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- Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in PracticePublication . Lourenço, Olga; Bosnic-Anticevich, Sinthia; Costa, Elísio; Fonseca, Joao A; Menditto, Enrica; Cvetkovski, Biljana; Kritikos, Vicky; Tan, Rachel; Bedbrook, Anna; Scheire, Sophie; Bachert, Claus; Białek, Sławomir; Briedis, Vitalis; Boussery, Koen; Canonica, G Walter; Haahtela, Tari; Kuna, Piotr; Novellino, Ettore; Samolinski, Boleslaw; Schünemann, Holger J; Wallace, Dana; Bousquet, JeanThe paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.
- Interventions Delivered in the Community Pharmacy to Manage Allergic RhinitisPublication . José, Jéssica; Cvetkovski, Biljana; Kritikos, Vicky; Tan, Rachel; Bosnic-Anticevich, Sinthia; Lourenço, OlgaPharmacists have a valuable role in the management of allergic rhinitis (AR) at the community pharmacy level. This role has been reported extensively in numerous papers. However, a systematic review of the available literature and a comprehensive analysis of the outcomes has not been published. This systematic review aimed to evaluate the impact of interventions developed by pharmacists on clinical AR outcomes. A thorough search was performed in three electronic databases, including studies published between January 2000 and June 2019. After the selection process, only three articles met the inclusion criteria and were further analysed. Despite the scarcity of the available studies, in all of them was clear that the pharmacist plays a pivotal role in the management of AR, significantly improving the patients' quality of life and symptom control. This systematic review also stresses the utmost importance to investigate and report practices and interventions developed by pharmacists using measurable outcomes.
- Management of allergic rhinitis symptoms in the pharmacy Pocket guide 2022Publication . Lourenço, Olga; Cvetkovski, Biljana; Kritikos, Vicky; House, Rachel; Scheire, Sophie; Costa, Elísio; Fonseca, Joao A; Menditto, Enrica; Bedbrook, Anna; Bialek, Slawomir; Briedis, Vitalis; Boussery, Koen; Canonica, G. Walter; Haahtela, Tari; Kuna, Piotr; Mullol, Joaquim; Orlando, Valentina; Samolinski, Boleslaw; Wallace, Dana; Duggan, Catherine; Paulino, Ema; Pinto, Gonçalo S.; Söderlund, Lars‐Åke; Bousquet, Jean; Bosnic‐Anticevich, SinthiaBackground: Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Methods: Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence-based, integrated care approach. Results: This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence-based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician. Conclusion: This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation.
- Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseasesPublication . Bousquet, Jean; Schünemann, Holger; Togias, Alkis; Erhola, Marina; Hellings, Peter; Zuberbier, Torsten; Agache, Ioana; Ansotegui Zubeldia, Ignacio Javier; Anto, Josep M.; Bachert, Claus; Becker, Sven; Kvedarienė, Violeta; Yusuf, Osman; Ohta, Ken; Moda, Giuliana; Münter, Lars; Chu, Derek K; Lourenço, Olga; Ryan, Dermot; Kuna, Piotr; Devillier, Philippe; Novellino, Enrico; Bergmann, Karl-Christian; Bonini, Mateo; Billo, Nils; Mathieu-Dupas, Eve; Portejoie, Fabienne; Reitsma, Sietze; Farrell, John; Sheikh, Aziz; Haahtela, Tari; Dykewickz, Marc; Morais-Almeida, Mario; Namazova-Baranova, Leyla; Cvetkosvki, Biljana; Fiocchi, Alessandro; Stelmach, Rafael; Samoliński, Bolesław; Brightling, Christofer E; Cardona, Victoria; Buhl, Roland; Miculinic, Neven; Salimäki, Johanna; Ebisawa, Motohiro; Iaccarino, Guido; Bedolla-Barajas, Martin; Roche, Nicolas; Guldemond, Nick A; Dauvilliers, Yves; Palkonen, Susanna; Fonseca, Joao A; Basagaña, Xavier; Cartier, Christine; Chkhartishvili, Ekaterine; Cecchi, Lorenzo; Monti, Ricardo; Suppli Ulrik, Charlotte; Kleine-Tebbe, Jorg; Annesi-Maesano, Isabella; Kardas, Przemyslaw; Garcia-Aymerich, Judith; Pugin, Benoit; Picard, Robert; Fontaine, Jean F; Colgan, Elaine; Custovic, Adnan; Murray, Ruth; van der Kleij, Rianne; Bjermer, Leif; Lodrup Carlsen, Karin