Haugbølle LS, Herborg H. Adherence to treatment: practice, education and research in Danish community pharmacy. Pharmacy Practice (Internet) 2009 Oct-Dec;7(4):185-194. International Series: Adherence Adherence to treatment: practice, education and research in Danish community pharmacy Lotte S. HAUGBØLLE, Hanne HERBORG. Received (first version): 25-Oct-2009 Accepted: 8-Dec-2009 ABSTRACT* pharmacies have prioritised their role in health care Objective: To describe the practice, education and and patient safety, this development can be research concerning medication adherence in expected to continue in future years. Danish community pharmacy. Methods: The authors supplemented their expertise Keywords: Medication Adherence. Pharmacists. in the area of medication adherence through their Denmark. contacts with other educators and researchers as well as by conducting searches in the Danish Pharmacy Practice Evidence Database, which CUMPLIMIENTO: REVISIÓN DE LA provides annually updated literature reviews on EDUCACIÓN, INVESTIGACIÓN, PRÁCTICA intervention research in Danish pharmacy practice. Y POLÍTICA EN ESPAÑA Results: Practice: Medication adherence is the focus of and/or is supported by a large number of services and initiatives used in pharmacy practice RESUMEN such as governmental funding, IT-supported Objetivo: Describir la práctica, educación e medicine administration systems, dose-dispensing investigación relativa a cumplimiento de la systems, theme years in pharmacies on adherence medicación en la farmacia comunitaria danesa. and concordance, standards for counselling at the Métodos: Los autores complementaron su counter, pharmacist counselling, medication reviews experiencia en el área del cumplimiento de la and inhaler technique assessment. Education: In medicación mediante sus contactos con otros Denmark, pharmacy and pharmaconomist students educadores e investigadores así como mediante are extensively trained in the theory and practice of búsquedas en la Base de Datos de Evidencia en adherence to therapy. Farmacia Práctica Danesa, que proporciona Pharmacy staff can choose from a variety of anualmente revisiones de la literatura sobre continuing education and post-graduate investigaciones de intervención en la farmacia programmes which address patient adherence. práctica danesa. Research: Nine ongoing and recently completed Resultados: Práctica: El cumplimiento de la studies are described. Early research in Denmark medicación es el centro de y/o esta incluida en un comprised primarily smaller, qualitative studies gran número de servicios e iniciativas utilizadas en centred on user perspectives, whereas later la farmacia práctica tales como financiación research has shifted the focus towards larger, gubernamental, sistemas de administración de quantitative, controlled studies and action-oriented medicamentos electrónicos, sistemas de studies focusing on patient groups with chronic dispensación de dosis, temas en farmacias sobre diseases (such as diabetes, asthma, coronary cumplimiento y concordancia, estándares de vascular diseases). consejo en el mostrador, consejo farmacéutico, Conclusions: Our analysis has documented that revisión de la medicación, y evaluación de la Danish pharmaceutical education and research has técnica de inhalación. Educación: en Dinamarca, focused strongly on adherence to treatment for los estudiantes de farmacia y técnicos de farmacia more than three decades. Adherence initiatives in son formados intensamente en teoría y práctica de Danish community pharmacies have developed cumplimiento terapéutico. El personal de la substantially in the past 5-10 years, and, as farmacia puede elegir entre una variedad de formación continuada y programas postgraduados que tratan del cumplimiento del paciente. * Investigación: Se describen nueve estudios en Lotte S. HAUGBØLLE. PhD(pharm). Associate Professor. marcha o concluidos. Las primeras investigaciones Faculty of Pharmacy, Department of Pharmacology and Pharmacotherapy . Copenhagen University. Copenhagen en Dinamarca comprendieron fundamentalmente (Denmark). estudios pequeños, cualitativos y centrados en las Hanne HERBORG. MSc (pharm). Director R&D, perspectivas del usuario, mientras que las últimas Pharmakon. Hillerød (Denmark). investigaciones mudaron su ámbito hacia estudios mayores, cuantitativos, controlados y estudios de Series editors: acción-orientada que se centraban en grupos de Marie P. SCHNEIDER. PhD. Researcher and lecturer in pacientes con enfermedades crónicas (como Pharmacy Practice. Community Pharmacy, Dpt of diabetes, asma, enfermedad coronaria). ambulatory care and community medicine, University Hospital, Lausanne (Switzerland). Conclusión: Nuestra investigación ha documentado Parisa ASLANI. PhD. Senior Lecturer in Pharmacy