Supporting respiratory patients in primary care: a qualitative insight from independent community pharmacists in London

Abstract

BackgroundCommunity pharmacists’ (CPs’) interventions have a positive impact on managing respiratory patients. However, methods used by CPs to assess patients’ inhaler technique and adherence are subjective. New technologies to objectively assess inhaler technique and adherence were introduced to address such a gap. This study aimed to explore CPs’ perceptions towards the management of respiratory patients regarding inhaler technique and adherence. In addition, it explored the views of CPs and their need of technologies to objectively assess inhaler technique and adherence. CPs were probed with a new technology called Inhaler Compliance Assessment (INCA) device, designed to objectively monitor both inhaler technique and adherence of patients using a dry powder inhaler, as an example.MethodsA qualitative study employing semi-structured interviews was conducted. A convenience and snowballing sampling strategy was employed to recruit CPs working in independent community pharmacies within West and South London. Twenty-three pharmacists were interviewed between August and November 2015. Data was analysed thematically using the framework methodology and coded using NVivo10 software.ResultsAnalysis revealed five main themes: services and limitations of patient support, the need and acceptability of new technologies to support respiratory patients, fragmented primary care, the need to promote the clinical role of CPs, and professional identity. Patient support was patchy and affected by several barriers related to pharmacists and patients. In addition, lack of communications with different healthcare professionals in primary care and inaccessibility to clinical records were identified as problematic issues. Some CPs perceived their clinical role to be lacking within the patient care pathway. Interestingly, CPs showed positive a attitude towards the use of technologies, such as the INCA technology to support patients and were willing to provide new services. However, remuneration appeared to be a major driver for willingness to offer new services or promote existing services.ConclusionThe current study highlighted some measures that can augment CPs’ clinical practice while managing patients, such as having accessibility to patients’ medical records and the use of technologies such as the INCA technology to promote objective counselling of patients.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3814-2) contains supplementary material, which is available to authorized users.

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

“…39 However, some of these EMDs assess adherence alone, whereas others assess IT alone. 38 The inhaler compliance assessment device, commercially referred to under the trademark of INCA, is one of the few EMDs that has the advantage of being an automatic and objective measure of both adherence and IT while patients are using their inhalers at home. 29,37,40,41 The aforementioned device is a small acoustic, battery-operated device that is mounted on the top of a dry-powder inhaler (DPI) (Figure 1).…”

“…35 This is further escalated by the fact that the most common methods currently used for adherence and IT assessment are reported to be either inaccurate or subjective. 15,29,[36][37][38] The use of electronic monitoring devices (EMDs), on the other hand, has been reported to provide a more accurate solution for monitoring IT and adherence to therapy for asthma and COPD patients. 39 However, some of these EMDs assess adherence alone, whereas others assess IT alone.…”

<p>Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model</p>

“…Fifteen countries were involved in the studies, with the most common study locations including the UK (n=5), Belgium (n=3), Australia (n=2), Canada (n=2), Spain (n=2), and the USA (n=2). The included studies involved both patient and pharmacist as participants, in A Primary prevention A1 Smoking cessation 24,25,[27][28][29][30]32,33,35,36,38,39,43,45,48 A2 Lifestyle advice 36,38,43 B Early detection B1 Assess patient risk and health status 24,35,36,40,41 B2 Self-diagnosis questionnaire 24,25,30,35,36,45,47 B3 Spirometry testing 24,30,35,40,47 B4 Referral/recommend high-risk customer to doctor 24,30,35,36,40,43,47 C Therapy management C1 General service in pharmacy 25,[27][28][29][31]…”

“…24,35,36 On the other hand, for patients already diagnosed with COPD, the pharmacist needs to ask them whether they smoke, inform them about the risks of smoking, and encourage them to quit . 25,[27][28][29][30]32,33,38,39,43,45,48 Other high-risk factors, such as diet and nutrition, 36,43 weight control, 36,43 drinking, 36 and other lifestyle changes that reduce the incidence and progression of diseases, have also been mentioned.…”

“…24,30,35,40,47 For all this, there may be some uncertainty in the questionnaire and LFTs, so it is necessary, according to the judgement of the pharmacist, to recommend seeking further medical treatment, even if the patients who are tested are at low risk. 48…”