A Role for Pharmacists in Respiratory Education

In one of this issue's research briefs, “Community pharmacy– based medication management program in asthma and chronic obstructive pulmonary disease,”1 Beauchesne and colleagues discuss a study of Quebec pharmacists who assessed patients with asthma and chronic obstructive pulmonary disorder. The largest barrier to this intervention was the lack of time available. That's the bottom line for pharmacists — we need more time with our patients. Our training gives us a false impression of what we are going to be doing when we get out into practice. We are the medication experts (and often the educators), but are just not used in the way we should be. More often than not, we spend more time dispensing medications than talking to our patients. On average, a complete respiratory interview (and education session) takes about 1–2 hours (the pharmacists in this current study found it took at least 30 minutes for the interview1). A complete patient history and assessment of the patient's breathing problems usually comprises 30–60 minutes. The remaining hour involves education on any issues identified, including dispelling any myths the patients may have brought with them. We can often dig further and determine what triggers may be causing their symptoms, find ways they can avoid them, discuss any concerns they may have, monitor their drug therapy, provide advice to improve adherence issues and, most importantly, ensure their device technique is correct. Approximately 70% of patients may be using their inhalers incorrectly.2 In many cases, poor or incorrect technique is the root cause of patients not having success with their medication therapy. So, can this be easily done in the community pharmacy setting (and is it practical)? Not when the pharmacy is busy and there are other patients waiting for your time and attention. Could you book an appointment? Absolutely! But do the patients themselves really understand what this is all about? The person in need of education probably doesn't even realize what you can do for them. They often may not believe they have the “time” for this either. We need to educate our patients on what we can really do for them and why it is important. Something certainly changes when you say to a patient, “Hi, I'm the pharmacist and we can take the next 45 minutes to an hour together talking about your asthma.” Suddenly, he or she has lots to tell us and there is lots that we can do to help! Remind your patients that time spent with their pharmacist can help them avoid unnecessary trips to the doctor and/or emergency. If you are not fortunate enough to have a practice site that routinely provides you with the time to do in-depth consultations, realize that even with only 3–5 minutes available, you can still make a difference to your patients with asthma and/or COPD. At each visit, consider choosing at least 1 or 2 questions to focus on: Are they using their inhaler correctly? (Ideally this should be considered at every visit.) Are they using a spacer with their MDI? Are they using it correctly? Are they rinsing and spitting after each inhaled corticosteroid use? (Even if they use a spacer). Are they avoiding their triggers? Do they know what their triggers are? Is their asthma under good control? (As many as 60% of patients do not have their asthma under good control, and many assume this is normal.3,4) Do they have an action plan? This is recommended for all respiratory patients. Do they smoke? (Cigarettes/marijuana) How often are they using the short-acting beta 2 agonist? Consider overusage. These are just a few of the many questions we should ask our respiratory patients. If you are asking about a patient's device technique, ask him to show you how he is using it. You may have placebo versions of common inhalation devices (available from most manufacturers), or ask your patient to show you with his or her own medication. This is a teachable moment for many and often gets patients interested enough to come back and see you again at a less busy time to talk more about their condition. The Respiratory Training and Educator Course (RESPTrec), created for health care professionals by the Lung Associations of Saskatchewan and Manitoba, can give you the confidence to do this in your high-paced practice setting, plus provide you with any tools you may require.5 With change upon us in many provinces, we need to develop new approaches to the reimbursement models in our pharmacies. New scopes of practice are coming our way, and we need to be charging for our nondispensing services. One BC asthma study6 demonstrated how pharmacists providing “enhanced” care vs “usual” care helped patients better self-manage their condition, resulting in fewer symptoms, less missed work and improved quality of life. The evidence is there — patients in the enhanced care group also had 75% fewer emergency room visits over those in the usual care group.6 Pharmacist services are valuable, and charging for these services shows the value to our patients. If you are just starting to move in this direction, you can start by providing your patients with an invoice so they can at least see that there is a value attached to the service. Look to your peers who are providing this type of patient care, ask for ideas and share your own. This is the only way we are going to be able to fulfill our potential and truly help our patients.

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