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Title: Pharmacists as the delivery channel for adherence support in asthma
Author: Mes, Marissa Ayano
ISNI:       0000 0004 8507 7110
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Non-adherence to inhaled corticosteroids remains a key challenge in asthma care in the United Kingdom (UK) - it increases healthcare costs, morbidity, and mortality. The growing pressure on UK primary care increased interest in pharmacists as a potential delivery channel for adherence support. However, research on UK pharmacist-led adherence support for asthma is limited. This thesis addresses the gap in the literature by examining the effectiveness of previous pharmacist-led interventions in improving adherence in adults with asthma (systematic review/meta-analysis, 11 studies), exploring the perspectives of UK pharmacists (online questionnaire, n = 127) and adults with asthma (qualitative study, n = 17) on pharmacist-led adherence support for asthma, and assessing the feasibility and acceptability of a new pharmacist-led adherence support intervention delivered to adults with asthma in general practice (before-and-after study, n = 31). Previous pharmacist-led interventions significantly improved adherence in adults with asthma (d = 0.49, 95% CI 0.35 - 0.64, p < 0.0001), with effective interventions addressing the ability and motivation to adhere to medication. UK pharmacists reported feeling most confident in and focusing mostly on patient education as adherence support (i.e. ability-related processes). Adults with asthma used their trust in other healthcare professionals (e.g. general practitioners) to gauge their trust in pharmacists. While they were open to pharmacist-led support due to gaps in existing asthma care, they were also concerned about pharmacist competency and role overlap with other healthcare professionals. The new pharmacist-led adherence intervention delivered in general practice demonstrated high acceptability among pharmacists and adults with asthma, but further work is needed to improve the feasibility of the study design. This research suggests that pharmacist-led adherence support is worth exploring further. With additional adherence-focused support/training for pharmacists and public awareness of pharmacist-led care, UK pharmacists may be able to make a valuable contribution to asthma care.
Supervisor: Horne, R. ; Taylor, S. J. C. ; Chan, A. H. Y. ; Wileman, V. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available