Impact of spirometry on pharmacists’ decision to refer

Objective: Asthma is a chronic condition best managed by pharmacotherapy, monitoring and patient self management. The 'gold standard' for lung function testing is spirometry which is performed less frequently than recommended and is less available in rural areas. This study trialled spirometry testing in country pharmacies. Methods: Pharmacies within the Riverina region were contacted to seek their participation; seven pharmacies with 13 associated pharmacists agreed to participate and took part in training to assist them to recruit patient participants and perform spirometry. Pharmacists were requested to assess the adequacy of the patient's medication, record their likely decision to refer patients to their general practitioner, perform spirometry and then record their actual referral decision. Results: There were 141 patient participants recruited; 93 acceptable spirometry tests performed. Eighty six participants (61%) were not using respiratory medications. Eight (9%) participants not taking respiratory medications, and 10 (18%) on respiratory medications, reported daily or persistent symptoms indicative of poorly managed asthma. Pharmacists initial assessment was to refer 38% of participants though 44% received referral after spirometry. Pharmacists were most likely to refer for medication-related concerns and were more confident in their decision-making when medictaion was adequate. Discussion: In total, as calculated by the researchers, 49% of participants were taking less respiratory medication or fewer medications than recommended for their severity classification and arguably should have been referred. Pharmacists pattern of referral suggested that they may have been reluctant to identify results of spirometry as the trigger for referral perhaps as this lies outside their traditional pattern of practice.