The role of community pharmacists in screening and subsequent management of chronic respiratory diseases: a systematic review
Objective: The purpose of this review was to evaluate the role of community pharmacists in provision of screening with/without subsequent management of undiagnosed chronic obstructive pulmonary disease (COPD) and uncontrolled asthma.
Methods: An extensive literature search using four databases (ie. Medline, PubMed, International Pharmaceutical Abstracts (IPA) and Scopus) with search terms pharmacy, screening, asthma or COPD was conducted. Searches were limited to the years 2003-2013, those in English and those reporting research with humans. Data retrieval, analysis and result presentation employed a scoping review method.
Results: Seventeen articles met the inclusion/exclusion criteria, of which fifteen studies were based on people with asthma and two were based on people with COPD. Only seven asthma studies and one COPD study involved screening followed by subsequent management. More than half of the people screened were found to be poorly controlled and up to 62% of people were identified at high risk for COPD by community pharmacists. The studies varied in the method and type of asthma control assessment/screening, the type of intervention provided and the outcomes measured. The limitations of the reviewed studies included varying definitions of asthma control, different study methodologies, and the lack of long-term follow-up. While many different methods were used for risk assessment and management services by the pharmacists, all the studies demonstrated that community pharmacists were capable of identifying people with poorly controlled asthma and undiagnosed COPD and providing them with suitable interventions.
Conclusion: The literature review identified that community pharmacists can play an effective role in screening of people with poorly controlled asthma and undiagnosed COPD along with delivering management interventions. However, there is very little literature available on screening for these chronic respiratory conditions. Future research should focus on development of patient care delivery model incorporating a screening protocol followed by targeted management interventions delivered by the community pharmacist.
2. National Health Priority Action Council (NHPAC). National Chronic Disease Strategy, Australian department of health and ageing, 2006. Online ISBN: 0642828695. http://www.health.gov.au/chronicdiseasestrategy (Accessed June 14 2013).
3. World Health Organization: Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. 2007. http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf (Accessed July 09 2013).
4. Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM. Economic burden of asthma: a systematic review. BMC Pulm Med. 2009;9:24. doi: 10.1186/1471-2466-9-24
5. GINA (Global Initiative for Asthma) 2009a. Global strategy for asthma management and prevention 2009 (update). Bethesda, Maryland: National Institutes of Health, National Heart, Lung and Blood Institute. http://www.ginasthma.org/uploads/users/files/GINA_Report_2011.pdf. (Accessed July 09 2013).
6. Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH. Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117(2):542-550.
7. Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007 Jun;119(6):1537-1538.
8. Holgate ST, Price D, Valovirta E. Asthma out of control? A structured review of recent patient surveys. BMC Pulm Med. 2006;6(Suppl 1):S2.
9. Vieira JW, Silva AA, Oliveira FM. Knowledge and impact on disease management by asthmatic patients. Rev Bras Enferm. 2008;61(6):853-857.
10. Laforest L, Van Ganse E, Devouassoux G, Osman LM, Bauguil G, Chamba G. Patient-reported adverse events under asthma therapy: a community pharmacy-based survey. Clin Pharmacol Ther. 2007 Aug;82(2):167-172.
11. The Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013. http://www.goldcopd.org/ (Accessed: July 09 2013).
12. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, Menezes AM, Sullivan SD, Lee TA, Weiss KB, Jensen RL, Marks GB, Gulsvik A, Nizankowska-Mogilnicka E; BOLD Collaborative Research Group. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet. 2007;370(9589):741-750.
13. Lyngs AM, Backer V, Gottlieb V, Nybo B, Ostergaard MS, Frølich A. Early detection of COPD in primary care--the Copenhagen COPD Screening Project. BMC Public Health. 2010;10:524. doi: 10.1186/1471-2458-10-524
14. Hersberger KE, Renggli VP, Nirkko AC, Mathis J, Schwegler K, Bloch KE. Screening for sleep disorders in community pharmacies - evaluation of a campaign in Switzerland. J Clin Pharm Ther. 2006 Feb;31(1):35-41.
15. Snella KA, Canales AE, Irons BK, Sleeper-Irons RB, Villarreal MC, Levi-Derrick VE, Greene RS, Jolly JL, Nelson AA. Pharmacy- and Community-Based Screenings for Diabetes and Cardiovascular Conditions in High-Risk Individuals. J Am Pharm Assoc (2003). 2006;46(3):370-377.
16. Lönnroth K, Karlsson M, Lan NT, Buu TN, Dieu TT. Referring TB suspects from private pharmacies to the National Tuberculosis Programme: experiences from two districts in Ho Chi Minh City, Vietnam. Int J Tuberc Lung Dis. 2003;7(12):1147-1153.
17. Bell CA, Eang MT, Dareth M, Rothmony E, Duncan GJ, Saini B. Provider perceptions of pharmacy-initiated tuberculosis referral services in Cambodia, 2005-2010. Int J Tuberc Lung Dis. 2012;16(8):1086-1091. doi: 10.5588/ijtld.11.0669
18. Community Pharmacy at the heart of public health. Published by the Pharmaceutical Services Negotiating Committee. www.psnc.org.uk. (Accessed July 09 2013).
19. Gupta S, Vij A, Cafiero E, Bloom D, Agarwal S, Donelan K, Kopans D, Saini S. Retail venue based screening mammography: assessment of women's preferences. Acad Radiol. 2012;19(10):1268-1272. doi: 10.1016/j.acra.2012.04.022
20. Krass I, Mitchell B, Clarke P, Brillant M, Dienaar R, Hughes J, Lau P, Peterson G, Stewart K, Taylor S, Wilkinson J, Armour C. Pharmacy Diabetes Care Program: analysis of two screening methods in Australian community pharmacy. Diabetes Res Clin Pract. 2007;75(3):339-347.
21. Naunton M, Peterson GM, Jones G. Pharmacist-provided quantitative heel ultrasound for rural women at risk of osteoporosis. Ann Pharmacother. 2006;40(1):38-44.
22. Fuller JM, Wong KK, Krass I, Grunstein R, Saini B. Sleep disorders screening, sleep health awareness, and patient follow-up by community pharmacists in Australia. Patient Educ Couns. 2011;83(3):325-335. doi: 10.1016/j.pec.2011.05.004
23. Peterson GM, Fitzmaurice KD, Kruup H, Jackson SL, Rasiah RL. Cardiovascular risk screening program in Australian community pharmacies. Pharm World Sci. 2010;32(3):373-380. doi: 10.1007/s11096-010-9379-8
24. Hourihan F, Krass I, Chen T. Rural community pharmacy: a feasible site for a health promotion and screening service for cardiovascular risk factors. Aust J Rural Health. 2003;11(1):28-35.
25. Howard K, Salkeld G. Home bowel cancer tests and informed choice - is current information sufficient? Aust N Z J Public Health. 2003;27(5):513-516.
26. Emmerton L, Buhrer Skinner M, Gardiner E, Nissen L, Debattista J. A trial of the distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies. Sex Health. 2011;8(1):130-132. doi: 10.1071/SH10068
27. Gudka S, Marshall L, Creagh A, Clifford R. To develop and pilot a best practice community pharmacy chlamydia screening model. Pharmacy Guild of Australia Research and Development Program. 2010. http://www.guild.org.au/services-programs/research-and-development/archive---fourth-agreement/iig-003 (Accessed July 14 2013).
28. Teh R, Chen T, Krass I. Consumer perspectives of pharmacist-delivered health information and screening services. Int J Pharm Pract. 2001;9(4):261-267.
29. Taylor J, Krska J, Mackridge A. A community pharmacy-based cardiovascular screening service: views of service users and the public. Int J Pharm Pract. 2012;20(5):277-284. doi: 10.1111/j.2042-7174.2012.00190.x
30. Emmerton L, Shaw J, Kheir N. Asthma management by New Zealand pharmacists: a pharmaceutical care demonstration project. J Clin Pharm Ther. 2003;28(5):395-402.
31. Portlock J, Holdem M, Patel S. A community pharmacy asthma MUR project in Hampshire and the Isle of Wight. Pharm J. 2009;282(7537):109-112.
32. Mangiapane S, Schulz M, Mühlig S, Ihle P, Schubert I, Waldmann HC. Community pharmacy-based pharmaceutical care for asthma patients. Ann Pharmacother. 2005;39(11):1817-1822.
