The impact of the clinical pharmacist on the use of inhalers among asthmatic patients in Alkarak region in the South of Jordan

Abstract

ObjectivesThe main aims of the study were to highlight the impact of clinical pharmacist in patient education on the correct use of inhalers, and its consequences on medication adherence, asthma control and clinical outcomes. Methods Pre-post-interventional study was conducted over two patient visits in Jordan at Alkarak Governmental Hospital. Inhaler technique evaluation was assessed at first and second visits. All patients received inhaler technique counselling service prior to second visit. Patient adherence was assessed using MMAS-8, and asthma control was assessed by spirometry and ATAQ scale. Key findings Complete data were available for 100 patients, 52% women, median age 45 (range 18-60) years and median duration of diagnosis 20 (range 2-55) years. Ninetysix per cent of patients (n = 96) were previously educated about the correct use of inhalers by different healthcare professionals' specialty. There was a statistically significant improvement in the correct handling of inhalers after patient re-education (P = 0.000). There also was a significant improvement in the level of control (from 7% (n = 7) to 90% (n = 90) of participants had high disease control) and adherence (from 6% (n = 6) to 12% (n = 12) of participants had high adherence rate) after education (P = 0.000 and P = 0.000 respectively). Significant number of asthmatic patients uses inhalers incorrectly despite the previous education on the correct inhaler technique. Incorrect use of inhalers is associated with negative outcomes. In this study, the result showed that incorrect handling of MDIs was significantly associated with frequent emergency department (ED) visits and hospitalizations (P = 0.031, P = 0.039) respectively. Conclusions The researchers concluded that effective educational intervention to the patients along with reassessment of inhaler technique and re-education by a well-trained clinical pharmacist gave positive impressive outcomes.

A review of pharmacy‐led interventions: identification of facilitators and barriers for the design of a new model of care for asthma

“…Pharmacists evaluated each step performed by the subject against the checklist, enabling the provision of structured feedback. The most common errors identified were immediate expiration after inhalation and not waiting between inhalations 29 . It was found that more errors were made by those who used two inhalers than by those using a single inhaler, and the number of errors was inversely related to asthma control 24 .…”

“…Assessment and training of proper inhaler technique was a primary intervention in most of the studies reviewed 11–14,19–23,26,29–33 . This was noted as a facilitator for success, resulting in improved medicine adherence, enabling the study to gain positive momentum 12,20,22 .…”

“…This was noted as a facilitator for success, resulting in improved medicine adherence, enabling the study to gain positive momentum 12,20,22 . Inhaler training for patients and caregivers included face‐to‐face physical demonstrations, in addition to written and verbal counselling 22,29 . Post‐counselling reductions in inhaler technique errors and the impact on asthma control were assessed in one study 24 …”

“…The use of inhalers was assessed by device‐specific checklists in some studies 19,22,23,24,26,27,29,30 . Pharmacists evaluated each step performed by the subject against the checklist, enabling the provision of structured feedback.…”

“…ACTs were completed at baseline and at each intervention, or at baseline and the end of the study. The four‐ or eight‐question Morisky medication adherence scale (MMAS) was used in four of the studies 12,22,25,29 . The four‐question survey (MMAS‐4) includes elements of forgetfulness and symptom severity, while the eight‐question survey (MMAS‐8) delves into other situational and emotional aspects of medication adherence.…”