title: How Can Community Pharmacy Enhance Asthma Care in Adult Patients? A Multiperspective Study
Creators: name: Mahmoud, A
Publisher: name: Liverpool John Moores University
Year: 2022

description: Asthma is a long term condition with an episodic nature. In the UK, approximately 5.4 million people are living with asthma. The evidence showed gaps in asthma care provided to adult patients, for example, some asthma patients are not receiving basic asthma care including annual asthma reviews, asthma action plans and inhaler technique checks. The increasing numbers of patients with long term conditions led to an increase in patients’ demands, accordingly, increasing the workload on the GP practices. In 2018, NHS England stated that 26 million people in England are living with at least one long term condition and around 50% of GP appointments are provided to patients with long term conditions. The community pharmacy contractual framework confirmed the future role of community pharmacy as an integral part of the primary care pathway for patients with long term conditions. Community pharmacy offers convenient and accessible primary care premises and community pharmacists are well-educated on the management of long term conditions. Additionally, community pharmacists are in regular contact with asthma patients. This PhD aimed to explore how community pharmacy can enhance asthma care in adult patients and suggest solutions to enhance asthma care. The PhD study started with a narrative review of studies that were conducted to evaluate asthma interventions in community pharmacy. Only one of the studies was conducted in England. The findings showed that community pharmacy might be able to support asthma patients with inhaler technique training and asthma reviews. Additionally, there was limited evidence on the provision of an AAP in community pharmacy and none of the studies involved asthma medication change in community pharmacy. Moreover, the study highlighted some barriers to the provision of asthma interventions in community pharmacy, mainly, difficulties in the identification of asthma patients and collecting their data. The findings of the review were utilised to build the design of the study that involved five phases, Mixed methods research. Phase 1 involved qualitative interviews with 17 stakeholders in the North West of England. In phase 1, the participants highlighted possible opportunities to enhance asthma management in adult patients. The findings support the need to enhance engagement with AARs in adult patients, quality of AARs, access to asthma reviews and asthma patients’ awareness of their condition and importance of follow-up. The participants highlighted that new interventions for asthma patients need to focus more on preventive and co-ordinated care. As well as this, health coaching might help asthma patients to self-manage their condition better. In phase 2, a retrospective case note review was conducted in a GP practice. This phase highlighted issues with asthma management in the study sample including asthma medication use (overusing their reliever inhaler or underusing their ICS inhaler), engagement with AARs, inhaler technique check, AAPs and referral to secondary care for follow-up. The findings showed that regular checks of patients’ records helped to identify patients who need review, difficulties in obtaining data regarding asthma symptoms control and inconsistency in the provision and recording of asthma action plans and inhaler technique checks. A sample of 13 patients was identified in phase 2 and interviewed in phase 3 to explore patients’ perspectives on their management of their asthma. According to some patients in phase 3, the quality of care provided to asthma patients varied among different locations, healthcare settings and different healthcare practitioners. Additionally, patients asked for continuity in their asthma care. Patients with comorbid allergic rhinitis, depression and/or anxiety showed interest in being provided with further support. Additionally, patients perceived that the ease of access to community pharmacy and the relationship of trust between patients and community pharmacists might be utilised in providing further support with their asthma. In phase 4, the findings of phases 1-3 were triangulated, summarised and shared with HCPs to get their feedback in phase 5. The feedback from HCPs with findings from phase 4 provided the evidence to answer the research question (how can community pharmacy enhance asthma care in adult patients). The answer was:  Enhancement in the provision of NMS to newly diagnosed asthma patients by helping community pharmacy to identify those patients.  A community pharmacy-based asthma support: According to the findings, asthma patients who do not attend their AARs, patients with controlled asthma and patients who have a risk for a future asthma attack (patients with poorly controlled asthma symptoms and those with allergic rhinitis or who need seasonal care) can be provided by support in community pharmacy. The study successfully suggested a possible community pharmacy-based asthma intervention that is evidence-based to discuss with stakeholders and test its feasibility.