title: Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Tasmania, Australia. bonnie.bereznicki@utas.edu.au
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Bereznicki
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
authors.forename: Shane L
authors.initials: SL
authors.lastname: Jackson
authors.forename: Haydn
authors.initials: H
authors.lastname: Walters
authors.forename: Kimbra
authors.initials: K
authors.lastname: Fitzmaurice
authors.forename: Peter
authors.initials: P
authors.lastname: Gee
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D010821:Physicians, Family; D011788:Quality of Life; D012017:Referral and Consultation; D016037:Single-Blind Method; D012984:Software; D011795:Surveys and Questionnaires; D013648:Tasmania / Q000453:epidemiology
chemical_list: D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents