Discussion Asthma care in general practice may be improved by a greater focus on prevention and control, including through follow-up after acute presentations, enhanced collaboration between GPs and ...PNs, and supportive practice models. in Australia, one in nine people reports having been diagnosed with asthma, with most asthma care delivered in general practice.12 However, opportunities to optimise the control of asthma are missed, including through poor adherence to asthma guidelines.3-5 Structural and knowledge barriers to asthma care delivered by general practitioners (GPs) have been identified, including time pressure, cost of spirometry and access to continuing medical education.4-6 Some of these barriers may be overcome by improving team care in asthma. Team work between GPs and practice nurses (PNs) enhances healthcare delivery; however, this can be impeded by a lack of clearly defined roles.78 Expanding the PN role may be challenged by the small business nature of Australian general practice and funding that does not support team care, and GPs not understanding PNs practice scope.910 To date, there has been little research examining GP and PN perspectives on delivering asthma care in general practice and how they could be supported to optimise management. The research team comprised GPs working in clinical practice and academic roles, and researchers with backgrounds in nursing, pharmacy, respiratory medicine and qualitative research. Participants were drawn from western Sydney, an area of high cultural diversity and pockets of social and economic disadvantage, where there is high use of general practice services.11 All interviews were conducted by the lead researcher, who had no prior affiliation with participants, over a period of three months in 2019.
Doctor of Philosophy
Excerpt Chapter 2 - A review of the literature has revealed that asthma management practices in the Australian community are currently suboptimal resulting in significant ...morbidity and mortality. In adolescent asthma there are added challenges, with problems of self-image, denial and non-adherence to therapy where self-management skills assume a greater importance (Forero et al 1996, Price 1996, Brook and Tepper 1997, Buston and Wood 2000, Kyngäs et al 2000). In rural and remote areas in Australia, asthma management practices have been shown to be poorer and mortality rates from asthma are considerably higher compared to metropolitan areas (AIHW ACAM 2005, AIHW 2006). Limited access and chronic shortages of specialist services in rural areas are shifting the burden more and more towards the primary sector (AIHW 2006). It becomes paramount that people with asthma in rural settings become involved in self-management of their asthma and that community based health care providers be more proactive in facilitating these self-management behaviours by appropriate education and counselling. Health promotion activities, which are a broad range of activities including health education, have been acknowledged as having the potential to improve the health status of rural populations (National Rural Health Alliance 2002). Community pharmacy settings have been shown to be effective sites for the delivery of health promotion, screening and education programs (Anderson 2000, Elliott et al 2002, Cote et al 2003, Hourihan et al 2003, Watson et al 2003, Boyle et al 2004, Goode et al 2004, Paluck et al 2004, Sunderland et al 2004, Chambers et al 2005, Saini et al 2006). In the case of asthma, outreach programs have been shown to have beneficial effects in terms of reducing hospital admissions and emergency visits and improved asthma outcomes (Greineder et al 1995, Stout et al 1998, Kelly et al 2000, Legorreta et al 2000, Lin et al 2004). We proposed to extend the role of the community pharmacist beyond the traditional realm of the “pharmacy” into the community in rural Australia with the first asthma outreach programs designed for community pharmacy. The outreach programs were designed to include two health promotion strategies, the first targeting adolescents in high schools and the second targeting the general community. The project aimed firstly, to assess the feasibility of using community pharmacists to deliver two asthma outreach programs, one targeting adolescents and one for the wider community in a rural area and secondly, to assess the programs’ impact on adolescent asthma knowledge and requests for information at the community pharmacy. Excerpt Chapter 3 - Patient education is one of the six critical elements to successful long-term asthma management included in international and national asthma management guidelines, which have emphasised education as a process underpinning the understanding associated with appropriate medication use, the need for regular review, and self-management on the part of the person with asthma (Boulet et al 1999, National Asthma Council 2002, National Asthma Education and Prevention Program 2002, British Thoracic Society 2003, NHLBI/WHO 2005). The ongoing process of asthma education is considered necessary for helping people with asthma gain the knowledge, skills, confidence and motivation to control their own asthma. Since most health care professionals are key providers of asthma education, their knowledge of asthma and asthma management practices often needs to be updated through continuing education. This is to ensure that the education provided to the patient conforms to best practice guidelines. Moreover, health care professionals need to tailor this education to the patients’ needs and determine if the education provided results in an improvement in asthma knowledge. A review of the literature has revealed that a number of questionnaires have been developed that assess the asthma knowledge of parents of children with asthma (Parcel et al 1980, Fitzclarence and Henry 1990, Brook et al 1993, Moosa and Henley 1997, Ho et al 2003), adults with asthma (Wigal et al 1993, Allen and Jones 1998, Allen et al 2000, Bertolotti et al 2001), children with asthma (Parcel et al 1980, Wade et al 1997), or the general public (Grant et al 1999). However, the existing asthma knowledge questionnaires have several limitations. The only validated asthma knowledge questionnaire was developed in 1990 and hence, out of date with current asthma management guidelines (Fitzclarence and Henry 1990). The shortcomings of the other knowledge questionnaires relate to the lack of evidence of the validity (Wade et al 1997, Grant et al 1999, Bertolotti et al 2001), being outdated 81 with current concepts of asthma (Parcel et al 1980) or having been tested on small or inadequately