Abstract
BackgroundAn interprofessional medication adherence program (IMAP) for chronic patients was developed and successfully implemented in the community pharmacy of the Department of ambulatory care and community medicine (Lausanne, Switzerland). This study assesses the capacity of a physician and a nurse at the infectious diseases service of a public hospital and of community pharmacists in the Neuchâtel area (Switzerland) to implement the IMAP in their practice.MethodsMixed method, prospective, observational study. Quantitative and qualitative analyses of the implementation process were conducted following the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance).ResultsImplementation started in November 2014. One physician, one nurse, and five pharmacists agreed to participate. Healthcare professionals perceived the benefits of the program and were motivated to implement it in their practice (adoption). Seventeen patients were included in the program; 13 refused to participate. The inclusion of naïve HIV patients was easier than the inclusion of experienced patients with difficult psychosocial issues (reach). Pharmacists were engaged in reinforcing patient medication adherence in 25% of interviews (effectiveness). Key facilitators expressed by healthcare professionals were patient inclusion by the physician and the nurse instead of the pharmacist and the organisation of regular meetings between all stakeholders. In contrast, the encountered barriers were the lack of time and resources, the lack of team uptake, and the lack of adoption by senior managers (implementation). Interviewed patients were all satisfied with this new program, encouraging healthcare professionals to scale it up. Structural changes allowed the hospital and one pharmacy to enter the maintenance stage (maintenance).ConclusionThe research team and collaboration between all professionals involved played an important role in this implementation. However, the dissemination of such a program to a larger scale and for the long term requires financial and structural resources as well as transitional external support.
Highlights
Introduction of a new ARTDifficulties described by the patientSuspected non-adherence by health professionalsOther Reasons for patient refusal (n, %)eRefused to change pharmacyDoesn’t feel the need for such supportFears about confidentiality
New studies adapted the consolidated framework for implementation research (CFIR) to list all potential factors that can influence the implementation of new services in community pharmacies [4, 5]
Feasibility This study showed that the physician and the nurse at the infectious disease service of the Neuchâtel hospital and local community pharmacists were able to implement the interprofessional medication adherence program (IMAP) in their practice
Summary
Introduction of a new ARTDifficulties described by the patientSuspected non-adherence by health professionalsOther Reasons for patient refusal (n, %)eRefused to change pharmacyDoesn’t feel the need for such supportFears about confidentiality. Even if a remuneration system exists, only a minority of pharmacists provide these interventions in practice and initiatives are often not implemented at scale across the population [2] This trend is not confined to Switzerland; implementation of such services in practice remains difficult worldwide [3]. The lack of motivation and the lack of benefits perceived by healthcare professionals are barriers that limit the adoption of these new services [2, 8, 11] External factors such as the patients’ needs and acceptance/perception, the lack of collaboration, and the opinion of other healthcare professionals influence the implementation of new services [8, 10, 12, 13]
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