Markus Messerli

Development of Clinical Pharmacy in Switzerland: Involvement of Community Pharmacists in Care for Older Patients

The role of the community pharmacist in primary care has been undergoing change in Switzerland in parallel to international developments: it has become more clinically and patient oriented. Special services of community pharmacists to older patients taking long-term or multiple medications, discharged from hospitals or experiencing cognitive impairment or disability have been developed. These services require more clinical knowledge and skills from community pharmacists and are based on, for example, ‘simple or intermediate medication reviews’ focused primarily to improve medication adherence and rational drug use by a patient. Reflecting the new role of community pharmacies, this article describes the current services provided by community pharmacies in Switzerland, e.g., ‘polymedication check’, ‘weekly pill organizer’, and ‘services for chronic patients’, as well as new Swiss educational and reimbursement systems supporting development of these services. In the international context, involvement of community pharmacists in patient-oriented care is growing. This review summarizes positive and negative experiences from implementation of community pharmacy services in Switzerland and provides examples for the development of such services in other countries.

Proposal of Standardization to Assess Adherence With Medication Records: Methodology Matters

Background: Medication adherence is the process by which patients take their medication as prescribed and is an umbrella term that encompasses all aspects of medication use patterns. Ambiguous terminology has emerged to describe a deviation from prescribed regimen, forcing the European ABC Project to define 3 phases of medication use: initiation, implementation, and discontinuation. However, different measures of medication adherence using medication records are currently available that do not always distinguish between these phases. The literature is lacking standardization and operationalization of the assessment methods. Objective: To propose a harmonization of standards as well as definitions of distinct measures and their operationalization to quantify adherence to medication from medication records. Methods: Group discussions and consensus process among all coauthors. The propositions were generated using the authors’ experiences and views in the field of adherence, informed by theory. Results: The concepts of adherence measures within the new taxonomy were harmonized, and the standards necessary for the operationalization of adherence measures from medication records are proposed. Besides percentages and time-to values, the addition of a dichotomous value for the reinitiation of treatment is proposed. Methodological issues are listed that should be disclosed in studies on adherence. Conclusions: The possible impact of the measures in adherence research is discussed. By doing this, the results of future adherence research should gain in accuracy. Finally, studies will become more transparent, enabling comparison between studies.

Mapping clinical pharmacy practice in Swiss hospitals: a cross-sectional study

Background Clinical pharmacy activities developed significantly in the last decade. The extent and organisation of these activities in Switzerland remained unknown. Objectives To map clinical pharmacy services (CPS) provided in Swiss hospitals and to discuss their development focusing on different cultural regions and healthcare systems. Methods We enrolled all chief hospital pharmacists affiliated with the Swiss Society of Public Health Administration and Hospital Pharmacists (n=47) for an online survey. We asked them to describe the extent and organisation of CPS concerning patient-related, therapy-related or process-related activities, the structural organisation and the available human resources. Results The survey took place from March to April 2013. It was completed by 44 chief hospital pharmacists (return rate 94%), representing the hospital landscape in Switzerland comprehensively. Thirty-three (75%) hospitals offered regular CPS and seven (16%) planned to do so. Institutions in regions without drug-dispensing physicians rather employed pharmacists assigned with clinical activities (n=20, 22% of 135.3 full-time equivalent (FTE)) than regions with partial (n=8, 7% of 35.8 FTE) or unrestricted drug dispensing by physicians (n=16, 6% of 68.1 FTE, p=0.026). Of hospitals with implemented CPS, 73% had weekly interprofessional ward rounds, and in 9.1%, clinical pharmacists daily reconciled medicines at patient discharge. Conclusions Our data show regional differences in the implementation and pattern of CPS. A significant correlation to drug dispensing by physicians in ambulatory care and human resources provided for CPS was found. While interprofessional ward rounds were performed periodically, seamless care activities by clinical pharmacists remained insufficiently established.

Humanistic outcomes and patient acceptance of the pharmacist-led medication review “Polymedication Check” in primary care in Switzerland: a prospective randomized controlled trial

Background Since 2010, Swiss pharmacists have been offering their patients a Polymedication Check (PMC), a new cognitive pharmacy service in the form of a medication review for patients taking ≥4 prescribed medicines for a period >3 months. While a first publication of this project reported on the impact of the PMC on patients’ adherence, the present paper focuses on humanistic outcomes. Methods This randomized controlled trial was conducted in 54 Swiss community pharmacies. After recruitment, the intervention group underwent a PMC in the pharmacy (T-0) and 28 weeks after T-0 (T-28), while the control group did not receive the PMC until 28 weeks after the study started (T-28). A clinical psychologist, blinded to the intervention, interviewed the patients 2 weeks (T-2) and 16 weeks (T-16) after T-0. Interviewer and patient both rated patient’s knowledge of own medicines use. Furthermore, patients reported satisfaction with their pharmacy and appraisal of their medicines use. The availability of a written medication plan was assessed at T-16. Acceptance of the service was measured using a patient’s self-report questionnaire at T-28. Results General linear model analysis for knowledge about medicines revealed a significant effect on the factor “group” (P=5.86, p=0.016), indicating that the intervention group had higher ratings for knowledge about their medication at T-2 and T-16 compared to controls. The majority (83%) of patients judged the counseling by the pharmacist as being helpful for their daily medication management. Availability of a written medication plan was comparable in both groups (52.5% vs 52.7%, p>0.05). Conclusion For the first time, the benefits of a complex pharmacist-led intervention were evaluated in Swiss primary care with a randomized controlled trial. The PMC increased patients’ subjective knowledge of their medicines compared to no medication review. The effect remained sustainable over time. Recommendations resulting from the pharmacist-led service were highly appreciated by the patients.

Swallowing difficulties with medication intake assessed with a novel self-report questionnaire in patients with systemic sclerosis - a cross-sectional population study

Objectives To assess subjective swallowing difficulties (SD) with medication intake and their practical consequences in patients suffering from systemic sclerosis (SSc) with a novel self-report questionnaire. Design and setting Based on a systematic literature review, we developed a self-report questionnaire and got it approved by an expert panel. Subsequently, we sent the questionnaire by post mail to SSc patients of the European Center for the Rehabilitation of Scleroderma Rheinfelden, Switzerland. Participants Patients were eligible if they were diagnosed with SSc, treated at the center, and were of age ≥18 years at the study start. Main outcome measures Prevalence and pattern of SD with oral medication intake, including localization and intensity of complaints. Results The questionnaire consisted of 30 items divided into five sections Complaints, Intensity, Localization, Coping strategies, and Adherence. Of the 64 SSc patients eligible in 2014, 43 (67%) returned the questionnaire. Twenty patients reported SD with medication intake (prevalence 47%), either currently (11; 26%) or in the past that had been overcome (9; 21%). Self-reported SD were localized mostly in the larynx (43%) and esophagus (34%). They were of moderate (45%) or strong to unbearable intensity (25%). Modification of the dosage form was reported in 40% of cases with SD. Adherence was poor for 20 (47%) patients and was not associated with SD (p=0.148). Conclusion Our novel self-report questionnaire is able to assess the pattern of complaints linked to medication intake, that is, localization and intensity. It may serve as a guide for health care professionals in selecting the most suitable therapy option, enabling tailored counseling to reduce inappropriate medication modifications.