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Support of medication adherence by community pharmacists in Czech and Slovak Republics: a questionnaire survey study

Support of medication adherence by community pharmacists in Czech and Slovak Republics: a... Eur. Pharm. J. 2018, 65 (1): 15-23. ISSN 1338-6786 (online) and ISSN 2453-6725 (print version), DOI: 10.1515/afpuc-2017-0006 EuR opEAn phARMACEutICAl JouRnAl Support of medication adherence by community pharmacists in Czech and Slovak Republics: a questionnaire survey study Original Paper 1 2 3 4 Molitorisová M. , Kotlářová J. , Snopková M. , Waczulíková I. Slovak Medical University in Bratislava, Faculty of Public Health, Bratislava, Slovak Republic Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy, Hradec Králové, Czech Republic Comenius University in Bratislava, Faculty of Pharmacy, Department of Organisation and Management of Pharmacy, Bratislava, Slovak Republic Comenius University in Bratislava, Faculty of Mathematics, Physics and Informatics, Department of Nuclear Physics and Biophysics, Bratislava, Slovak Republic Received 28 November, 2016, accepted 24 March, 2017 Abstract Introduction: Intervention of pharmacists in medication adherence can meaningfully contribute to achieving therapeutic outcomes. Exploring the real-life readiness and opportunities of pharmacists may result in the adoption of measures, which could be seen through improvement of patients´ adherence to pharmacotherapy. Aim: The aim of the paper was to make a survey on community pharmacists´ potential in medication adherence support in its connectivity to technical and personnel factors, which underline the capacities of pharmacies in dealing with medication adherence. Methods: The questionnaire survey was conducted from October to December 2014 and involved 158 pharmacists from 117 Czech (CZ) and 41 Slovak (SK) community pharmacies. The structured questionnaire surveyed both technical and personnel factors, including provision of consultancy services related to medication adherence. Non-adherence risk reduction was evaluated by adopting Morisky Scale modified from the pharmacist’s perspective. Questionnaires outcomes were summarised in contingency tables and analyzed for associations between respective categorical variables using χ or exact tests and association coefficients. All results are reported as significant at P≤0.05. Results: The average score of adherence support (CZ/SK 1.95/1.93) was significantly higher as compared to that of persistence or concordance (P<0.001). Reduction of non-adherence risk reached the score of a medium degree (P=0.73, average 2.29 in CZ and 2.22 in SK). These findings were significantly associated with personnel capacities (provision of consultancy, preference for the use of recommended procedures in CZ (P<0.001), number of years of practice in SK (P=0.029)), while significant association with technical equipment (consultancy room) in the SK (P=0.037). Conclusion: The pharmaceutical care is developing towards the improvement of medication adherence in both countries - assuming a medium degree of adherence support. Further progress may be observed in strengthening the pharmacists’ personnel capacities, and accelerated mainly using information technologies, i.e. through technical capacities. Keywords community pharmacy – consultancy – medication adherence – Czech and Slovak Republics IntR oduC tIon Modern public healthcare accentuates the importance of pharmacy have been progressively applied to the practice of professional capacities of pharmacists from the perspective community pharmacies. This means that, along with hospital of their engagement in integrated and evidence-based and clinical pharmacists, the pharmacists practicing in pharmaceutical practice. Such practice is expected to expand community pharmacies are also continuously becoming more towards and consolidate existing expertise in the areas of engaged in dealing with drug related problems (DRPs) (PCNE, responsible use of medicines, innovation, disease prevention 2006). The most common problems include drug interactions, and treatment. This will also involve cooperation with other adverse effects and dosage regimes, but the pharmacists’ healthcare practitioners, and above all, with patients (FIP, attention is also continuously shifting towards issues of 2011). medication adherence. Adherence of patients to treatment is With the onset of the development of modern pharmaceutical a fundamental requirement for achieving therapeutic effect. care, the findings garnered within the field of clinical Not complying with a prescribed therapeutic regime leads * E-mail: milica.molitorisova@gmail.com © European Pharmaceutical Journal OR 15 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. to therapeutic failure and increased costs for the treatment (one pharmacist from one community pharmacy), that of diseases (Kriška et al., 2015, Spinewine et al., 2012). It is a represented 56.5% of 207 pharmacies grouped in the well-known worldwide problem that not only affects acute association of independent pharmacists and in cooperation illnesses, but more frequently chronic diseases. According to with the Faculty of Pharmacy in Hradec Králové, Charles the WHO (2003), up to 50% of chronically ill patients do not University. From a geographical perspective, all 14 regions of comply with the recommended treatment regime. Therefore, CZ were covered. innovative and more effective multidisciplinary approaches are The SK data set was composed of 41 community pharmacists being sought that would improve patients´ adherence, built (one pharmacist representing one community pharmacy) upon an equal relationship with patients and the systematic out of 128 (31.8%) that we approached via students of the improvement of patients’ health literacy (Spinewine et al., Faculty of Pharmacy, Comenius University in Bratislava) Taitel et al., 2012). A promising approach is to link adherence undertaking their mandatory practice there. From with pharmacovigilance, which has become an indispensable a geographical perspective, 7 out of 8 regions of SK were part of the responsible use of medicines (Leporini, 2014, Sun covered. et al., 2014). In practice, interventions are used to improve We are conscious of the fact that there is no specification medication adherence; recently, with the help of wireless and of the Good Pharmacy Practice, which would be available mobile technologies, for instance, to improve dosage regimes exclusively for the selected data sets of CZ and SK (Středa & Hána, 2016). Essentially, there is an increasing array pharmacists-responders, as compared to other CZ and SK of evidence that non-adherence can be effectively tackled by community pharmacists, and could therefore represent a two complementary approaches: firstly, via a multidisciplinary systematic error in this regard. approach, and secondly, via electronic and computerized We used a structured questionnaire in the Czech and healthcare systems (e-Health). If pharmacists are to be a Slovak languages to estimate the pharmacists’ support for part of this, monitoring and systemic support of medication medication adherence. The questionnaire was addressed to adherence should become one of the priorities of their the heads of pharmacies or to their deputies, who answered practice and of drug dispensation related activities. about their practice in a specific pharmacy. It contained 15 Despite continuous scientific evaluation of pharmacists’ questions divided into 5 categories that enabled us to map involvement in DRPs, medication adherence including, the basic characteristics of pharmacies, such as a geographic treatment satisfaction and patient education programs, only distribution, size, as well as specific technical and personnel a limited number of studies have been performed concerning factors. The aim was to examine the intensity and extent of the role of community pharmacists in DRPs in the Czech (CZ) pharmaceutical patient-oriented care from the perspective and Slovak (SK) Republics (Masaryková et al., 2014, Vlček et of the pharmacists taking part in this survey, regarding the al., 2009). A review of the existing literature reveals that there surveyed medication adherence promotion provided in has been no research whatsoever on medication adherence a pharmacy. The questionnaire was available online (Fig. 1). support or on the reduction of non-adherence risks by community pharmacists (this is also the case specifically