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. 2023 Oct 5:12:100340.
doi: 10.1016/j.rcsop.2023.100340. eCollection 2023 Dec.

The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy

Rachel House  1   2 , Vicky Kritikos  1 , Biljana Cvetkovski  1   2 , Janet Rimmer  2   3 , Kwok Yan  1   4 , Lynn Cheong  5 , Jean Bousquet  6 , Olga Lourenco  7 , Sinthia Bosnic-Anticevich  1   2
Affiliations

The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacy

Rachel House et al. Explor Res Clin Soc Pharm. .

Abstract

Background: The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR.

Objectives: To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy.

Methods: This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively.

Results: Six pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR.

Conclusions: While there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.

Keywords: Allergic rhinitis; Community pharmacy; Guideline; Pharmacist; Self-select; Suboptimal management.

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Conflict of interest statement

RH, BC, LC, OL declare no conflict of interest. VK has received honoraria from AstraZeneca, GlaxoSmithKline and Pfizer. JR declares no conflict of interest, has received sponsorship from GlaxoSmithKline, AstraZeneca, Sanofi, Stallergenes. KY has received honoraria for speaking and consulting from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Meda, Mundipharma and Pfizer. JB reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi- Aventis, Takeda, Teva, Uriach, other from KYomed-Innov, outside the submitted work. SBA is a member of the Teva Pharmaceuticals Devices International Key Experts Panel, has received research support from Research in Real Life, has received lecture fees and payment for developing educational presentations from Teva, GlaxoSmithKline, AstraZeneca and Mundipharma; and has received Honoria from AstraZeneca, 10.13039/100001003Boehringer Ingelheim, GlaxoSmithKline, for her contribution to advisory boards/key international expert forum.

Figures

Fig. 1
Fig. 1
Study design and data collection
Fig. 2
Fig. 2
Flow chart of survey response rates for pre-and-post-AR-CMaP.
Fig. 3
Fig. 3
Appropriateness of medication purchased by people with AR pre AR-CMaP (n=205)* and post-AR-CMaP (n=210).*one patient was using steroid tablets therefore the appropriateness of treatments could not be determined.
See this image and copyright information in PMC

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