Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly.
OBJECTIVE
To assess, using a standard observational tool, the ability of patients to demonstrate and maintain proper inhaled medication administration techniques following pharmacist education.


METHODS
Six-month observational study.


METHODS
Patients' homes or adult day health center.


METHODS
Patients in a Program for All-inclusive Care for the Elderly (PACE) prescribed one or more inhaled medications used at least once daily.


METHODS
Instruction by on-site clinical pharmacist.


METHODS
Hickey's Pharmacies Inhaler Technique assessment (score range: 0-20, higher better).


RESULTS
Forty-two patients were evaluated at baseline, taught proper techniques for using inhaled medications, assessed immediately following the education, and re-assessed 4-6 weeks later. The mean pre-assessment score was 14 (SD 4.5, range 0-20), the initial post-assessment score increased to 18 (SD 3, range 10-20). The second post-assessment (4-6 weeks later) score mean was 17.7 (SD 3, range 10-20). Both follow-up scores were significantly improved from baseline (p < 0.05). Multivariable analysis indicated the strongest predictors of second post-training score were: score after initial pharmacist training and being subscribed to auto-refill. These characteristics predicted ∼70% of the variance in the second score (p < 0.001).


CONCLUSIONS
These results indicate that education by a pharmacist combined with an auto-refill program can improve and sustain appropriate inhaler use by community-dwelling elders in a PACE program. The improved score was maintained 4-6 weeks later indicating a sustained benefit of medication administration education. Optimal inhaler use ensures optimal dosing and supports appropriate inhaler treatment in lieu of oral agents.
Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, 360 Huntington Avenue, R218TF, Boston, MA, 02115, USA; Elder Service Plan of the Harbor Health Services, 1135 Morton Street, Mattapan, MA, 02126, USA. Electronic address: c.bouwmeester@neu.edu.
Carla
C
Bouwmeester
Atrius Health - Harvard Vanguard Medical Associates, 485 Arsenal Street, Watertown, MA, 02472, USA. Electronic address: Jacqueline_Kraft@atriushealth.org.
Jacqueline
J
Kraft
Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, 360 Huntington Avenue, R218TF, Boston, MA, 02115, USA; Center for the Evaluation of Value and Risk in Health (CEVR), The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA. Electronic address: kbungay@tuftsmedicalcenter.org.
Kathleen M
KM
Bungay
D000280:Administration, Inhalation; D000069537:Adult Day Care Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage; D016503:Drug Delivery Systems; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination / Q000008:administration & dosage; D006801:Humans; D057187:Independent Living / Q000193:education*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D010595:Pharmacists; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D000069447:Tiotropium Bromide / Q000008:administration & dosage
D001993:Bronchodilator Agents; D000068297:Fluticasone-Salmeterol Drug Combination; D000069447:Tiotropium Bromide
Asthma; COPD; Education; Elderly; Inhaler use; PACE; Pharmacist