Home' Australian Pharmacist : Australian Pharmacist January 2015 Contents Australian Pharmacist January 2015 I ©Pharmaceutical Society of Australia Ltd.
‘I think it’s going to take that little
bit longer for all GPs to recognise
pharmacies aren’t trying to take over
their services.’ Ph10
‘Some of them were quite happy with
sending customers with asthma; some
other GPs were, you know, a bit upset,
I don’t know. They felt offended by it...
most of them were quite cooperative.’ Ph11
A recurring theme when discussing
facilitators was the perceived need for
increased patient interest in asthma and
knowledge of pharmacists’ capabilities.
Suggestions to improve pharmacy’s
image included a promotional campaign
for pharmacy and a professional in-store
‘I just don’t think that the people realise how
asthma is really affecting their lives.’ Ph9
5. Importance of continuing asthma
education and training
Several respondents commented
that regular refresher courses and
knowledge updates lead to better
practice. Participating in trials such as
the PAMS was also seen as an effective
way of updating knowledge and skills.
A willingness to provide education
sessions for other staff, patients and the
broader community was also stated. One
respondent suggested that combined
education sessions with doctors would
assist with collaboration.
The streamlined ‘practice ready’
The advisory panel discussed the PAMS
service components to be included for
the streamlined ‘practice ready’ service
and identified seven components
(research tools and duplicated clinical
measures) to be omitted. These were
assessed as not likely to have a clinical
impact on the service (Table 2).
The new ‘practice ready’ patient template
and corresponding time points are shown
in Table 3.
By following the ‘practice ready’
service template, an external specialist
pharmacist was able to conduct multiple
patient visits, on a single day, using pre-
organised appointments. Pharmacy one
was medium sized, rural and independent
and pharmacy two was large, suburban
and part of a banner group. An analysis
of the time taken for the patient visits
showed a large reduction in the median
times, from those recorded in the original
The first patient visits included
180 interventions delivered across
the 10 patients, an average of 18 per
patient (Table 5). A large number of the
interventions, 67% of the total, were
related to three areas of the service:
to allay misbeliefs and fill gaps in the
patients’ asthma knowledge, to identify
and rectify medication issues and to
assess and optimise inhaler technique.
Each patient set goals (range = 2 to 4,
mode = 2) at the end of the consultation.
Half of the patients were assessed as
requiring referral back to their physician.
The second patient visit occurred
between one and two months after visit
1, and was completed by seven patients.
One patient left the study for personal
reasons, and two patients, despite
accepting the appointment times, did
not turn up and further efforts to arrange
alternative appointment times were
unsuccessful. These two patients both
reported poor asthma control and recent
hospital admissions at visit 1.
At visit 2, most patients (5/7)
demonstrated appropriate inhaler
technique as measured by observing
device use and scoring steps correctly
completed, whereas no patients had
demonstrated this at visit 1. A single step
correction was required for two patients.
All patients at visit 1 had medication-
related issues (knowledge gaps, regimen
understanding etc.), whereas at visit 2, this
was reduced to 23% of patients. Setting
goals with the patient accounted for 37%
of visit 2 interventions.
Thematic analysis of the post-service patient
interviews revealed patients’ views on their
appreciation of the service and its perceived
benefits, their willingness to be guided by
the pharmacists’ expertise, and a lack of prior
awareness and expectations of pharmacy
services and their monetary value.
‘I wasn’t too sure, I expected like the lung
tests and things like that, but I didn’t
expect actually coaching on the using of
sprays, I thought they were easier...’ (P7)
‘I certainly think it is worth a fee, just
what that fee is I don’t know and whether
I would be prepared to pay it is another
thing to...well you know the Drs are...
$50–$60 aren’t they? I’d probably put
it in line with that...but I’d still rather it
stayed on the health card.’ (P4)
The results provide a new perspective on
the capability and readiness of pharmacists
to deliver positive patient outcomes in
asthma. Pharmacists have already shown
that they can fill the asthma management
treatment gap with evidence-based,
cost-effective services and are willing to
do so in the right circumstances. Patients
have also expressed their satisfaction with
the pharmacist asthma services they have
received in trials (21,29–32). A greater
understanding of the reasons why this has
not led to an uptake of pharmacy asthma
services was a focus of this research.
In combining this cohort’s research trial
experiences with their post-trial practice
perspective, we were able to identify
issues specific to the translation and
sustainability of pharmacy services. We
then used the practitioners’ experiences
to remodel an evidence-based
comprehensive asthma service, retaining
the essential elements to deliver health
outcomes, and then tested it in practice.
The ‘practice ready’ model, when tested in
two pharmacies, was less time consuming
than the previous research-focussed
trial, and was acceptable to patients. The
completing patients showed asthma
management practice improvements,
including disease/medication knowledge
and inhaler technique proficiency, whilst
also displaying an ability to self-manage
through their setting of goals.
Other issues exposed when the
respondents were unsupported
(outside of a trial), however, may still
need addressing. These included a
lack of ability and/or confidence to
independently develop and market
services, implementing practice change,
setting prices and charging for services.
Further issues, also observed during
PAMS,21 include low confidence recruiting
patients, conducting spirometry
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