D1.9 Pharmacist

Community pharmacists are medicines experts in the primary care setting and are well placed to engage in early detection/case finding of COPD, and COPD care programs due to their frequent interactions with patients during prescription refill. Monitoring and optimising COPD maintenance therapy in a community pharmacy has the potential to improve COPD management. Evidence from overseas suggests that such interventions significantly improved both inhalation technique and medication adherence, and significantly decreased the estimated annual severe exacerbation rate (Tommelein 2014). Structured education about COPD provided by a clinical pharmacist and a comprehensive pharmaceutical care program significantly improved medication adherence, improved quality of life, decreased severe exacerbation and hospitalisation rate, and higher quit rates (Xin 2016).

Clinical pharmacist-delivered education (15- 30 min) emphasising medication adherence, disease, and medication knowledge led to a significant improvement in self-reported medication adherence rate at 1 month compared to usual care (90.1% vs. 66.3%, p < 0.001) in an open-labelled, randomised, controlled trial in outpatients with physician diagnosed COPD attending a hospital in Vietnam (Nguyen 2024) [evidence level II]. Significant improvements in inhaler techniques and mMRC scores were also observed in the intervention arm, although there may have been an observation bias due to a lack of blinding of the assessors. Such interventions have not been evaluated in Australian community pharmacies in large trials.

A pharmacist-led medication adherence management intervention in 53 Spanish community pharmacies comprising motivational interviewing principles to assess adherence, identification of barriers for medication adherence and tailored strategies to address identified barriers, and monthly follow-ups was effective at improving medication adherence (self-reported data) compared to usual care in patients with COPD at 6 months (92.9% (87.0%-96.2%) vs 72.5% (62.3%-80.7%); 4.93 (2.20 – 11.1) p=0.0001). Patients in the intervention group also had lower Clinical COPD Questionnaire (CCQ) scores (MD −0.50, 95% CI −0.82 to −0.18, p<0.05) when compared with the control group (Torres-Robles 2022) [evidence level II].

Community pharmacists are ideally positioned to play a vital role in all key stages of an integrated COPD patient care pathway, smoking cessation support, support/monitoring of management plans to the provision of advice and counselling regarding medications, inhaler technique and treatment adherence (van der Molen 2017).  The skill sets, frequency of contact with patients, expertise regarding available treatments, and convenience to patients, in terms of the location, opening times and ‘open door’ consultation opportunities are the strengths of community pharmacists (Fathima 2013). Australian community pharmacists, with adequate training could play a bigger role in optimising medicine use by patients with chronic respiratory conditions.

Pharmacists are involved in education about medications and supply of medications. They can help smokers quit by advising about nicotine replacement and can counsel patients requesting over-the-counter salbutamol. They are well placed to monitor for medication problems and complications and suggest solutions (eg, individual dosing dispensers) (Beney 2000). This is particularly important where multiple comorbid conditions require treatment with multiple medications that have potential interactions, or when confusion exists about timing of medication administration.