Community pharmacists as medication educators

Abstract

We read with interest the paper by Cain et al1Cain WT Cable G Oppenheimer JJ The ability of the community pharmacist to learn the proper actuation techniques of inhaler devices.J Allergy Clin Immunol. 2001; 108: 918-920Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar about the ability of the community pharmacist to learn the proper actuation techniques of inhaler devices. We agree with the observations of the authors that the pharmacist can be an important resource for patients using these devices and that knowledge about available inhalation systems is essential. In fact, in 1995 the National Heart, Lung, and Blood Institute published “The Role of the Pharmacist in Improving Asthma Care,” which emphasizes inhalation device instruction as a key component. The absence of detail in the Cain paper, however, limits the interpretation and generalizability of their findings. The authors include no information to indicate how many community pharmacists were included in the sample, nor do they provide any details about recruitment or compensation methods. In addition, the authors offer no demographic information (eg, professional degree attained, years in practice, specialized training in asthma, type of practice site, geographic area of practice) about the subjects. Although a single investigator evaluated the performance of each study subject, the literature suggests that some consideration should be given to the intrarater reliability of the observations.2Gray SL Nance AC Williams DM Pulliam CC Assessment of interrater and intrarater reliability in the evaluation of metered dose inhaler technique.Chest. 1994; 105: 710-714Crossref PubMed Scopus (27) Google Scholar Furthermore, it appears that evaluation steps were not prioritized. We would suggest that for a metered-dose inhaler, allowing time between puffs is relevant; in addition, for each device, an understanding of when it should be cleaned, refilled, or replaced represents important evaluation parameters, perhaps more so than some of the steps listed. Although each of these issues is important for evaluating the usefulness of the study results, admittedly none directly influences the authors' suggestions that patients might be presenting to community pharmacists for education and counseling about the use of inhaler products and that pharmacists should have the ability to provide this information. Without the details noted above, however, the authors' conclusion that “[b]oth primary care physicians and specialists should not assume that their patients are receiving accurate instructions on the use of inhalation devices from their local pharmacist” is not well substantiated. Indeed, some pharmacists are involved in comprehensive disease management, providing education, recommendations about environmental control measures, and collaborative development of self-management and action plans for asthma.3Chan DS Callahan CW Moreno C Multidisciplinary education and management program for children with asthma.Am J Health Syst Pharm. 2001; 58: 1413-1417PubMed Google Scholar, 4Fischer LR Scott LM Boonstra DM DeFor TA Cooper S Elkema MA et al.Pharmaceutical care for patients with chronic conditions.J Am Pharm Assoc. 2000; 40: 174-180Scopus (17) Google Scholar A potential limitation in providing these services, however, is the current lack of pharmacist compensation for educational activities. Commonly, a third-party payment to a pharmacy is reimbursement for a drug product's cost plus a fee for associated dispensing costs. This lack of support, in combination with the nationwide shortage of pharmacists, could result in an inability to provide value-added services on a consistent basis. Nevertheless, we are confident that instruction about the correct use of inhaler devices will continue to be included in school of pharmacy curricula and through continuing education programs for pharmacists.