Evaluation der Kampagne "Künftige Nichtraucher” des Schweizerischen Apothekerverbands

Zusammenfassung: Mit dem Ziel, die Bevölkerung für das niederschwellige Beratungsangebot in Apotheken zu sensibilisieren, organisierte der Schweizerische Apothekerverband in 616 Apotheken die Kampagne "Künftige Nichtraucher”. Die Evaluation beurteilte die Beratungstätigkeit der Apotheken im Bereich Tabakentwöhnung und untersuchte die Einstellung der Projektverantwortlichen in den Apotheken gegenüber der Kampagne und der Tabakprävention. Die Dokumentation der Raucherberatungen erfolgte mittels Aktivitätsstatistik eine Woche vor und während der Aktion. Ein standardisierter Fragebogen erfasste an deren Ende die Einstellung gegenüber der Kampagne und der Tabakprävention. 32% der an der Kampagne teilnehmenden Apotheken führten die Aktivitätsstatistik. Der Rücklauf des Fragebogens zur Erfassung der Einstellung betrug 58%. Stärkster Prädiktor der Beratungshäufigkeit war die Variable "Apotheke mit mehrheitlich Passantenkundschaft”. Für die Beratungsintensität war es die Variable "Besuch des Workshops und Weiterbildung des Apothekenteams”, d. h. die bestmögliche Weiterbildung vor der Kampagne. Die positivste Einstellung gegenüber der Tabakprävention und das grösste Interesse an einer weiteren Kampagne zeigten Verantwortliche aus Apotheken mit mehrheitlich häufiger und intensiver Beratungstätigkeit. Mit der vorliegenden Studie kann gezeigt werden, dass Raucherentwöhnung in Apotheken durchführbar ist. Hauptvoraussetzungen dafür sind Motivation für die Prävention sowie eingehende Weiterbildung der Apothekerlnnen und des Apothekenteam

Clinical evaluation of IDAS II, a new electronic device enabling drug adherence monitoring

Objective: The goal of this study was to evaluate clinically the acceptability of the IDAS II (Intelligent Drug Administration System), a new electronic device that enables drug adherence monitoring. Methods: IDAS II was compared to another electronic monitor, the Medication Event Monitoring System (MEMS) in a randomised two-way cross-over study involving 24 hypertensive patients treated with irbesartan. Patients used each device for 2months. The main parameter of evaluation was the patients' opinion on both devices. Rates of adherence and blood pressure were also assessed. Results: Most patients considered both devices to be reliable reminders (IDAS II: 75%;MEMS: 84%, p = ns). Ten patients (42%) preferred the MEMS, while 11 (46%) preferred the IDAS II; three (12%) expressed no preference. Patients found the MEMS device easier to use than the IDAS device (p < 0.001) but appreciated the IDAS blister packs better than the MEMS bulk packaging (p < 0.01). Over the 4-month period, the median "taking adherence” was excellent (99.2%) and comparable with both devices. However, the regularity of drug intake timing was higher with the IDAS II (p < 0.01). Conclusion: IDAS II, a new electronic device enabling drug adherence monitoring without reconditioning of the drugs appears to be a well-accepted device. Overall, practicability and acceptability of the IDAS II and the MEMS device were similar. Thus, IDAS II could be a useful tool for the management of long-term therapie

Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators.

1) To evaluate the participation rate and identify the practical barriers to implementing a community pharmacist-led medication review service in francophone Switzerland and, 2) To assess the effectiveness of external support. A qualitative survey was undertaken to identify barriers to patient inclusion and medication review delivery in daily practice among all contactable independent pharmacists working in francophone Switzerland (n=78) who were members of a virtual chain (pharmacieplus), regardless of their participation in a simultaneous cross-sectional study. This study analyzed the dissemination of a medication review service including a prescription and drug utilization review with access to clinical data, a patient interview and a pharmaceutical report to the physicians. In addition, we observed an exploratory and external coaching for pharmacists that we launched seven months after the beginning of the cross-sectional study. Poor motivation on the part of pharmacists and difficulties communicating with physicians and patients were the primary obstacles identified. Lack of time and lack of self-confidence in administering the medication review process were the most commonly perceived practical barriers to the implementation of the new service. The main facilitators to overcome these issues may be well-planned workflow organization techniques, strengthened by an adequate remuneration scheme and a comprehensive and practice-based training course that includes skill-building in pharmacotherapy and communication. External support may partially compensate for a weak organizational framework. To facilitate the implementation of a medication review service, a strong local networking with physicians, an effective workflow management and a practice- and communications-focused training for pharmacists and their teams seem key elements required. External support can be useful to help some pharmacists improve their service management skills. Adequate remuneration seems necessary to encourage initial investments to provide such a service. Future research in this area may help improve the process and design of training programs, as well as the monitoring of implementation for each new pharmaceutical service

The Role of Community Pharmacists in Travel Health and Vaccination in Switzerland.

