The Impact of Clinical Pharmacist Intervention on Asthmatic Patient's Outcomes

The Impact of Clinical Pharmacist Intervention on Asthmatic Patient's Outcomes at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia, 2022: A Randomized Controlled Trial

The goal of this trial is to determine whether or not clinical pharmacist led intervention for 3 months improves asthma control of asthmatic patients' outcomes as compared to the usual care 2023. The main question it aims to answer is does clinical pharmacist led interventions improve patient outcomes of asthmatic patients? Patients in the intervention group will receive a protocol-defined intervention at the start of the study and at the 1- , 3 and 6-month follow-up visits. Patients in the control group will receive the usual pharmacist care.

There are poor patient outcomes in the study area as it is evident in previous studies where almost ninety five percent of patients had not well controlled Asthma. Moreover, the rate of non-adherence to inhalational anti asthmatics is high and more than half of asthmatic patients received inappropriate treatment. All those poor patient outcomes can be easily prevented and those studies have recommended that patient education and proper patient consultation to optimize the benefits of treatment by integrating clinical pharmacists. Thus, pharmacists are at sealing point at which most of medication information must be provided if a conducive system is created which can greatly improve patient's treatment outcome. This study will generate strong evidence on the impact of clinical pharmacists at improving asthma control. It will also be an excellent tool in ascertaining and promoting what a well-trained clinical pharmacist can contribute to the health care through patient centered practice. Currently, there are a great number of clinical pharmacists who are wasting their knowledge and skill in a routine and traditional way of dispensing despite they are well trained to provide a patient centered care which in turn curb many limitations of a traditional way of dispensing with a minimal patient contact time and provision of in adequate information to them. Despite the importance of clinical pharmacists services to the improvement of asthma outcomes, clinical pharmacists face many challenges in the involvement of asthma patients, such as poor awareness among general public, lack of specific legislation and recognition from other health care providers Previously done studies have shown that clinical pharmacist led interventions had improvements in asthma outcomes. However, evidence for different interventions is not totally conclusive; Therefore, the present randomized controlled trial will set up to study the hypothesis that such pharmacist intervention will result in an improved asthma control in adult patients over a 6-month period.

The outcome assessor assessing patient outcomes will be blind. The participants and the intervention providers (Clinical pharmacists) will not be blind for patient assignment to one of the trial groups.

Patients in the intervention group will receive a protocol-defined clinical pharmacist intervention at the start of the study and at the 1- , 3 and 6-month follow-up visits.

Patients in the intervention group will receive a protocol-defined intervention at the start of the study and at the 1- , 3 and 6-month follow-up visits for education on disease and treatment 40 minutes, administration and dosage 6 minutes, drug interaction and other drug therapy problems 20 minutes for a total of 66 minutes. The intervention will include education about asthma triggers and the need of minimizing them, asthma symptoms, warning signs, proper inhalation use technique, cigarette smoking cession when appropriate, the need of adherence and they will also counseled to wash their mouth after the use of controller medications. In addition, pharmaceutical care evaluation will be carried out and any drug therapy problems will be addressed accordingly and finally every intervention provided will be recorded.

A blinded investigator will assess change in asthma control using the Asthma control test score (ACT). This is a clinically validated asthma control measure that consists of five questions with five alternative responses (classified by decreasing level of asthma control, scored from 5 to 1). The ACT score (range 5-25) is calculated by adding the responses to the five questions; the higher the score, the better asthma control. The ACT will be completed at randomization, as well as 1, 3, and 6 months later. Patients with a maximum score of 25 will be considered "completely controlled," while those with an ACT score of 20-24 will be considered as having "well-managed" asthma, and those with a score of 15-19 will be categorized as "uncontrolled" asthma.

Asthma exacerbation is one that necessitates the use of oral glucocorticoids, as well as a trip to the emergency room or hospitalization

Two validated measures of adherence will be used to assess adherence throughout the study: prescription refill rates and self reporting. During the trial period, the number of units of controller medicine provided to each patient will be documented, and adherence will be computed. The test of adherence to inhaler instrument (TAI) will be used to assess self reported adherence at the end of the trial (TAI).) The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma TAI scores 50, 46-49 and less than 45 will be considered as adherent, intermediate adherent and non-adherent respectively.

The inhalation technique will be rated using an eight-point checklist for metered dosage inhalers (MDI). One point will be awarded for each correct step, and the total score for the inhalation technique will be given as a percentage of correct steps. Patients who make serious inhalation technique errors (failure to remove cap and/or shake MDI; failure to load device and/or inhale fast and deeply via device ) will be given a sum score of zero. For ethical reasons, such major errors will also be corrected in patients belonging to the control group. Good MDIs use technique: when patients respond to greater than or equal to seven the mean score of MDIs use technique (≥70%). Poor MDIs use technique: when patients respond to less than seven the mean score of MDIs use technique (< 70%).

An updated version of the Knowledge of Asthma and Asthma Medicine questionnaire will be used to assess patients' knowledge of asthma and its treatment at the start of the intervention period and after the 6-month follow-up.

Using the PCNE(Pharmaceutical Care Network Europe) Classification tool Version 6.2 from Pharmaceutical Care Network Europe (PCNE) drug therapy problems will be identified. The PCNE V 6.2 has four primary issue domains, eight primary cause domains, and five primary intervention domains. There are 37 grouped sub-domains for causes, 9 grouped sub-domains for problems, and 17 grouped sub-domains for effects.Pharmaceutical care evaluation will be carried out and any drug therapy problems will be addressed accordingly.

Asthma-specific quality of life will be assessed at the start of the intervention period and after the 6-month follow-up period using the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)).

Inclusion Criteria: Age of 18 years or older Physician's diagnosis of asthma Exclusion Criteria: Participation in another asthma education program Pregnancy Communication difficulties Seasonal asthma (asthma symptoms that only occur in a seasonal pattern) Other pathologies such as COPD, emphysema, lung cancer, respiratory infection Terminal illness (any disease that is reasonably expected to result in the patient's death) Having an asthma control test level of <15 (indicating seriously uncontrolled asthma; for ethical reasons, these patients will be immediately referred ) or Having an asthma control test level equaling 25 (indicating complete asthma control; no room for improvement) will be excluded from the study.

The time frame will start from the time when summary data are published or start 6 months after publication.