Sophie Lauzier

Association between community pharmacy loyalty and persistence and implementation of antipsychotic treatment among individuals with schizophrenia

Background Non‐adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non‐adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. Objective To assess the association between the level of community pharmacy loyalty and persistence with and implementation of antipsychotic drug treatment among individuals with schizophrenia. Methods A cohort study using databases from the Quebec health insurance board (Canada) was conducted among new antipsychotic users insured by Quebecs public drug plan. Level of community pharmacy loyalty was assessed as the number of pharmacies visited in the year after antipsychotics initiation. Persistence was defined as having an antipsychotic supply in the users possession on the 730th day after its initiation and implementation as having antipsychotics in the users possession for ≥80% of the days in the second year after antipsychotics initiation (among persistent only). Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). Results 6,251 individuals were included in the cohort and 54.1% had their drug prescriptions filled in >1 pharmacy. When compared to those who had their prescriptions filled in a single pharmacy, those who had their prescriptions filled in ≥4 different pharmacies were 22% more likely to be non‐persistent (aPR = 1.22; 95%CI = 1.10–1.37) and 49% more likely to have an antipsychotic for <80% of the days (aPR = 1.49; 95%IC = 1.28–1.74). Conclusion This first exploration of community pharmacy loyalty in the context of severe mental illness indicates that this healthcare organisation factor might be associated with antipsychotics persistence and implementation. Identification of individuals with low community pharmacy loyalty and initiatives to optimize community pharmacy loyalty could contribute to enhanced persistence and implementation. HighlightsThis cohort included individuals with schizophrenia who started antipsychotics.54% had their drug prescriptions filled in >1 pharmacy in the year after initiation.Visiting ≥4 pharmacies was associated with non‐persistence and non‐compliance.

Contributions of community pharmacists to patients on antidepressants—a qualitative study among key informants

Background Patients with an antidepressant drug treatment (ADT) report unmet needs and a significant proportion stop their ADT prematurely. Community pharmacists can play a key role in supporting these patients. Objective To explore the perspectives of various leaders in health care about the current and potential contributions of community pharmacists to patients on ADT. Setting The province of Quebec (Canada). Method We conducted a qualitative descriptive exploratory study using interviews among leaders who were involved in health care services, pharmaceutical services, physician and pharmacist education, as well as patient and healthcare professional associations. Verbatim transcripts of interviews were analyzed using computer-assisted thematic analysis. Main outcome measure Perspectives about the contributions of community pharmacists to patients on ADT. Results Interviews revealed that pharmacists are perceived to be accessible drug experts whose particular strengths are their thorough knowledge of drugs, their commitment to ensure ADT safety and tolerability, as well as their commitment to inform and support patients. Leaders trained in pharmacy or representatives of pharmacy organizations had concrete expectations for pharmacists’ increased involvement in monitoring ADT adherence and efficacy. They extensively discussed the regulatory and organizational changes required to enhance this role. Leaders also stated that, in addition to patients, health care teams could benefit from pharmacists’ expertise and support. Conclusion Participating key informants perceived the need for enhanced pharmacist monitoring of ADT adherence and efficacy. They also expressed their openness to an increased collaboration between health care teams and pharmacists.

Women’s Beliefs on Early Adherence to Adjuvant Endocrine Therapy for Breast Cancer: A Theory-Based Qualitative Study to Guide the Development of Community Pharmacist Interventions

Adjuvant endocrine therapy (AET) taken for a minimum of five years reduces the recurrence and mortality risks among women with hormone-sensitive breast cancer. However, adherence to AET is suboptimal. To guide the development of theory-based interventions to enhance AET adherence, we conducted a study to explore beliefs regarding early adherence to AET. This qualitative study was guided by the Theory of Planned Behavior (TPB). We conducted focus groups and individual interviews among women prescribed AET in the last two years (n = 43). The topic guide explored attitudinal (perceived advantages and disadvantages), normative (perception of approval or disapproval), and control beliefs (barriers and facilitating factors) towards adhering to AET. Thematic analysis was conducted. Most women had a positive attitude towards AET regardless of their medication-taking behavior. The principal perceived advantage was protection against a recurrence while the principal inconvenience was side effects. Almost everyone approved of the woman taking her medication. The women mentioned facilitating factors to encourage medication-taking behaviors and cope with side effects. For adherent women, having trouble establishing a routine was their main barrier to taking medication. For non-adherent women, it was side effects affecting their quality of life. These findings could inform the development of community pharmacy-based adherence interventions.

