Polypharmacy
Conditions
Keywords
Compliance, Adherence, Polypharmacy, Medicines use, Medication review, Pharmaceutical care, Primary care, Drug related problem, Patient safety
Brief summary
Since October 2010, Swiss community pharmacies can offer a 'Polymedication Check' (PMC) to patients on ≥4 prescribed drugs taken over ≥3 months. Aims: To evaluate first experiences shortly after implementation, missed pharmaceutical care issues and barriers to implementation on pharmacist's level as well as patient's acceptance through qualitative and descriptive studies To evaluate the impact of PMC in Swiss primary Care and to evaluate economic, clinical and humanistic outcomes in a subsequent randomized controlled trial.
Detailed description
Evaluating the newly implemented Swiss 'Polymedication-Check', a specialised medication review and screening for adherence issues, offers a large field of interesting research questions. Using the current PMC-Protocol as a structured interview guide, pharmacists are able to document their counselling on medication use issues and other drug related problems. In a randomized-controlled trial we aim at analysing 800 recruited patients from 70 study pharmacies during seven months. Patients were recruited in the regions Basel, Aargau-Solothurn, Waadt in Switzerland and randomised using 1:1 block randomisation. Primary outcome focuses on the improvement of adherence and persistence after 'Polymedication Check' (using medication possession ratio (MPR), gaps in medicines history records and patient's interviews). Second outcomes are time to planned or unplanned consulting with a physician or hospitalisation, knowledge, safety of medicines use and patients management of polypharmacy.
Interventions
BEHAVIORALMedication review
Polymedication Check (PMC) is a pharmacist's led medication review focusing medicines management, adherence issues and other drug related problems. The PMC has been implemented in 2010 as a new cognitive service provided by any community pharmacist to patient with polypharmacy (n\>3 drugs) on long term conditions (\> months). This specialised medication review follows a structured predefined protocol and is reimbursed by swiss health insurances. As an outcome, pharmacist may install a compliance support e.g. weekly filled pill organizer.
Sponsors
University of Basel
University Hospital, Basel, Switzerland
Polyclinique Médicale Universitaire, PMU, Lausanne
Swiss Pharmacy Association, pharmaSuisse
Kurt Hersberger
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* more than 3 drugs over at least 3 months prior to recruitment * german or french language (written and spoken) * medicines use in self management
Exclusion criteria
* provision of Polymedication Check in the past * living in a nursing home * use of prefilled pill organiser or individually blistered medication
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Medication possession ratio (MPR), gaps and persistence in medicines use | Seven months after recruitment | Improvement of adherence seven months after 'Polymedication-Check' using medication possession ratio (MPR), gaps and persistence out of history records from community pharmacy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to planned or unplanned consulting with a physician or hospitalisation | Seven months after recruitment | Time to planned or unplanned consulting with a physician or hospitalisation |
| Patient knowledge about his medicines | After two weeks, four and seven months after recruitment | Patient knowledge about his medicines use, assessed through PMC (intervention goup) and two telephone interviews (both groups) |
| Self reported adherence | At study start and two weeks, four and seven months after after recruitment | Self report of adherence: is assessed with self administrated questionnaires and telephone interviews |
| Patients safety | After two weeks, four and seven months after recruitment | Patients safety is assessed through a) telephone interview with a focus on perceived safety and b) number of drug related problems addressed and solved at study end. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Use of compliance aids | At study start and two weeks, four and seven months after after recruitment | Compliance aids may be in use prior to recruitment, recommended after intervention by pharmacist, recommendation can be refused or accepted and the compliance aid can be filled by the patient himself or specialised service from the pharmacy. |
Countries
Switzerland
Outcome results
None listed