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. 2018 Jun 11:13:1863-1872.
doi: 10.2147/COPD.S163826. eCollection 2018.

Pharmacists' training to improve inhaler technique of patients with COPD in Vietnam

Tu-Son Nguyen  1   2 , Thi Lien Huong Nguyen  1 , Thi Thuy Van Pham  1 , Susan Hua  2 , Quy Chau Ngo  3 , Shu Chuen Li  2
Affiliations

Pharmacists' training to improve inhaler technique of patients with COPD in Vietnam

Tu-Son Nguyen et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Incorrect use of inhalers is very common and subsequently leads to poor control of COPD. Among health care providers, pharmacists are in the best position to educate patients about the correct use of inhaler devices.

Objective: The objective of this study was to evaluate the impact of pharmacist-led training on the improvement of inhaler technique for COPD patients in Vietnam.

Patients and methods: For this pre- and post-intervention study, standardized checklists of correct use of metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) were used to evaluate the inhaler technique. A scoring system (maximum score =8) was applied before and after training to guarantee assessment uniformity among pharmacists. Three methods including "face-to-face training", "teach-back" and "technique reminder label" were used. After the baseline evaluation (T0), the inhaler technique was reassessed after 1 month (T1), 3 months (T2), 6 months (T3) and 12 months (T4).

Results: A total of 211 COPD patients participated in the study. Before the training, a high rate of errors was recorded. After the training, the percentage of patients using MDIs and DPIs perfectly increased significantly (p<0.05). The mean technique score for MDIs and DPIs improved from 6.0 (T0) to 7.5 (T3) and 6.9 (T4) and 6.7 (T0) to 7.6 (T3) and 7.2 (T4), respectively (p<0.05). The average training time was 6 minutes (T0) and 3 minutes (T3), respectively.

Conclusion: Pharmacist-led comprehensive inhaler technique intervention program using an unbiased and simple scoring system can significantly improve the inhaler techniques in COPD patients. Our results indicated a 3-month period as the optimal time period between training and retraining for maintaining the correct inhaler technique. The training would be highly feasible and suitable for implementing in the clinical setting. Our model of pharmacist-led training should be considered as an effective solution for managing COPD patients and better utilization of health care human resources, especially in a developing country like Vietnam.

Keywords: MDI; Turbuhaler®; teaching and scoring methods; technique reminder label; technique score.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram for the time of assessing technique and dropout rates.
Figure 2
Figure 2
Comparison of the percentage of patients performing the correct inhaler technique over the study period. Notes: T0, baseline; T1, after 1 month; T2, after 3 months; T3, after 6 months and T4, after 12 months. p: p-value of the McNemar’s test determined the difference in the percentage of patients who performed the correct technique (all the correct steps) between time points T1, T2, T3, T4 and T0. Abbreviation: MDI, metered-dose inhaler.
Figure 3
Figure 3
Comparison of the mean technique score for MDI across the study period. Notes: T0, baseline; T1, after 1 month; T2, after 3 months; T3, after 6 months and T4, after 12 months. p: p-value of ANOVA and post hoc tests in comparison of the score between after the training (T1, T2, T3, T4) and before training (T0). Abbreviations: ANOVA, analysis of variance; MDI, metered-dose inhaler; SD, standard deviation.
Figure 4
Figure 4
Comparison of the mean technique score for Turbuhaler® across the study period. Notes: T0, baseline; T1, after 1 month; T2, after 3 months; T3, after 6 months and T4, after 12 months. p: p-value of ANOVA and post hoc tests in comparison of the score between T1, T2, T3, T4 and T0. Abbreviations: ANOVA, analysis of variance; SD, standard deviation.
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