Pharmacist Provided Spirometry Services: A Scoping Review.

PURPOSE: Despite international guidelines' recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. METHODS: In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: "pharmacist or pharmacy" and "spirometry or pulmonary function test or lung function test." Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. RESULTS: A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. CONCLUSION: Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.

Essential Role of Pharmacists in Asthma Care and Management.

Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients' concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.

Medication therapy management clinic: perception of healthcare professionals in a University medical center setting.

OBJECTIVE: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting. METHODS: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. RESULTS: Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as 'excellent', 44% as 'good', 5% as 'fair', and 0% stated 'poor'. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise. CONCLUSIONS: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Medication therapy management clinic: perception of healthcare professionals in a University medical center setting / Consulta de gestion de la farmacoterapia: percepción de los profesionales de la salud en un centro médico universitario

Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting. Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise. Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with indepth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management (AU)

Objetivo: Determinar la percepción general y la utilización de los servicios de una consulta de gestión de la farmacoterapia (MTM) por profesionales de la salud de una centro médico universitario grande y urbano. Métodos: Este fue una encuesta transversal y anónima enviada a 195 profesionales de la salud, incluyendo médicos enfermeras y farmacéuticos del Centro de Salud Ambulatorio de la Universidad de Illinois, para determinar su percepción y utilización de la consulta de MTM. El cuestionario consistía en 12 preguntas y fue aplicado a través de una aplicación online segura. Resultados: Sesenta y dos (32%) profesionales de la salud completaron la encuesta. El 82% estaban familiarizados con la consulta de MTM y el 63% habían remitido pacientes a esta consulta. La adherencia a la medicación y la gestión de la enfermedad fueron los dos motivos más frecuentes de remisión. La falta de conocimiento sobre el procedimiento adecuado de remisión fue la razón más predominante para no remitir pacientes a la consulta de MTM. De los profesionales que conocían los servicios de MTM, el 44% evaluó la atención como ‘excelente’, el 44% como ‘buena’, el 5% como regular’ y el 0% como ‘pobre’. Las fortalezas de la consulta de MTM incluyeron la educación intensa de los pacientes, el seguimiento intensivo, y la reconciliación de la medicación detallada proporcionada por los farmacéuticos clínicos. De entre los que estaban familiarizados con la consulta de MTM, las recomendaciones incluyeron: aumentar los esfuerzos de marketing para incrementar el conocimiento de la consulta de MTM, crear acuerdos colaborativos de práctica entre farmacéuticos del MTM y médicos, y asegurar que las notas clínicas fuesen más breves. Conclusión: En una institución académica grande y urbana, la consulta de MTM se percibió como un recurso valioso para optimizar la atención a pacientes proporcionado educación profunda asociada a medicamentos prescritos y enfermedades. Estos beneficios identificados de la consulta de MTM produjeron frecuentes remisiones de pacientes, específicamente para ayuda con su adherencia a la medicación y gestión de la enfermedad (AU)

An evidence-based approach to COPD: part 1.

OVERVIEW: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD.

A pharmacist and health promoter team to improve medication adherence among Latinos with diabetes.

BACKGROUND: There is a need to improve blood glucose levels of underserved Latino patients with uncontrolled diabetes. OBJECTIVE: To determine the feasibility of a pharmacist and health promoter team designed to address the barriers to medication adherence and adjustment and improve self-care among Latinos with type 2 diabetes. METHODS: Clinical staff at the University of Illinois at Chicago Medical Center referred Latino patients with uncontrolled diabetes (hemoglobin A(1c) [A1C] > or =8.0%) to the study. A research assistant assessed patients on diabetes and medical history, medication list, medication adherence and related habits, health literacy, diabetes knowledge and numeracy, beliefs in benefits of diabetes therapy, depression, social support, and access to care. A bilingual, bicultural health promoter reviewed these assessments and worked with patients through home and clinic visits and telephone calls. The health promoter communicated with a pharmacist to receive assistance in medication management (reconciliation and adjustment). Participants received case management for 6 months. RESULTS: Nine patients were successfully recruited. The mean age was 58 years and mean duration of diabetes was 21 years. Successful collaboration between pharmacists and the health promoter required frequent communication and intense effort to address complex patient barriers. Health promoter contact time, in person, per participant ranged from 0 minutes to 640 minutes, and telephone call time ranged from 27 minutes to 111 minutes during the study period. Eight participants had medication adjustments during the study period, with a maximum of 7 adjustments per participant. Mean hemoglobin A1C declined from an average of 9.6% to 9.0%. Two patients are presented as case studies to describe how the pharmacist-health promoter team functioned. Information was obtained from health promoter records, survey results, and chart reviews. CONCLUSIONS: The pharmacist and health promoter team management of uncontrolled diabetes among Latinos appears to be a feasible approach to improving medication management.

Systematic review and meta-analysis of combination therapy for smoking cessation.

OBJECTIVES: To review published clinical trials on combination therapy for smoking cessation and determine the role of this regimen for treating tobacco dependence. DATA SOURCES: Search terms included in this systematic review were nicotine replacement patch, nicotine replacement therapy, nicotine replacement gum, nicotine replacement inhaler, nicotine replacement nasal spray, nicotine replacement lozenge, bupropion SR (for sustained release), combination therapy, smoking cessation, and varenicline. Trials conducted from 1994 through October 10, 2007, were identified using EBM Reviews: Cochrane Central Register of Controlled Trials and Medline. STUDY SELECTION: Clinical trials of various regimens for smoking cessation were included based on a large sample size (n > or = 200); use of first-line smoking cessation therapies; double-blind, randomized, placebo-controlled design; and study duration of 1 year or more. The primary objective of the included clinical trials was to assess the efficacy of combination therapy. Studies that involved medications other than first-line therapies, adolescents, and post hoc analyses and that were not written in English were excluded. DATA SYNTHESIS: Five clinical trials meeting the inclusion criteria were reviewed. All of the studies included the use of the nicotine replacement patch along with one other agent. A total of 2,204 patients were treated. Combination therapy was significantly better than monotherapy at all pooled comparisons (P < 0.05). The aggregated relative risk of abstinence comparing combination with single treatment groups was 1.42 (95% CI 1.21-1.67), 1.54 (1.19-2.00), and 1.58 (1.25-1.99) at 3, 6, and 12 months, respectively. Adverse effects with combination nicotine replacement therapy were minimal and similar to placebo or monotherapy. CONCLUSION: Current literature indicates that combination therapy is statistically better than monotherapy in smoking cessation treatment as assessed by 3-, 6-, and 12-month abstinence rates. Adverse effects and adherence to combination therapy are similar to monotherapy and placebo.