Structure of the questionnaire with regards to the technical and personnel capacities of community pharmacies). Therefore, further investigations I. Geographic distribution of pharmacies in 5 categories conducted in this area could rectify this lacuna. This work according to the number of inhabitants in the local has a character of a pilot study. It might contribute to the region: up to 4,999, from 5,000 to 9,999, from 10,000 evaluation of hypothesis on a non-adherence risk reduction to 49,999, from 50,000 to 99,999 and above 100,000 by pharmacists and detection in which form and with what inhabitants; intensity medication adherence could be supported by II. Technical equipment of pharmacies, meaning the community pharmacists in CZ and SK. In addition, we have spatial, technical and technological capacities of also focused on counselling and consultations provided by pharmacies, which are determined according to the pharmacists in order to determine personnel and technical legal requirements on pharmaceutical care provision in factors of pharmacies that may correlate with support for CZ (Decree No 92/2012) and SK (Decree No 129/2012). adherence in both countries. In the questionnaire, we have focused on spatial capacities–space for confidential conversation with the MEthodS patient designated for counselling and consultations; III. Personnel capacities of community pharmacies, meaning Study design and participants the number of professional employees, and the number of years of professional experience of the respondent Questionnaire survey on adherence support was provided and his or her qualification; engagement of pharmacists by 158 community pharmacists from CZ and SK community into counselling and consultancy; pharmacies in a period from November till December of 2014. IV. Counselling and consultations provided by pharmacists The CZ data set was composed of 117 community pharmacists to resolve DRPs. In this context, these activities are 16 17 7. Do you cooperate with a medical or healthcare practitioner in your pharmacy regarding DRPs? a) yes b) no Note: DRPs means Drug Related Problems (e.g. interactions, incorrect use, attitude and behavior of patients, etc.) 7.1 If yes, how often do you do so? a) daily b) 2-3 times per week c) 1-2 times per month d) 5-6 times per month 8. Do you take records of interventions in your pharmacy (DRPs)? a) yes b) no 8.1 If yes, in which form do you take such records? a) electronic form b) paper form Eur. Pharm. J. 2018, 65 (1): 15-23 9. Do you have a system in your pharmacy that counts the number of patients and their revisits? a) yes Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. b) no 9.1 If yes, please make an estimate of proportions of loyal vs random patients in your pharmacy: a) loyal patients (v %) Figure 1. Questionnaire to community pharmacists b) random patients (v %) Please answer the questions in the suggested form: 10. In which manner do you offer support/motivate patients towards higher compliance in the recommended a) closed question – if applicable, use number 1 therapy? (multiple choice possible) b) open questions - please provide the answers citing relevant data and information a) educating patient with the use of available information materials b) suggesting a cheaper alternative in the alternative form of generic substitution 1. Type and size of the pharmacy: c) offering consultations (individual counselling) 1.1 Type d) support programs for a larger group of patients - e.g. group discussion, audio-visual programs a) community pharmacy which is part of an association, alliance or cooperative e) other (please specify): b) community pharmacy which is part of a pharmacy network (one brand) Note: Compliance means that the patient’s behavior follows the treatment recommendation by a healthcare c) community pharmacy which is not part of an association, alliance or cooperative or a network professional (medicine practitioner, nurse, etc.) e) non-state hospital pharmacy d) state-owned hospital pharmacy 11. Do you provide any consultations to patients, or individual counselling on use of medicine? 1.2 Number of professional employees (pharmacists and lab workers) employed on part- and full-time basis: a) yes a) 1-5 b) no b) 6-10 11.1 If yes, how often do you do so? c) > 10 a) daily 2. Municipality/town/region in which the pharmacy is located: b) 2-3 times per week a) municipality/town c) 1-2 times per month b) region d) 5-6 times per month 3. Number of years of professional experience (1 person per pharmacy): 12. How do you usually identify the risk of non-adherence? What questions do you usually ask the patient? a) 0-9 The questions related to: (multiple choice is possible) b) 10-19 a) forgetfulness c) 20-29 b) missing dosage of medicine in case of adverse or side effects occur d) > 29 c) early termination of therapy d) compliance with the time of use of medicine 4. Which professional/scientific area(s) are you specialized in? Please specify: e) other (please specify): a) I am specialized in: f1 )3 w . I en do n wha ot t a m sk a qu nner es do tions yo u usually offer support for adherence? (multiple choice is possible) b) I do not have a specialty a) we provide information about use of medicine 5. Is your pharmacy equipped with an appropriate space for consultations and therapy assessment, or Note: Non-adherence could be spontaneous, intentional or unintentional. Spontaneous non-adherence is usually b) we provide the information related to the use of medicine and verify if the patient understands the information a specialized workplace where information on medicines is provided? (in accordance to CZ Decree No caused by forgetfulness and is usually solved by continuous reminding that is linked to usual daily activities and c) we recommend to patient his/her appropriate system to monitoring and recording use of medicines medicines dispensers. Intentional non-adherence is a deliberate non-complying with the recommended treatment. 92/2012 Coll. & SK Decree No 129/2012 Coll.) d) other (please specify) 5.1 Consultation space or room e) we do not offer such support a) yes Note: Adherence means an affirmative attitude on behalf of patient towards treatment, acting in accordance with b) no the pharmacotherapy recommended by the healthcare practitioner. It significantly influences the therapeutic value of the prescribed medicine. 5.2 Discrete zone a) yes 14. In what manner do you offer support for persistence – continuity of treatment – throughout the b) no recommended period of therapy? (multiple choice is possible) 5.3 How often do you provide consultations to patients beyond the usual drug dispension-related activities? a) daily a) we engage the patient by asking questions related to his or her readiness to undertake a long-term treatment b) 1-3 times per week b) we agree with the patient on a continuous cooperation c) we communicate with a medical practitioner in case we have suspect that the patient deliberately adjusts the c) 1-3 times per month length of the recommended pharmacotherapy d) other (please specify) d) other (please specify) 6. Please provide information on your 2 or 3 most frequently used sources of information related to medicines e) we do not offer such support and recommended procedures of the Czech Pharmacists´ Association and how frequently you use them: Note: Persistence – means continuity throughout the entire treatment (i.e. patient uses medicine throughout the Source/form/frequency of information related to medicines entire therapy). 