6 Pharmacy World & Science Volume 23 No. 1 2001 Article Introduction Pharmacists have a unique opportunity to support patients undergoing long-term treatment, since they are accessible and frequently contacted health profes- sionals. Promising results have been reported from trials where pharmacists have intensively counselled and monitored groups of asthma patients [1-3]. However, in daily practice asthma counselling is rarely provided [4-7]. Prerequisites for their adequate per- formance in asthma management are that pharma- cists have a positive attitude and recognise their role in supporting the care. In addition they must have sufficient knowledge, skills and confidence. In general, pharmacists have a positive attitude towards asthma counselling [4 7 8]. However, there The perceived role and skills of pharmacists in asthma management after in-house training • Kirsti K. Vainio, Maarit J.H. Korhonen, Anne M. Hirvonen and K. Hannes Enlund Pharm World Sci 2001;23(1): 6-12. © 2001 Kluwer Academic Publishers. Printed in the Netherlands. Kirsti K. Vainio (correspondence), Maarit J.H. Korhonen and K. Hannes Enlund: Department of Social Pharmacy, University of Kuopio, P.O.B. 1627, FIN-70211 Kuopio, Finland, (e-mail: Kirsti.Vainio@uku.fi) Anne M. Hirvonen: Association of Finnish Pharmacies, Helsinki, Finland Keywords Asthma Continuing education Counselling Knowledge Pharmacist Practice research Role Skills Abstract Objective: To evaluate perceived roles and skills of pharma- cists in asthma management before and after a training intervention that consisted of six in-house training sessions. Method: Altogether 315 pharmacists in the intervention group and 121 pharmacists in the control group participated in the study. The data on study variables were collected by a questionnaire during the first and last training sessions. Main outcome measures: Pharmacists’ perceptions of their role, perceived skills, estimates of patients receiving counsel- ling and experienced problems. Results: Based on their ratings for 16 topics, the pharmacists’ perceptions about their role in counselling asthma patients remained rather stable. Handling of the inhalers and inhala- tion technique were considered as the most important aspects of counselling and issues dealing with the disease were regarded as the least important. Using a self-rated scale (4-10 scale), pharmacists’ perceived counselling skills impro- ved in the intervention group (6.5 vs 7.6), but not in the con- trol group (6.5 vs 6.4). In the intervention group, the phar- macists’ estimates of the proportion of new users of asthma medicines receiving counselling increased from 48% to 61% and that of old users from 18% to 26%. Before the training, the most commonly experienced problem in counselling was the pharmacists’ lack of knowledge and skills. After the trai- ning, pharmacists experienced problems mainly with com- munication. Conclusion: When pharmacists are included in the support system for any patient group, their capabilities of fulfilling their role have to be assessed. In particular, communication skills and outcome-oriented counselling require attention. Accepted October 2000 is some uncertainty especially about the pharmacists’ role in asthma management. Traditionally, pharma- cists have been seen as the source for asthma medica- tion, not as a source of information or counselling. Even after realising the importance of counselling, pharmacists have adopted a rather narrow role, focus- ing primarily on instructing new patients on how to utilize inhalers and inhalation devices [5 8]. Pharmacists tend to assume that asthma patients have been counselled by a doctor or nurse. There is also a general belief that long-term patients do not need any counselling since they have experience in using their medications. Pharmacists also assume that some patients do not expect or even want to be counselled. It could be argued that pharmacists lack a clear picture of patients’ problems and counselling needs. As the approach of treating asthma has changed during recent years, it is not surprising that there is lack of knowledge among pharmacists about the dis- ease itself as well as the management of the disease [4 9 10]. This may lead to poor self confidence to initiate a counselling session with an asthma patient. Pharmacists themselves have also expressed their need for asthma training [4 7 8]. Furthermore, there is a need for communication training since few phar- macists have received any training in patient educa- tion and counselling during their basic education. Finnish pharmacies with an average number of 5-6 pharmacists (MSc and BSc) are optimally sized for carrying out in-house continuing education and train- ing. In order to improve pharmacists’ abilities in asth- ma counselling, we designed a pilot intervention that takes place at work, is practice oriented and makes use of participants themselves as trainers in group learning. The aim of the training was to expand the role of pharmacists in asthma care and improve pharmacists’ skills to counsel asthma patients by focusing on current treatment practices and patient needs in asthma management. The impact of the training was evaluated in terms of pharmacists’ per- ceived roles and perceived skills, as well as self-report- ed counselling practices and problems encountered. Material and methods Outline of the in-house training The participating pharmacies were sent from the University of Kuopio the training materials. These included a study plan covering six sessions (Appendix A), a course package, two videotapes, and samples of inhaled dosage forms and their devices. Each partici- pating pharmacy had chosen a co-ordinator who was free to modify the details of the training both in terms of contents and procedures according to the needs and interests of the pharmacists. As an optimal size for the study group we suggested five to eight per- sons to facilitate discussion. All members of the study group were encouraged to participate in preparing