Clinical pharmacist counseling improves outcomes for Taiwanese asthma patients
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Objective To assess the impact of an asthma educational program provided by a nurse combined with asthma counseling provided by a pharmacist on asthma knowledge, quality of life and clinical outcomes in Taiwanese patients with asthma. Setting All patients were recruited from Pulmonary Medicine outpatient clinic, the Tri-Service General Hospital, Taipei, Taiwan. Asthma education was given in three one-hour sessions offered during monthly clinic visits. Method A total of 91 asthma patients were randomly assigned to a nurse-administered education program (Group 1), the education program with additional pharmacist counseling (Group 2), or a control group receiving routine care only (control). Three questionnaires were used for assessment at months 0, 3 and 6. Outcomes were compared between groups to determine efficacy. Main Outcome Measure Asthma knowledge, health-related quality of life, and medication adherence were measured at baseline and 3 and 6 months after enrollment. Results A total of 104 patients were enrolled; 91 completed the study. Knowledge scores of patients in Groups 1 and 2 increased significantly compared to control group. Both intervention groups showed significant increases in knowledge scores with longer follow-up. Group 2 showed a significant improvement in clinical symptoms between baseline (month 0) and month 6 (4.99 vs. 4.21, P = 0.008). No significant differences in medication adherence were seen among groups. Conclusion Regular nurse-administered asthma education with additional pharmacist counseling improves asthma knowledge and clinical symptoms in asthma patients.
KeywordsAsthma Clinical outcomes Medication adherence Patient education Pharmacists Taiwan
The authors thank the patients who participated in the project and collected these data.
Conflicts of Interest
- 1.Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) (2008). http://www.ginasthma.org. Accessed May 8, 2010.
- 2.Taiwan Department of Health, Executive Yuan. Health and vital statistics (2007). http://www.doh.gov.tw. Accessed May 8, 2010.
- 9.Calfee CS, Katz PP, Yelin EH, Iribarren C, Eisner MD. The influence of perceived control of asthma on health outcomes. Chest. 2006;130(5);1312–8. http://chestjournal.chestpubs.org/content/130/5/1312.full.pdf+html Google Scholar
- 10.Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BD, et al. A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma. Health Technol Assess. 2005;9(23):iii–iv, 1–167. http://www.hta.ac.uk/execsumm/summ923.htm
- 11.Buist AS, Vollmer WM, Wilson SR, Frazier EA, Hayward AD. A randomized clinical trial of peak flow versus symptom monitoring in older adults with asthma. Am J Respir Crit Care Med. 2006;174(10):1077–87. http://ajrccm.atsjournals.org/cgi/reprint/174/10/1077 Google Scholar
- 12.FitzGerald JM, Gibson PG. Asthma exacerbations 4: Prevention. Thorax. 2006;61(11):992–9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2121160/pdf/992.pdf
- 13.Mayo PH, Weinberg BJ, Kramer B, Richman J, Seibert-Choi OS, Rosen MJ. Results of a program to improve the process of inpatient care of adult asthmatics. Chest. 1996;110(1):48–52. http://chestjournal.chestpubs.org/content/110/1/48.long Google Scholar
- 16.Barthwal MS, Katoch CDS, Marwah V. Impact of optimal asthma education programme on asthma morbidity, inhalation technique and asthma knowledge. J Assn Phys India. 2009;57(1):574–9.Google Scholar
- 17.Walker J, Winkelstein M, Land C, Lewis-Boyer L, Quartey R, Pham L, et al. Factors that influence quality of life in rural children with asthma and their parents. J Pediatr Health Care. 2008;22(6):343–50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2592842/pdf/nihms76619.pdf
- 18.Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2002; Issue 3. Art. No.: CD004107. doi: 10.1002/14651858.
- 19.Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004;59(2):94–9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746945/pdf/v059p00094.pdf Google Scholar
- 20.Diamond SA, Chapman KR. The impact of a nationally coordinated pharmacy-based asthma education intervention. Can Respir J. 2001;8(4):261–5. http://www.pulsus.com/journals/past_issues.jsp?sCurrPg=journal&jnlKy=4&fold=Past%20Issues
- 22.Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47(2):76–83. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC463574/pdf/thorax00362-0008.pdf
- 25.Nogueira KT, Silva JR, Lopes CS. Quality of life of asthmatic adolescents: assessment of asthma severity, comorbidity, and life style. J Pediatr (Rio J). 2009;85(6):523–30. http://www.jped.com.br/conteudo/09-85-06-523/ing.asp?cod=2039
- 26.Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest. 1999;115(5):1265–70. http://chestjournal.chestpubs.org/content/115/5/1265.full.pdf+html
- 31.Rutten-van Mölken MP, Custers F, van Doorslaer EK, Jansen CC, Heurman L, Maesen FP, et al. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J. 1995;8(6):888–98. http://erj.ersjournals.com/cgi/reprint/8/6/888
- 36.Nathan JA, Pearce L, Field C, Dotesio-Eyres N, Sharples LD, Cafferty F, Laroche CM. A randomized controlled trial of follow-up of patients discharged from the hospital following acute asthma: best performed by specialist nurse or doctor? Chest. 2006;130(1):51–7. http://chestjournal.chestpubs.org/content/130/1/51.full.pdf+html
- 38.Kritikos V, Saini B, Bosnic-Anticevich SZ, Krass I, Shah S, Taylor S, et al. Innovative asthma health promotion by rural community pharmacists: a feasibility study. Health Promot J. 2005;16(1):69–73.Google Scholar
- 40.Saini B, Smith L, Armour C, Krass I. Instructional design and assessment: an educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Edu. 2006;70(5):S1–S10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637026/pdf/ajpe118.pdf Google Scholar
- 44.Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008;31(4):790–9. http://erj.ersjournals.com/cgi/content/full/31/4/790 Google Scholar
- 47.Barbanel D, Eldridge S, Griffiths C. Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax. 2003;58(10):851–4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746491/pdf/v058p00851.pdf
- 48.McLean W, Gillis J, Waller R. The BC Community Pharmacy Asthma Study: a study of clinical, economic and holistic outcomes influenced by an asthma care protocol provided by specially trained community pharmacists in British Columbia. Can Respir J. 2003;10(4):195–202. http://www.pulsus.com/journals/past_issues.jsp?sCurrPg=journal&jnlKy=4&fold=Past%20Issues
- 49.Weinberger M, Murray MD, Marrero DG, Brewer N, Lykens M, Harris LE, et al. Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA. 2002;288(13):1594–602. http://jama.ama-assn.org/cgi/content/full/288/13/1594 Google Scholar
- 51.Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM. Economic burden of asthma: a systematic review. BMC Pulm Med [serial on the Internet]. 2009;9:24+[16 pages]. http://www.biomedcentral.com/bmcpulmmed.
- 54.Kheir NM, Emmerton L, Shaw JP. Assessing the responsiveness of the Asthma Quality of Life Questionnaire with pharmaceutical care. Pharm World Sci. 2008 Aug;30(4):322–8. http://qspace.qu.edu.qa/handle/10576/10552