Family caregivers' reported nonadherence to the controller medication of asthma in children in Casablanca (Morocco): Extent and associated factors

ABSTRACT Objective: Recent statistics show a relatively high prevalence of asthma among Moroccan children and a weak control over their symptoms. To our knowledge, no research has been carried out to document adherence to the controller treatment in this population. This study aims 1) to assess the extent of childrens nonadherence to the controller treatment of asthma in an urban region of Morocco as reported by a family caregiver, and 2) to identify the associated factors. Methods: We conducted a cross-sectional study among caregivers of asthmatic children (2–12 years old) in different health and education facilities of Casablanca-Settat. We administered face-to-face questionnaires incorporating validated instruments (Medication Adherence Rating Scale-Asthma (MARS-A), Beliefs about Medicines Questionnaire (BMQ), Asthma Knowledge Questionnaire). Univariate and multivariate log-binomial regressions evaluating the association between several factors and reported nonadherence were performed (prevalence ratios (PR) and 95% confidence intervals (CI)). Results: Through two public hospitals, three private medical clinics, and one private school, 103 caregivers were recruited. Low adherence to the controller treatment of asthma was reported by 48% of the caregivers (MARS-A <45). In the multivariate model, caregivers with the lowest level of knowledge about asthma were almost three times more likely to report low adherence compared to caregivers with the highest level (PR = 2.93; 95% CI: 1.14–7.52). Conclusions: This study highlights the finding that low adherence is widespread in this context and also the importance of targeting caregivers knowledge of asthma for interventions.

Patient perspectives on the role of community pharmacists for antidepressant treatment: A qualitative study

Objectives: Patients prescribed antidepressant drug treatment (ADT) for major depression report several needs in relation to their treatment, and a large proportion of these patients will end ADT prematurely. Community pharmacists may play an important role in monitoring ADT and supporting these patients. However, little is known about patient experiences of the services provided in community pharmacies. The objectives of this study were to 1) explore patients’ experiences with the services community pharmacists provide for ADT and 2) identify potential avenues for improvement of pharmacists’ services within the context of ADT. Methods: A qualitative descriptive exploratory study was conducted among individuals diagnosed with major depression who had initiated ADT at some point in the 12 months prior to their participation in the study. A total of 14 persons recruited in a local health centre and a community-based organization participated in individual interviews. A thematic analysis of the interview transcripts was conducted. Results: Pharmacists tend to concentrate their involvement in treatment at initiation and at the first refill when questions, uncertainties and side effects are major issues. Patients felt that the pharmacists’ contributions consisted of providing information and reassurance; in these respects, their needs were met. Participants had few ideas as to what additional services pharmacists could implement to improve patients’ experience with ADT. Patients’ sole expectations were that pharmacists extend this information role to the whole length of the treatment and enhance the confidentiality of discussions in pharmacy. Conclusion: Pharmacists should provide counselling throughout the entire treatment rather than passively waiting for patients to ask their questions. However, facilitation of open discussions may not be achieved unless confidentiality at pharmacies is secured.

Neighbourhood Material and Social Deprivation and Exposure to Antidepressant Drug Treatment: A Cohort Study Using Administrative Data

Objective: To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan. Method: We conducted an administrative database cohort study of adults covered by the Quebec public drug plan who were diagnosed with a new episode of unipolar depression. We assessed material and social deprivation using an area-based index. We considered exposure to an ADT as having ≥1 claim for an ADT within the 365 days following depression diagnosis. Among those exposed to ADT, ADT quality was assessed with 3 indicators: first-line recommended ADT, persistence with the ADT, and compliance with the ADT. Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI). Results: Of 100,432 individuals with unipolar depression, 65,436 (65%) were exposed to an ADT in the year following the diagnosis. Individuals living in the most materially deprived areas were slightly more likely to be exposed to an ADT than those living in the least deprived areas (aPR, 1.04; 95% CI, 1.03 to 1.06). The likelihoods of being exposed to a first-line ADT, persisting for the minimum recommended duration and complying with the ADT were independent of the deprivation levels. Conclusions: Neighbourhood deprivation was not associated with ADT quality among individuals insured by the Quebec public drug plan. It might be partly attributable to the public drug plan whose goal is to provide equitable access to prescription drugs regardless of income.

Beliefs influencing community pharmacists' interventions with chronic kidney disease patients: A theory-based qualitative study

Background: Drug‐related problems (DRPs) are highly prevalent in chronic kidney disease (CKD) patients. Community pharmacists are ideally positioned to manage these DRPs. However, little is known about the factors influencing their interventions with CKD patients. Objectives: Using the theory of planned behavior (TPB), this qualitative study sought to: (1) explore the behavioral beliefs (perceived advantages and disadvantages), normative beliefs (perceived expectations of significant others) and control beliefs (perceived barriers and facilitators) influencing community pharmacists interventions related to identifying and managing DRPs in CKD; and (2) compare these beliefs among three DRPs prevalent in CKD patients. Methods: Community pharmacists in Quebec, Canada participated in face‐to‐face individual semi‐structured interviews. The topic guide was based on the TPB. Three vignettes were presented to stimulate community pharmacists thoughts about their interventions regarding: (1) the use of an inappropriate over‐the‐counter laxative; (2) prescriptions of anti‐inflammatory medications; and (3) non‐adherence to antihypertensive medication. Integral transcripts of audio recordings were analyzed using thematic analysis. The findings on each of the three DRPs were systematically compared. Results: Fifteen community pharmacists participated in the study. All expressed a positive attitude toward DRP management, mentioning advantages such as gaining the patients loyalty as a client and avoiding CKD complications. Participants mentioned that patients and physicians generally approve their interventions, but the dynamics of these relationships may vary depending on the DRP. Common barriers in the management of the three DRPs were the pharmacists limited time and heavy workloads. The pharmacists felt that the main disadvantage is that these interventions interrupt the workflow in the pharmacy. Conclusion: Community pharmacists hold positive views of their interventions in CKD. However, enhancing community pharmacists involvement in CKD care may require measures to facilitate pharmacists proactivity, inter‐professional collaboration and a work organization adapted to clinical activities.

Comparative impact of two continuing education activities targeted at COPD educators on educational outcomes: protocol for a non-randomized controlled study using mixed methods

BackgroundTherapeutic patient education (TPE) improves quality of life and reduces health care utilization among patients with chronic obstructive pulmonary disease (COPD). However, benefits from TPE might depend on the performance of the educators and training is needed to ensure the effective delivery of TPE interventions. Based on the framework by Moore et al. (J Contin Educ Health Prof 29:1-15, 2009), we will compare the impact of two continuing education (CE) activities on TPE in regard to the following educational outcomes: (1) learning, (2) self-report of competence, (3) performance of the educators, and (4) outcomes of COPD patients who will meet the newly trained educators for TPE.MethodsWe will conduct a non-randomized controlled study using mixed methods. Educators will first participate in a CE activity on TPE that will include a role-playing simulation (experimental group) or in a lecture on TPE (comparison group) and then will perform TPE in COPD patients. Among educators, we will assess: (1) learning, by measuring knowledge about TPE, and (2) self-report of competence using self-administered questionnaires before and after the activity. Then, after the CE activity, we will assess (3) educators’ performance levels in delivering TPE by rating a videotaped TPE intervention. In COPD patients who will meet the newly trained educators for TPE after either CE activity, we will assess (4) quality of life and resource utilization using interviewer-administered questionnaires, before and after TPE. Statistical analyses will compare the experimental group against the comparison group using multivariate models. Using a semi-structured interview guide, we will conduct interviews with educators and perform content analysis. Results will be integrated in order that qualitative results further explain the quantitative ones.DiscussionTo the best of our knowledge, this is the first controlled mixed methods study to compare the impact of two CE activities on TPE in regard to four educational outcomes. We believe this study will serve as a model for evaluating CE activities on TPE. Results from this study could increase educators’ performance levels in delivering effective TPE interventions, and, in turn, COPD patient outcomes.Trial registrationThe study was registered on https://clinicaltrials.gov/ (NCT02870998) on March 15, 2016.

Association between interpersonal continuity of care and medication adherence in type 2 diabetes: an observational cohort study

BACKGROUNDnPrior studies have shown that, compared to patients with a low level of interpersonal continuity of care, patients with a high level of continuity of care have a lower likelihood of hospital admission and emergency department visits, and a higher likelihood of patient satisfaction. We sought to determine whether higher levels of continuity of care are associated with medication persistence and compliance among new users of oral antidiabetic treatment.nnnMETHODSnWe conducted a medicoadministrative cohort study of new users of oral antidiabetics aged 18 years or more among people covered by the Quebec public drug plan. We excluded people with fewer than 730 days of treatment and those who had been in hospital for 275 days or more in the first or second year after initiation of antidiabetic treatment. We categorized continuity of care observed in the first year after treatment initiation as low, intermediate or high. The association between continuity of care and medication persistence and compliance was assessed using generalized linear models.nnnRESULTSnIn this cohort of 60u202f924 new users of oral antidiabetic treatment, compared to patients with a high level of continuity of care, those with an intermediate and a low level of continuity of care were less likely to be persistent (adjusted prevalence ratio 0.97 [95% confidence interval (CI) 0.96-0.98] and 0.96 [95% CI 0.95-0.97], respectively) and compliant (adjusted prevalence ratio 0.98 [95% CI 0.97-0.99] and 0.95 [0.94-0.97], respectively) with their antidiabetic treatment.nnnINTERPRETATIONnA higher level of interpersonal continuity of care was associated with a higher likelihood of drug persistence and compliance. Since the strength of this association was weak, further research is required to determine whether continuity of care plays a role in medication adherence.