way pharmacists are viewed in the public’s eye. At least, that’s the case in Australia based on a survey that evaluated patient feedback regarding a novel, evidence-based community pharmacist–delivered asthma service.
“Despite national surveys indicating pharmacists are amongst the most trusted health professionals within Australia, the expectations of a community pharmacist outside the realms of medication supply by patients are reportedly low,” said lead author of the study Sarah Serhal, MIPH, BPharm, PhD candidate. “The difference between public expectation and awareness and possible broader pharmacist roles within chronic care management may be due to a large extent on a lack of public awareness of pharmacy health services’ capacity.”
The asthma service consisted of patients engaging in a series of pharmacist-patient consultations over a 12-month period. The consultations were focused on 3 core evidence-
based asthma interventions addressing known contributors to less-than-ideal asthma control: poor medication adherence, suboptimal inhaler technique, and uncontrolled allergic rhinitis.
The researchers found that the pharmacy asthma service offered a welcome model for pharmacist intervention in asthma care that was rated highly in terms of overall satisfaction, delivery satisfaction, and impact by patients with asthma across a broad range of backgrounds and communities.
Survey results
The research team received feedback from 71% of patients who completed the full 12-month service.
The results revealed high overall patient satisfaction, with 86% of respondents indicating they were very satisfied with the service. Patients said they had an improved understanding and management of their asthma and allergic rhinitis.
Almost all patients (98%) reported that they were satisfied with the service delivery, including the pharmacist’s knowledge and ability to offer assistance. The study findings also showed that patients who had controlled asthma at the end of the trial had higher levels of overall satisfaction with the ability to better manage their condition.
“Very few patients had negative feedback about the service or could offer suggestions for future improvements,” said Serhal. She said, based on this feedback alone, the program in its current structure aligns well with patient expectations and needs.
“However, the evaluation survey does not represent feedback from patients who decided to discontinue [service] and received an incomplete service,” she noted.
| Patient satisfaction with service delivery and perceived impact of Pharmacy Asthma Service (n = 101) |
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Satisfaction criteria
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Patients who agreed/ strongly agreed, n (%)
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Satisfaction with service delivery (Cronbach alpha = 0.93)a
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1. Time taken by your pharmacist to deliver the service
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95 (94)
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2. Privacy and surroundings in the pharmacy
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92 (91)
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3. Your pharmacists’ ability to answer your questions or concerns
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99 (98)
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4. Information and explanations provided by your pharmacist
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98 (97)
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Perceived impact of service (Cronbach alpha = 0.87)b
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1. It helped me remember to pick up my medicines from the pharmacy
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57 (56)
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2. It helped me recognize and understand my hay fever/allergic rhinitis symptoms
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74 (73)
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3. It helped me understand which medicines will best treat my hay fever/allergic rhinitis symptoms
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77 (76)
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4. It improved my knowledge about asthma
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81 (80)
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5. It motivated me to use my preventer medications as prescribed
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82 (81)
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6. It helped me address concerns I had about my medication
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85 (84)
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7. It improved my confidence in managing my asthma
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90 (89)
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8. It helped me understand how to best use my inhaler
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92 (91)
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Source: Serhal et al. JAPhA. 2022. Abbreviation used: IQR, interquartile range. Note: Scores were based on a 5-point Likert-type scale (1 = strongly disagree; 2 = disagree; 3 = neither agree nor disagree; 4 = agree; 5 = strongly agree).
a Median score for satisfaction with service delivery was 5.0 (IQR 5–5).
b Median score for perceived impact of service was 4.4 (IQR 4–4.9).
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Universal positioning
Recent estimates find that approximately 20% to 50% of Americans have severe, uncontrolled asthma. Like Australia, pharmacist interventions in asthma care in the United States have been shown to improve patient asthma outcomes. Pharmacists are especially well-positioned, regardless of practice location, to review inhaler technique with patients and provide quick counseling.
Jean Moon, PharmD, FCCP, BCACP, an associate professor at the University of Minnesota College of Pharmacy, said she was not surprised to see the positive satisfaction rates represented in this study.
“Pharmacists are especially primed to care for patients with asthma,” she said. “Proper inhaler technique is key to asthma management, and pharmacists understand the nuances of these devices in order to provide invaluable and accessible patient intervention.”
Moon said that in her practice, pharmacists provide similar services to the ones described in the study, in addition to spirometry and being able to make therapeutic changes through collaborative practice agreements.
“As a country where we have some of the highest rates of asthma, this is another condition pharmacists can demonstrate their role on the health care team,” Moon said. But she said payment is still lacking for these types of services pharmacists provide. “Better understanding of patient satisfaction with these services and the shifting patient expectations for the pharmacist may continue to pave the road for a truly sustainable model in the community setting,” Moon said.
From updated guidelines and recommendations to new biologic therapies and diagnostic tools, treating and managing asthma is also an evolving practice.
“We can speculate that because of their participation, this [survey] cohort would now have higher expectations of pharmacy and the capacity of their pharmacists to assist in chronic care management,” said Serhal. “It would be interesting to see how expectations of patients evolve with the rising availability of pharmacy-based health services, and how this shift in expectations will affect future patient satisfaction outcomes.”
Additionally, she noted that it would be worthwhile to explore if patient satisfaction in one service motivates patients to seek pharmacist assistance in other therapeutic areas. ■