15. How do you increase trust in patients in order to achieve their concordance? (multiple choice is possible) a) we provide personal counselling related to the selected drug form, application and dosage Recommended procedures b) we consult with patient the recommended medication dose titration (e.g. due to skin irritation) c) we identify with the patient his or her options for a routine use of medicines in accordance with the maintenance therapy recommended by a medicine practitioner (e.g. system of notifications, personal monitoring and recording) d/ we engage the patient in different way (please specify): 7. Do you cooperate with a medical or healthcare practitioner in your pharmacy regarding DRPs? e) we do not deal with such issue a) yes b) no Note: Concordance means a partnership between patient and pharmacist that leads to an agreement on why and how to use the relevant medicines. Unlike compliance, concordance represents an agreement based on a patient’s Note: DRPs means Drug Related Problems (e.g. interactions, incorrect use, attitude and behavior of patients, etc.) own conviction, reached as a result of an individual approach and it is based on the provision of adequate 7.1 If yes, how often do you do so? information, including an explanation of the expected therapeutic effect and adverse effects, the costs of treatment a) daily and other relevant factors. b) 2-3 times per week c) 1-2 times per month d) 5-6 times per month 8. Do you take records of interventions in your pharmacy (DRPs)? a) yes b) no 8.1 If yes, in which form do you take such records? a) electronic form b) paper form 9. Do you have a system in your pharmacy that counts the number of patients and their revisits? a) yes b) no 9.1 If yes, please make an estimate of proportions of loyal vs random patients in your pharmacy: a) loyal patients (v %) b) random patients (v %) 10. In which manner do you offer support/motivate patients towards higher compliance in the recommended therapy? (multiple choice possible) Figure 1. Questionnaire to community pharmacists. a) educating patient with the use of available information materials b) suggesting a cheaper alternative in the alternative form of generic substitution c) offering consultations (individual counselling) d) support programs for a larger group of patients - e.g. group discussion, audio-visual programs understood as going beyond the scope of primary Statistical methodology e) other (please specify): Note: Co(nec mpliance essar means y) inf that the patientor ’s bema haviortion pr follows the treatmo envided b t recommendation by individual y a healthcare professional (medicine practitioner, nurse, etc.) pharmacists about safe and appropriate use of dispensed To process the results of the questionnaires, we used 11. Do you provide any consultations to patients, or individual counselling on use of medicine? a) yes medicines. methods of descriptive and inductive statistics. The core b) no 11.1 If yes, how often do you do so? V. Oerff ing support by pharmacists to follow of the questionnaire was formed around the questions of a a) daily b) 2-3 times per week a recommended pharmacotherapy in order to achiev e: dichotomic or polytomic character. The final quantities were c) 1-2 times per month d) 5-6 times per month a. Compliance, adherence, persistence and concordance. summarized in a contingency table. To test associations, we 12. How do you usually identify the risk of non-adherence? What questions do you usually ask the patient? 2 The terms and definitions refer to a literature review by used the chi-squared test (χ ) or exact tests (Fisher and Fisher- The questions related to: (multiple choice is possible) a) forgetfulness Vrijens et al. (2012); Freeman-Halton tests). The differences between groups were b) missing dosage of medicine in case of adverse or side effects occur c) early termination of therapy b. Reducing the risk of non-adherence – we used four tested by the t-test and, in relevant cases, by non-parametric d) compliance with the time of use of medicine e) other (please specify): item Morisky Medication Adherence Scale (Morisky methods (Mann-Whitney test for analysis of variations). f) we do not ask questions Note: Non-adherence could be spontaneous, intentional or unintentional. Spontaneous non-adherence is usually et al., 1986), which we modified from the pharmacist’s We analysed the degree of associations with correlation caused by forgetfulness and is usually solved by continuous reminding that is linked to usual daily activities and medicines dispensers. Intentional non-adherence is a deliberate non-complying with the recommended treatment. perspective, who responds according to his/her coefficients: Cramér’s V and Goodman and Kruskal’s gamma. experience and common practice in communication For certain comparisons, we introduced an odds ratio (OR) with patients on medication use (Fig. 1, question 12/a-d). with the respective confidence interval, 95% (95% CI). In all 16 17 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 1. Consultancy and resolving DRPs by community pharmacists. Consul- Cohen Cohen tations p Kappa p Kappa dRp s CZ score dRp s SK score on dRp s (95% CI) (95% CI) NO YES SUM NO YES SUM Yes 19 62 81 4 34 38 -0.074 0.554 0.796 (-0.241 to 0.00004 (0.183 to No 6 30 36 3 0 3 0.092) 0.926) Total 25 92 117 7 34 41 cases, we tested at a significance level of alpha ≤0.05. We We did not find a correlation between revisits of patients and performed the analyses with StatsDirect 2.8.0 (StatsDirect resolving DRPs in the data sets. Ltd., Cheshire, UK) and Microsoft Office Excel 2010 (Microsoft Corporation). Support of medication adherence Study’s limitations Each evaluated activity of pharmacists aimed at an improvement of medication adherence, persistence or The legal framework for personal data protection of patients, concordance, was scored with one point. The overall relative their unavailable medication history and non-existence of score for all activities combined could range from 0 to 4 points. the e-Health in CZ and SK limited our study with regards to The more intensive the support of a pharmacist was, the community pharmacist’s support on specific patient, his/ higher the score. We did not observe significant differences her specific type of problem/s and pharmacotherapeutic between CZ and SK in support of the adherence, persistence outcome/s. Therefore, collected data from the pharmacists’ or concordance. Support for adherence reached the average responses give an estimate on the medication adherence level with the highest scoring value in both countries. Support promotion provided in respective pharmacies participating for adherence (CZ: 1.95; SK: 1.93) was significantly higher than in the questionnaire survey. support for persistence (CZ: 1.18;SK: 1.07), and was also higher than support for concordance (CZ: 1.28;SK: 1.27), (Fig. 2). We RESult S used the adopted Morisky scale to estimate with what intensity non-adherence risk could be reduced. We evaluated this from Consultations, counselling and DRPs the perspective of the pharmacist, who addresses one or more critical areas of a patient’s attitude and behaviour, which The majority of pharmacists in our data set stated that they can help to uncover patient’s compliance with a prescribed provide consultations or counselling to patients (CZ: 69.2%, pharmacotherapy. In CZ, we measured that the overall average SK: 92.7%). We investigated whether these activities could be score was marginally higher than for SK. It reached the medium associated with resolving DRPs. Unlike CZ, in SK there was a degree of support in both data sets [CZ: 2.29 and SK: 2.22; significant and high concurrence in answers (answer type yes- P = 0.739; 95% CI for the difference in mean scores went from yes) that showed that if SK pharmacists provide consultations, (-0.35) to 0.49]. The difference was attributed to a higher score they do so in order to help patients in finding solution to achieved by CZ pharmacists concerning the reduction of any DRPs and, on the other hand, those pharmacists that do risk that patient would not comply with the recommended not provide consultations, do not engage with DRP-solving time of medication use (P = 0.032; the lower and upper limits activities (answer type no-no), P < 0.0001 (Table 1). of the 95% CI for the odds ratio were 1.02 and 5.09). Other risk In registering DRPs, we found a statistically significant factors were comparable with SK. These include forgetfulness, difference in favour of SK pharmacists (P = 0.008). Pharmacists missing medication or termination of medication use due to do register DRPs, although there is no e-Health currently at adverse reaction or, on the contrary, because therapeutic effect place in either country. Such registrations therefore tend has already been attained (Table 2). to be non-systematic and rare. Due to the small number of responses, we could not assess to what extent DRPs are Relationship analysis between estimated support for registered in either paper or electronic form. In both countries, medication adherence and technical and personnel pharmacists deal with DRPs at a similar rate of frequency, characteristics of pharmacies usually either daily or 2 to 3 times per week (P = 0.052). Just about half of the pharmacists (50.8%) in both countries The survey demonstrated that geographic parameters of register loyal patients and their revisits. Loyal patients location (in relation to the number of