Study protocol: Development, implementation, evaluation and refinement of a translational allergic rhinitis clinical management pathway (AR-CMaP) for community pharmacies

Abstract Background Allergic Rhinitis (AR) is a highly burdened chronic respiratory disease( Pawankar et al., 2013; Meltzer and Bukstein, 2011; Brozek et al., 2017; Keith et al., 2012) , 1 , 2 , 3 , 4 which affects about 40% of the world's population. 5 Research shows that only 15% of people with AR, in the community pharmacy setting are using optimal AR medication( Tan et al., 2018) . 6 There is a clear need to better implement AR management guidelines so that more effective medication selection and an evidence-based approach to the management of AR is implemented. Objective This paper describes the methods that will be used to develop, implement, evaluate and refine an evidence-based, guideline informed allergic rhinitis clinical management pathway, Allergic Rhinitis Clinical Management Pathway (AR-CMaP) for community pharmacy. Methods AR-CMaP was developed based on the latest AR management guidelines for pharmacy( Bosnic-Anticevich et al., 2018) 7 and empirical evidence associated with patient self-management behaviours in community pharmacy( Tan et al., 2017) , 8 utilising the Promoting Action on Research Implementation in Health Services implementation framework (Phase 1). AR-CMaP was then implemented in six pharmacies in the Australian Capital Territory (ACT), Australia (Phase 2). The impact of AR-CMaP on AR management in the pharmacy (AR medication management and pharmacy practice) will be evaluated in a pre-post intervention study design (Phase 3). Phase 4 will involve the refinement of AR-CMaP to ensure its generalisability and scalability; readiness for large-scale dissemination across different pharmacy locations (e.g. rural, remote, metropolitan) and different pharmacy business models. Conclusions There is an urgent need to develop a translational AR clinical pathway, to address the wide-spread challenge of suboptimal AR management and burden of AR on individuals and society. This protocol paper describes the methods underpinning the development, implementation, evaluation and refinement of an evidence-based AR clinical pathway for community pharmacy setting, which is in line with current clinical evidence and feasible for effective implementation into the community pharmacy setting.