Adherence counseling during patient contacts in Swiss community pharmacies

Patient Preference and Adherence Dovepress open access to scientific and medical research Original Research Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.38.22.117 on 13-Jul-2018 For personal use only. Open Access Full Text Article Adherence counseling during patient contacts in Swiss community pharmacies This article was published in the following Dove Press journal: Patient Preference and Adherence 24 April 2015 Number of times this article has been viewed Fabienne Boeni Isabelle Arnet Kurt E Hersberger Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland Purpose: Numerous studies showed the effectiveness of pharmaceutical care in improving medication adherence in primary care patients. However, in daily pharmacy practice, the provision of pharmaceutical care appears to be limited. We aimed at quantifying the content of counseling by community pharmacy staff during patient contacts, especially adherence counseling, and at investigating pharmacist views about their practice of adherence counseling. Patients and methods: A Master’s student in Pharmacy observed patient contacts at selected community pharmacies in the region of Basel, Switzerland. Content of counseling was manually ticked on a checklist with predefined themes (administration, dose, effect, and adherence). Pharmacists working in the pharmacy were interviewed on triggers, topics, and barriers in adherence counseling. Results: In 20 community pharmacies and during a total of 148.1 hours, 1,866 patient contacts were observed. During the 1,476 patient contacts including the dispensing of one or more medications, counseling was provided to 799 (54.1%) patients; with 735 (49.8%) patients counseled about administration, 362 (24.5%) about dose, 267 (18.1%) about effect, and 99 (6.7%) about adherence. Significantly more patients received counseling when they obtained prescribed versus over-the-counter medication (P=0.002), a new prescription versus a repeat prescription (P0.001), or when they were served by a pharmacist versus by another staff member (P0.001). Of the 33 interviewed pharmacists, all except one reported actively approaching patients for adherence counseling. Triggers included medication-related and patient-related factors. The pharmacists named predominantly product-centered topics of adherence counseling. The most cited barriers were rejection of counseling by the patient and lack of time. Conclusion: Half of the patients receiving one or more medications were counseled, and only 6.7% of all contacts included adherence counseling. Future studies should clarify how barriers to adherence counseling at the community pharmacy can be overcome. Keywords: pharmaceutical care, community pharmacy, medication adherence Introduction Correspondence: Fabienne Boeni Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland Tel +41 61 267 15 29 Fax +41 61 267 14 26 Email 597 submit your manuscript | www.dovepress.com Patient Preference and Adherence 2015:9 597–605 Dovepress © 2015 Boeni et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/PPA.S76027 Powered by TCPDF (www.tcpdf.org) Pharmaceutical care has been defined as “…the pharmacist’s contribution to the care of individuals in order to optimize medicines use and improve health outcomes,”1 and the pharmacist has been designated as part of the health care team for added value in the health care system.2–4 Pharmaceutical care activities practiced by community pharmacies have been shown effective in improving medication adherence.5–12 Faceto-face counseling during dispensing of medication is part of pharmaceutical care.4 Counseling can include providing education to patients (eg, about therapy, their condition), intervening in a patient’s drug therapy (eg, optimizing intake times), and ultimately, helping improve medication adherence.13 Previous studies reported significantly improved adherence and persistence through targeted counseling by community pharmacists.14–16 Dovepress Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.38.22.117 on 13-Jul-2018 For personal use only. Boeni et al Counseling practice in community pharmacies has been reported to be limited. In a pan-Europe comparison in 2009, the mean total score of pharmaceutical care provision, expressed as a percentage of the total score achievable, ranged from 31.6% to 52.2%.17 Patient counseling was reported to be only a minor task in every day practice in the community pharmacy,18–21 and communication was predominantly nonmedical or product-centered, instead of patient-centered.22–24 At the dispensing of prescription medication, Swiss pharmacists are reimbursed for providing counseling on dose, frequency, administration, duration of use, storage, and potential adverse effects.25 Introduced in 2005, this was the first acknowledgment of cognitive services delivered by community pharmacists to improve the patients’ use of medication. Additionally, the provision of a dose-dispensing aid by the pharmacy is reimbursed.26 To our knowledge, the current counseling practices in Swiss community pharmacies have not yet been addressed, especially the content of adherence counseling. The aim of this study was to quantify the content of counseling by community pharmacy staff during patient contacts, with a specific focus on adherence counseling, and to investigate the views of community pharmacists about their practice of adherence counseling. Material and methods Of 106 community pharmacies in the region of Basel, Switzerland, community pharmacies that had participated in previous studies27,28 were approached consecutively, according to a random number list, until the sample size of 20 was reached. This number was calculated to enable approximately 2,000 patient contacts, assuming that counseling would take 5 minutes and one investigator could observe approximately 100 patients during 8 hours. We did not perform analysis of health communication between pharmacy staff and patients, but rather, we observed and quantified the content of counseling. A Master’s student in Pharmacy observed the patient contacts of the pharmacy staff in sequential order during 1 day at each pharmacy. The observation began at the entrance of one pat (...truncated)