Improving asthma management : patient-pharmacist partnership program in enhancing therapy adherence
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Adherence to long-term asthma controller medications is an important factor in effective asthma management. Suboptimal adherence to asthma controller medications is prevalent. This three-study dissertation presents a patient-pharmacist partnership program designed to enhance therapy adherence and provides preliminary results on the effectiveness of this program. Study one consists of two parts. First, patient-centered, asthma-specific tools addressing key asthma adherence barriers in community pharmacy settings were developed. Second, five interviews with community pharmacists were conducted and three main topics were covered. In the first topic, “use of tools and overall approach”, pharmacists reported the need for the identification of patients’ barriers and that they found the proposed tools to be helpful in identifying and addressing patients’ concerns. In the second topic pharmacists reported “barriers to implementation”, such as time and workflow, patients’ perception of the pharmacists and absence of reimbursement. The last topic included “facilitators and suggestions for implementation” and the following were suggested: identifying patients upfront based on their refill history, placing a note on filled prescriptions, raising awareness among patients, involving technicians in the process of identifying patients, having a dedicated pharmacist staff and adding the proposed approach into in-store health clinics/fairs. Study two was a cross-sectional pilot test of the developed tool for identification of patients’ barriers to adherence in community pharmacy settings. The objective was to examine the association between asthma control, adherence barriers and asthma management characteristics. Significant (p<0.05) associations were found between the Morisky adherence scale score and the modified ASK instrument barriers score, as well as with the reported number of barriers, but not between adherence and asthma control. Possession of an asthma action plan was found to be a significant (p=0.001) predictor of a higher level of adherence, although less than half of the patients had such a plan. In study three, the developed tools were pilot-tested in community pharmacies to assess effectiveness. Adult patients with persistent asthma in both the intervention and control groups were evaluated for asthma medication adherence, barriers to adherence and asthma control at baseline and 3 months later. While patients in the control group received usual care, those in the intervention group were provided with patient-specific education and counseling pertaining to their adherence issues. At 3 months, patients’ were evaluated again and the analyses showed a significant improvement in barrier score between the pre and post period (increase by 3.9±6.9, p=0.035) and a clinically meaningful increase (by 2.7 points) in asthma control in the intervention group only. There were no significant changes in adherence pre to post in either the intervention group or control group. These studies provide insight into adherence behavior of patients with asthma and demonstrate how suboptimal asthma management can be addressed in community pharmacy settings. Pharmacists can effectively target common reasons for poor asthma adherence and management, such as lack of understanding how medications work and not knowing the goals of therapy.