Lelubre Mélanie, Clerc Olivier, Grosjean Marielle, Amighi Karim, De Vriese Carine, Bugnon Olivier, Schneider Marie-Paule
Community pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
Community pharmacy, Department of ambulatory care and community medicine, University of Lausanne, Lausanne, Switzerland.
BMC Health Serv Res. 2018 Nov 20;18(1):874. doi: 10.1186/s12913-018-3641-5.
An interprofessional medication adherence program (IMAP) for chronic patients was developed and successfully implemented in the community pharmacy of the Department of ambulatory care and community medicine (Lausanne, Switzerland). This study assesses the capacity of a physician and a nurse at the infectious diseases service of a public hospital and of community pharmacists in the Neuchâtel area (Switzerland) to implement the IMAP in their practice.
Mixed method, prospective, observational study. Quantitative and qualitative analyses of the implementation process were conducted following the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance).
Implementation started in November 2014. One physician, one nurse, and five pharmacists agreed to participate. Healthcare professionals perceived the benefits of the program and were motivated to implement it in their practice (adoption). Seventeen patients were included in the program; 13 refused to participate. The inclusion of naïve HIV patients was easier than the inclusion of experienced patients with difficult psychosocial issues (reach). Pharmacists were engaged in reinforcing patient medication adherence in 25% of interviews (effectiveness). Key facilitators expressed by healthcare professionals were patient inclusion by the physician and the nurse instead of the pharmacist and the organisation of regular meetings between all stakeholders. In contrast, the encountered barriers were the lack of time and resources, the lack of team uptake, and the lack of adoption by senior managers (implementation). Interviewed patients were all satisfied with this new program, encouraging healthcare professionals to scale it up. Structural changes allowed the hospital and one pharmacy to enter the maintenance stage (maintenance).
The research team and collaboration between all professionals involved played an important role in this implementation. However, the dissemination of such a program to a larger scale and for the long term requires financial and structural resources as well as transitional external support.
针对慢性病患者的跨专业药物依从性项目（IMAP）已开发并在门诊护理与社区医学部（瑞士洛桑）的社区药房成功实施。本研究评估了瑞士纳沙泰尔地区一家公立医院传染病科的一名医生、一名护士以及社区药剂师在其实践中实施IMAP的能力。
采用混合方法、前瞻性观察研究。依据RE-AIM模型（覆盖范围、有效性、采用情况、实施过程和维持情况）对实施过程进行定量和定性分析。
实施工作于2014年11月启动。一名医生、一名护士和五名药剂师同意参与。医疗保健专业人员认识到该项目的益处，并积极在其实践中实施（采用情况）。该项目纳入了17名患者；13名患者拒绝参与。纳入初治HIV患者比纳入有复杂心理社会问题的经验丰富患者更容易（覆盖范围）。在25%的访谈中，药剂师致力于加强患者的药物依从性（有效性）。医疗保健专业人员提到的关键促进因素包括由医生和护士而非药剂师纳入患者，以及所有利益相关者之间定期组织会议。相比之下，遇到的障碍包括时间和资源短缺、团队参与度不足以及高级管理人员未采用（实施过程）。接受访谈的患者对这个新项目都很满意，这鼓励医疗保健专业人员扩大该项目规模。结构调整使医院和一家药房进入维持阶段（维持情况）。
研究团队以及所有参与专业人员之间的合作在此次实施过程中发挥了重要作用。然而，将这样一个项目大规模、长期推广需要财政和结构资源以及过渡性外部支持。