This review presents the Swiss strategy initiated over the last several years to implement vaccination by community pharmacists. National health authorities aimed to integrate community pharmacists in the National Vaccination Strategy (NVS) in order to increase the vaccination rate in the Swiss population. To support this aim, universities and the Swiss Association of Pharmacists developed pre- and post-graduate education programmes on vaccination for pharmacists. Finally, each Swiss canton (sovereign for health-related aspects) set proper regulations to authorize pharmacists to vaccinate and to determine which vaccines could be administered. As of September 2018, 19 cantons (out of 26) had authorized influenza vaccinations under the sole responsibility of an accredited community pharmacist. Additional vaccinations were available in 13 cantons (e.g., tick-borne encephalitis or hepatitis A, B, or A and B). Such implementation in other countries should follow a similar top-down (following a national strategy to improve vaccination coverage) and stepwise (starting with influenza to demonstrate the competencies of community pharmacists) strategy, supported by the development of research, education and accreditation. The development of health advice related to travels in community pharmacies should follow the same development in Switzerland. Currently, it offers the opportunity for strengthening travellers' safety, beyond vaccination issues

A Novel Approach to Better Characterize Medication Adherence in Oral Anticancer Treatments.

Purpose: This study aims to describe a 12-month medication adherence with oral anticancer medications (OAMs) in a routine care medication adherence program, and to better characterize non-persistence. Patients and methods:In this observational, one-centered, longitudinal study, medication adherence was monitored electronically while patients were taking part in a medication adherence program for 12 months or until treatment stop. Patients were &gt;18 years and starting or taking one of the following OAMs: letrozole, exemestane, imatinib, sunitinib, capecitabine, or temozolomide. Non-persistence was defined as any premature treatment interruption due to patient's unilateral decision or to a medical decision because of adverse effects. The Kaplan Meier survival function estimate was used to characterize persistence, and Generalized Estimating Equations (GEE) were adopted to fit implementation. Statistical analyses were performed using the R software package. Results: Forty-three outpatients with various tumor entities were enrolled. Reasons for quitting the medication adherence program and/or OAM medication were characterized as OAM discontinuation due to adverse effects or toxicity (n = 5), planned OAM completion time (n = 10), OAM failure (cancer relapse) (n = 5) and non-compliance to the adherence program (n = 3). In persistent patients, the implementation rates were high (from 98% at baseline to 97% at 12 months). The probability of being persistent at 12 months was estimated at 85%. Conclusion: A better characterization of both persistence and implementation to OAMs in real life settings is crucial for understanding and optimizing medication adherence to OAMs. The complex identification of non-persistence underlines the need to carefully and prospectively assess OAM interruption or treatment switch reasons. The GEE analysis for describing implementation to OAMs will allow researchers and professionals to take advantage of the richness of longitudinal real-time data, to avoid reducing such data through thresholds and to put them into perspective with OAM blood levels

Adherence: a review of education, research, practice and policy in Switzerland.

Nonadherence to medication treatment regimens is a major preventable risk behavior in both acute and chronic diseases. Community pharmacists are facilitators in community care for promoting medication adherence and they should implement interdisciplinary medication adherence programs. To do so, pharmacists should be educated in medication adherence, and new pharmaceutical care policies should be implemented. The healthcare system should evolve to better meet the specific needs of patients. this article describes what has been undertaken in the last decade in medication adherence in terms of education, research, practice and policy in Switzerland. Medline was searched, with the search limited to Switzerland. The three Swiss pharmacy schools were also contacted to collect information about the medication adherence content of both their courses and research programs. National policies related to medication adherence were also reviewed for relevant content. two pharmacy schools offer courses devoted specifically to medication adherence. The number of hours dedicated to the topic varies between 4 to13. a total of 16 studies met the inclusion criteria. Chronic patients were the focus of 9 studies. Medication adherence was the primary outcome of all studies; 10 studies also measured clinical outcomes. Nine studies evaluated the prevalence of medication nonadherence; three studies evaluated the feasibility of new technologies for monitoring adherence; three studies evaluated medication adherence enhancing programs. Policies: three cognitive pharmaceutical services are reimbursed by healthcare insurers, which are directly related to medication adherence. Pharmacists in Switzerland have been actively involved in medication adherence research since the mid '90s. Specific medication adherence courses have entered the curriculum of pharmacy schools, and policies in Switzerland are slowly beginning to meet needs of chronic patients by the introduction of pharmaceutical cognitive services and reimbursement fees

The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment.

Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND. This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time t, adherence was computed as the proportion of patients taking medication as prescribed at that time. We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up). Our findings support the hypothesis that HAND is associated with reduced cART adherence

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED&gt;20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (&gt;20 or ≤20). Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics