Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study

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• 作者：Julien Marquis ; Marie P. Schneider…
• 关键词：Cognitive pharmaceutical services ; Community pharmacy ; Interdisciplinary collaboration ; Implementation ; Medication adherence ; Pharmacists ; Qualitative research ; Switzerland
• 刊名：International Journal of Clinical Pharmacy
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：36
• 期：5
• 页码：1014-1022
• 全文大小：217 KB
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• 作者单位：Julien Marquis (1) (2)
  Marie P. Schneider (1) (2)
  Brenda Spencer (3)
  Olivier Bugnon (1) (2)
  Sophie Du Pasquier (2) (4)
  
  1. Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
  2. Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
  3. Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
  4. Community Pharmacy, Pharmacie de la Policlinique Médicale Universitaire, Rue du Bugnon 44, 1011, Lausanne, Switzerland
  
• ISSN：2210-7711

文摘

Background Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?. Objective To explore pharmacists-perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. Setting Community pharmacies in French-speaking Switzerland. Method Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. Main outcome measure Community pharmacists-experiences and perceptions of the determining factors influencing the implementation of the adherence programme. Results Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme’s implementation was pre-existing collaboration with physicians. Conclusion A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.