Abstract
Background
Asthma remains a major global public health challenge, affecting over 300 million individuals and contributing to significant morbidity, healthcare utilization, and avoidable mortality. Despite the availability of effective treatments, asthma control remains suboptimal for many patients due to a range of factors including poor adherence, environmental exposures, disparities in care access, and the heterogeneous nature of the disease. New Zealand has a high prevalence of asthma and one of the highest hospital admission rates for asthma among OECD countries. However, the impact on New Zealand Europeans is less so than on other ethnic groups, especially Māori and Pasifika, reflecting broad inequities in healthcare.
Aim
The aim of this research was to assess the feasibility of a new model of care in pharmacy for patients with asthma through a multifaceted approach that incorporates stakeholder engagement and patient-centred interventions. The overall research was guided by the findings from each study described in the individual chapters.
Key objectives included the codesign of the model of care to implementation and assessment of its feasibility. The impact of the pharmacist-led intervention on medication adherence and symptom monitoring was secondary.
By addressing biomedical and social determinants of health together with the engagement of the patient and their primary healthcare team, this research sought to inform personalised, equitable, and sustainable models of asthma care. The anticipated outcomes included reduced exacerbation rates, improved quality of life for patients, and actionable insights for policy and practice in asthma management.
Methods
To address the needs of the most affected populations of New Zealand, this research used a Māori inclusive framework ([1] He Pikinga Waiora) to design and implement a model of care for asthma in community pharmacy. In a nutshell, the project was designed “by the people for the people”. A narrative review, focusing on both global and national pharmacy-based interventions for asthma management, was conducted to inform the proposed research. The review aimed to identify potential facilitators and barriers to effective implementation, providing a foundation for the design and objectives of this research. Focus group meetings and interviews were then held with general practitioners (GPs), nurses, pharmacists and caregivers of and/or patients with asthma to gain insight into strengths and limitations of this venture and the barriers facing each group in terms of providing or accessing this service. Interest from pharmacists, pharmacy technicians, general practitioners, nurses and patients were sought to co-design a model of care for asthma patients in pharmacy. The feasibility study was implemented at three pharmacies (two in South Auckland and one in Whanganui), selected based on the resources available to provide the service and their geographical proximity to areas of high asthma prevalence. Participants had five meetings with the pharmacist to undertake assessments. During the baseline visit, participant demographics were collected, and each participant was assigned a unique code to anonymise their data. Participants completed assessments including the Asthma Control Test (ACT), medication adherence Test (MAT), and inhaler technique at each visit. They received structured asthma education covering triggers, symptoms, medication use, inhaler technique, and risks of poor control. Each participant was provided with a personalised asthma plan and instructions on when and how to access treatment. Assessment data were analysed to identify changes in behaviour and asthma control from baseline. Post-intervention questionnaires from GPs, nurses, pharmacists, and participants were used to evaluate the study’s feasibility.
Results
Alongside the identified barriers and facilitators, the literature review also outlined key elements critical to successful interventions. These insights, together with stakeholder input and guidance, contributed to the co-design of the feasibility study protocol (model of care).
For the feasibility study, each pharmacy recruited three participants who received pharmacist intervention over five visits from November 2024 to March 2025.
The research was primarily to assess whether a model of care for asthma is doable in New Zealand. Data from assessments performed were purely indicative and not conclusive.
There was an overall improvement in asthma control for all the participants from baseline to visit-five. While the correct use of metered-dose inhalers (MDIs) posed a greater challenge compared to other inhaler devices (turbuhalers, accuhalers or the ellipta, there was overall improvement in inhaler technique over the five visits. There was a mean shift from low to medium in terms of medication adherence over the four-month period. The changes in scores were noted with no definitive conclusions.
Post-intervention feedback, using Likert scales (1-5), was generally positive despite some challenges. Time constraints and disruptions during the festive period and the start of the new school term were the most commonly reported issues across all groups.
The stakeholders agreed that there was a demand for the study (mean score: 4.45,var:0.7) and it was acceptable in its design (mean score:4.3,var:0.6). The information provided was considered adequate, clearly communicated, and helpful. The health care professionals (HCP) agreed that the partnership between the pharmacies and medical centres was successful with a mean score of 4.2 (var:0.4).
While there is strong potential for embedding pharmacist-led asthma care into routine practice, its sustainability depends on addressing key systemic challenges. Delivering effective, patient-centred care requires recognising and responding to the barriers faced by healthcare professionals, including time constraints, lack of training, and fragmented communication between services. To support long-term implementation, policy changes are essential, particularly those that provide dedicated funding, workforce support, and structural integration of pharmacists within primary care teams. Without these enablers, the full potential of pharmacist-led models to improve asthma outcomes and reduce health inequities may not be realised.