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. 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

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

History of pharmacist intervention in asthma education
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 education1
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
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
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
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
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 clinic1
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”?