inhabitants) or size of represented more than 50% of all patients visiting pharmacies. pharmacies by the number of professional employees, namely, 18 19 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 2. Non-adherence risk reduction from pharmacists-responders´ perspective in the most frequent areas. Reduction of risk Country oR totA l p of non-adherence CZ SK 95% CI 1. Forgetfulness Yes 64 24 88 0.855 0.717 0.387 to 1.861 No 53 17 70 2. n ot complying with the recommended timing of usage of medicines Yes 85 22 107 2.294 0.032 1.022 to 5.091 No 32 19 51 3. Missing dosages of medicines in case of occurrence of adverse or side effects Yes 67 27 94 0.694 0.361 0.304 to 1.541 No 50 14 64 4. Early termination of treatment after achieving the desired therapeutic effect Yes 52 18 70 1.022 > 0.999 0.470 to 2.241 No 65 23 88 Total score value 2.29 2.22 0.739 95% CI -0.350 to 0.492 n 117 41 158 SK and CZ – there is a stronger relationship between the number of years of experience and adherence support in SK (p = 0.029), whereas we could not establish a correlation in CZ (P = 0.175). Moreover, in the SK data set, we also found a strong linear relationship between the number of years of professional experience and medication adherence support (P = 0.0496) (Table 3). We also found a strong correlation between the preferential source of information for pharmacists as the Recommended Procedures authorized by the Czech Chamber of Pharmacists (2010) and support for adherence by CZ pharmacists (P = 0.005), in comparison to SK pharmacists, where a similar source of information was not available. We observed, that majority of pharmacists cooperated with Figure 2. Support of patients’ attitude to follow recommended healthcare practitioners in solving the DRPs in both countries pharmacotherapy. (CZ: 78.6%; SK: 82.9%; P = 0.51; 95% CI 0.253 to 2.023) (Table 4). A close relationship between adherence and DRPs was did not correlate with the estimated degree of support for confirmed in the CZ data set (P = 0.00015) as compared to the medication adherence. SK data set, despite Cramer’s V showing a weak association The CZ and SK sets of pharmacies are equipped with technical (0.334). It is possible, that if data sets were larger, we would equipment, that is, a discrete zone given by law and eventually, not observe the difference between CZ and SK data sets. a consultation room– dedicated for consultancy purpose by law (Table 5). in CZ, not regulated in SK. The SK pharmacists, while using consultation rooms, were engaged more with adherence- dISCuSSIon related issues as compared to CZ (P = 0.037; Cramér’s V = 0.37). On the other hand, the CZ pharmacists use the consultancy Results of the questionnaire survey matched with our rooms – if they are equipped with – more frequently than prediction that pharmacists had been involved in the SK pharmacists, although at the margin of significance medication adherence support, as similarly published by (P = 0.058). other authors (Lau et al., 2010, Santschi et al., 2012, Vlček, et Majority of the survey’s respondents had a qualification in al., 2009). We assume that pharmacists can support patient pharmacy (CZ: 88%; SK: 83%). As far as the number of years adherence and they are able to reduce the risk of patients´ of professional experience (practice) of the pharmacists (i.e., non-adherence, reaching in average the medium degree. the respondents) is concerned, our data showed that the We found that support for medication adherence has respondents mostly had between 20 and 29 years of practice been provided to a greater degree than support for other in both data sets. When it comes to the number of years of forms of patients’ adherence attitudes towards treatment, professional experience, we found a difference between such as persistence and concordance. (Herein, we refer to 18 19 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 3. Association between the number of years of pharmacists´ practice and support for medication adherence. Support to medication adherence (n = number of pharmacists-responders) We inform We provide We recommend We do not Fisher- Number patient information that patient Good provide Freeman- of about and verify creates his or her Other Sum man- P support to Halton practice use of if patient own system of (n) (n) Kruskal adherence exact (years) medicines understands monitoring of use gamma (n) P (n) it (n) of medicines (n) CZ 0 – 9 1 3 7 3 4 18 10 – 19 5 5 17 9 4 40 0.135 20 – 29 2 7 8 11 7 35 0.294 0.175 (0.06 to > 29 2 0 9 10 3 24 0.33) Total 10 15 41 33 18 117 SK 0 – 9 1 4 0 2 0 7 10 – 19 1 1 8 2 1 13 0.348 20 – 29 1 1 0 3 2 7 (0.04 to 0.029 0.024 0.66) > 29 1 3 2 3 5 14 Total 4 9 10 10 8 41 Table 4. Interdisciplinary teamwork between community pharmacists and healthcare practitioners. Cooperation between pharmacist and a healthcare practitioner on dRp s (n = number of pharmacists-responders) CZ SK Cooperation Fisher exact n % n % Total Yes 92 78.6 34 82.9 126 P = 0.51 No 25 21.4 7 17.1 32 95% CI: 0.253 to 2.023 Total 117 100.0 41 100.0 158 Table 5. Adherence support and resolving DRPs by community pharmacists. Association between adherence support and dRp s resolving by pharmacists (n = number of pharmacists-responders) We do not provide Missing Early support to Not complying dosages of termination Fisher- adherence with the Adherence medicines of treatment Freeman- We inform Forgetfulness recommended Sum Cramér’s and in case of after achieving Halton patient (n) timing of (n) V DRPs occurrence the desired exact about usage of of adverse or therapeutic P use of medicines (n) side effects (n) effect (n) medicines (n) CZ Yes 3 14 28 30 17 92 No 7 1 13 3 1 25 0.00015 0.4553 Total 10 15 41 33 18 117 SK Yes 4 7 7 10 6 34 No 0 2 3 0 2 7 0.3561 0.3345 Total 4 9 10 10 8 41 20 21 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. terms and definitions on medication adherence used in the practitioner/clinic setting) has been often highlighted at questionnaire by Vrijens et al. (2012)). As the issues of scientific symposia and discussed by more authors (Pape et persistence and concordance are more complicated – the al., 2011, Rojaz-Fernandez et al., 2014). According to recently processes are more complex and demanding (professionally, published data from SK pharmacies by Masaryková et al., in terms of time or work organization). We estimate that the DRPs most frequently relate to poor treatment efficacy pharmacists supported patients only at a low degree of and therapy costs (2015). Non-adherence very likely intensity in these activities. In general, this degree of support represents the common denominator of these problems. could change if pharmacists were more actively, or even The risk of non-adherence should be detected and resolved pro-actively, engaged in the cooperation with patients responsibly, whereas cooperation between pharmacists and and healthcare practitioners in both countries. It is most healthcare practitioners gives a solid ground for furnishing probably associated with education and further training, effective and prompt solutions to the identified problems. their motivation, as well as availability of specific intervention To examine other possibilities of how to increase support for package/s motivational interviews with patients, patients’ patient adherence, the specific profile of risk patients could education, home medicines review, dose administration aid, be considered, which the pharmacists could focus on. medication use review, etc.), enabling the pharmacists to Our findings indicated that there is a close association improve patient adherence (Lau et al., 2010, Salvo & Cannon- between support for medication adherence and personnel Breland, 2015). capacities (factors) of pharmacy. These factors mostly We found that the location of a pharmacy and the number concern the professional experience of pharmacists and of inhabitants in a location does not influence support for the quality of consultation and counselling, which might be medication adherence in either country (for pharmacies efficiently supported by training and/or authorized sources located in larger cities or smaller municipalities). As far as of recommendations for pharmacists such as Recommended technical factors were concerned, we focused on discrete Procedures of the Czech Pharmacists’ Association available zones and consultation rooms and their use. In SK, where since 2010. Recently, the Association opened new courses discrete zones are mandatory