ABS34: Could interchangeable use of dry powder inhaler compromise quality of care? An international study of physicians and pharmacists

Abstract

Introduction:

In the future there is greater potential for switching devices without physician and patient involvement at the pharmacy as more devices containing common products become available.

Aims:

To explore the opinion of physicians and pharmacists of switching DPI devices without physician and patient involvement.

Subjects and methods:

A Delphi process was undertaken with respiratory leaders to identify themes. These were developed into structured questionnaires for physicians and pharmacists.

Results:

502 general practitioners (GPs) and 254 pharmacists from Australia, Canada, France, Germany and the UK completed the questionnaires spring 2005. Over half GPs and pharmacists considered patient involvement in selection of DPI to be important, 91% GPs noting involvement improves adherence. Majority GPs expressed concerns about possibility of receiving different inhalers with each prescription, particularly patient confusion and negative impact on asthma control (90% and 79% of GPs respectively). Pharmacists particularly concerned about patient confusion (77%). Both GPs and pharmacists anticipated a negative impact on adherence, device handling, therapeutic effect and workload if patients were switched from usual DPI. Majority GPs and half pharmacists thought DPIs should be prescribed by brand name, and there should be official recognition that DPIs are not interchangeable.

Conclusions:

This study suggests that indiscriminate switching of DPIs could result in patient confusion, device misuse and loss of asthma control. Interchangeable use of DPIs could compromise quality of care. DPIs should only be switched with physician and patient agreement, and patient training.

Conflict of interest and funding

D. Price has no shares in pharmaceutical companies. He has received speaker's honoraria for speaking at sponsored meetings from the following companies marketing respiratory products: 3M, Altana, Astra Zeneca, BI, GSK, MSD, Novartis, Pfizer, Schering-Plough. He has received honoraria for advisory panels with; 3M, Altana, Astra Zeneca, BI, GSK, MSD, Novartis, Pfizer, Schering-Plough. He or his research team have received funding for research projects from: 3M, Altana, Astra Zeneca, BI, GSK, MSD, Novartis, Pfizer, Schering-Plough, Viatris.