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Kendra Procacci, Pharm.D, BCPS, AE-C Genine Thormahlen, Pharm.D, AE-C

Kendra Procacci, Pharm.D, BCPS, AE-C Genine Thormahlen, Pharm.D, AE-C. History of Pharmacist intervention in asthma education. Ashville Project

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Kendra Procacci, Pharm.D, BCPS, AE-C Genine Thormahlen, Pharm.D, AE-C

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  1. Kendra Procacci, Pharm.D, BCPS, AE-CGenine Thormahlen, Pharm.D, AE-C

  2. History of Pharmacist intervention in asthma education • Ashville Project • Assessed clinical, humanistic, and economic outcomes of community pharmacy-based asthma management program in 207 patients with asthma over a 5 yr period • Significant improvements in lung function, asthma control, symptoms and QOL • Decrease in ER visits and hospitalizations • Total direct and indirect cost savings of $584, 307 or $1955/pt/yr • Numerous other studies also support pharmacists’ role in asthma education

  3. History of Pharmacist intervention in asthma education • EPR-3 guidelines place new emphasis on providing asthma education at multiple points of care and describe community pharmacies as effective sites for asthma self-management • Section 3, components 2, Education for a partnership in asthma care notes “studies of pharmacy-based education directed toward understanding medication and teaching inhaler and self-monitoring skills show the potential of using community pharmacies a point of care for self-management education. Studies report difficulties in implementation, but they also demonstrate benefits in improving asthma self0management skills and asthma outcomes”

  4. Asthma collaborative practice agreement at PHC • Staffing • Clinical pharmacist • UM faculty (AE-C) • Referrals • Providers (2 mid-levels, 3 MDs), Staff Pharmacist • Asthma clinic visit (40 min) • Asthma education, inhaler technique, pharmacist can add or change medications for allergies, asthma, and GERD • Peak flow meter asthma action plan • Referral to medication assistance programs • Spirometry

  5. Results over 18 month period • 121 patients with asthma seen in the clinic • 116 (96%) had mild, moderate, or severe persistent asthma • Only 74 (61.2%) had appropriate medications for their classifications • Meds added during 37 (30.5%) of consultations • Only 9 patients (7%) had ever used a peak flow meter at home and none were currently using peak flow meters • 47 (39%) had proper inhaler technique • 62 (51%) current smokers • 46 (38%) had received a flu shot in the previous year

  6. Follow-up Results • Only 37 (31%) of patients returned for follow-up • 33/37 (89.1%) had documented improvement based on ACT or symptoms • 29/37 (78.4%) had improved compliance • 29/37 (78.4%) had improved inhaler technique • 4 patients successfully quit smoking

  7. Barriers • Time • Time with patient • Tracking information • Contacting patients for follow-up • Figuring out billing issues • Funding • Pharmacist time • Equipment (spacers and peak flow meters) • Appropriate referrals • Patient follow-up • Coming back for follow-up • Using peak flow meters • Lack of reimbursement for interventions

  8. Shopko Asthma Clinic • Staffing • 1 Clinical Pharmacist from UM (AE-C) • 1 fourth-year pharmacy student • Referrals • Trying to generate referrals from urgent care clinics and EDs • Running monthly “Asthma Clinic Walk-in Days” • Asthma clinic visits (45-60 minutes) • Asthma education (disease state, medications), inhaler technique, peak flow monitoring, avoiding/controlling triggers • Smoking cessation (if appropriate) • Spirometry

  9. Shopko Asthma Clinic • Making therapy recommendations • Report is sent to the patient’s PCP detailing assessment and recommendations • Differences from PHC • No in-house referral source • No collaborative practice agreement for RPh to change medications • No billing department

  10. Barriers • Referrals/Collaborative practice • How can we increase referrals? • How can we improve our advertising? Advertising is crucial because we do not have a direct referral source • Collaborative practice agreement would be ideal…but some physicians feel there is conflict of interest supporting a “for-profit” pharmacy chain store. How do we convince them otherwise? • Funding • Should we charge for these services ? How much? • Pharmacists cannot bill for asthma education. Spirometry?

  11. Barriers • Follow-up • How do we encourage patients to follow-up? Difficult to get patients to follow-up, especially if we are charging them! • We don’t know if changes to drug therapy were made from our recommendations. How do we track this? • Time • How can we be more efficient? • How can we encourage more staff RPh participation because they lack the extra time to “do more work”?

  12. Questions

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