What difference can pharmacist-driven management of adult patients with chronic persistent asthma make at a tertiary Academic Hospital in Gauteng, South Africa?

• Autores: Nonhlanhla Ntuli Pinky, Natalie Schellack, Andries Gous
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 19, Nº. 2, 2017, págs. 112-124
• Idioma: inglés
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• Resumen

  • Background: A large number of patients have not yet benefited from the advances in asthma treatment and are still insufficiently controlled, placing severe limits on daily life and placing them at risk for asthma-related morbidity and mortality. The aim of the study was to determine the effect of clinical pharmacy services on the medicine management of patients treated at an asthma clinic at Dr. George Mukhari Academic Hospital (DGMAH), Garankuwa, Gauteng Province, South Africa. Objectives: The objectives of the study were to assess the therapy of adult patients with chronic persistent asthma according to national Standard Treatment Guidelines (STG), the South African (SA) Thoracic Society Guidelines and international Global Initiative for Asthma (GINA) Guidelines, to record and categorise patient outcomes according to the Asthma Control Test (ACT), inhaler technique, peak expiratory flow (PEF) and spirometry and to describe the type of interventions a clinical pharmacist can make in ensuring safe and effective asthma control. Method: This was a prospective, cross sectional, quantitative design over a period of 11 months. Using purposive quota sampling, patients visiting the hospital pharmacy to collect their monthly prescriptions and attending the Pulmonology Clinic for review were invited to participate in the study if they fulfilled the inclusion criteria.The research entailed six visits, once a month, as scheduled for appointments with the medical team, or on collection of monthly prescriptions. This study focused on appropriate therapy management according to the STG, the South African Thoracic Society and GINA Guidelines. Asthma control was assessed using inhaler technique, a pre-defined checklist and level of asthma control using ACT. Peak flow using a peak flow meter was measured and spirometry results were recorded. Results: A total of 71 patients were recruited, with only 59 being included in the study. Of the 59 patients, 27 (45%) presented with moderate symptoms and 25 (42.37%) with severe symptoms. A total of 173 medications were prescribed. The most commonly prescribed medications were short-acting β2 agonists (SABA) (57; 32.95%) and inhaled corticosteroids (ICS) (47; 27.17%). The least prescribed medications were ICS and long-acting β2 agonists (LABA) combination (15; 8.67%). There were 32 (68%) ICS medications prescribed without doses. The doses were only indicated in 14 (30%) of the ICS medications prescribed and nine (64.3%) were not prescribed according to the severity or symptoms. A significant proportion of patients (49; 83.05%) were classified as uncontrolled and/or partly controlled and only 10 patients were controlled (16.95%) at baseline with mean ACT scores of 15.12 (±4.89). At the end of the study, the mean was 20.73 (±2.76) with a statistical significant improvement (5.93; p = 0.0005). Irregular use of ICS was observed in 38 (64.41%) patients and it was associated with poor asthma control (p = 0.0367). The mean inhaler technique scores at baseline were 2.64 (±0.76). Poor inhaler technique was associated with poor asthma control (p = 0.0164). At the end of the follow-up, the mean was significantly higher at 6.07 (±0.27), with a statistically significant change (3.5; p ≤0.0001). No significant changes in PEF and spirometric measures were observed. A total of 891 interventions were delivered by the pharmacist over the 11 months. Overall, 240 (26.94%) interventions related to inhaler technique; 226 (25.36%) related to asthma education, knowing symptoms and identifying and avoiding trigger factors;110 (12.35%) related to both patient knowledge of drug therapy-controller versus reliever and facilitating adherence to controller medication and 84 (9.43%) related to drug regimen. Conclusion: The study highlighted inappropriate or under-treatment of patients with chronic persistent asthma, unsatisfactory compliance to treatment guidelines and a lack of achieving guideline-based outcomes at baseline. The findings also indicated that a pharmacist-driven asthma programme, based on national guidelines, can add value to the care of chronic asthma, in terms of clinical outcomes for patients