C; Jutel, Marek; Solé, Dirceu; Williams, Sian; Illario, Maddalena; Ouedraogo, Solange; Nekam, Kristof; Wang, De Y; Buonaiuto, Roland; Lieberman, Philip; Todo-Bom, Ana; Bindslev-Jensen, Carsten; Kritikos, Vicky; Price, David; Paulino, Ema; Cepeda Sarabia, Alfonso M; De Manuel Keenoy, Esteban; Viart, Frédéric; Okubo, Kimihiro; Sanchez-Borges, Mario; Dubakiene, Ruta; Courbis, Anne Lise; Bourrez, Jean Marc; Gaga, Mina; Thibaudon, Michel; Guzman, Maria Antonieta; Dantas, Carina; Menditto, Enrica; Pinnock, Hilary; Keil, Thomas; De Feo, Giulia; Gotua, Maia; Silva, J da; Laune, Daniel; Williams, Dennis M; Zeng, Stéphane; Montefort, Steve; Hajjam, Jawad; Bedbrook, Anna; González Diaz, Sandra; Neou, Angelo; Marien, Gert; Marshall, Gailen D; Malva, Joao; Vandenplas, Olivier; Valiulis, Arunas; Akdis, Cezmi A; Pali-Schöll, Isabella; Kalayci, Omer; Gamkrelidze, Amiran; Nyembue Tshipukane , Dieudonne; Zidarn, Mihaela; Muraro, Antonella; Costa, Elísio; Bonniaud, Philippe; Kaidashev, Igor; Matricardi, Poalo M; Menditto, Enrica; Melo-Gomes, Elisabete; Waserman, Susan; Bennoor, Kazi Saifuddin; Prokopakis, Emmanuel P; Di Capua, Stefania; Jung, Ki-Suck; Plavec, Davor; Neffen, Hugo; Papadopoulos, Nikos; Gemicioglu, Bilun; Lipworth, Brian; Mihaltan, Florin; Mohammad, Yousser; Yorgancıoglu, Arzu; Bouchard, Jacques; Sisul, Juan-Carlos; Leonardini, Lisa; Rottem, Menahenm; Pfaar, Oliver; Ventura, Maria Teresa; Ivancevich, Juan C; Panzner, Peter; Brusselle, Guy; Zhang, Luo; Carriazo, Ana M; Manning, Patrick; Stellato, Cristina; Romano, Antonino; Bialek, Slawomir; Kull, Inger; Raciborski, Filip; Mullol, Joaquin; Klimek, Ludger; Meltzer, Eli O; Spranger, Otto; Brozek, Jan; Boulet, Louis P; Somekh, David; Valovirta, Erkka; Rolland, Christine; Mogica Martinez, Maria Dolores; Valenta, Rudolf; Casale, Thomas; Benveniste, Samuel; O'Hehir, Robyn; Mösges, Ralf; Eller, Esben; Schmid-Grendelmeir, Peter; Briedis, Vitalis; Popov, Ted A; Napoli, Luigi; O'B Hourihane, John; Joos, Guy; Chavannes, Niels; Picard, Robert; Naclerio, Robert; Bewick, Michael; Sousa, Jaime Correia de; Dokic, Dejan; Yiallouros, Panayiotis; Cruz, Alvaro; Loureiro, Claudia C; Phillips, Jim; To, Teresa; Valentin Rostan, Marylin; Tomazic, Peter Valentin; Carr, Warner; Khaitov, Mussa; Bosse, Isabelle; Okamoto, Yoshitaka; Czarlewski, Wienczyslawa; Pereira, Ana-Maria; Le Thi Tuyet, Lan; Zernotti, Mario; Fink-Wagner, Antjie; Masjedi, Mohamed R; Rosario, Nelson; Vezzani, Giorgio; Wagenmann, Martin; Viegi, Giovanni; Cingi, Cemal; Louis, Renaud; Vasankari, Tuula; Rodo, Xavier; Toppila-Salmi, Sanna; Illario, Maddalena; Ierodiakonou, Despo; Park, Hae-Sim; Fokkens, Wytske J; Wickman, Magnus; Wroczynski, Piotr; D'Amato, Gennaro; Maspero, Jorge F; Sova, Milan; Bateman, Eric; Roller-Wirnsberger, Regina E; Kowalski, Marek L; Rajabian-Söderlund, Rojin; Pham-Thi, Nhân; Emuzyte, Regina; Dedeu, Antoni; Mercier, Jacques; Valero, Antonio; Arnavielhe, Sylvie; Mahboub, Bassam; Sooronbaev, Talant; Walker, Samantha; Humbert, Marc; Gomez, Maximiliano; Wallace, Dana; Blain, Hubert; Melén, Erik; El-Gamal, Yaya; Khaltaev, Nikolai; Bosnic-Anticevich, Sinthia; Wong, Gary; Canonica, Giorgo W; Milenkovic, Branislava; Mair, Alpana; Linnemann, Désirée Larenas; Zar, Heather J; Onorato, Gabrielle; Pépin, Jean-Louis; Tsiligianni, Ioanna; Zhong, Nan SBackground: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Nextgeneration guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
- ARIA pharmacy 2018: Allergic rhinitis care pathways for community pharmacyPublication . Bosnic-Anticevich, Sinthia; Costa, Elísio; Menditto, Enrica; Lourenço, Olga; Novellino, Ettore; Bialek, Slawomir; Briedis, Vitalis; Buonaiuto, Roland; Chrystyn, Henry; Cvetkovski, Biljana; Di Capua, Stefania; Park, Hae-Sim; Phillips, Jim; Plavec, Davor; Stellato, Cristiana; Somekh, David; Sisul, Juan; To, Teresa; Todo-Bom, Ana; Tomazic, Peter Valentin; Toppila-Salmi, Sanna; Valero, Antonio; Popov, Todor A; Potter, Paul C; Prokopakis, Emmanuel P; Roller-Wirnsberger, Regina E; Rottem, Menachem; Ryan, Dermot; Samolinski, Boleslaw; Sanchez-Borges, Mario; Schunemann, Holger J; Sheikh, Aziz; Ventura, Maria