Authors (including presenting author) :
Wong CL(1), Fan HC(2), Liu RWT(2), Lee SY(3), Lee CH(3), Yick PK(1)
Affiliation :
(1) Department of Pharmacy, 2) Department of Medicine and Geriatrics, (3) Nursing Services Division, RTSKH
Introduction :
Multiple types of inhalation devices available in recent years has become a challenge for patients with respiratory diseases. Poor inhalation technique can lead to inadequate symptom control and increase risk of exacerbations. Pharmacists have a pivotal role in providing assessment and counseling in multi-disciplinary respiratory care. Incorporation of “teach-back”, video-assisted strategies in assessment and education model may improve adherence and clinical outcomes.
Objectives :
(1) To improve patients’ adherence and minimize critical errors of inhaler use; (2) To improve symptom control of patients with chronic obstructive pulmonary disease (COPD).
Methodology :
A quasi-experimental, prospective, pre- and post- intervention study was conducted. Subjects were recruited by physician/nurse referral or pharmacist screening. Two assessment and education sessions by a pharmacist were provided to each patient. The “teach-back” approach (patients demonstrate technique to pharmacist) was adopted and demonstration videos were incorporated as counselling tools. Primary outcome is inhalation technique performance. Secondary outcomes include adherence-related outcomes, clinical outcomes, patients’ satisfaction and medication cost saving.
Result & Outcome :
From September 2018 to April 2019, 132 patients (mean age: 69.1) completed the 1st(T1) and 2nd(T2) assessment and education sessions (median duration 8 weeks apart). Average time spent was 10 minutes for the 1st session and 7 minutes for the 2nd session. Inhalation technique of 223 inhalation devices was assessed. Mean inhalation technique performance in the maintenance group (N=169) improved significantly from 58.3% pre-intervention to 99.0%(T1) and 95.4%(T2) post-intervention (p< 0.01). In the inhaler-naïve group (N=54), the mean performance was 99.7%(T1) and 97.7%(T2) post-intervention. The proportion of inhaler use with critical error(s) dropped significantly from 75.1% pre-intervention to less than 2% post-intervention (p< 0.01). Self-reported non-adherence rate reduced significantly post-intervention (p< 0.01). For COPD patients (N=72), average Modified Medical Research Council (mMRC) grade decreased from 2.94 to 2.33 (p< 0.01) and COPD Assessment Test (CAT) score decreased from 23.2 to 14.8 (p< 0.01) post-intervention. A total medication cost of HKD$34,187 was saved. All patients were satisfied with the service.
The intervention improved inhalation technique, and the effect could be maintained after a median duration of 8 weeks. The intervention prevented critical errors, improved medication adherence and symptom control. The service was financially sustainable. Routine pharmacist involvement in multi-disciplinary respiratory care is highly encouraged.
