The effectiveness of pharmacist interventions in improving quality of life in patients with difficult asthma
- TGD Capstick1, 2, IJ Clifton 1, J Morgan 2, A Blenkinsopp 2.
- 1Leeds Teaching Hospitals NHS Trust and 2School of Pharmacy, University of Bradford
Aim
The aim of the study is to measure the effects of coordinated information and advice about medicines from hospital and community pharmacists on asthma control and quality of life in patients with difficult asthma.
Introduction
Of the 5.2 million people with asthma in the UK, approximately one in every 40 have severe asthma that needs the maximum available treatments advised in national asthma guidelines (known as the ‘British Thoracic Society / Scottish Intercollegiate Guidelines Network British Guideline on the Management of Asthma’). Despite this the asthma is still inadequately controlled in about half of these patients and they are classed as having ‘difficult asthma’. It is thought that there is potential for improvement of the care and health of these patients through better use of medicines and greater input from pharmacists but more research is needed. A co-ordinated approach where patients receive information and advice from hospital specialist pharmacists and local community pharmacists (sometimes known as local chemists) could help patients with their asthma medicines and lead to improvements in health. Our proposed study would test this and would be the first study to do this in the UK.
Objectives
The primary objective is to measure the impact of the intervention on asthma control. Secondary objectives include the impact on quality of life, exacerbations, lung function, inhaler technique, adherence and healthcare resource utilisation.
Methodology
The patients in the study (52 in total) will be recruited from adult patients living in the community and attending a specialist difficult asthma clinic in a hospital. Patients will be randomly chosen to have either an appointment with the specialist pharmacist (intervention group), or usual medical care (control group).
Usual care will involve seeing the Consultant or Specialist Registrar (doctor) in the clinic at the start of the study and 6 months later.
Patients in the intervention group will receive i) assessment and education on asthma, optimisation of asthma treatment and review of their inhaler technique, from a hospital Advanced Clinical Pharmacist at the start of the study and 6 months later and ii) will also be referred for a medicines use review (MUR) from their usual community pharmacist (chemist), to take place 1-2 months after their hospital clinic appointment. The Advanced Clinical Pharmacist will be working closely with the Consultant, and in order to ensure that patients are not disadvantaged by an appointment with the pharmacist, they will discuss each patient’s appointment.
Outputs of the Research
Results will be measured using methods that have been developed by experts in asthma and tested in previous research. Asthma control will be measured using Juniper’s Asthma Control Questionnaire (ACQ). Other measurements will cover quality of life, use of medication, use of healthcare resources, and inhaler technique.
The results of this study will be made available to the NHS and to patients so that they can help to inform the design of services for people with asthma in the future. The research will be written up as a report by the Lead Investigator, pharmacist Toby Capstick, in a report that will be part of his Doctor of Pharmacy degree at the University of Bradford. It is also anticipated that the results will be published in a scientific journal, and presented at local, national or international meetings.
