Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study

Abstract

ObjectivesPharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy.DesignA controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations.ResultsThere was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed.ConclusionsIncreases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities.

Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy

“…The necessity to adapt the intervention was related to logistical issues of recruitment and reach29 31 and these barriers need to be understood before considering the intervention for wider health system implementation. Again, further qualitative research could potentially provide insight into the logistical barriers encountered 31.…”

“…Again, further qualitative research could potentially provide insight into the logistical barriers encountered 31. Nevertheless, despite the significant adaptation, positive outcomes were achieved 29. The intervention resulted in increased medical referral of patients with poorly controlled asthma as per the SABA guidelines.…”

“…Triangulation methods involving two different approaches, using formalised tools, were chosen for evaluation of the common-sense SABA guideline implementation intervention designed by Watkins et al :29 The ITAX was retrospectively applied to evaluate the mechanism (how the intervention was designed to achieve outcomes), fidelity (how well the intervention was delivered as planned) and logistics (how the intervention was delivered) 6

The theoretical rationale of the common-sense intervention was examined through retrospective application of the BCW framework, the COM-B model and BCTTv1 described in the work by Michie et al 21

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“…28 This practice deficit was addressed by a common-sense intervention in 2013. The intervention aimed to formalise the role of pharmacy assistants, improve internal referral from pharmacy assistants to pharmacists and improve medical referral of patients with poorly controlled asthma, in the supply of non-prescription SABAs 29. The results of the intervention were positive but variable and require consideration on how they can be improved before wider implementation is appropriate 29…”

The Impact of an Educational Intervention on the Skill of Community Pharmacists in the Use of a Pressurized Metered-dose Inhaler: A Covert Simulated Patient Approach in Pakistan

“…This methodology has been adapted from exploratory, quasi-experimental research conducted at Western Australian community pharmacy setups. 13 At baseline, all the pharmacists working in targetted pharmacies were approached to get signed the Informed Consent Form (ICF) for the participation in the current study. The principal investigator along with another trained pharmacist had visited the targetted pharmacies to collect the data.…”