Abstract
Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring, multidose-dispensing system in community pharmacies. A mixed-method study was conducted with pharmacy staff, who packaged and dispensed medications in smart multidose packages and monitored real-time medication intake via web-portal. Pharmacy staff participated in semi-structured interviews. The Technology Acceptance Model, Theory of Planned Behaviour and Capability, Opportunity, Motivation, Behaviour Model informed the interview guide. Interview transcripts were analyzed thematically and findings were mapped back to the frameworks. The usability was assessed by the System Usability Scale (SUS). Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist-perceived patient factors. The mean SUS was found to be 80.63. Products with real-time adherence monitoring capabilities are valued by pharmacists. A careful assessment of infrastructure—including pharmacy workload, manpower and financial resources—is imperative for successful implementation of such interventions in a community pharmacy setting.
Highlights
Non-adherence to therapies is a global healthcare challenge
It has been argued that TAM alone cannot predict healthcare providers’ beliefs about the use of health-related technology [29], we used an integrated approach of combing two behaviour theories—Theory of Planned Behaviour (TPB) and COM-B Model with TAM framework—to explore the factors affecting the implementation of technology-based adherence intervention in a community pharmacy setting, and to add rigour to the study
Three pharmacists and one pharmacy assistant participated in the one-on-one semi-structured interview
Summary
Non-adherence to therapies is a global healthcare challenge. Medication adherence is reported to be approximately 50% in patients with chronic illnesses [1]. Medication non-adherence has been linked to negative health outcomes for patients, as well as increased costs to healthcare systems. A population-based cohort study in patients with hypertension reported a higher risk of stroke Another study examining the effect of medication non-adherence on healthcare costs in diabetic patients demonstrated that improving adherence can save approximately $661 million to $1.16 billion annually [3]. Medication adherence can be determined directly by measuring drug or metabolite levels in the bodily fluids or indirectly by assessing prescription records, pill counts, patient self-reports through interviews, questionnaires or diaries, and/or electronic medication packaging devices [5]
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