Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management.
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.
Bereznicki
Bonnie J
BJ
Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Tasmania, Australia. bonnie.bereznicki@utas.edu.au
Peterson
Gregory M
GM
Jackson
Shane L
SL
Walters
Haydn
H
Fitzmaurice
Kimbra
K
Gee
Peter
P
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
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents