Riding a Perfect Storm to Improve Asthma Outcomes

July 19, 2012

Mona G. Tsoukleris, PharmD, MS

It seems that a perfect storm is brewing. If you look up the term, most definitions equate "perfect storm" with disaster or refer to it with negative connotations. Wikipedia refers to it as describing "an actual phenomenon that happens to occur in such a confluence resulting in an event of unusual magnitude" (1). Pharmacy may have a perfect storm brewing "“ but in the positive sense. Pharmacy could ride (or better yet, drive) a series of recent events to improve our patients' outcomes, especially those with asthma, and create a paradigm shift in the practice of community pharmacy.

Pharmacists received mention in the Affordable Healthcare Act and our importance was strongly reinforced in a recent report from the U.S. Surgeon General (2). This report identifies the readiness of pharmacists for better integration into the health care team in the face of health care reform. It also advocates for movement toward facilitating compensation through actions such as recognition as health care providers under the Social Security Act. It also refers to the need for policy and legislation supporting compensation so that these services can be sustained and further advanced when shown to improve health care. Having these facts disseminated at such a high level in the U.S. health care system is monumental. Although the Surgeon General's report and the ACA focus on primary care roles of pharmacists such as within the medical home, community pharmacists are so accessible that they are probably the most underutilized in the profession.

In late May 2012, the U.S. Department of Health and Human Services announced the Coordinated Federal Action Plan to reduce asthma disparities (3). This Obama administration initiative attempts to coordinate the efforts of 16 different federal agencies involved in addressing asthma disparities. It recognizes the importance of collaboration between health care providers as well as community involvement in addressing asthma disparities. The initiative calls for identification and targeting of services to individuals disproportionately affected by asthma, reduction of barriers to asthma care, and improvement of the capacity of community-based asthma health care. Community pharmacists are well positioned to influence each of these.

Since asthma is one of the most common diseases affecting children and affects almost 26 million people in the United States alone, we have a unique opportunity to improve the health of large numbers of patients. Despite the passing of over two decades since the first release of the NIH Guidelines for the Diagnosis and Management of Asthma and approval of many new medications and drug delivery devices, asthma control rates remain exceedingly low. Evidence from the CHOICE survey (4) reveals that only about 50% of patients with asthma were receiving controller medication and of those, only 14% were considered to be well controlled.

One contributor to poor asthma outcomes is low adherence, including inability to use inhalers properly, resulting in little to no drug delivery. Inhalers are notoriously difficult to use and much research has demonstrated that health care professionals are often also woefully unprepared to provide counseling so desperately needed by patients. Adding to the problem is the ever-increasing number of inhalers reaching the market, making it difficult to maintain competency to educate accurately. The NIH expert panel has recommended that inhaler technique be assessed at each visit. Pharmacists not only dispense these devices, but are also the most accessible health care providers. As such, given our training as "drug experts" we are in a unique, yet underutilized position to positively affect asthma outcomes in the communities we serve. Patients also continue to highly respect pharmacists as we ranked second among professionals Gallup's 2011 annual Honesty and Ethics survey (5).

Pharmacists have the opportunity to play an important role in asthma care initiatives, ensuring that patients receive asthma medications they can use properly and result in asthma control. In 2012, we are making progress, but more needs to occur. About 17 years ago, NIH issued a publication advocating for the roles of the pharmacist in asthma care. We have yet to see universal adoption of these potential roles in pharmacy. This is a challenge to pharmacists, especially to community pharmacists. If you are not yet providing services to improve the outcomes of your patients with asthma, get involved now. The timing is right. Let's drive the "perfect storm" to create a paradigm shift in the practice of community pharmacy to better serve our patients.

Mona Tsoukleris, PharmD, MS

(1) http://en.wikipedia.org/wiki/Perfect_storm
(2) http://www.usphs.gov/corpslinks/pharmacy/documents/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf
(3) http://www.hhs.gov/news/press/2012pres/05/20120531c.html
(4) Colice GL et al. The CHOICE survey: high rates of persistent and uncontrolled asthma in the United States. Annals of Allergy, Asthma & Immunology 2012;108(3):157-162.
(5) http://www.gallup.com/poll/151460/Record-Rate-Honesty-Ethics-Members-Congress-Low.aspx