Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention.

Introduction: The Initial Medication Adherence (IMA) intervention is a multidisciplinary and shared decision-making intervention to improve initial medication adherence addressed to patients in need of new treatments for cardiovascular diseases and diabetes in primary care (PC). This pilot study aims to evaluate the feasibility and acceptability of the IMA intervention and the feasibility of a cluster-RCT to assess the effectiveness and cost-effectiveness of the intervention. Methods: A 3-month pilot trial with an embedded process evaluation was conducted in five PC centers in Catalonia (Spain). Electronic health data were descriptively analyzed to test the availability and quality of records of the trial outcomes (initiation, implementation, clinical parameters and use of services). Recruitment and retention rates of professionals were analyzed. Twenty-nine semi-structured interviews with professionals (general practitioners, nurses, and community pharmacists) and patients were conducted to assess the feasibility and acceptability of the intervention. Three discussion groups with a total of fifteen patients were performed to review and redesign the intervention decision aids. Qualitative data were thematically analyzed. Results: A total of 901 new treatments were prescribed to 604 patients. The proportion of missing data in the electronic health records was up to 30% for use of services and around 70% for clinical parameters 5 months before and after a new prescription. Primary and secondary outcomes were within plausible ranges and outliers were barely detected. The IMA intervention and its implementation strategy were considered feasible and acceptable by pilot-study participants. Low recruitment and retention rates, understanding of shared decision-making by professionals, and format and content of decision aids were the main barriers to the feasibility of the IMA intervention. Discussion: Involving patients in the decision-making process is crucial to achieving better clinical outcomes. The IMA intervention is feasible and showed good acceptability among professionals and patients. However, we identified barriers and facilitators to implementing the intervention and adapting it to a context affected by the COVID-19 pandemic that should be considered before launching a cluster-RCT. This pilot study identified opportunities for refining the intervention and improving the design of the definitive cluster-RCT to evaluate its effectiveness and cost-effectiveness. Clinical trial registration: ClinicalTrials.gov, identifier NCT05094986.

Farmacia comunitaria, adherencia al tratamiento y COVID-19

La falta de adherencia es un problema mundial cada vez mayor y es la responsable de que los resultados esperados en salud se alejen de la realidad, aumentando el gasto sanitario. Comprender por qué un paciente no es adherente requiere identificar los factores implicados en su caso concreto y personalizar las estrategias a seguir. Para abordar la no adherencia desde la farmacia comunitaria tenemos el protocolo de la guía ADHe+ de dispensación y uso racional del medicamento, que clasifica a los pacientes no adherentes en tres perfiles (confundido, desconfiado y banalizador), facilitando la tarea de evaluación de sus creencias hacia un medicamento en concreto y en un momento determinado. Siguiendo el protocolo propuesto por la guía, el farmacéutico puede detectar la no adherencia en los medicamentos que el paciente recoge y en los que no e indagar en las causas. Pero el momento actual que estamos viviendo de pandemia por COVID-19 está cambiando el paradigma de la cronicidad. El miedo al contagio, la ralentización de los procesos asistenciales por las nuevas medidas de higiene, la telemedicina, el confinamiento y el desconocimiento de la nueva situación por parte de pacientes y sanitarios puede afectar mucho a la adherencia terapéutica Non-adherence to treatment is becoming more and more of a global issue and is responsible for the fact that expected health results are getting further away from reality and increasing spending on healthcare. To understand why a patient is not adhering to treatment it is necessary to identify the factors involved in his or her specific case and personalize the strategies to be followed. In order to approach non-adherence to treatment from the community pharmacy perspective, we use the protocol from the ADHe+ guide on the dispensing and rational use of the drug, which classifies non-adhering patients into three profiles (confused, wary and trivializing), facilitating the task of assessing their beliefs with regards to a certain medicine and at a given time. Following the protocol suggested by the guide, pharmacists can detect non-adherence to the medicines the patient collects and does not collect and look into the causes. However, the current times of pandemic that we are experiencing-caused by COVID-19-are changing the pattern of chronicity. Fear of infection, the slowing down of care processes due to the new hygiene measures, telemedicine, quarantine, and the lack of awareness about the new situation by both the patients and healthcare professionals may have a great impact on therapeutic adherence

Community pharmacy, adherence to treatment and COVID-19

Lack of adherence is a growing global problem and is responsible that the expected results in health depart from reality, increasing the Health expenditure. Understanding why a patient is not adherent requires identifying the factors involved in your specific case and customize the strategies to follow. For address non-adherence from the community pharmacy we have the protocol of the guide ADHe + dispensing and rational use of the drug, which classifies patients not adherents in three profiles (confused, suspicious and trivializing), facilitating the task evaluation of their beliefs towards a specific medicine and at a certain time. Following the protocol proposed by the guide, the pharmacist can detect non-adherence in the medicines that the patient collects and in which they do not and inquire in the causes. But the current moment that we are experiencing a pandemic due to COVID-19 The paradigm of chronicity is changing. The fear of contagion, the slowdown of healthcare processes for new hygiene measures, telemedicine, confinement and the ignorance of the new situation by patients and health professionals It can greatly affect therapeutic adherence.