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Redalyc.Developing a Generic, Individualised Adherence Pharmacy Practice ISSN: 1885-642X [email protected] Centro de investigaciones y Publicaciones Farmacéuticas España Herborg, Hanne; Haugbølle, Lotte S.; Sørensen, Lene; Rossing, Charlotte; Dam, Pernille Developing a generic, individualised adherence programme for chronic medication users Pharmacy Practice, vol. 6, núm. 3, july-september, 2008, pp. 148-157 Centro de investigaciones y Publicaciones Farmacéuticas Granada, España Available in: http://www.redalyc.org/articulo.oa?id=69060306 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Herborg H, Haugbølle LS, Sørensen L, Rossing C, Dam P. Developing a generic, individualised adherence programme for chronic medication users. Pharmacy Practice 2008 Jul-Sep;6(3):148-157. Original Research Developing a generic, individualised adherence programme for chronic medication users Hanne HERBORG, Lotte S. HAUGBØLLE, Lene SØRENSEN, Charlotte ROSSING, Pernille DAM. Received (first version): 28-Mar-2008 Accepted: 31-Jul-2008 ABSTRACT* DESARROLLO DE UN PROGRAMA DE Objective: The scope of this article is to describe the ADHERENCIA GENÉRICO E background for and content of an adherence INDIVIDUALIZADO PARA USUARIOS DE counselling programme with a specific focus on an MEDICACIÓN CRÓNICA individualised, multi-dimensional adherence model for patients with a potential adherence problem (a RESUMEN so-called ‘individualised systems model’). Objetivo: El ámbito de este artículo es describir los Methods: An intervention programme based on antecedentes y el contenido de un programa de WHO’s systems model for adherence was consejo en adherencia específicamente enfocado a developed for implementation in primary health care un modelo multidimensional individualizado de and tested in a development project in Danish adherencias para pacientes con un posible problema pharmacies in 2004-2005 in three pharmacies and 4 de adherencia (conocido como ‘modelo de sistemas GP practices by 27 patients. Data were collected individualizado’). from the participants by registration forms, Métodos: Se desarrolló un programa de questionnaires, and focus groups. Since the intervención basado en el modelo de sistemas de la programme was to support patients in the self- OMS para adherencia y se probó en un proyecto management process regarding choice and danés desarrollado en 2004-2005 en 3 farmacias y 4 implementation of medication treatment, various consultas de médicos generales con 27 pacientes. strategies were used and different theoretical Se recogieron los datos de los participantes en assumptions and choices made prior to setting up formularios, cuestionarios y grupos focales. Como the study. These strategies include distinguishing el programa era para apoyar a los pacientes en el between different types of non-adherence, a model proceso de auto-gestión en cuanto a la selección, e for stages of change, self-efficacy, narratives, implantación del tratamiento medicamentoso, se motivating interviewing strategies and coaching usaron varias estrategias y se hicieron a priori techniques. These strategic and theoretical choices varias asunciones teóricas y elecciones para are described in the article. arrancar el estudio. Estas estrategias incluyeron Results: The strategies and theoretical reflections diferenciar los distintos tipos de no-adherencia, un formed the platform for the creation of a counselling modelo de estados de cambio, auto-eficacia, programme, which was tested in two forms, a basic narrativas, estrategias de entrevistas motivadoras, y and an extended version - provided by either a técnicas de entrenamiento. Estas estrategias y pharmaconomist or a pharmacist. The result section elecciones teóricas se describen en el artículo. also describes a toolbox of instruments to enable Resultados: Las estrategias y reflexiones teóricas pharmacy staff and GPs to tailor a counselling crearon la plataforma para la creación de un programme for patients individually called ‘Safe and programa de consejo, que se probó de dos formas, effective use of medicines’. Besides, the results una versión básica y una extensa – proporcionado include a description of how the WHO-model is bien por un farmacoeconomista o un farmacéutico. transformed into an individualised counselling La sección de resultados también describe un model. conjunto de instrumentos para capacitar al personal Keywords: de la farmacia y a los médicos a dirigir un Patient Compliance. Counseling. Self programa de consejo para pacientes denominado Efficacy. Denmark. ‘Uso efectivo y seguro de medicamentos’. Además, los resultados incluyen una descripción de cómo se transformó el modelo de OMS en un modelo de