Desarrollo de la práctica

A final theme of motivation was ways in which pharmacists continue to be motivated to provide their asthma education programmes to the community.

Subtheme 1: Improvements

Pharmacists from Pharmacy A were encouraged by the improvements their patients had shown since being a part of their education programme. For some pharmacists these improvement were clinical, whereas for other the improvements were those that were affecting the day to day lives of their patients. The outcomes talked about by the participants were very similar to those focused upon in the literature, especially the clinical outcomes.

For participant 2, choosing to work with those patients they’d identified as being at risk was a positive for the experience of pharmacists. This pharmacist felt that because of the situation these patients were in they were guaranteed to show changes, and this is encouraging for pharmacists that work with these patients.

66 P2: in some ways, the fact that you’re treating the people that have definitely,

are definitely going to get improvements and will experience improvement, on a psychological basis, is a better way to do it

Participant 2 came at the results from a scientific angle and so believed that the only way to tell if the asthma control of patients was improving was to assess them using the ACT score. If the scored had improved, there was the assumption that this improvement was directly related to the programme.

P2: looking at numbers, and that’s the only, that’s the only assessment we can get…..so you have to assume that they haven’t got better, or haven’t had an improved

score for, by chance

Participants 4 and 5 also used the ACT score to judge their patient’s progress, as well as prescription pick-ups, hospital visits, and antibiotic use. As outlined by participant 5, the vast majority of patients participating in Pharmacy A’s education programme were showing improvements. These improvements let pharmacists know that what they are doing is working, which in turn motivates them to continue providing the programme.

P4: just improvements in asthma control tests…..and also just seeing people

pick up preventers more regularly and not need relievers. Less hospital admissions, for some patients.

P5: so out of the 55 we’ve had about two people who’ve had a reduced asthma control test score…..you can see a reduction in their Ventolin (reliever) usage. And the red inhalers (preventer) or the purple inhalers (preventer) stay the same…..I’ve seen a reduction in some people with their antibiotics as well.

Pharmacists were also motivated by the feedback they received from their patients, and changes that were evident in their lives. Participant 3 did not mention clinical outcomes like the other pharmacists from Pharmacy A, but gave a number of specific examples of the changes in their patient’s lives. This seemed to be a much more motivating factor for participant 3, who identified their own positive feelings in response to this feedback.

P3: everyone always say to me “Thank you so much for ringing,” you know. And it’s really neat because you feel “Oh that was good,” you know, “That was really what we should be doing.”

67 P3: we’ve had one quite low socio family…..all the children seem to

suffer…..the children have not…..there hasn’t been the hospitalisation…..so that was nice…..I really thought that was a really great outcome for her

P3: one little chap is able to complete a game of rugby now, without really

gasping…..he’s actually improved with his running sport, running around

This example shared by participant 3 is an encouraging results of the programme. Children with asthma have identified that they often feel physically restricted and that this results in them being not as successful when running or playing sports with their healthy peers (Grover, Armour, et al., 2013). It is a positive step that this common experience can be managed allowing children to run and play with their peers.

Participant 4 also illustrated feelings of success when patients were telling them about decreases in symptoms which were resulting in a better quality of life.

P4: so when someone says “I’m not waking up at night coughing,” that’s pretty

big

The satisfaction these participants are expressing is a positive outcome for pharmacists carrying out asthma interventions, and one that can be translated to other programmes. Australian pharmacists who have been involved with community intervention were proud of the work they were doing and the feedback they were receiving from their patients (Bereznicki et al., 2011).

Subtheme 2: The future of the programme

Pharmacists were not only motivated to continue the existing programme, but to expand it in the future. Professional recognition was a motivating factor for participants 2 and 5. Pharmacists seem to have a desire to gain not only personal professional recognition, but recognition from their community and from their community of health care

professionals. Participant 2 felt that pharmacists were under-appreciated and under-used and this programme had the ability to prove that pharmacists had a role to play beyond handing out medication.

P2: pharmacists as such have been underutilised heaps of times…..the thing is

that the pharmacist’s role should be more about medicines and medicine management

68 Participant 5 was motivated by the possibility of expansions into other pharmacies, and the recognition that would coincide with this expansion.

P5: I’d hope for it to expand to other pharmacies and have a nationally consistent programme. And I’d hope we’d get more awareness of it.

The same Australian pharmacists who proud of the work they were doing also reported high levels of professional satisfaction from their enhanced clinical role (Bereznicki et al., 2011)

Pharmacists were also motivated by the possibility that they could continue to help patients make positive changes to their health, focusing on other areas of chronic illness.

P2: but there’s no doubt about it that if we’ve got the same issues that apply

here with adherence and that type of thing, it’ll apply to other parts…..if you had other assessment tools, whether you could do it with diabetes or hypertension or that they of thing

P3: I think it should remain but perhaps expand into COPD patients…..so yeah,

and keep on keeping on. Keep identifying, keep going with it. We don’t do COPD but

that is definitely out there. It may be that this could help…..yeah I think it just needs to

keep going

P5: and we would hope that we’d get more programmes like this, concerning

other areas. Like smoking’s a big thing and heart disease is another big thing…..so

we’d just hope we’d get other things in the pharmacy, and just leave the GP with the

complex patients