The impact of pharmacist’s intervention in medication therapy management (MTM) program for asthma on clinical and disease outcomes of asthma.

Asthma patients recruited for the current trial belonging to the interventional group would undergo educational intervention. This educational intervention would be conducted at the patient counselling rooms in MTM clinics located within the premises of different hospitals. The registered licensed pharmacist (who would also be principal investigator) would conduct educational intervention that include personalized interview/ counselling session with the patient. Incase if patient has any disability or cognitive problem, the caretaker of patient would be provided counselling. The educational intervention would be individually given to patients and in person in medication therapy management clinics within district health quarters (DHQ) in Pakistan. This educational intervention will be divided in 3 sessions, with a total of 3 sessions of 30-40 minutes. The approximate time duration for each visit of patients was of 2-3 months, therefore, one module of intervention would be delivered to patient during each visit. During counselling sessions, the patient would be guided in three modules containing information regarding their disease, treatment protocols and procedures. Moreover, occupational therapy as well as the lifestyle modifications would be guided to the patient. The detail of each module included in the educational intervention is discussed below: The brief description of the educational intervention is as follows: First Module of Educational Intervention (Visit-1) The first module of educational intervention would provide following information to the patients: Basic description of Asthma (sign, symptoms, indications). Pharmacist will inquire about past medical, medication and family history for asthma, Pulmonary Function test (PFT) results, adherence history and inhaler technique of patient. Pharmacist will describe the therapeutic indications (Pulmonary Function test (PFT), Forced Expiratory Volume (FEV) etc) to patients, Detailed guidance regarding the prescribed asthma medications (corticosteroids, bronchodilators), the importance of adherence and compliance with the prescribed medication, the signs and symptoms of acute asthma attacks and asthma exacerbations, the importance of allergen testing, the importance of smoking cessation, occupational therapy for asthma and the necessary medications that should be available at home for acute asthma attacks. Patients would be instructed on the proper use of Peak flow meter to monitor peak expiratory flow (PEF) and maintain record in patient logbook. Afterwards, patients concerns and queries would be addressed. Second Module of Educational Intervention (Visit-2) The second module covers the following education for the patients: Educating patients regarding the prescribed drug therapy, possible trigger factors of asthma, measures for avoiding trigger factors and the benefits of avoiding allergens for prevention of asthma exacerbations. The precautions to be taken at home to avoid asthma exacerbations. The importance of anti-histamine medications uses in asthma, proper use of medications, the importance of steroids especially inhaled corticosteroids in asthma management, the proper usage technique of inhalers, the importance of nebulizing frequently, the proper usage technique of nebulizer that is being used by the patient. The importance of medication adherence, the adverse drug reactions (ADR) associated with the asthma medications would be described to patients (corticosteroids, beta agonists, Theophylline, Leukotriene, anti-histamines). Afterwards, patients concerns and queries would be addressed. Third Module of Educational Intervention (Visit-3) The third module covers the following education for the patients: Benefits of life style modifications, mild exercise (10-15 minutes of walk), improving diet intake especially including anti-inflammatory food items in diet, control of stress & anxiety, avoiding smoke, avoidance of environmental allergens (dust, pollens), the cons of having pets and birds at home, the incidence of cold/flu and its management at home. Furthermore, the detailed outline of asthma complications (Hypotension, Respiratory acidosis, Chronic airways inflammation, Sleep apnea, Pneumonia), their prevention, recognition and treatment would be guided to patients. Afterwards, patients concerns and queries would be addressed.