Development And Evaluation Of The Home Pharmacy Asthma Care (Hom-Pac) Programme Among Adult Patients With Asthma From Kulim Hospital, Kedah, Malaysia

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dc.contributor.authorRamadoo@Devudu, Jaya Muneswarao
dc.date.accessioned2022-03-16T06:50:58Z
dc.date.available2022-03-16T06:50:58Z
dc.date.issued2021-05
dc.description.abstractAsthma control among adult patients in Malaysia is unsatisfactory. Several guidelines have recommended home care interventions as part of asthma management strategies. The evidence of home-based care in improving asthma outcomes is well established in the paediatric population but limited among adults. To date, there are no published studies that evaluated the effectiveness of pharmacist-led home care interventions, specifically in adult asthma patients. The Home Pharmacy Asthma Care (HOM-PAC) programme was developed to enable pharmacists to provide comprehensive home-based care for adult asthma patients. Therefore, the present study aimed to develop and evaluate the effectiveness of the HOM-PAC programme in patients with asthma. A two-arm, 6-month, open-label, parallel-group, randomised controlled trial (RCT) was conducted. Patients with uncontrolled asthma symptoms were recruited from the adult respiratory clinic of Kulim Hospital, Kedah. The patients were assigned to either the intervention (HOM-PAC programme) or control (usual care) groups based on a pre-generated random list. A total of three visits (3 months apart) were planned for patients in the intervention group. The patients in the control group did not receive the HOM-PAC intervention and continued their regular clinic follow-ups. Fifty-one patients in the intervention group and 54 patients in the control group completed the study and were included in the final analysis. The symptom score based on Asthma Control Test (ACT) was significantly higher in the intervention group (median 22, IQR 4) compared with the control group (median 19, IQR 2); p <0.001. The proportion of patients who achieved minimal important difference in ACT score was significantly higher in the intervention group (n = 33, 64.7%), compared with the control group (n = 8, 14.8%); p <0.001. The proportion of patients in the intervention group that made at least one “overall” (critical and non-critical) inhaler technique error was significantly lower (p <0.05). Similarly, significantly fewer patients in the intervention group (n = 14, 27.5%) made at least one “critical” inhaler technique error compared with the patients in the control group (n = 35, 64.8%); p <0.001. A higher number of patients in the intervention group achieved optimal inspiratory flow rates for their controller inhaler devices (p <0.05). The patients in the intervention group also had significantly higher medication adherence score (based on adherence questionnaire) towards their controller inhalers (median 49.0, IQR 5) compared with the control group (median 45, IQR 7.3); p <0.01. The proportion of patients categorised as adherent to their controller inhalers was significantly higher in the intervention group (p <0.05). The patients in the intervention group also had significantly higher written asthma action plan ownership (p <0.01) and asthma knowledge (p <0.05). The within-group analysis reported that the patients in the intervention group had significant improvements in home inhaler management in terms of inhaler stock, storage, and expiry (p <0.05). However, there were no significant differences in asthma exacerbations and peak expiratory flow rates between the study groups. In conclusion, the HOM-PAC programme can serve as an additional intervention complementing the existing healthcare system to improve outcomes among adult patients with asthma.en_US
dc.identifier.urihttp://hdl.handle.net/123456789/14897
dc.language.isoenen_US
dc.publisherUniversiti Sains Malaysiaen_US
dc.subjectPharmacyen_US
dc.titleDevelopment And Evaluation Of The Home Pharmacy Asthma Care (Hom-Pac) Programme Among Adult Patients With Asthma From Kulim Hospital, Kedah, Malaysiaen_US
dc.typeThesisen_US
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