Closing the knowledge gap in Malaysian pharmacists: A virtual Allergic Rhinitis Boot Camp initiative

Baharudin Abdullah; Ramiza Ramza  Ramli; Norasnieda Md Shukri; Sakinah Mohamad

doi:10.4081/mrm.2021.775

Closing the knowledge gap in Malaysian pharmacists: A virtual Allergic Rhinitis Boot Camp initiative

Authors

Baharudin Abdullah Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan https://orcid.org/0000-0001-9138-9215
Ramiza Ramza Ramli Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan https://orcid.org/0000-0001-8196-321X
Norasnieda Md Shukri Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan https://orcid.org/0000-0003-2192-9751
Sakinah Mohamad Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan https://orcid.org/0000-0002-4388-5350

DOI: https://doi.org/10.4081/mrm.2021.775

Keywords:

Allergic rhinitis, ARIA, Boot camp, antihistamines, patient compliance, management

Abstract

Background: In primary care, general practitioners (GPs) and pharmacists are at the frontline to identify, classify and manage patients suffering from allergic rhinitis (AR). The Allergic Rhinitis and its impact on Asthma (ARIA) guidelines aid clinicians in disease management by providing evidence-based recommendations. A recently published ASEAN primary care survey demonstrated that the awareness of ARIA guidelines was high among GPs but notably lower in pharmacists. Hence, this study seeks to evaluate the effectiveness of a Boot Camp education initiative in bridging the unmet needs in pharmacist awareness and education.
Methods: The boot camp was organised as a virtual event. The participants answered the same questionnaire before (pre-assessment) and immediately after (post-assessment) the boot camp session. Statistical analysis was performed on the data paired between the pre- and post- assessments using SPSS v. 25.0 software.
Results: The boot camp survey results showed that second-generation oral antihistamines and allergen avoidance are the most preferred options for AR treatment in pharmacy practice, irrespective of the disease severity. In both pre- and post-assessments, efficacy was ranked as the most important factor considered for choosing an antihistamine and which affects patient adherence. With the boot camp initiative, there was a statistically significant increase in awareness about the patient profiling tool (from 31.6% to 88.2%) and ARIA guidelines (from 40.4% to 91.2%) among the pharmacists (p<0.05). The proportion of pharmacists who were able to identify, classify and refer AR patients was significantly increased in post-assessment (p<0.05). Post the boot camp, among the proportion of pharmacists (91.2%) who were already aware of ARIA, a high percentage of them further agreed that ARIA guidelines were useful in identifying and treating patients with AR, as well as classifying AR, respectively (97.6%, 95.2%, and 93.5%).
Conclusions: Based on improvements in knowledge and understanding of disease management post assessment, the Allergic Rhinitis Boot Camp initiative is effective and relevant to pharmacy practice. Outreach programs like this reiterate the emphasis on patient compliance and importance of utilizing ARIA guidelines in pharmacy practice that facilitates better management of AR in primary care.

References

Pawankar R, Bunnag C, Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA Update 2008. World Allergy Organ J 2012;5:S212-7.

Tong MCF, Lin JSC. Epidemiology of allergic rhinitis throughout the world. In: Akdis CA, Hellings PW, Agache I, editors. EAACI Global atlas of allergic rhinitis and chronic rhinosinusitis. Zurich: European Academy of Allergy and Clinical Immunology; 2015. p. 62-3.

Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. WAO White Book on Allergy: Update 2013, Executive Summary. World Allergy Organization; 2013.

Katelaris CH, Lai CK, Rhee CS, Lee SH, Yun WD, Lim-Varona L, et al. Nasal allergies in the Asian-Pacific population: results from the allergies in Asia-Pacific survey. Am J Rhinol Allergy 2011;25:S3-15.

Bjorksten B, Clayton T, Ellwood P, Stewart A, Strachan D, Group IPIS. Worldwide time trends for symptoms of rhinitis and conjunctivitis: Phase III of the International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol 2008;19:110-24.

Wang DY, Chan A, Smith JD. Management of allergic rhinitis: a common part of practice in primary care clinics. Allergy 2004;59:315-9.

Shi L. The impact of primary care: a focused review. Scientifica (Cairo) 2012;2012:432892.

Baharudin A, Abdul Latiff AH, Woo K, Yap FB, Tang IP, Leong KF, et al. Using patient profiles to guide the choice of antihistamines in the primary care setting in malaysia: Expert Consensus and Recommendations. Ther Clin Risk Manag 2019;15:1267-75.

Greer N, Bolduc J, Geurkink E, Rector T, Olson K, Koeller E, et al. Pharmacist-led chronic disease management: A systematic review of effectiveness and harms compared with usual care. Ann Intern Med 2016;165:30-40.

George PP, Molina JA, Cheah J, Chan SC, Lim BP. The evolving role of the community pharmacist in chronic disease management - a literature review. Ann Acad Med Singap 2010;39:861-7.

Castillo D, Burgos F, Gascon MP. The role of community pharmacies in respiratory disease control. Arch Bronconeumol 2015;51:429-30.

Tan R, Cvetkovski B, Kritikos V, Yan K, Price D, Smith P, et al. Management of allergic rhinitis in the community pharmacy: identifying the reasons behind medication self-selection. Pharm Pract (Granada) 2018;16:1332.

May JR, Dolen WK. Management of allergic rhinitis: A review for the community pharmacist. Clin Ther 2017;39:2410-9.

Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63:S8-160.

Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 2017;140:950-8.

Bousquet J, Lund VJ, van Cauwenberge P, Bremard-Oury C, Mounedji N, Stevens MT, et al. Implementation of guidelines for seasonal allergic rhinitis: a randomized controlled trial. Allergy 2003;58:733-41.

Prepageran N, Wang de Y, Nair G, Maurer M. The status quo and unmet needs in the management of allergic rhinitis and chronic rhinosinusitis: a Malaysian perspective. Asia Pac Allergy 2014;4:142-8.

Canonica GW, Triggiani M, Senna G. 360 degree perspective on allergic rhinitis management in Italy: a survey of GPs, pharmacists and patients. Clin Mol Allergy 2015;13:25.

Koberlein J, Vent J, Mosges R. On the sustainability of guideline implementation. World Allergy Organ J 2010;3:258-61.

Abdullah B, Snidvongs K, Recto M, Poerbonegoro NL, Wang Y. Primary care management of allergic rhinitis: a cross-sectional study in four ASEAN countries. Multidiscip Respir Med 2020;15:726.

Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010;126:466-76.

Navarro-Locsin CG, Romualdez JA. Attitudes, practices on allergic rhinitis of generalists and specialists in Philippine National Capital Region. Asia Pac Allergy 2015;5:203-9.

Leynaert B, Neukirch C, Liard R, Bousquet J, Neukirch F. Quality of life in allergic rhinitis and asthma. A population-based study of young adults. Am J Respir Crit Care Med 2000;162:1391-6.

Ponnusankar S, Surulivelrajan M, Anandamoorthy N, Suresh B. Assessment of impact of medication counseling on patients' medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns 2004;54:55-60.