Development of pharmaceutical care in Malta

Abstract

The research presented in this thesis examined the development of pharmaceutical care in Malta with a focus on asthma. The public's views were sought regarding services provided by community pharmacists and the pharmacist's extended role. The perceived importance that pharmacists placed on various aspects of pharmaceutical care was also assessed. Skin testing of asthmatic patients revealed comparatively high levels of atopy, sensitisation trends which were similar to other populations reported in the published literature, and a high level (29%) of sensitisation to the mould Altemaria alternata. A total of 152 asthmatic patients participated in a randomised, controlled, community based phannaceutical care study for 12 months. When compared to controls, intervention patients reported a significant improvement in health-related quality of life, a significant improvement in inhaler technique and significantly lower levels of wheeze and chest tightness on waking. Focus group interviews, which were utilised to determine health-related issues of importance to asthma patients, revealed that asthmatics lacked sufficient knowledge and skills to assume more independence and responsibility in the management of their condition. Asthma imposed several limitations on lifestyle, it had a negative impact on the quality oflife of the entire family, generated negative feelings and caused concern to patients over their future. A survey of the Maltese general public regarding the services provided by community pharmacists yielded encouraging results from the pharmaceutical profession perspective, showing strong support for the extended role of the community pharmacist. The survey results, however, indicated that community pharmacists need to be more active in giving advice in the treatment of minor ailments and when dispensing OTC products. An assessment of the importance that pharmacists placed on pharmaceutical care showed that while they recognised the importance of various aspects of this model of practice, they placed greater emphasis on the more traditional practice roles.