title: Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma.
abstract: BACKGROUND
  Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting.
  
  
  OBJECTIVE
  To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol.
  
  
  METHODS
  Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral.
  
  
  RESULTS
  A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted.
  
  
  CONCLUSIONS
  A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.
authors.affiliation: School of Biomedical, Biomolecular and Chemical Sciences, The University of Western Australia, Crawley, Australia. carl.schneider@uwa.edu.au
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schneider
authors.forename: Alan W
authors.initials: AW
authors.lastname: Everett
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.forename: Cale
authors.initials: C
authors.lastname: Padgett
authors.forename: Scott
authors.initials: S
authors.lastname: Ripley
authors.forename: Kevin
authors.initials: K
authors.lastname: Murray
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kendall
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Clifford
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / 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 / Q000592:standards; D037001:Directive Counseling / Q000458:organization & administration / Q000592:standards; D004512:Education, Pharmacy; D005260:Female; D006801:Humans; D007397:Internship, Nonmedical; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs; D016544:Patient Simulation; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D012017:Referral and Consultation / Q000458:organization & administration; D014904:Western Australia; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D004366:Nonprescription Drugs; D000420:Albuterol