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Design of an implementation study related to an interdisciplinary ART adherence program for HIV patients in community pharmacies

par Lelubre, Melanie ;Clerc, Olivier;Grosjean, Marielle;Amighi, Karim ;De Vriese, Carine ;Bugnon, Olivier ;Schneider, Marie Paule
Référence Pharmaceutical Care Network Europe Working Conference (4-6 feb 2015: Mechelen, Belgium)
Publication Publié, 2015

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Résumé :

Background : The community pharmacy of the Department of ambulatory care & community medicine (Lausanne, Switzerland) implemented an interdisciplinary antiretroviral therapy (ART) adherence program for HIV patients in 2004. This program aims to support and to reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic measure (MEMSTM) and feedback. The positive impact of this program has already been demonstrated (Krummenacher et al., Aids Care 2011) but the capacity to implement it in other community pharmacies and medical settings has never been assessed. Purpose of Study or Program: The aim of this study is to assess the capacity of the infectious diseases service of a public hospital and community pharmacies of Neuchâtel area (Switzerland) to implement an interdisciplinary ART adherence program based on the Lausanne collaborative model.Study or Program Design and Methods: Quantitative and qualitative analysis of an implementation process through a multicentric and prospective study will be conducted following the Re-AIM model (www.re-aim.org). This evaluation framework is used to assess the impact of an intervention on health care and to transfer an intervention into the current health system. The five dimensions of the Re-AIM are: Reach, Effectiveness, Adoption, Implementation and Maintenance. Quantitative variables will be collected through patients’ medical records, and prospectively during medical and adherence assessments at the hospital and at the pharmacy (SISPhaTM Software). Qualitative variables related to implementation will be collected during separated focus groups with doctors and nurses on the one hand and with pharmacists on the other. Patient’s perception will also be collected during individual interviews. Data will be continuously collected and implementation will be assessed at 12 and 24 months.Findings of Study or Program: Implementation started in November 2014. One physician, 1 nurse and 5 pharmacists agreed to participate. So far, 5 patients accepted the inclusion and 5 refused. Collected quantitative data are divided into 3 categories: patient-related (sociodemographic and clinical data, electronic adherence data, length of follow-up), program adoption-related (number of pharmacists, physicians and nurses involved) and program reach-related (number of patients who accepted and refused). Qualitative analysis will bring information about feasibility and utility of the program, adoption, motivation, identified barriers and facilitators, satisfaction, interdisciplinary collaboration, collaboration with patients and proposals for improvement. Conclusions and Program Implications: Transfer of this program just started from an academic to a regional setting. The implementation study should facilitate firstly adoption and secondly dissemination. Key steps, as well as necessary changes to implement this program further within pharmacy and medical setting, will be highlighted.