characterised subject samples e.g. subject samples consisting of mainly middle class and well educated parents (Brook et al 1993, Wigal et al 1993, Moosa and Henley 1997, Allen and Jones 1998, Allen et al 2000, Ho et al 2003). Furthermore, most of the published asthma knowledge questionnaires have been designed to assess the asthma knowledge of the consumer (i.e. a lay person with asthma or a parent/carer of a person with asthma). There is no questionnaire specifically developed to assess the asthma knowledge of health care professionals, who are key providers of asthma education. It is hence important to have a reliable and validated instrument to be able to assess education needs and to measure the impact of training programs on asthma knowledge of health care professionals as well. An asthma knowledge questionnaire for health care professionals might also be used to gauge how successful dissemination and implementation of guidelines have been. Excerpt Chapter 4 - Asthma self-management education for adults that includes information about asthma and self-management, self-monitoring, a written action plan and regular medical review has been shown to be effective in improving asthma outcomes (Gibson et al 1999). These interventions have been delivered mostly in a hospital setting and have utilised individual and/or group formats. Fewer interventions have been delivered in a primary care setting, usually by qualified practice nurses and/or general practitioners or asthma educators and, to date, their success has not been established (Fay et al 2002, Gibson et al 2003). Community pharmacy provides a strategic venue for the provision of patient education about asthma. Traditionally, patient education provided by community pharmacists has been individualised. However, group education has been shown to be as effective as individualised education with the added benefits of being simpler, more cost effective and better received by patients and educators (Wilson et al 1993, Wilson 1997). While small group education has been shown to improve asthma outcomes (Snyder et al 1987, Bailey et al 1990, Wilson et al 1993, Yoon et al 1993, Allen et al 1995, Kotses et al 1995, Berg et al 1997, de Oliveira et al 1999, Marabini et al 2002), to date, no small-group asthma education provided by pharmacists in the community pharmacy setting has been implemented and evaluated.
Issue addressed: Asthma awareness in a rural community and the involvement of the community pharmacist in proactive health promotion. Methods: Between September 2002 and May 2003, seven community ...pharmacists from Orange, a rural town in New South Wales, were trained to provide two asthma outreach programs: one targeting adolescents in high schools (Year 11 students) using Triple A training; and a public forum on asthma for the wider community. Results: There was a significant increase in the mean asthma knowledge scores of Year 11 students in each high school after Triple A training. From the multivariate analysis, although there was a significant increase in mean asthma knowledge scores over time (F=101.09, df=1, p<0.001), there were no differences between high schools (F=2.79, df=2, p>0.05). There was a significant increase in the proportion of asthma-related pharmacy visits involving requests for information on asthma and on asthma devices at the four different time points. Conclusions: The study provided a unique opportunity for community pharmacists to increase asthma awareness in a rural setting. The study demonstrated that it is feasible for rural community pharmacists to become involved in proactive health promotion and effectively provide asthma outreach programs. (author abstract)
Objectives (1) To investigate pharmacy students' perceptions of 10 occupations within the medical and allied professions: community pharmacists, dentists, dietitians, general medical practitioners ...(GPs), hospital pharmacists, medical specialists, nurses, occupational therapists, physiotherapists and social workers. (2) To explore students' perceptions of community and hospital pharmacists at different stages of a four‐year undergraduate programme and at the year of pre‐registration training.
Method A 90‐item questionnaire was administered to 543 pharmacy undergraduates and 95 graduates undergoing their pre‐registration year training in 2001.
Setting Faculty of Pharmacy, The University of Sydney, Australia.
Key findings Students perceived the health care professions along three major dimensions, relating to “empathy”, “potency” and “expertise”. On an empathy dimension, students rated community pharmacists the highest and medical specialists the lowest. On a potency dimension, students rated medical specialists the most powerful, community and hospital pharmacists significantly lower, and nurses the lowest. On an expertise dimension, students rated medical specialists the highest and dietitians the lowest. A significant pattern of differences was noted in students' perceptions and a possible decline was identified in the potency rating of pharmacists at different stages of the pharmacy programme.
Conclusion These differences may be attributed to the differences in the students' value systems, skills and experiences, the influence of reference groups and the content and structure of the educational and training programme in each year.
Issue addressed: Asthma awareness in a rural community and the involvement of the community pharmacist in proactive health promotion. Methods: Between September 2002 and May 2003, seven community ...pharmacists from Orange, a rural town in New South Wales, were trained to provide two asthma outreach programs: one targeting adolescents in high schools (Year 11 students) using Triple A training; and a public forum on asthma for the wider community. Results: There was a significant increase in the mean asthma knowledge scores of Year 11 students in each high school after Triple A training. From the multivariate analysis, although there was a significant increase in mean asthma knowledge scores over time (F=101.09, df=1, p<0.001), there were no differences between high schools (F=2.79, df=2, p>0.05). There was a significant increase in the proportion of asthma-related pharmacy visits involving requests for information on asthma and on asthma devices at the four different time points. Conclusions: The study provided a unique opportunity for community pharmacists to increase asthma awareness in a rural setting. The study demonstrated that it is feasible for rural community pharmacists to become involved in proactive health promotion and effectively provide asthma outreach programs. (author abstract)
