COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates

Figures & data

Figure 1 Assessment of patient needs and provision of COPD interventions: (A), pharmacological; and (B), non-pharmacological. Shaded boxes highlight the key clinical assessments conducted by the “consultant” pharmacists. The unshaded boxes to the right of the arrows provide a summarized version of interventions provided to address key issues that became apparent through the systematic assessment. PR=Pulmonary Rehabilitation.

Notes: *Foster JM, Smith L, Bosnic-Anticevich SZ et al. Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma. Intern Med J. 2012;42(6):136–144.⁵⁴ #Maples P, Franks A, Ray S, Stevens AB, Wallace LS. Development and validation of a low-literacy Chronic Obstructive Pulmonary Disease Knowledge Questionnaire (COPD-Q). Patient Educ Couns. 2010;81(1):19–22.⁵⁸

Abbreviations: GP, general practitioner; COPD, chronic obstructive pulmonary disease.

Figure 2 Inhaler technique assessment and education. This figure highlights the evidence-based three-step “show and tell” sequential process followed to assess and train patients at the baseline visit and, if required, at follow-up face-to-face visits. Based on the results published by: Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns 2008;72:26–33.⁸⁵

Table 1 Comparison of Outcome Measures at Baseline and Study End

Outcome Measure	n	Mean (± SD) or Median (Range) or n (%)	P-value
Median COPD-Q knowledge score
Baseline	37	70.0 ± 12.8 (46–92)	0.001
Study end	27	84 ± 11.7 (54–100)
Mean CAT score
Baseline	37	21.1 ± 6.7 (8–36)	0.21
Study end	27	19.3 ± 5.9 (7–35)
Median mMRC score
Baseline	36	1.0 ± 0.9 (0–4)	0.19
Study end	26	1.0 ± 0.6 (0–3)
Mean MRA
Baseline	35	78 ± 41 (17–205)	0.69
Study end	25	83.6 ± 22.4 (17–116)
Mean Foster Score
Baseline	36	99.3 ± 15.9 (69–150)	0.44
Study end	26	97.6 ± 14.9 (67–150)
Mean Inhaler technique competence
Baseline	35	78 ± 18 (40–100)	0.006
Study end	26	89.6 ± 10.6 (53–100)
COPD action plan ownership (n (%))
Baseline	36	2 (5.6)	<0.001
Study end	27	19 (70.4)
PR attendance (n (%))
Baseline	37	10 (27%)	0.39
Study end	27	10 (37%)
Flu vaccination (n (%))
Baseline	37	32 (86.5%)	0.18
Study end	27	26 (96%)
Pneumonia vaccination (n (%))
Baseline	37	15 (40.5%)	<0.001
Study end	27	22 (81%)
Smokers (n (%))
Baseline	37	7 (19%)	0.40
Study end	27	3 (11%)
Exacerbations (n (%))
Baseline	36	21 (58%)	0.04
Study end	27	9 (33%)

Notes: Whilst the significance for change in the magnitude of these outcomes across the study was done based on a paired sample analysis of data from completers (n=27), we have reported the values from the complete sample at baseline (n=37) to provide an overall snapshot at the initial time point. Significant p values are bold.

Abbreviations: COPD, chronic obstructive pulmonary disease; MRA, medication refill adherence; PR, pulmonary rehabilitation; SD, standard deviation; COPDQ, chronic obstructive pulmonary disease knowledge questionnaire;⁵⁸ Foster Score refers to the Foster score adherence questionnaire;⁵⁴ CAT, COPD Assessment Test;⁵⁵ mMRC, modified Medical Research Council (mMRC) dyspnoea scale.⁵⁶

Table 2 Inhaler Technique – Mean Number, Range and Percentage of Correct Steps at Each Visit

Inhaler	Number of Steps	Visit 1 (N=35) Mean Steps ± SD (Range)/(%Correct Steps)	Visit 2 (N = 30) Mean Steps ± SD (Range)/(%Correct Steps)	Visit 3 (N = 26) Mean Steps ± SD (Range)/(%Correct Steps)
Accuhaler^®	10	(n=4) 7.5 ± 1.7 (5–9)/(75%)	(n=3) 8.4 ± 0.5 (8–9)/(84%)	(n=2) 10/(100%)
pMDI+spacer	10	(n=4) 9.3 ± 0.9 (8–10)/(93%)	(n=4) 9.0 ± 0.8 (8–10)/(90%)	(n=2) 9.3 ± 0.8 (8–10)/(93%)
Turbuhaler^®	12	(n=4) 9.5 ± 1.0 (8–10)/(79%)	(n=5) 11.4 ± 0.9 (10–12)/(95%)	(n=7) 10.8 ± 1.2 (9–12)/(90%)
Handihaler^®	19	(n=10) 14.6 ± 4.3 (8–19)/(77%)	(n=10) 16.2 ± 1.8 (13–17)/(85%)	(n=5) 14.4 ± 3.6 (10–17)/(76%)
pMDI	13	(n=8) 7.2 ± 3.3 (5–12)/(55%)	(n=3) 13/(100%)	(n=1) 13/(100%)
Breezhaler^®	17	(n=2) 16.5 ± 0.7 (16–17)/(97%)	(n=2) 16.5 ± 0.7 (16–17)/(97%)	(n=3) 13.3 ± 4.0 (9–17)/(78%)
Ellipta^®	10	(n=12) 7.9 ± 1.2 (6–10)/(79%)	(n=11) 9.7 ± 0.5 (9–10)/(97%)	(n=11) 9.2 ± 0.9 (8–10)/(92%)
Genuair^®	12	(n=4) 8.0 ± 2.9 (5–12)/(67%)	(n=3) 10.3 ± 0.6 (10–11)/(86%)	(n=1) 11/(92%)
Respimat^®	11	(n=11) 9.4 ± 1.9 (6–11)/(85%)	(n=10) 10.4 ± 0.8 (9–11)/(95%)	(n=8) 10.5 ± 0.5 (10–11)/(95%)

Abbreviations: ^®, registered trademark; SD, standard deviation.

Foster JM, Smith L, Bosnic-Anticevich SZ, et al. Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma. Intern Med J. 2012;42(6):136–144. doi:10.1111/j.1445-5994.2011.02541.x

 PubMed Web of Science ®Google Scholar

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 PubMed Web of Science ®Google Scholar

Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns. 2008;72(1):26–33. doi:10.1016/j.pec.2008.01.014

 PubMed Web of Science ®Google Scholar

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