components of pharmacies in DRPs, enabling additional services, which include (Decree No 129/2012), consultation rooms are additional recommendations in terms of dosage and therapeutic regime. spaces not required by law. The outcomes suggested that The Association is planning to extend its recommendations there is an association between support for adherence (DRPs) into other areas of pharmaceutical professional consultancy. and the usage of consultation rooms, which has been stated Since 2013, the Czech Chamber of Pharmacists offers a mobile by Masaryková et al., 2015 too. In CZ, only pharmacies that application mapping the pharmacies with consultation actively provide consultations and counselling have such rooms. All these initiatives, as mentioned hereby, represent consulting rooms (Decree No 92/2012). Despite strong useful electronic tools that could enable the pharmacists to differences in terms of the legislative requirements in the address patients’ adherence and vice-versa, in more effective two countries, our finding showed that CZ pharmacies way. use consultation rooms more frequently - though the In general, we can assume that the support for medication frequency was only marginally higher than SK pharmacies. adherence is provided in both CZ and SK pharmacies. This finding indicates that legislation is not the unique It reaches a medium degree and develops in the right factor that influences the extent to which pharmaceutical direction – towards concordance in the pharmacist-patient care is provided. In this respect, other factors, both personal relationship. The responses to our survey suggest that the and professional, also have significant importance. The development of interdisciplinary cooperation with other difference in the legislative and societal development of healthcare professionals, mostly medical practitioners, pharmaceutical care in the two countries reveals potential remains challenging (non-systematic and rare registration that we could elaborate upon to increase support for of DRPs). The e-Health system will soon be introduced in medication adherence by pharmacists. both countries, and is expected to become an important From the perspective of personnel characteristics of pharmacy, factor in this dimension, as it will enable connection with the degree of support for adherence was not dependent relevant data and information. It is also recognizable that upon the number of professional workers. However, in the SK recommended practice, education in DRPs and life-long data set, we found that the number of years of professional education of pharmacists represent important pre-requisites experience increase the probability that the pharmacists for further development of pharmaceutical care in medication approach patients, discuss a prescribed treatment and try to adherence support. help to resolve patients’ DRPs. We assume, that SK pharmacies, in comparison to CZ pharmacies, provide such a kind of ConCluSIon consultations that are closely linked to resolving DRPs in collaboration with healthcare practitioners.The importance of We analysed the current state of provision of counselling interdisciplinary cooperation in DRPs (most notably effective and consultation services aimed at supporting medication interaction between community pharmacist and healthcare adherence by community pharmacies through a questionnaire 20 21 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. survey in CZ and SK. Based on the pharmacists’ responses, ACKno WlEdgEMEnt S we assumed a medium degree of support for patient adherence, predominantly provided in order to resolve DRPs We thank the Academia, the Faculty of Pharmacy in Hradec in both countries. We can also point out that education and Králové, Charles University and the Faculty of Pharmacy, experience for pharmacists could be one of the crucial factors Comenius University in Bratislava for their support to address in ensuring support for adherence. Its progress might also be and engaged community pharmacies into the study in both accelerated through the use of information technologies, as the Czech and Slovak Republics. We would also like to thank research in multiple countries has also demonstrated recently. all community pharmacies taking part in the Survey. We conclude that our findings can offer a solid base for further investigations aimed at evidence-based interventions in this area, and so to contribute to pharmaceutical care development. dECl ARAtIonS List of Abbreviations CI: Confidence Interval CZ: Czech or Czech Republic dRp s: Drug-related problems e-h ealth: Electronic and computerized healthcare system FaF uK: Faculty of Pharmacy, Comenius University in Bratislava or Faculty of Pharmacy in Hradec Králové, Charles University oR: Odds Ratio SK: Slovak or Slovak Republic Who: World Health Organization χ : chi-squared test References [1] Czech Chamber of Pharmacists: Counselling in Pharmacies. to antihypertensives: a randomised controlled trial. BMC Health ( h ttps://w w w.lek ar nici.cz/Pro - verejnost/POR ADENST VI--- Services Research. 2010; doi: 10.1186/1472-6963-10-34. PubMed KONZULTACE.aspx); (in Czech). Revised September 7, 2010. [8] Leporini C, De Sarro G, Russo E. Adherence to therapy and Accessed March 2016. adverse drug reactions: is there a link? Expert Opinion on Drug [2] Czech Chamber of Pharmacists: Pharmacies in Smartphones. Safety. 2014; doi: 10.1517/14740338.2014.947260. PubMed (h ttp://w w w.lek ar nici.cz/P r o - v er ejnost/I nf or mac e -pr o - [9] Masaryková L, Fulmeková M, Lehocká Ľ, Fazekaš T. Identifying verejnost/Lekarny-v-mobilu.aspx); (in Czech). Revised November and solving drug-related problems in terms of the community 15, 2013. Accessed March 2016. pharmacists. Čes slov farm. 2014;63:32-39; (in Slovak). [3] Decree No 92/2012 Coll. on the requirements for the minimum [10] Morisky DE, Green LW, Levine DM. Concurrent and predictive technical and material equipment of health facilities and home validity of a self-reported measure of medication adherence. care contact centers. Ministry of Health. (https://portal.gov.cz/ Med Care. 1986;24(1):67-74. app/zakony/zakonPar.jsp?idBiblio=77185&nr=92~2F2012&rpp= [11] Pape GA, Hunt JS, Butler KL et al. Team-based care approach to 15#local-content); (in Czech). Revised March 15, 2012. Effective cholesterol management in diabetes mellitus: two-year cluster April 1, 2012. Accessed March 4, 2016. randomized controlled trial. Arch Intern Med. 2011;171(16):1480-6. [4] Decree No 129/2012 Coll. on the requirements for good pharmacy PubMed practice. Ministry of Health of the Slovak Republic. (http://jaspi. [12] PCNE - Pharmaceutical Care Network Europe Foundation: justice.gov.sk/jaspiw1/htm_zak/jaspiw_mini_zak_zobraz_skup1. The PCNE Classification V5.01. 2006. (http:// www. pcne. org). asp?skupina=1); (in Slovak).Revised April 12, 2012. Effective May Published 2006. Accessed March 4, 2016. 15, 2012. Accessed March 4, 2016. [13] Rojas-Fernandez CH, Patel T, Lee L. An Interdisciplinary Memory [5] FIP. International Pharmaceutical Federation:FIP/WHO Joint Clinic: A Novel Practice Setting for Pharmacists in Primary Care. Guidelines on Good Pharmacy Practice - Standards for Quality Ann Pharmacother. 2014 Jun;48(6):785-95. PubMed Services. 2011. (http://www.fip.org/www/uploads/database_file. [14] Salvo MC, Cannon-Breland ML. Motivation interviewing php?id=331&table_id=). Accessed March 4, 2016. for medication adherence. J Am Pharm Assoc. 2015 Jul- [6] Kriška M, Gajdošík J, Dukát A, Bernadič M. Zlyhanie farmakoterapie Aug;55(4):e354-61. PubMed – možnosti prevencie. Bratislava: Slovak Academic Press; 2015; [15] Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist (in Slovak). interventions to improve cardiovascular disease risk factors in [7] Lau R, Stewart K, McNamara KP et al. Evaluation of a community diabetes: a systematic review and meta-analysis of randomized pharmacy-based intervention for improving patient adherence controlled trials. Diabetes Care. 2012;35(12):2706-17. Pub Med 22 23 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. [16] Spinewine A, Fialová D, Byrne S. The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People. Drugs Aging. 2012;29(6):495-510. PubMed [17] Středa L, Hána K. (eHealth and telemedicine). Praha: Grada Publishing; 2016; (in Czech). [18] Sun AP, Kirby B, Black C, Helms PJ, Bennie M, McLay JS. Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study. BMC Pharmacology and Toxicology. 2014; doi:10.1186/2050-6511-15-11. PubMed [19] Vlček J, Malý J, Dosedel M. (Pharmaceutical care of patients with diabetes mellitus and its relationship to clinical pharmacy). Vnitr Lek. 2009;Apr; 55(4):384-8; (in Czech). PubMed [20] World Health Organization (WHO): Chronic diseases and health promotion: Adherence to long-term therapies: evidence for action. (http://www.who.int.). Published 2003. Accessed March 4, 2016. [21] Vrijens B, De Geest S, Hughes DA et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012 May;73(5):691–705. PubMed [22] Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Preference and Adherence. 2012;6:323-329. PubMed 22 23 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Facultatis Pharmaceuticae Universitatis Comenianae de Gruyter

