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Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management

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Abstract

Objective To assess the impact of an intervention initiated by community pharmacists, involving the provision of educational material and general practitioner (GP) referral, on asthma knowledge and self-reported asthma control and asthma-related quality of life (QOL) in patients who may have suboptimal management of their asthma, as evidenced by pharmacy dispensing records. Setting Community pharmacies throughout Tasmania, Australia. Methods Forty-two pharmacies installed a software application that data mined dispensing records and generated a list of patients with suboptimal asthma management, as indicated by having three or more canisters of inhaled short-acting beta-2-agonists dispensed in the preceding 6 months. Identified patients were randomised to an intervention or control group. At baseline, intervention patients were mailed intervention packs consisting of a letter encouraging them to see their GP for a review, educational material, asthma knowledge, asthma control and asthma-related QOL questionnaires, and a letter with a dispensing history to give to their GP. Pharmacists were blinded to the control patients’ identities for 6 months, after which time intervention patients were sent repeat questionnaires, and control patients were sent intervention packs. Main outcome measures Asthma knowledge, asthma control and asthma-related QOL scores. Results Thirty-five pharmacies completed the study, providing 706 intervention and 427 control patients who were eligible to receive intervention packs. Intervention patients’ asthma control and asthma-related QOL scores at 6 months were significantly higher compared to the control patients (P < 0.01 and P < 0.05, respectively) and to the intervention patients’ baseline scores (P < 0.001 and P < 0.05, respectively). Symptom-related QOL was significantly higher compared to the control patients (P < 0.01) and activities-related QOL significantly improved compared to baseline (P < 0.05). No significant change was observed in asthma knowledge. Conclusion The results suggest that community pharmacists are ideally placed to identify patients with suboptimal asthma management and refer such patients for a review by their GP. This type of collaborative intervention can significantly improve self-reported asthma control and asthma-related QOL in patients identified as having suboptimal management of their asthma. A larger trial is needed to confirm the effects are real and sustained.

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Acknowledgements

We would like to thank the participating patients, community pharmacists and GPs. Members of the Project Working Group, Dr Keith Miller, Sue Leitch, Guy Dow-Sainter, and Sharyn Beswick were all invaluable in our project design and implementation. We would also like to thank Dr James Markos, Cathy Beswick and Melanie Blackhall.

Funding

Funding for this project was provided by the Commonwealth Department of Health and Ageing and the Asthma Foundations Australia. via an Asthma Targeted Intervention Grant.

Conflicts of interest

None.

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Authors and Affiliations

  1. Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Tasmania, Australia

    Bonnie J. Bereznicki, Gregory M. Peterson, Shane L. Jackson, Kimbra Fitzmaurice & Peter Gee

  2. Menzies Research Institute, University of Tasmania, Tasmania, Australia

    Haydn Walters

Authors
  1. Bonnie J. Bereznicki
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  2. Gregory M. Peterson
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  3. Shane L. Jackson
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  4. Haydn Walters
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  5. Kimbra Fitzmaurice
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  6. Peter Gee
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Correspondence to Bonnie J. Bereznicki.

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Bereznicki, B.J., Peterson, G.M., Jackson, S.L. et al. Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management. Pharm World Sci 30, 869–875 (2008). https://doi.org/10.1007/s11096-008-9242-3

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  • DOI: https://doi.org/10.1007/s11096-008-9242-3

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