Teresa; Valovirta, Erkka; Valiulis, Arunas; Wagenmann, Martin; Kritikos, Vicky; Bousquet, Jean; Zuberbier, Torsten; Mair, Alpana; Orlando, Valentina; Paulino, Ema; Salimäki, Johanna; Söderlund, Rojin; Wallace, Dana; Waserman, Susan; Wickman, Magnus; Yiallouros, Panayiotis; Yorgancioglu, Arzu; Yusuf, Osman; Zar, Heather J; Zernotti, Mario E; Zhang, Luo; Zidarn, Mihaela; Wroczynski, Piotr; Williams, Dennis M; Tan, Rachel; Agache, Ioana; Ansotegui, Ignacio J; Cruz, Alvaro A; Sousa, Jaime Correia de; Chavannes, Niels H; Czarlewski, Wienczyslawa; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Philippe; Anto, Josep M; Bedbrook, Anna; Bachert, Claus; Bewick, Mike; Bindslev-Jensen, Carsten; Brozek, Jan L; Canonica, Giorgio Walter; Cardona, Victoria; Carr, Warner; Casale, Thomas; El-Gamal, Yehia; Gaga, Mina; Dykewicz, Mark S; Fonseca, João; Fokkens, Wytske J; Kuna, Piotr; Kowalski, Marek; Klimek, Ludger; Kvedarienė, Violeta; Linnemann, Désirée Larenas; Laune, Daniel; Le Thi Tuyet, Lan; Guzman, Maria Antonieta; Haahtela, Tari; Hellings, Peter; Illario, Maddalena; Ivancevich, Juan Carlos; Just, Jocelyne; Kaidashev, Igor; Khaitov, Musa; Khaltaev, Nikolai; Keil, Thomas; Maier, Dieter; Mahboub, Bassam; Lodrup Carlsen, Karin C; Malva, João; Manning, Patrick J; Okamoto, Yoshitaka; Ohta, Ken; O'Hehir, Robyn; Onorato, Gabrielle L; Palkonen, Susanna; Panzner, Petr; Papadopoulos, Nikolaos G.; Almeida, Mário Morais; Mösges, Ralph; Mullol, Joaquim; Münter, Lars; Murray, Ruth; Naclerio, Robert; Namazova-Baranova, Leyla; Nekam, Kristof; Nyembue, Tshipukane Dieudonné; Okubo, Kimihiro; Pfaar, Oliver; Pawankar, RubyPharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
- The impact of implementing an allergic rhinitis clinical management pathway (AR-CMaP) in the community pharmacyPublication . House, Rachel; Kritikos, Vicky; Cvetkovski, Biljana; Rimmer, Janet; Yan, Kwok; Cheong, Lynn; Bousquet, Jean; Lourenço, Olga; Bosnic-Anticevich, SinthiaBackground The Allergic Rhinitis Clinical Management Pathway (AR-CMaP) was developed to overcome the challenge of implementing current AR guidelines in the Australian community pharmacy practice and support pharmacists in optimally managing patients' AR. Objective(s) To evaluate the impact of AR-CMaP on patients' behaviour and pharmacists' needs in managing AR in the pharmacy. Methods This study used a cross-sectional, pre-post study design in which the primary outcome was the appropriateness of medications purchased from community pharmacies in Australia. Patient data were collected before and after the implementation of AR-CMaP. Pharmacist needs were recorded before and after AR-CMaP training. Data were analysed descriptively. Results Six pharmacies, 19 pharmacists and a total of 416 patients were included in the study; 206 pre-AR-CMaP implementation and 210 post-AR-CMaP implementation. Pre-AR-CMaP, 22.4% of patients purchased appropriate AR medication compared with 29.0% post-AR-CMaP implementation. Over half the patient cohort (52%) consulted a pharmacist pre-AR-CMaP and 37% consulted a pharmacist post-AR-CMaP implementation. Post-AR-CMaP, pharmacists reported increased awareness of barriers such as patients' lack of time, patients' perceptions about the pharmacist's role and patient choice to self-manage. Pharmacists also rated an increased desire to interact with other health care providers (HCPs) in caring for patients with AR. Conclusions While there was a non-statistically significant increase in the proportion of patients purchasing optimal AR medication, AR-CMaP did empower patients to self-select their own medication without further detriment. Moreover, following the implementation of AR-CMaP, pharmacists developed a greater awareness of their role in AR management, exemplified by their increased desire to be actively involved in AR management and increased interaction with other HCPs. Future research needs to explore more effective tools to support pharmacists' clinical decision-making and target patients' self-selection of AR medications. This study highlights that there is an ingrained self-reliance of AR decision-making that has become a habit for people living with AR.