Support of medication adherence by community pharmacists in Czech and Slovak Republics: a questionnaire survey study

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Abstract

Eur. Pharm. J. 2018, 65 (1): 15-23. ISSN 1338-6786 (online) and ISSN 2453-6725 (print version), DOI: 10.1515/afpuc-2017-0006 EuR opEAn phARMACEutICAl JouRnAl Support of medication adherence by community pharmacists in Czech and Slovak Republics: a questionnaire survey study Original Paper 1 2 3 4 Molitorisová M. , Kotlářová J. , Snopková M. , Waczulíková I. Slovak Medical University in Bratislava, Faculty of Public Health, Bratislava, Slovak Republic Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy, Hradec Králové, Czech Republic Comenius University in Bratislava, Faculty of Pharmacy, Department of Organisation and Management of Pharmacy, Bratislava, Slovak Republic Comenius University in Bratislava, Faculty of Mathematics, Physics and Informatics, Department of Nuclear Physics and Biophysics, Bratislava, Slovak Republic Received 28 November, 2016, accepted 24 March, 2017 Abstract Introduction: Intervention of pharmacists in medication adherence can meaningfully contribute to achieving therapeutic outcomes. Exploring the real-life readiness and opportunities of pharmacists may result in the adoption of measures, which could be seen through improvement of patients´ adherence to pharmacotherapy. Aim: The aim of the paper was to make a survey on community pharmacists´ potential in medication adherence support in its connectivity to technical and personnel factors, which underline the capacities of pharmacies in dealing with medication adherence. Methods: The questionnaire survey was conducted from October to December 2014 and involved 158 pharmacists from 117 Czech (CZ) and 41 Slovak (SK) community pharmacies. The structured questionnaire surveyed both technical and personnel factors, including provision of consultancy services related to medication adherence. Non-adherence risk reduction was evaluated by adopting Morisky Scale modified from the pharmacist’s perspective. Questionnaires outcomes were summarised in contingency tables and analyzed for associations between respective categorical variables using χ or exact tests and association coefficients. All results are reported as significant at P≤0.05. Results: The average score of adherence support (CZ/SK 1.95/1.93) was significantly higher as compared to that of persistence or concordance (P<0.001). Reduction of non-adherence risk reached the score of a medium degree (P=0.73, average 2.29 in CZ and 2.22 in SK). These findings were significantly associated with personnel capacities (provision of consultancy, preference for the use of recommended procedures in CZ (P<0.001), number of years of practice in SK (P=0.029)), while significant association with technical equipment (consultancy room) in the SK (P=0.037). Conclusion: The pharmaceutical care is developing towards the improvement of medication adherence in both countries - assuming a medium degree of adherence support. Further progress may be observed in strengthening the pharmacists’ personnel capacities, and accelerated mainly using information technologies, i.e. through technical capacities. Keywords community pharmacy – consultancy – medication adherence – Czech and Slovak Republics IntR oduC tIon Modern public healthcare accentuates the importance of pharmacy have been progressively applied to the practice of professional capacities of pharmacists from the perspective community pharmacies. This means that, along with hospital of their engagement in integrated and evidence-based and clinical pharmacists, the pharmacists practicing in pharmaceutical practice. Such practice is expected to expand community pharmacies are also continuously becoming more towards and consolidate existing expertise in the areas of engaged in dealing with drug related problems (DRPs) (PCNE, responsible use of medicines, innovation, disease prevention 2006). The most common problems include drug interactions, and treatment. This will also involve cooperation with other adverse effects and dosage regimes, but the pharmacists’ healthcare practitioners, and above all, with patients (FIP, attention is also continuously shifting towards issues of 2011). medication adherence. Adherence of patients to treatment is With the onset of the development of modern pharmaceutical a fundamental requirement for achieving therapeutic effect. care, the findings garnered within the field of clinical Not complying with a prescribed therapeutic regime leads * E-mail: milica.molitorisova@gmail.com © European Pharmaceutical Journal OR 15 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. to therapeutic failure and increased costs for the treatment (one pharmacist from one community pharmacy), that of diseases (Kriška et al., 2015, Spinewine et al., 2012). It is a represented 56.5% of 207 pharmacies grouped in the well-known worldwide problem that not only affects acute association of independent pharmacists and in cooperation illnesses, but more frequently chronic diseases. According to with the Faculty of Pharmacy in Hradec Králové, Charles the WHO (2003), up to 50% of chronically ill patients do not University. From a geographical perspective, all 14 regions of comply with the recommended treatment regime. Therefore, CZ were covered. innovative and more effective multidisciplinary approaches are The SK data set was composed of 41 community pharmacists being sought that would improve patients´ adherence, built (one pharmacist representing one community pharmacy) upon an equal relationship with patients and the systematic out of 128 (31.8%) that we approached via students of the improvement of patients’ health literacy (Spinewine et al., Faculty of Pharmacy, Comenius University in Bratislava) Taitel et al., 2012). A promising approach is to link adherence undertaking their mandatory practice there. From with pharmacovigilance, which has become an indispensable a geographical perspective, 7 out of 8 regions of SK were part of the responsible use of medicines (Leporini, 2014, Sun covered. et al., 2014). In practice, interventions are used to improve We are conscious of the fact that there is no specification medication adherence; recently, with the help of wireless and of the Good Pharmacy Practice, which would be available mobile technologies, for instance, to improve dosage regimes exclusively for the selected data sets of CZ and SK (Středa & Hána, 2016). Essentially, there is an increasing array pharmacists-responders, as compared to other CZ and SK of evidence that non-adherence can be effectively tackled by community pharmacists, and could therefore represent a two complementary approaches: firstly, via a multidisciplinary systematic error in this regard. approach, and secondly, via electronic and computerized We used a structured questionnaire in the Czech and healthcare systems (e-Health). If pharmacists are to be a Slovak languages to estimate the pharmacists’ support for part of this, monitoring and systemic support of medication medication adherence. The questionnaire was addressed to adherence should become one of the priorities of their the heads of pharmacies or to their deputies, who answered practice and of drug dispensation related activities. about their practice in a specific pharmacy. It contained 15 Despite continuous scientific evaluation of pharmacists’ questions divided into 5 categories that enabled us to map involvement in DRPs, medication adherence including, the basic characteristics of pharmacies, such as a geographic treatment satisfaction and patient education programs, only distribution, size, as well as specific technical and personnel a limited number of studies have been performed