que la educación y la investigación farmacéuticas Practice. Faculty of Pharmacy, University of Sydney danesas se han centrado fuertemente en el (Australia). cumplimiento del tratamient durante más de tres www.pharmacypractice.org (ISSN: 1886-3655) 185 Haugbølle LS, Herborg H. Adherence to treatment: practice, education and research in Danish community pharmacy. Pharmacy Practice (Internet) 2009 Oct-Dec;7(4):185-194. décadas. Las iniciativas sobre cumplimiento en las prices and profit margins All Danish pharmacies are farmacias comunitarias danesas se desarrollaron members of the Association of Danish Pharmacies. sustancialmente en los pasados 5-10 años y, como Pharmaconomists (formerly referred to as pharmacy las farmacias han priorizado su papel en los assistants) may dispense prescriptions and advise cuidados de salud y en la seguridad del paciente, customers in a pharmacy.6 puede esperarse que este desarrollo continúe en los próximos años. Adherence standards and guidelines Community pharmacies in Denmark play a key role Palabras clave: Adherencia a la medicación. in providing the public with information and Farmacéuticos. Dinamarca. counselling in the use of medicines, self-care and disease prevention. They provide medicines and medicine-related services in accordance with national laws and regulations, the WHO-approved Guidelines for Good Pharmacy Practice and Danish quality standards for pharmacies. INTRODUCTION At present, there are no official Danish adherence The consequences of poor adherence to long-term policies on medication non-adherence. However, therapies include poor health outcomes and medication is a key topic in The Strategy for Chronic increased health care costs. Adherence can be Conditions.7 The strategy, which focusses on the defined as “... the extent to which a person’s organisation and provision of health care and on behaviour – taking medication, following a diet patient self-management is currently being and/or lifestyle changes, corresponds with agreed implemented at regional level. Moreover, the Danish 1,2 recommendations from a health care practitioner”. Society for Patient Safety has developed medication This article describes the initiatives taken in the safety strategies in which adherence is a focus, and which is expected to attract more attention in the Danish primary health care sector, specifically 8 community pharmacy, concerning medication future. adherence practice, education and research. The Association of Danish Pharmacies launched its 7 “Standard for Counselling at the Counter” in 2007. METHODS The standard sets out three different levels for counselling at the counter: A ´basic´, ‘extended’ and The information concerning policy and practice is an ´advanced’ level. At the basic level, the standard based firstly on the authors’ extensive knowledge, requires pharmacy staff to invite all customers and secondly, on a mapping of pharmacy practice purchasing medicines for themselves to a activities in Nordic countries conducted in 2008 for ‘dialogue’, by asking questions and giving the Nordic Pharmacy Association.3 information about the medicine. At the extended level, the pharmacy staff should, in addition, ask The results in the research section are based on questions about customers’ specific risks and searches in 1) the Danish Pharmacy Practice provide relevant counselling according to the Evidence Database and 2) PubMed. The Danish customer’s needs. At the advanced level, pharmacy Pharmacy Practice Evidence Database has been staff is required to also assess symptoms and developed and is operated and annually updated by identify ‘alarm signals’ in order to help the customer Pharmakon (the Danish College of Pharmacy prevent medicine-related problems. Pseudo- Practice- www.pharmakon.com). It is an electronic customer studies have been used to investigate searchable database, comprising literature reviews whether customers receive counselling in (published in English and Scandinavian languages) 9 accordance with the standard’s basic level. and Danish reports in key pharmacy practice areas, with emphasis on primary care.4,5 The following Occasional services delivered with temporary keywords were used in the Pubmed search: funding (compliance OR adherence OR concordance) AND (intervention* OR (clinical trial)) AND medication or In 2005-06, several policy papers highlighting the need to focus on adherence to medicines were medicines or drugs AND ((primary care) or 10,11 (pharmacist OR pharmacists OR pharmacy OR published. The Medication Reimbursement pharmacies).As a second strategy, input was Committee report led to a parliamentary decision to allocate DKK 10 million (EUR 1.33 million) annually sought from researchers in key organizations: 12 Pharmakon, Association of Danish