33. Martinez FJ, Raczek AE, Seifer FD, Conoscenti CS, Curtice TG, D'Eletto T, Cote C, Hawkins C, Phillips AL; COPD-PS Clinician Working Group. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD. 2008;5(2):85-95. doi: 10.1080/15412550801940721
34. Laforest L, Van Ganse E, Devouassoux G, Osman LM, Brice K, Massol J, Bauguil G, Chamba G. Asthmatic patients' poor awareness of inadequate disease control: a pharmacy-based survey. Ann Allergy Asthma Immunol. 2007;98(2):146-152.
35. Laforest L, Van Ganse E, Devouassoux G, Chretin S, Bauguil G, Pacheco Y, Chamba G. Quality of asthma care: results from a community pharmacy based survey. Allergy. 2005;60(12):1505-1510.
36. Mendes Z, Madeira A, Suzete C, Sonia I, Marianela V, Artur TA,Antonio SL, Mario M. Asthma Control Assessment using Asthma Control Test in Portugese Pharmacies. Rev Port Imunoalergologia 2010;18(4):313-330.
37. Mehuys E, Van Bortel L, Annemans L, Remon JP, Van Tongelen I, Van Ganse E, Laforest L, Chamba G, Brusselle G. Medication use and disease control of asthmatic patients in Flanders: a cross-sectional community pharmacy study. Respir Med. 2006;100(8):1407-1414.
38. Nishiyama T, Chrystyn H. The Jones Morbidity Index as an aid for community pharmacists to identify poor asthma control during the dispensing process. Int J Pharm Pract. 2003;11(1):41-46.
39. Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: feasability and acceptability of training by pharmacists. Respir Med. 2011;105(12):1815-1822. doi: 10.1016/j.rmed.2011.07.004
40. Barbanel D, Eldridge S, Griffiths C. Can a self-management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax. 2003;58(10):851-854.
41. Armour CL, Lemay K, Saini B, Reddel HK, Bosnic-Anticevich SZ, Smith LD, Burton D, Song YJ, Alles MC, Stewart K, Emmerton L, Krass I. Using the Community pharmacy to identify patients at risk of poor asthma control and factors which contribute to this poor control. J Asthma. 2011;48(9):914-922. doi: 10.3109/02770903.2011.615431
42. Saini B, LeMay K, Emmerton L, Krass I, Smith L, Bosnic-Anticevich S, Stewart K, Burton D, Armour CL. Asthma disease management - Australian pharmacists’ interventions improve patients’ asthma knowledge and this is sustained. Patient Educ Couns. 2011;83(3):295-302. doi: 10.1016/j.pec.2011.05.001
43. Saini B, Krass I, Armour CL. Development, implementation, and evaluation of a community pharmacy-based asthma care model. Ann Pharmacother. 2004;38(11):1954-1960
44. Bereznicki BJ, Peterson GM, Jackson SL, Walters EH, Fitzmaurice K, Gee PR. Pharmacist‐initiated general practitioner referral of patients with suboptimal asthma management. Pharm World Sci. 2008;30(6):869-875. doi: 10.1007/s11096-008-9242-3
45. Bereznicki BJ, Peterson GM, Jackson SL, Walters EH, Fitzmaurice KD, Gee PR. Data-mining of medication records to improve asthma management. Med J Aust. 2008;189(1):21-25.
46. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, Brusselle G. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008 Apr;31(4):790-799.
47. Armour CL, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L, Stewart K. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62(6):496-502.
48. Armour CL, Reddel HK, LeMay KS, Saini B, Smith LD, Bosnic-Anticevich SZ, Song YJ, Alles MC, Burton DL, Emmerton L, Stewart K, Krass I. Feasibility and effectiveness of an evidence-based asthma service in Australian community pharmacies: A pragmatic cluster randomized trial. J Asthma. 2013;50(3):302-309. doi: 10.3109/02770903.2012.754463
49. Castillo D, Guayta R, Giner J, Burgos F, Capdevila C, Soriano JB, Barau M, Casan P; FARMAEPOC group. COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study. Respir Med. 2009;103(6):839-45. doi: 10.1016/j.rmed.2008.12.022
50. Fuller L, Conrad WF, Heaton PC, Panos R, Eschenbacher W, Frede SM. Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting. J Am Pharm Assoc (2003). 2012;52(5):e59-e66.
51. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59-65.
52. Jones KP, Cleary R, Hyland M. Predictive value of a simple asthma morbidity index in a general practice population. Br J Gen Pract. 1999;49(438):23-26.
53. Juniper EF, Svensson K, Mörk AC, Ståhl E. Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Respir Med. 2005;99(5):553-558.
54. Steen N, Hutchinson A, McColl E, Eccles MP, Hewison J, Meadows KA, Blades SM, Fowler P. Development of a symptom based outcome measure for asthma. BMJ. 1994;309(6961):1065-1068.
55. National Asthma Campaign, Asthma management handbook. National Asthma Campaign Ltd., Melbourne, Australia, 2002.
56. Bereznicki B, Peterson G, Jackson SL, Walters EH, Gee PR. The Sustainability of a community pharmacy intervention to improve the quality use of asthma medication. J Clin Pharm Ther. 2011;36(2):144-151. doi: 10.1111/j.1365-2710.2010.01165.x
57. Simpsom M, Gissing PM, Burton DL, Burton MA, Bowman SL. Pharmaceutical care: Impact on asthma medication use. J Pharm Prac Res. 2004;34(1):26-29.
58. Miedinger D, Neukomm E, Chhajed PN, Schnyder A, Naef M, Ackermann M, Leuppi JD. The use of the Asthma Control Test in general practice and its correlation with asthma control according to the GINA guidelines. Curr Med Res Opin. 2011;27(12):2301-2308. doi: 10.1185/03007995.2011.630722
59. Juniper EF, Bousquet J, Abetz L, Bateman ED; GOAL Committee. Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the asthma control questionnaire. Respir Med. 2006;100(4):616-621.
60. Wallenstein GV, Carranza-Rosenzweig J, Kosinski M, Blaisdell-Gross B, Gajria K, Jhingran P. A psychometric comparison of three patient-based measures of asthma control. Curr Med Res Opin. 2007;23(2):369-377.
61. Yawn BP. Factors accounting for asthma variability: achieving optimal symptom control for individual patients. Prim Care Respir J. 2008;17(3):138-147. doi: 10.3132/pcrj.2008.00004
62. Brown CM, Barner JC, Shepherd MD. Issues and barriers related to the provision of pharmaceutical care in community health centers and migrant health centers. J Am Pharm Assoc (2003). 2003;43(1):75-77. doi: 10.1331/10865800360467088
63. Emmerton L, Smith L, LeMay KS, Krass I, Saini B, Bosnic-Anticevich SZ, Reddel HK, Burton DL, Stewart K, Armour CL. Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia. BMC Health Serv Res. 2012;12:164. doi: 10.1186/1472-6963-12-164
64. Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009;43(1):85-97. doi: 10.1345/aph.1K612
65. Holton CH, Beilby JJ, Harris MF, Harper CE, Proudfoot JG, Ramsay EN, Ruffin RE. Systematic care for asthma in Australian general practice: a randomised controlled trial. Med J Aust. 2010;193(6):332-337.
66. Ayorinde AA, Porteous T, Sharma P. Screening for major diseases in community pharmacies: a systematic review. Int J Pharm Pract. 2013;21(6):349-361. doi: 10.1111/ijpp.12041
67. Mehuys E, Boussery K, Adriaens E, Van Bortel L, De Bolle L, Van Tongelen I, Remon JP, Brusselle G. COPD Management in Primary Care: An Observational, Community Pharmacy–Based Study. Ann Pharmacother. 2010;44(2):257-266. doi: 10.1345/aph.1M481
68. Sinclair HK, Bond CM, Stead LF. Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst Rev. 2004;(1):CD003698.
69. American Pharmacists Association Foundation. White paper on expanding the role of pharmacists in chronic obstructive pulmonary disease. J Am Pharm Assoc (2003). 2011;51(2):203-211. doi: 10.1331/JAPhA.2011.11513
70. Verma A, Harrison A, Torun P, Vestbo J, Edwards R, Thornton J. Are pharmacists reducing COPD'S impact through smoking cessation and assessing inhaled steroid use? Respir Med. 2012;106(2):230-234. doi: 10.1016/j.rmed.2011.08.011
71. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.