consejo individualizado. Palabras clave: Cumplimiento del paciente. Consejo. Auto-eficacia. Dinamarca. * Hanne HERBORG. MSc (pharm). Director of R&D, Pharmakon. Hillerød, (Denmark). Lotte S. HAUGBØLLE. PhD (pharm). Associate Professor, Copenhagen University. Copenhagen (Denmark). Lene SØRENSEN. PhD (pharm). Consultant R&D; Pharmakon. Hillerød, (Denmark). INTRODUCTION Charlotte ROSSING. PhD (pharm). Section Manager, Pharmakon. Hillerød, (Denmark). Poor adherence to the treatment of chronic Pernille DAM. MSc (public health science). Consultant diseases is a worldwide problem of significant R&D, Pharmakon. Hillerød, (Denmark). www.pharmacypractice.org 148 Herborg H, Haugbølle LS, Sørensen L, Rossing C, Dam P. Developing a generic, individualised adherence programme for chronic medication users. Pharmacy Practice 2008 Jul-Sep;6(3):148-157. magnitude, about 50% on average in developed pharmacy as a coordinating point of care. The countries and even higher in developing countries.1 programme identifies potential non-adherence, The consequences of poor adherence to long-term analyses the character of the problems identified, therapies are poor health outcomes and increased including drug-related problems, explores patient health care costs, among other things. resources and provides concordance-based follow- up sessions and individually based interventions. Adherence is defined as ‘... the extent to which a person’s behaviour - taking medication, following a Using a systems approach to study the processes diet and/or lifestyle changes, corresponds with of medication on the individual patient level is a agreed recommendations from a health care well-known phenomenon in the pharmacy research practitioner’.1-3 Adherence, thus, requires the area. In recent years, a system-oriented approach patient’s agreement to the recommendation. Since as suggested by WHO has been operationalised 1997, where the concept was launched for the first and used on the individual patient level in several time in the UK, ‘concordance’ has been used to pharmaceutical care projects aiming to prevent and describe this process of shared decision making solve drug-related problems and consequently concerning medicine use.4 Adherence and avoid drug-related morbidity and mortality5 and concordance need to go hand in hand. We use the likewise a systems approach is used in the patient term adherence throughout the article, also when safety and medication error literature. comparing our results to the results of other studies in which only the term compliance has been used. Studies have shown how community pharmacies, in close collaboration with GPs, play an important role With the model shown in Figure 1, WHO argues for in improving adherence, through detecting quality a systems approach to studying adherence, an problems in the drug use process and through approach made up of the interplay between the supporting patients’ self-management with relevant, following five dimensions: patient-related factors; individually tailored solutions.6-11 social/economic factors; therapy-related factors; condition-related factors and health-system related An intervention programme was developed for factors.1 Therefore, a suitable programme and implementation in primary health care and tested in model for identifying and solving non-adherence a development project in Danish pharmacies in needs should take its starting point in these 2004-2005. Overall, the development project aimed dimensions. at developing and validating a pharmacy-based primary care programme with the objective of ensuring safe and effective medicine use among users of hypertensive medicines. The scope of this article is to describe the strategic and theoretical background for and content of an adherence counselling programme with a specific focus on an individualised, multi-dimensional adherence model for patients with a potential adherence problem, exemplified by a concrete case illustrating the use of the model. METHODS Design The development project was set up as a formative evaluation, the main purpose of which is learning from and optimising an intervention. Figure 1. The five dimensions of adherence as suggested From December 2004 through May 2005, three by the World Health Organisation pharmacies implemented, tested and validated the According to WHO1, non-adherence should not be programme in cooperation with 4 GP practices. viewed as an isolated, single-factor problem, but Twenty-seven patients with potential for non- rather as a multi-dimensional problem not adherence were included in the study. Of this determined exclusively by patient factors, as is seen number, 23 users of anti-hypertension medication
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