concerning factors. The aim was to examine the intensity and extent of the role of community pharmacists in DRPs in the Czech (CZ) pharmaceutical patient-oriented care from the perspective and Slovak (SK) Republics (Masaryková et al., 2014, Vlček et of the pharmacists taking part in this survey, regarding the al., 2009). A review of the existing literature reveals that there surveyed medication adherence promotion provided in has been no research whatsoever on medication adherence a pharmacy. The questionnaire was available online (Fig. 1). support or on the reduction of non-adherence risks by community pharmacists (this is also the case specifically Structure of the questionnaire with regards to the technical and personnel capacities of community pharmacies). Therefore, further investigations I. Geographic distribution of pharmacies in 5 categories conducted in this area could rectify this lacuna. This work according to the number of inhabitants in the local has a character of a pilot study. It might contribute to the region: up to 4,999, from 5,000 to 9,999, from 10,000 evaluation of hypothesis on a non-adherence risk reduction to 49,999, from 50,000 to 99,999 and above 100,000 by pharmacists and detection in which form and with what inhabitants; intensity medication adherence could be supported by II. Technical equipment of pharmacies, meaning the community pharmacists in CZ and SK. In addition, we have spatial, technical and technological capacities of also focused on counselling and consultations provided by pharmacies, which are determined according to the pharmacists in order to determine personnel and technical legal requirements on pharmaceutical care provision in factors of pharmacies that may correlate with support for CZ (Decree No 92/2012) and SK (Decree No 129/2012). adherence in both countries. In the questionnaire, we have focused on spatial capacities–space for confidential conversation with the MEthodS patient designated for counselling and consultations; III. Personnel capacities of community pharmacies, meaning Study design and participants the number of professional employees, and the number of years of professional experience of the respondent Questionnaire survey on adherence support was provided and his or her qualification; engagement of pharmacists by 158 community pharmacists from CZ and SK community into counselling and consultancy; pharmacies in a period from November till December of 2014. IV. Counselling and consultations provided by pharmacists The CZ data set was composed of 117 community pharmacists to resolve DRPs. In this context, these activities are 16 17 7. Do you cooperate with a medical or healthcare practitioner in your pharmacy regarding DRPs? a) yes b) no Note: DRPs means Drug Related Problems (e.g. interactions, incorrect use, attitude and behavior of patients, etc.) 7.1 If yes, how often do you do so? a) daily b) 2-3 times per week c) 1-2 times per month d) 5-6 times per month 8. Do you take records of interventions in your pharmacy (DRPs)? a) yes b) no 8.1 If yes, in which form do you take such records? a) electronic form b) paper form Eur. Pharm. J. 2018, 65 (1): 15-23 9. Do you have a system in your pharmacy that counts the number of patients and their revisits? a) yes Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. b) no 9.1 If yes, please make an estimate of proportions of loyal vs random patients in your pharmacy: a) loyal patients (v %) Figure 1. Questionnaire to community pharmacists b) random patients (v %) Please answer the questions in the suggested form: 10. In which manner do you offer support/motivate patients towards higher compliance in the recommended a) closed question – if applicable, use number 1 therapy? (multiple choice possible) b) open questions - please provide the answers citing relevant data and information a) educating patient with the use of available information materials b) suggesting a cheaper alternative in the alternative form of generic substitution 1. Type and size of the pharmacy: c) offering consultations (individual counselling) 1.1 Type d) support programs for a larger group of patients - e.g. group discussion, audio-visual programs a) community pharmacy which is part of an association, alliance or cooperative e) other (please specify): b) community pharmacy which is part of a pharmacy network (one brand) Note: Compliance means that the patient’s behavior follows the treatment recommendation by a healthcare c) community pharmacy which is not part of an association, alliance or cooperative or a network professional (medicine practitioner, nurse, etc.) e) non-state hospital pharmacy d) state-owned hospital pharmacy 11. Do you provide any consultations to patients, or individual counselling on use of medicine? 1.2 Number of professional employees (pharmacists and lab workers) employed on part- and full-time basis: a) yes a) 1-5 b) no b) 6-10 11.1 If yes, how often do you do so? c) > 10 a) daily 2. Municipality/town/region in which the pharmacy is located: b) 2-3 times per week a) municipality/town c) 1-2 times per month b) region d) 5-6 times per month 3. Number of years of professional experience (1 person per pharmacy): 12. How do you usually identify the risk of non-adherence? What questions do you usually ask the patient? a) 0-9 The questions related to: (multiple choice is possible) b) 10-19 a) forgetfulness c) 20-29 b) missing dosage of medicine in case of adverse or side effects occur d) > 29 c) early termination of therapy d) compliance with the time of use of medicine 4. Which professional/scientific area(s) are you specialized in? Please specify: e) other (please specify): a) I am specialized in: f1 )3 w . I en do n wha ot t a m sk a qu nner es do tions yo u usually offer support for adherence? (multiple choice is possible) b) I do not have a specialty a) we provide information about use of medicine 5. Is your pharmacy equipped with an appropriate space for consultations and therapy assessment, or Note: Non-adherence could be spontaneous, intentional or unintentional. Spontaneous non-adherence is usually b) we provide the information related to the use of medicine and verify if the patient understands the information a specialized workplace where information on medicines is provided? (in accordance to CZ Decree No caused by forgetfulness and is usually solved by continuous reminding that is linked to usual daily activities and c) we recommend to patient his/her appropriate system to monitoring and recording use of medicines medicines dispensers. Intentional non-adherence is a deliberate non-complying with the recommended treatment. 92/2012 Coll. & SK Decree No 129/2012 Coll.) d) other (please specify) 5.1 Consultation space or room e) we do not offer such support a) yes Note: Adherence means an affirmative attitude on behalf of patient towards treatment, acting in accordance with b) no the pharmacotherapy recommended by the healthcare practitioner. It significantly influences the therapeutic value of the prescribed medicine. 5.2 Discrete zone a) yes 14. In what manner do you offer support for persistence – continuity of treatment – throughout the b) no recommended period of therapy? (multiple choice is possible) 5.3 How often do you provide consultations to patients beyond the usual drug dispension-related activities? a) daily a) we engage the patient by asking questions related to his or her readiness to undertake a long-term treatment b) 1-3 times per week b) we agree with the patient on a continuous cooperation c) we communicate with a medical practitioner in case we have suspect that the patient deliberately adjusts the c) 1-3 times per month length of the recommended pharmacotherapy d) other (please specify) d) other (please specify) 6. Please provide information on your 2 or 3 most frequently used sources of information related to medicines e) we do not offer such support and recommended procedures of the Czech Pharmacists´ Association and how frequently you use them: Note: Persistence – means continuity throughout the entire treatment (i.e. patient uses medicine throughout the Source/form/frequency of information related to medicines entire therapy). 