A review of pharmacy-led interventions: identification of facilitators and barriers for the design of a new model of care for asthma

Abstract

The objective of this narrative review was to determine the facilitators and barriers identified in pharmacy-led interventions that improve outcomes in patients with asthma and support the implementation of interventions in practice. EMBASE, Web of Science, Google Scholar, and PubMed were used to identify 17 relevant articles. Seven studies were randomised controlled studies and 10 were one-arm, pre-post evaluations of all participants enrolled. Questionnaires assessing asthma control, medicine adherence, and knowledge about asthma were used, while checklists were used to assess inhaler technique. Studies with planned interventions in a clinic or general practice setting and lasting for 6 months (compared to longer interventions of 48 weeks) were more successful in retaining participation in the program. Education was the key intervention in which inhaler technique training was the most common. Knowledge about the disease, its aetiology, trigger factors, and medication used were covered in 10 of the studies. Fifteen of the articles reported an improvement in the asthma of patients receiving intervention by the pharmacist, measured by their asthma control test scores, emergency department visits, or reduced emergency steroid prescriptions. This review highlights five key requirements for the success of pharmacy-based interventions for asthma management: (a) developing and maintaining a skilled workforce; (b) close proximation of a general practitioner practice or clinic to the pharmacy; (c) patient education on the disease and medicine; (d) structured and standardised intervention and assessment; and (e) length of the intervention suitable to the pharmacist and the patient.