Abstract
Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice. Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes. Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data. Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079). Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.
Highlights
Optimal management of asthma is known to save lives; suboptimal asthma control within the community is globally evident and is often underpinned by ineffective use of effective medicines (Rabe et al, 2004; Price et al, 2015; Reddel et al, 2015; World Health Organisation, 2020)
Pharmacies were required to: be approved to dispense Pharmaceutical Benefits Scheme (PBS) medicines as part of the National Health Scheme defined in Section 90 of the National Health Act 1953 (Section 90 pharmacy); have an area physically separated from the retail trading floor to ensure privacy during consultations; and have a minimum of two pharmacists on duty at times when the service was to be delivered
To ensure that rural and urban pharmacies were representative of the distribution of the Australian population in New South Wales (NSW), Western Australia (WA), and Tasmania, randomization was stratified according to State and remoteness index using the Pharmacy Access/Remoteness Index of Australia (PhARIA)
Summary
Optimal management of asthma is known to save lives; suboptimal asthma control within the community is globally evident and is often underpinned by ineffective use of effective medicines (Rabe et al, 2004; Price et al, 2015; Reddel et al, 2015; World Health Organisation, 2020). In response to feedback from pharmacists in earlier trials (Armour et al, 2007; Gordois et al, 2007; Armour et al, 2013) and to increase accessibility of evidence-based interventions to asthma patients within the Australian community, a trial was designed to implement a streamlined and technologically supported Pharmacy Asthma Service (PAS). As opposed to other studies, the PAS targeted only three evidence-based interventions known to improve control of asthma These interventions addressed 1) poor adherence, (Reddel et al, 2015), characterized by underuse of preventer medication and/. Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice
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