A systematic review and meta-analysis of the impact of collaborative practice between community pharmacist and general practitioner on asthma management

Journal of Asthma and Allergy Dovepress open access to scientific and medical research Journal of Asthma and Allergy downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-Oct-2019 For personal use only. Open Access Full Text Article A systematic review and meta-analysis of the impact of collaborative practice between community pharmacist and general practitioner on asthma management This article was published in the following Dove Press journal: Journal of Asthma and Allergy Naeem Mubarak 1,2 Ernieda Hatah 3 Tahir Mehmood Khan 4 Che Suraya Zin 1 1 Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Kuantan, Malaysia; 2Lahore Pharmacy College, Lahore Medical & Dental College, University of Health Sciences, Lahore, Pakistan; 3Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 4Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan Correspondence: Che Suraya Zin Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Universiti Islam Antarabangsa Malaysia Kampus Kuantan, Pahang Darul Makmur, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan, Pahang 25200, Malaysia Tel +60 111 488 1605 Email Naeem Mubarak Lahore Pharmacy College, Lahore Medical & Dental College, University of Health Sciences, Lahore, North Tulspura, Canal Bank Road, Lahore 54000, Pakistan Tel +92 333 555 3729 Email Objective: This systematic review aims to investigate the impact of collaborative practice between community pharmacist (CP) and general practitioner (GP) in asthma management. Methods: A systematic search was performed across 10 databases (PubMed, Medline/Ovid, CINAHL, Scopus, Web of Science, Cochrane central register of controlled trials, PsycARTICLES®, Science Direct, Education Resource Information Centre, PRO-Quest), and grey literature using selected MeSH and key words, such as “community pharmacist”, “general practitioner”, and “medicine use review”. The risk of bias of the included studies was assessed by Cochrane risk of bias tool. All studies reporting any of the clinical, humanistic, and economical outcomes using collaborative practice between CPs and GPs in management of asthma, such as CPs conducting medications reviews, patient referrals or providing education and counseling, were included. Results: A total of 23 studies (six RCTs, four C-RCT, three controlled interventions, seven pre– post, and three case control) were included. In total, 11/14 outcomes were concluded in favor of CP-GP collaborative interventions with different magnitude of effect size. Outcomes, such as asthma severity, asthma control, asthma symptoms, PEFR, SABA usage, hospital visit, adherence, and quality of life (QoL) (Asthma Quality-of-Life Questionnaire [AQLQ]; Living with Asthma Questionnaire [LWAQ]) demonstrated a small effect size (d≥0.2), while inhalation technique, ED visit, and asthma knowledge witnessed medium effect sizes (ES) (d≥0.5). In addition to that, inhalation technique yielded large ES (d≥0.8) in RCTs subgroup analysis. However, three outcomes, FEV, corticosteroids usage, and preventer-to-reliever ratio, did not hold significant ES (d<0.2) and, thus, remain inconclusive. The collaboration was shown to be value for money in the economic studies in narrative synthesis, however, the limited number of studies hinder pooling of data in meta-analysis. Conclusion: The findings from this review established a comprehensive evidence base in support of the positive impact of collaborative practice between CP and GP in the management of asthma. Keywords: community pharmacist, general practitioner, inter-professional collaboration, asthma, collaborative care, clinical outcomes Introduction Among the four major groups of chronic diseases, chronic respiratory diseases have the second highest estimated economic burden for 2011–2025 (US$ 1.59 trillion) and are responsible for 15% of deaths in the world.1 Chronic respiratory diseases affect air passages and associated structures of lungs, which lead to either airways’ 109 submit your manuscript | www.dovepress.com Journal of Asthma and Allergy 2019:12 109–153 DovePress © 2019 Mubarak et al. This work is published and licensed by Dove Medical Press Limited. 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Examples of chronic respiratory diseases, which are in the headlines for global mortality and morbidity, include asthma, chronic obstructive pulmonary disease, pulmonary hypertension, and occupational lung disease. Asthma is defined as a “heterogenous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms, such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation”.2 In low- and middle-income countries, asthma is comparatively more pervasive than any other chronic respiratory disease, and is a prime mover of mortality and disability in all age and gender groups, especially children. In 2015 alone, the death toll due to asthma was 383,000 globally.1,3,4 It is recommended that every country should make updated strategies for efficient diagnosis and medicine management of asthma with an emphasis on capacity building of health professionals. The capacity building may include reinforcing the role of potential healthcare professionals and strengthening the integration of community and primary healthcare by finding innovative ways and new horizons for collaborative efforts and actions.1,2,5,6 Effective management of asthma heavily depends on the strategy of medication management to improve adherence and to avoid any medication misadventure. This management of medication is essential, since the patient is taking medications long-term on a daily basis and there are many groups of medications involved in asthma management, such as short acting beta agonist (SABA), long acting beta agonist (LABA), and inhaled steroids. Involvement of general practitioner in management of asthma General practitioners (GPs) have generally been involved in asthma management in primary care. However, some studies reported s (...truncated)