Breakout Session 2B : Evaluation and Management of Patients with Uncontrolled Asthma - PowerPoint Presentation

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Breakout Session 2B:Evaluation and Management of Patients with Uncontrolled Asthma

Steven Chen, PharmD

Associate Dean for Clinical Affairs, USC School of Pharmacy

Keith

Funjinaga

, PharmD

Director of Pharmacy, Inland Behavioral and Health Services

FRAMING AND PURPOSE

The intent of this session is to apply Comprehensive Medication Management to patients with uncontrolled asthma, leading to safe and rapid control

WHAT YOU WILL HEAR…

Evaluation of the asthma patient

Testing

Assessment

Plan for rapid control

Asthma Action Plan

WHO’S IN THE ROOM?Health system leaders

Health plans leaders

Quality improvement experts

Pharmaceutical industry

Pharmacy technicians

Physicians

Nurses

Community-based pharmacists

Ambulatory care pharmacists

Other

Commit to providing a comprehensive assessment of your asthma patient at every visit, not assuming that previously mastered knowledge / skills persist.

Asthma exacerbation = treatment failure

Patients with asthma who understand the underlying cause of asthma, the role their medications play, the use of devices, and receive an asthma action plan will markedly reduce risk of exacerbations.

Asthma Control can be achieved in 4 visits.

REQUEST

ASSERTIONS

Breakout Format

Review of materials / resources

Pair up: PharmD and “patient”

PharmD conducts CMM evaluation

Reconvene: What went well? What was challenging? Did you identify and resolve key medication-related problems?

Introduction

Introduce yourself as Dr. ­­­______________, clarify that you're a Doctor of Pharmacy / Advanced Practice Pharmacist / Student Pharmacist and the purpose of the visit (reason patient was referred / self-referred and “…to make sure your medications are working the best for you while avoiding side effects and other problems”)

Assessment of knowledge and top concerns of patient

High-level evaluation of your patient’s disease state knowledge and primary concerns

Avoid sounding like interrogating, questioning competency

“Can you tell me what you’ve been told about your asthma?

“How are you doing with your asthma?“

“What goals do you have for treating your asthma?”

“Do you have any worries or concerns about asthma?”

Assessment of knowledge and top concerns of patient

Sample questions to avoid:

“What do you know about asthma?”

“Are you aware that your asthma is in really bad shape?“

“Don’t you want to get your asthma under full control?

“Aren’t you worried about what uncontrolled asthma can do to you

?”

Respond to patients concernsWith permission, provide supplemental and accurate informationAim for engagement (taking personal interest) and activation (motivated to take action) using Motivational Interviewing techniques whenever possible

Asthma Symptom Evaluation

In the past 4 weeks…

“How many times per week did you have asthma symptoms (cough, wheeze, chest tightness, shortness of breath) in the DAYTIME?” (>2)

“How many times did you wake due to asthma at NIGHT?” (Any)

“How many times did you need your rescue inhaler each week?”(>2)

“Does asthma prevent you from participating in any activities?” (Y)

Sx

Control

:

0 = Well-controlled1-2 = Partly Controlled3-4 = Uncontrolled

Asthma Evaluation

Acute care utilization

Self-monitoring: Peak flow levels (dates, times, values), rescue inhaler diary if available

Self-care: Do habits compliment medications?

Nutrition

Exercise

Weight management needs

Smoking

Asthma Evaluation

“What triggers / sets off your asthma symptoms?”

Inquire about risk factors if not documented, e.g., GERD, allergic rhinitis, anxiety, depression, NSAIDs

Confirm diagnosis: Did the patient have asthma as a child? Is the patient at risk for COPD (e.g., smoking history, age)?

Asthma Medication Evaluation

Evaluate all medications (

including Rx, OTC, supplements, herbals

):

“Can you tell me what you were told about the purpose of (medication)?”

“How do you take it (when, with food,

etc

)?”

“Did you take your medication today / last night (latest dose)? Do you ever forget or skip taking it? How often? Is it just because you forget, or is there another reason?”

“Do you have any problems or concerns with any of your medications?”Screen for common side effectsHave patient demonstrate use of all devices Are test results available to ensure all medications are being used safely & effectively?Are all medications evaluated for appropriateness and effectiveness (selection, dosing), safety (given other meds and comorbidities), and ability for patient to take / use as directed (dexterity, administration, access / affordability)?

Asthma Management Approach:

E.S.C.APE in 4 Visits

E

:

Evaluate

& correct asthma knowledge and use of medications, step up treatment if needed (2-7 days after exacerbation, otherwise 1-2

wks

)

S

: Step-up meds (add or increase doses), manage triggers (2-4 wks)C: Continue dose titration, reinforce proper use of devices (2-4 wks)APE: Action Plan Established based on personal best peak flow when stable https://ginasthma.org/wp-content/uploads/2019/01/GINA-Implementation-Toolbox-2019.pdf

Breakout Format

Review of materials / resources

Pair up: PharmD and “patient”

PharmD conducts CMM evaluation

Breakout Format

Review of materials / resources

Pair up: PharmD and “patient”

PharmD conducts CMM evaluation

Reconvene: What went well? What was challenging? Did you identify and resolve key medication-related problems?

E.S.C.APE in 4:

Evaluate

Step-up

Continue

Action Plan Established

Motivate, engage, education (devices!), activate

Check-in every 3-6 months, even when under control

Asthma Breakout Takeaways