A Pharmacist-Informed COPD Service for Delivery in Community Pharmacies

Abstract

Methods: This study used an explanatory sequential mixed methods design to understand community pharmacists' perspectives on providing interventions for patients with COPD. First, community pharmacists across Wisconsin were surveyed to understand their intentions to provide a selection of evidence-based interventions for COPD management. Responses to the Theory of Planned Behavior-informed survey were analyzed using descriptive statistics, correlation matrices, and multivariate linear regression. Second, a sample of survey participants were interviewed to understand how they are currently providing interventions for COPD management, how their ideal COPD service would look, and the materials and skills necessary to successfully implement the service. We conducted a deductive content analysis of interview transcripts within the context of the Knowledge-to-Action model. Finally, survey and interview results were synthesized to identify components and inform the development of the community pharmacy COPD service. Results: Surveys were completed by 34 practicing community pharmacists in Wisconsin. The surveyed pharmacists had moderate to high intentions to perform medication profile reviews, provide vaccination services, and educate on inhaler technique—intending to provide the intervention for 82.9%, 57.1%, and 50.3% of their patients with COPD, respectively. Perceived moral obligation, subjective norms, and having a private counseling space were significant predictors of intention for multiple interventions. Follow-up interviews were conducted with eight participants. Pharmacists described gaps for three of the five surveyed interventions: lacking the knowledge needed to discuss pulmonary rehabilitation, rarely assessing inhaler technique when dispensing refills, and discomfort initiating conversations on smoking cessation. Compensation for pharmacist-provided services and variation between types of community pharmacies were identified as important contextual features of this health care environment. Key barriers and facilitators to implementing COPD services in community pharmacies include reimbursement, staffing and time; physical space; demonstration resources; relationships with prescribers; technology; and reduced access to care in rural areas. Pharmacists described five essential components of their ideal community pharmacy COPD service as well as two possible interventions that should be explored further: (1) comprehensive medication review, (2) inhaler education, (3) adherence-related interventions, (4) smoking cessation consultation, (5) immunizations, (6) COPD symptoms assessment, and (7) discussions of pulmonary rehabilitation. Insights gained through integration revealed confirmation, expansion, and discordance between quantitative and qualitative findings. Conclusions: This study provided a deeper understanding of COPD management in community pharmacies and laid the groundwork for a comprehensive service that aligns with the expanding role of pharmacists in chronic disease management. The envisioned service, which will be iteratively developed in collaboration with community pharmacists, holds the potential to enhance accessibility to high-quality, personalized care for individuals with COPD, contributing to the broader landscape of patient-centered health care delivery.