Qualitative Evaluation to Identify Barriers to Providing Inhaler Technique Education

by Pharmacists: A Focus Group Study

Sena Avila, Jared Tate, Kendall Day, PharmD Candidates and Jeannie Lee, PharmD, BCPS, BCGP, FASHP
University of Arizona College of Pharmacy
Background Methods
 Worldwide, over 300 million people are living with asthma and over 210 million people are living with COPD (Connolly  A focus group design was utilized, which was approved by the University of Arizona
2016). Institutional Review Board.
 COPD is the third leading cause of death worldwide (Connolly 2016).  Licensed, Arizona pharmacists were invited to participate in the focus group.
 Treatment for chronic lung disease generally entails long-term therapy with inhaled medications, commonly more than  De-identified demographic information was collected to describe the characteristics
one inhaler. Inhalers are readily available and are often viewed as relatively simple devices. of the study participants and their experiences in inhaler education.
 Proper inhalation technique ensures medication delivery with symptom control and prevents exacerbations (Axtell 2016).  During the focus group, conducted by student pharmacists, data were collected by
 Therefore, along with the prescriber, the pharmacist is charged with the responsibility of ensuring the patient understands note taking and audio recording, which were transcribed for analysis.
and can correctly use their inhalers.  Descriptive data about the participants were reported using summary means,
medians, and standard deviations.
Objective  Transcripts and researcher notes were compiled and analyzed via content analysis
to extract common themes regarding barriers that limit appropriate patient
 The purpose of this study was to describe barriers that exist at the outpatient pharmacy level in providing appropriate education on inhaled medication use.
patient education on inhaler technique. Themes and insights gained may be used to design future interventions to  Nine participants had experiences in outpatient pharmacy practice including patient
facilitate inhaler education by pharmacists and to improve appropriate inhaler use among patients to ensure maximal education on inhaler use at the point of medication dispensing; one in inpatient
treatment effectiveness. practice.

Results Discussion
 A total of 10-licensed, practicing, pharmacist participated in the focus group discussion. Demographic information  Pharmacists described that the most significant
for participants is displayed in Figure 1. barriers to providing inhaler use education were
 The majority of participants (n=8) routinely discussed inhaler use with their patients, but only one felt that their patient-specific factors and a lack of tools/resources.
patients used them correctly. Figure 1.
 All participants had either a PharmD (n=5) or RPh (n=5) degree.

Pharmacist Demographics (N=10)

Conclusion
 There were two main barriers to inhaler education discussed in the focus group, summarized as follows:
1. Patient-specific factors, such as refusal or unwillingness of patients to participate. This was attributed to privacy 50  Strategies to improve pharmacist-patient
concerns, lack of time, misunderstanding about role of the pharmacist in patient education, or patients feeling 45 interactions and combat some of the barriers were
they are already proficient in their inhaler use and technique. 40 discussed. Prioritizing these areas as a focus for
 “Patients who have been on inhalers for a long time think they know how to use them, but I think a lot of them 35
pharmacist training and process implementation
need refreshers” 30
25 within pharmacies may help improve patient
 “Many patients misunderstand the role of the pharmacist and think we are only proficient at counting pills”
 “Patients, in general, don’t want to wait for counseling” 20 adherence to inhaled medications and outcomes.
 “I think there’s also a privacy issue. The patient doesn’t want people overhearing their business. People are a 15  Larger focus groups including broader pharmacist
10 groups are needed to better understand and
little hesitant” 5
2. The lack of tools and resources for pharmacists including a general shortage of time and competing corroborate these obstacles in other regions. 
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References
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 Suggestions to overcome these barriers include: ea SD xpe xpe
M y E y E • Axtell S., Haines S., Fairclough J. Effectiveness of Various
1. Use of demonstration devices and incorporating APPE students ac ac Methods of Teaching Proper Inhaler Technique. 2016.
 “I make it a point in my pharmacy to have the demo devices in my pharmacy. I’m lucky to have APPE students arm arm • Connolly M., Yohannes A. The impact of depression in older
Ph Ph patients with chronic obstructive pulmonary disease and
at my pharmacy at all times as well to help with counseling.” n SD
ea asthma. 2016; 0378-5122 (92): 9-14
2. Encouraging the use of spacers M
• Erickson SR, Horton A, Kirking DM. Assessing metered-dose
 “I actually have asthma. As a pharmacist I think I know what to do and how to do it. But a spacer was life inhaler technique: comparison of observation vs. patient self-
changing for me. Mastering the technique is really difficult, and if I as a pharmacist have a life changing report. J Asthma 1998;35(7):575–583.
experience with a spacer, I now encourage all patients to use them” • Fink JB, Rubin BK. Problems With Inhaler Use: A Call for
3. Setting patient expectations Improved Clinician and Patient Education. Respiratory Care.
 “After dispensing, telling them ‘I’m going to periodically review technique with you just to make sure you are 2005;50(10):1360-1375.
Disclosure: The authors have no conflict of interest to disclose. • Hanania NA., Wittman R., Kesten S., Chapman KR. Medical
getting the most benefit our of your inhaler, this is something I do with all my patients’ to make sure they don’t Contacts: Jeannie Lee, PharmD - jlee@pharmacy.arizona.edu personnel’s knowledge of and ability to use inhaling devices:
feel singled out” metered-dose inhalers, spacing chambers and breath-actuated
 “At refills, instead of asking people if they want to talk to the pharmacist, make it something that you just do, dry powder inhalers. Chest 1994;105(1):111–116.
part of your routine. Don’t even act like it’s an option”