[Experiences of health care providers with the implementation of medication schemes on paper]. / Observations des prestataires de soins lors de l'implémentation d'un schéma de médication en version papier.

BACKGROUND: Medication management demands information exchange between healthcare professionals of intra- and transmural care. AIM: The goal of this study is to determine if a paper medication overview improves the information exchange between healthcare professionals of primary and secondary care in the South Eastern part of Limburg. METHODS: A paper medication overview was implemented in this region. A pre and post survey were used to gather healthcare professionals opinions about the potential of the paper medication overview. The expectations, experiences and the use of the medication overview were gathered. RESULTS: The most important barriers are the time investment of healthcare professionals and patient involvement. A paper medication overview appears to be mostly used to reduce medication errors. Few healthcare professionals see potential in the paper medication overview as a tool to improve communication. An electronic medication overview yields more possibilities as well for intramural care as for transmural care. CONCLUSION: A paper medication overview is perceived as a tool to reduce medication errors. Although it is very time consuming to keep the paper medication overview up-to date, it yields a lot of possibilities to improve information exchange between different kinds of healthcare professionals. Patient involvement is crucial to establish the flow of healthcare information.

[Vitalink: a digital platform to share patient health records in primary care. Report of the pilot projects for sharing medication schemes]. / Partage en ligne des données en première ligne de soins via Vitalink. Rapport des projets-pilotes Vitalink pour le partage des schémas de médication.

Vitalink is a digital platform to share health patient data among health care professionals in primary care. The Flemish community started the development of this platform in collaboration with representatives of professional associations primary care. Sharing medication charts online was the first Vitalink project. In December 2012 four pilot regions in Flanders (Turnhout, Limburg, Aalst and Halle) tested medication chart sharing through Vitalink. Due to difficulties with software development effective sharing started only in April 2013. The test phase was ended in October 2013. Each pilot region made an evaluation report. Conclusions were similar: the realization business cases were limited. Integration in end user software was insufficiently performant. Moreover, interpretation of downloaded medication charts was found out to differ among participating software applications. Because of these problems exchange of patient records among primary care actors was limited. Therefore research questions could not be conclusively answered. Nevertheless the Vitalink pilot project can be considered successful in some ways. Collaboration and communication among health care professionals and their associations was ameliorated. The awareness of digital data sharing in primary care is growing. Pilot projects created buy in among patients, physicians, pharmacists and nurses. Uniform lay-out guidelines were established in deliberation with all participating actors. Since November 2013 Vitalink is in production. Medication charts, summarized electronic health records and vaccination data can be uploaded to the platform and health care professionals that are registered can consult them. End user software must still be developed to make broad use of the platform feasible. Meanwhile further deliberation with software vendors and professional associations can be organized in order to achieve the implementation and integration of user friendly Vitalink modules.

[Adherence to chronic medication: also a frequent problem in Belgium!]. / L'observance thérapeutique des traitements chroniques: problématique pour les patients belges aussi!

Medication adherence in chronic conditions such as asthma, type 2 diabetes, heart failure, HIV and cancer appears to be a frequent problem. However, the literature on adherence in patients who use inhaled corticosteroids (ICS), oral hypoglycemic agents, drugs for heart failure, antiretrovirals or oral chemotherapy, contains little or no relevant data for Belgium. In the context of a Master thesis in Pharmaceutical care at KU Leuven, a quantitative study was performed to determine the prevalence of adherence to chronic medication in Belgium. This retrospective, cross-sectional study used a database containing refill data of a regional pharmacists' association (KLAV). Out of the 603 pharmacies affiliated with this association, all 50 pharmacies where HIV medication was delivered, were selected. Dispensing data from the selected pharmacies were collected from 01/07/2008 to 31/12/2009 for five pathologies, i.e.; asthma, type 2 diabetes, heart failure, HIV and cancer. Adherence (TT) was calculated with the Medication Refill Adherence (MRA) method. In order to determine whether there were associations between age, gender, drug class and adherence, Chi-square tests were used. Compared with the other patients, cancer patients were the most adherent in taking their drugs (median adherence rate = 88%). In addition, this was the only group in which the median adherence rate was above the set limit of 80%. The patients who were prescribed inhaled corticosteroids were the least adherent (median adherence rate = 38%). More than 50% of patients with asthma/COPD, heart failure and diabetes were classified as "under-users". Furthermore, the results showed a significant association within asthma patients between gender and adherence. In asthma, type 2 diabetes, heart failure and HIV patients there was a significant relationship between age and adherence and drug class and adherence. As the current study has some limitations, the results should be handled with caution. Nevertheless, the current study shows that also in Belgium there is a problem with medication adherence in chronic conditions, especially in asthma patients.