Optimal management of a chronic disease, like asthma, requires the active participation of patients. To achieve this, patients require education about asthma. Many of the recommended components of asthma care and management might not be effective without adequate patient education. Pharmacists in community, hospital and clinic practice are well placed to provide continued information and reinforcement of key messages, in order to improve compliance with medication and the outcomes of asthma management plans. Pharmacists may be able to increase medication adherence with patient counselling and monitoring systems and by facilitating communication with physicians. However, regardless of this, it remains uncertain whether pharmacist-patient interactions improve patient outcomes, and in spite of recommendations for teamwork and a multidisciplinary approach in the education of asthma patients, medical doctors and nurses are still largely responsible for carrying out the greatest part of patient education. The objectives of this study were therefore to determine the impact of pharmaceutical care services at a primary health care level on the management and well-being of asthmatic patients; to determine the effect of complex or multi-faceted pharmaceutical interventions, in patients with asthma, on lung function, asthma knowledge, attitudes and perceived self-management efficacy, asthma related quality of life and asthma control; and to determine the extent to which pharmacotherapeutic interventions, with regards to medication changes and dosage changes, are accepted and implemented by doctors. A randomised-control study was conducted at a primary health care clinic in the Eastern Cape. A total of 120 patients were allocated to two groups of sixty patients each (a Control Group and an Intervention Group). Baseline values were measured and follow-up interviews and post-intervention data collection were conducted three months afterwards for each group. Patients in the Control Group were attended to by the clinic staff as usual. Patients in the Intervention Group were educated on their disease by a pharmacist. The use of a customised 500ml plastic bottle as a spacer was suggested and each patient’s medication was evaluated against the Standard Treatment Guidelines for the management of asthma in adults at the primary health care level and where necessary, prescribing recommendations were made. Following assessment of the medication regimens of the patients in the Intervention Group, a total of 49 prescribing recommendations were made, of which 73 percent were accepted by both the doctor and patient. After educating the patients in the Intervention Group on inhaler technique, a significant improvement in technique was observed at the 3-month follow-up assessment (p<0.05). Using a short form of the Asthma Quality of Life Questionnaire (AQLQ(S)), a significant improvement post-intervention in mean total quality of life score (p<0.05) and mean average quality of life score (p<0.05) in the Intervention Group, were demonstrated. An improvement in mean activity limitation score in the Intervention Group post-intervention was also recorded for the activity limitation subscale of the AQLQ(S) (p<0.05). On measuring changes in asthma related knowledge, attitudes and self-efficacy, using a questionnaire (KASE-AQ), a significant improvement in mean knowledge score in the Intervention Group after the intervention (p<0.05) was also shown. With regards to lung function, both vital capacity (percent FVC) and expiratory flow volumes (percent FEV1) improved significantly in the Intervention Group (p<0.05). This study therefore demonstrated that multi-faceted pharmacist interventions, including medication assessment, asthma education, education on inhaler technique and the provision of medication aids in the form of spacers, can significantly improve the management of asthma patients and improve their well-being and quality of life.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nmmu/vital:10154 |
| Date | January 2007 |
| Creators | Mostert, Zhan |
| Publisher | Nelson Mandela Metropolitan University, Faculty of Health Sciences |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis, Masters, MPharm |
| Format | xii, 189 leaves, pdf |
| Rights | Nelson Mandela Metropolitan University |
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