Home' Australian Pharmacist : Australian Pharmacist January 2015 Contents Australian Pharmacist January 2015 I ©Pharmaceutical Society of Australia Ltd.
None of the respondents reported
continuing to provide a pharmacy asthma
service following the PAMS trial. Thematic
analysis of the interviews yielded five
emergent themes, including professional
and practice-related issues that could
impede service implementation and
sustainability. Most of the respondents
suggested key factors that may enhance
future service uptake.
1. Impact of PAMS participation
Despite not continuing to provide a
structured service, the respondents
unanimously stated that participation
in the PAMS trial had led to an
improvement in the way that patients
with asthma were managed in their
pharmacies. They reported a greater
awareness of asthma issues, and their
improved knowledge had led to an
increased confidence, more structure
to asthma-related counselling and
a resultant improvement in patient
interactions. Many had maintained
an area of asthma focus in their
pharmacies including inhaler technique
checking, encouraging spacer use,
providing specialised smoking cessation,
recommending action plan use and trigger
awareness and avoidance education.
‘PAMS has given me the skills...I’ve got
more confidence to demonstrate the
products and...more confidence to
really give the right information.’ Ph2
2. Pharmacist/ pharmacy related issues
with asthma service provision
The issue raised by the most
respondents (11/19) was a perceived
lack of time to expand into structured
service delivery. The reported factors
affecting pharmacists’ workloads
included increasing business-related
compliance, accreditation requirements,
administrative issues, increased
importance of effective stock ordering
and changing S3 regulations.
Several respondents commented
that asthma service provision is time
intensive and therefore negatively affects
other workflow. They found this to be
compounded by a more competitive
retail market, resulting in decreased
‘ We physically just don’t have the
manpower to actually lose a pharmacist
off the floor for any length of time if they
are not funded.’ Ph17
‘It would really just be a staffing issue
and with that comes the inherent cost
involved in having the extra staffing and
then whether you can pass that on to the
Several respondents emphasised
the need for a business model that
provided a return on time and money
invested before they would consider
implementing a service outside of a
government-funded program. This
model, they believed, had not been
presented to them.
‘It is not to question the value of it, it’s
just that in the scheme of things it brings
very little and costs a lot.’ Ph6
A lack of confidence to charge a service
fee was a theme expressed by several
respondents. A change in the mindset of
the pharmacist and the patient would be
required, they suggested, to affect new
payment and pricing structures. Concern
for universality of access was also
expressed for a ‘user-pays’ service.
Table 2. Component omissions from PAMS for the ‘practice ready’ asthma service
Service component omitted
Advisory group’s reason for omission
1. Six item Asthma Control Questionnaire (ACQ) (where asthma control is
scored 0-6, score averaged for all items).
2. Full medication regimen review using the Brief Medication
Questionnaire – comprises 4 questions with 32 components.
These two clinical research measurement components were
substituted with regular practice tools:
• Five item Pharmacy Asthma Control Screening tool (PACS) retained -
validated practice tool (where asthma control is scored as good, fair or
poor – asthma control classified by worst scoring in any criteria).
• A full medication regimen replaced with abridged Brief
Medication Questionnaire (BMQ)27
comprises 2 questions with
3. Perceived control of asthma – 11 item validated measure asking
patients to range on a 5 point Likert scale, their perception of the
control of their asthma.
4. Impact of asthma on quality of life – 20 item validated measure asking
patients to range on a 5 option Likert-like scale, their perception of the
impact of asthma on their quality of life.
5. Asthma quality of life – 12 item validated questionnaire asking patients
about daily functional problems experienced as a result of asthma.
These validated research tools were assessed as not likely to have a
clinical impact as they are not patient intervention components.
6. Days off work/school – self-reported section asking the patient how
many days off work they have had due to asthma in the previous six
7. History of doctor/ hospital visits – self-reported section asking the
patient questions quantifying their use of hospital and GP services
related to asthma in the previous six months.
Measuring the economic effect of the intervention was assessed to
be not relevant for regular practice.
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