Kendra procacci pharm d bcps ae c genine thormahlen pharm d ae c
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Kendra Procacci, Pharm.D, BCPS, AE-C Genine Thormahlen, Pharm.D, AE-C PowerPoint PPT Presentation

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

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

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”

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

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

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


  • 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

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

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


  • 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?


  • 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”?


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