Feasibility of the ‘Respiratory Adherence Care Enhancer’ (RACE) instrument supporting self-management by community pharmacists in asthma/COPD patients with maintenance inhaler therapy
- At: PPR 2022 (2022)
- Type: Poster
- Poster code: PT-24
- By: VISSER, Claire (Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands)
- Co-author(s): Claire Visser, Phd, Pharmacist, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands, Netherlands
Background: Suboptimal self-management of maintenance inhaler therapy is observed in ≈ 50% of asthma and Chronic Obstructive Pulmonary Disease (COPD) patients. Driving factors consist of various types of barriers. The ‘Respiratory Adherence Care Enhancer’ (RACE) instrument has been developed to support self-management in these patients. This instrument consists of 1) the RACE-questionnaire identifying individual barriers to self-management of inhaler maintenance therapy, achievable treatment goals and disease control; 2) an infographic visualizing barriers for self-management and 3) a consult with the community pharmacist for tailored care with interventions to overcome barriers.
Objective: Primary goal was to assess the feasibility of the RACE-instrument from the perspective of asthma/COPD patients and community pharmacists on self-management before progressing to a definitive randomized controlled trial.
Methods: A feasibility study was conducted in five community pharmacies in the Netherlands, as part of a prospective pilot study. Within each participating pharmacy five asthma and five COPD patients with inhaler maintenance therapy were selected for the intervention based on data retrieved from the pharmacy information system. Patients were invited to fill out the RACE-questionnaire at baseline and at follow-up after one month. Results were displayed at both timepoints after which a consult with the pharmacist took place. In advance, two trainee pharmacists were trained to provide tailored support with the RACE-instrument in consults. Subsequent patient-reported experience measures on the use of the instrument were collected through a questionnaire. Feasibility was assessed on 1) patient recognition of identified barriers, 2) the process of setting treatment goals and 3) impediments and facilitators obtained from experiences. Descriptive analysis was performed.
Results: Pharmacist consults were performed in 44 patients (48% with asthma and 52% with COPD) with a total of 85 consults (44 at baseline and 41 at follow-up). Visualization of self-management barriers in general were recognized by 84% of patients with similar results observed for asthma and COPD. The barrier ‘Social discomfort’ was least recognized by 63% of patients. Setting treatment goals was new and challenging for patients and pharmacists, especially in patients with controlled disease. The majority of patients considered the instrument useful, felt heard and understood during consults and appreciated the person-centered support.
Conclusion: Use of the RACE-instrument was feasible for pharmacists and asthma/COPD patients to discuss and improve self-management of maintenance inhaler therapy. Future research has to demonstrate its effect on clinical outcomes.
Trial registration number: Netherlands Trial Register: NL9759; registered 10th October 2021.
Keywords: Asthma, Chronic obstructive pulmonary disease (COPD), Self-management, Tailored care, Feasibility.