Transcript OClin 2 - Global Knowledge

Effectiveness of
Counselling for
Asthmatic Children in
Hospital Melaka
By Ng Wang Sing
Hospital Melaka
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INTRODUCTION
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INTRODUCTION
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Paediatric asthma is a major global health
problem (von Mutius 2000).
Asthma can impair the child’s ability to enjoy
and participate in activities and affect sleep
patterns and academic (Lenney et al. 1994).
A local study found 13.8% of primary school
children in Kuala Lumpur to be asthmatic (CPG
KKM - 2002).
Many factors are involved in achieving good
control of asthma.
i) Non pharmacological
ii) Pharmacological
von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82(suppl II):ii2-ii5.
Lenney W, Wils NEJ, O’Neill BA. The burden of paediatric asthma. Eur Respir Rev
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1994;4:49-62.
INTRODUCTION
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Patient might need to carry out complex
medication plans, initiate home
environmental changes and monitor asthma
symptoms.
Patient education for asthma selfmanagement is effective in improving
asthma control (Gibbson et al. 2002).
The role of pharmacists in patient education
and evaluation of therapy is taking on more
relevance everyday.
Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P et al. Self-management
education and regular practitioner review for adults with asthma. Cochrane Database
Syst Rev
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2002;CD001117.
AIM & OBJECTIVES
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AIM & OBJECTIVES
AIMS
To study the effectiveness of counseling by Pharmacist on
Asthmatic children.
OBJECTIVES
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To determine the outcome of asthmatic children in terms of
improvement in symptoms
To determine the improvement of inhaler technique post
counselling sessions.
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METHODOLOGY
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METHODOLOGY
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This is a prospective analytical study from June
2006 – 31 October 2006 .
Inclusion criteria:
Children with stable and moderate asthma
Age of the patient: 1 to 15 years old
Exclusion criteria:
Children have illness other than asthma
Newly diagnosed asthma
Patients who refused to participate in this study
An oral informed consent had been obtained from
care givers.
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METHODOLOGY
Interventions:
 Modified Asthma Control Test (ACT) questionnaires was used to
measure the asthmatic control.
 Consists of 5 questions:
1. Limitation of physical activities due to asthma.
2. Day time asthmatic symptoms
3. Nocturnal cough
4. Frequency of using nebulizer or bronchodilator
5. Perception of parents towards the control of asthma of their
children.
 Scores on each item can range from 1 to 5 (1: maximum
impairment & 5: no impairment).
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METHODOLOGY
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At admission to the programme, the questionnaire
was administered by caregivers.
The technique of using easyhaler of patients who
were on easyhaler was assessed.
The child and caregivers received an explanatory
booklet during counselling session.
The pharmacist and children with their parents
scheduled a visit for 4 weeks and 8 weeks later.
For subsequent visit, same questionnaire was
administered by caregiver and technique of using
easyhaler was assessed.
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DEFINITION OF COUNSELING
1.
2.
3.
4.
5.
Basic facts about
asthma
Roles of
Medications
Skills
Environmental
control measure
When and How to
take rescue
action
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METHODOLOGY
Data analysis:
 The statistical analysis of data was done using
the Statistical Package for Social Sciences for
Windows (SPSS) version 12.0.
 Comparisons of asthmatic symptoms were
made between pre-intervention status
(baseline) and post-intervention status (4
weeks and 8 weeks).
 Data was analyzed using McNemar test for
repeated measures.
 P values of 0.05 or less were considered
statistical significant.
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ALGORITHM
Identify Asthmatic patients in clinic
Take patient baseline information
(Questionnaire 1 given)
Counselling by Pharmacist
TCA first month
(Questionnaire 2 given)
TCA second month
(Questionnaire 3 given )
Continue follow-up
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RESULT
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CHARACTERISTICS OF PATIENTS
Gender of Patients
23 (72%)
9 (28%)
Male
Female
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CHARACTERISTICS OF PATIENTS
Races of Patient
5 (16%)
3 (9%)
24 (75%)
Malay
Chinese
Indian
Majority of patients are Malay, followed by
the Indian and Chinese
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Types of Medications
Number of patient
20
3
15
10
15
13
5
1
0
Easyhaler
MDI + aerochamber
Types of Inhaler
Beclomethasone + salbutamol + salmeterol
Beclomethasone and salbutamol
Salbutamol only
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RESULTS: CONTROL OF ASTHMA
SYMPTOMS
Number of Patients
35
32
32
32
p=0.549
30
25
25
20
p=0.109
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19
13
15
10
7
10
5
0
ACT 1
ACT 2
ACT 3
Asthma Control Test (ACT)
Sample of Patient
Good Control
Poor Control
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RESULTS:TECHNIQUE OF USING
EASYHALER
13
14
Number of patient
15
15
16
12
10
8
6
4
2
1
2
1
1
0
0
0
Baseline
Good
Follow-up 1
Moderate
Followup 2
Poor
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DISCUSSION
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DISCUSSION
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Structured counselling by pharmacist can improve
the asthmatic control of some patients.
Counselling may improve the awareness about
asthma, inform them about medication and
improve patients’ attitude.
Using medicines without being aware of
fundamental facts about the treatment may lead to
mistakes or non-compliance.
Regular and repeated guidance by pharmacists
and physicians is important to be ensure patient is
coping with treatment (Närhi et al. 2001).
Närhi U, Airaksinen M, Tanskanen P, Enlund H. The effects of a pharmacy-based
intervention on the knowledge and attitudes of asthma patients. Patient Educ Couns
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2001;43:171-177.
DISCUSSION
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The pharmacists identified any drug therapy
problems.
The pharmacist gave recommendations
about the correct use of inhalers and
reinforced the indications of medicines.
The education and intervention seem to be
important because patient and caregivers
often ignore or fail to remember instruction
given by physician.
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LIMITATIONS
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Small convenience sample with no
control group limits generalization and
interpretation of the results.
Asthma control was reported by care
givers but not patient themselves.
Selection bias
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CONCLUSION
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Proper counseling helps to achieve good
control of disease in asthmatic children.
It is useful in clarifying many myths and
mistaken concepts about drug therapy
and disease.
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THANK YOU