Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model

International Journal of Chronic Obstructive Pulmonary Disease Dovepress open access to scientific and medical research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 05-Sep-2020 For personal use only. Open Access Full Text Article REVIEW Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model This article was published in the following Dove Press journal: International Journal of Chronic Obstructive Pulmonary Disease Yuqi Hu Dongning Yao Carolina Oi Lam Ung Hao Hu State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, People’s Republic of China Purpose: This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management. Methods: A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized. Results: Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socio-economic aspects were also identified. Conclusion: Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management. Keywords: community pharmacy, community pharmacist, chronic obstructive pulmonary disease, COPD, systematic review, logic model Introduction Correspondence: Carolina Oi Lam Ung; Hao Hu State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, N22-2057, Taipa, Macau. People’s Republic of China Tel +853 88228538 Email ; submit your manuscript | www.dovepress.com DovePress http://doi.org/10.2147/COPD.S254477 Powered by TCPDF (www.tcpdf.org) Chronic obstructive pulmonary disease (COPD) has been a major challenge in the field of public health worldwide because of its high morbidity and mortality rates. In 2012, more than 3 million people worldwide died of this disease and its complications, and it is expected to be the third leading cause of death by 2030.1 COPD cannot be cured, as a chronic progressive disease, but it can be controlled at a relatively stable stage after effective treatment.2 However, most patients with COPD cannot control the progress of the disease effectively. One of the key reasons for this is that patients face many International Journal of Chronic Obstructive Pulmonary Disease 2020:15 1863–1875 1863 © 2020 Hu et al. This work is published and licensed by Dove Medical Press Limited. 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Hu et al medication-related problems, including low medication adherence rates,3,4 inability to use inhaler devices correctly,5 and failure to take medication properly.6 The medicationrelated issues that COPD patients face and the consistent care that they need to manage their chronic conditions highlight the importance of the professional role of pharmacists.7 The responsibility of the pharmacist is no longer simple drug-adjustment work, but has been expanded to become patient-centric diversified health management.8,9 The situation is particularly prominent in COPD, in which the roles of pharmacist had been expanded to encompass prevention, screening potential patients, disease counselling, comprehensive disease management, and education.10–12 Studies have demonstrated that COPD patients benefit from multifactorial intervention by clinical pharmacists, including improvement of their COPD knowledge, medication adherence, and quality of life; and decreases in the hospitalization rate and exacerbations.13,14 However, a thorough understanding of the role of community pharmacists in COPD management is comparatively scarce. Being positioned as the first point of contact with the healthcare service and medical experts, community pharmacists are uniquely placed to help manage each stage of COPD.15–18 However, the components of professional services provided by community pharmacists for COPD patients, health-related outcomes from community pharmacist interventions, and the impact of contextual factors vary in the existing literature.19 There is a need to comprehensively review and summarize community pharmacists’ contribution to COPD management into a theoretical structure to guide the planning and implementation of community pharmacist’s’ professional services for COPD patients in community settings. Thus, the aim of this research was to identify and analyse the professional services provided by community pharmacists for patients with COPD, the outcomes of such services, and contextual factors affecting the practice, using a systematic literature review guided by the logic modelling approach. It is expected that the findings could help to g (...truncated)