15. How do you increase trust in patients in order to achieve their concordance? (multiple choice is possible) a) we provide personal counselling related to the selected drug form, application and dosage Recommended procedures b) we consult with patient the recommended medication dose titration (e.g. due to skin irritation) c) we identify with the patient his or her options for a routine use of medicines in accordance with the maintenance therapy recommended by a medicine practitioner (e.g. system of notifications, personal monitoring and recording) d/ we engage the patient in different way (please specify): 7. Do you cooperate with a medical or healthcare practitioner in your pharmacy regarding DRPs? e) we do not deal with such issue a) yes b) no Note: Concordance means a partnership between patient and pharmacist that leads to an agreement on why and how to use the relevant medicines. Unlike compliance, concordance represents an agreement based on a patient’s Note: DRPs means Drug Related Problems (e.g. interactions, incorrect use, attitude and behavior of patients, etc.) own conviction, reached as a result of an individual approach and it is based on the provision of adequate 7.1 If yes, how often do you do so? information, including an explanation of the expected therapeutic effect and adverse effects, the costs of treatment a) daily and other relevant factors. b) 2-3 times per week c) 1-2 times per month d) 5-6 times per month 8. Do you take records of interventions in your pharmacy (DRPs)? a) yes b) no 8.1 If yes, in which form do you take such records? a) electronic form b) paper form 9. Do you have a system in your pharmacy that counts the number of patients and their revisits? a) yes b) no 9.1 If yes, please make an estimate of proportions of loyal vs random patients in your pharmacy: a) loyal patients (v %) b) random patients (v %) 10. In which manner do you offer support/motivate patients towards higher compliance in the recommended therapy? (multiple choice possible) Figure 1. Questionnaire to community pharmacists. a) educating patient with the use of available information materials b) suggesting a cheaper alternative in the alternative form of generic substitution c) offering consultations (individual counselling) d) support programs for a larger group of patients - e.g. group discussion, audio-visual programs understood as going beyond the scope of primary Statistical methodology e) other (please specify): Note: Co(nec mpliance essar means y) inf that the patientor ’s bema haviortion pr follows the treatmo envided b t recommendation by individual y a healthcare professional (medicine practitioner, nurse, etc.) pharmacists about safe and appropriate use of dispensed To process the results of the questionnaires, we used 11. Do you provide any consultations to patients, or individual counselling on use of medicine? a) yes medicines. methods of descriptive and inductive statistics. The core b) no 11.1 If yes, how often do you do so? V. Oerff ing support by pharmacists to follow of the questionnaire was formed around the questions of a a) daily b) 2-3 times per week a recommended pharmacotherapy in order to achiev e: dichotomic or polytomic character. The final quantities were c) 1-2 times per month d) 5-6 times per month a. Compliance, adherence, persistence and concordance. summarized in a contingency table. To test associations, we 12. How do you usually identify the risk of non-adherence? What questions do you usually ask the patient? 2 The terms and definitions refer to a literature review by used the chi-squared test (χ ) or exact tests (Fisher and Fisher- The questions related to: (multiple choice is possible) a) forgetfulness Vrijens et al. (2012); Freeman-Halton tests). The differences between groups were b) missing dosage of medicine in case of adverse or side effects occur c) early termination of therapy b. Reducing the risk of non-adherence – we used four tested by the t-test and, in relevant cases, by non-parametric d) compliance with the time of use of medicine e) other (please specify): item Morisky Medication Adherence Scale (Morisky methods (Mann-Whitney test for analysis of variations). f) we do not ask questions Note: Non-adherence could be spontaneous, intentional or unintentional. Spontaneous non-adherence is usually et al., 1986), which we modified from the pharmacist’s We analysed the degree of associations with correlation caused by forgetfulness and is usually solved by continuous reminding that is linked to usual daily activities and medicines dispensers. Intentional non-adherence is a deliberate non-complying with the recommended treatment. perspective, who responds according to his/her coefficients: Cramér’s V and Goodman and Kruskal’s gamma. experience and common practice in communication For certain comparisons, we introduced an odds ratio (OR) with patients on medication use (Fig. 1, question 12/a-d). with the respective confidence interval, 95% (95% CI). In all 16 17 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 1. Consultancy and resolving DRPs by community pharmacists. Consul- Cohen Cohen tations p Kappa p Kappa dRp s CZ score dRp s SK score on dRp s (95% CI) (95% CI) NO YES SUM NO YES SUM Yes 19 62 81 4 34 38 -0.074 0.554 0.796 (-0.241 to 0.00004 (0.183 to No 6 30 36 3 0 3 0.092) 0.926) Total 25 92 117 7 34 41 cases, we tested at a significance level of alpha ≤0.05. We We did not find a correlation between revisits of patients and performed the analyses with StatsDirect 2.8.0 (StatsDirect resolving DRPs in the data sets. Ltd., Cheshire, UK) and Microsoft Office Excel 2010 (Microsoft Corporation). Support of medication adherence Study’s limitations Each evaluated activity of pharmacists aimed at an improvement of medication adherence, persistence or The legal framework for personal data protection of patients, concordance, was scored with one point. The overall relative their unavailable medication history and non-existence of score for all activities combined could range from 0 to 4 points. the e-Health in CZ and SK limited our study with regards to The more intensive the support of a pharmacist was, the community pharmacist’s support on specific patient, his/ higher the score. We did not observe significant differences her specific type of problem/s and pharmacotherapeutic between CZ and SK in support of the adherence, persistence outcome/s. Therefore, collected data from the pharmacists’ or concordance. Support for adherence reached the average responses give an estimate on the medication adherence level with the highest scoring value in both countries. Support promotion provided in respective pharmacies participating for adherence (CZ: 1.95; SK: 1.93) was significantly higher than in the questionnaire survey. support for persistence (CZ: 1.18;SK: 1.07), and was also higher than support for concordance (CZ: 1.28;SK: 1.27), (Fig. 2). We RESult S used the adopted Morisky scale to estimate with what intensity non-adherence risk could be reduced. We evaluated this from Consultations, counselling and DRPs the perspective of the pharmacist, who addresses one or more critical areas of a patient’s attitude and behaviour, which The majority of pharmacists in our data set stated that they can help to uncover patient’s compliance with a prescribed provide consultations or counselling to patients (CZ: 69.2%, pharmacotherapy. In CZ, we measured that the overall average SK: 92.7%). We investigated whether these activities could be score was marginally higher than for SK. It reached the medium associated with resolving DRPs. Unlike CZ, in SK there was a degree of support in both data sets [CZ: 2.29 and SK: 2.22; significant and high concurrence in answers (answer type yes- P = 0.739; 95% CI for the difference in mean scores went from yes) that showed that if SK pharmacists provide consultations, (-0.35) to 0.49]. The difference was attributed to a higher score they do so in order to help patients in finding solution to achieved by CZ pharmacists concerning the reduction of any DRPs and, on the other hand, those pharmacists that do risk that patient would not comply with the recommended not provide consultations, do not engage with DRP-solving time of medication use (P = 0.032; the lower and upper limits activities (answer type no-no), P < 0.0001 (Table 1). of the 95% CI for the odds ratio were 1.02 and 5.09). Other risk In registering DRPs, we found a statistically significant factors were comparable with SK. These include forgetfulness, difference in favour of SK pharmacists (P = 0.008). Pharmacists missing medication or termination of medication use due to do register DRPs, although there is no e-Health currently at adverse reaction or, on the contrary, because therapeutic effect place in either country. Such registrations therefore tend has already been attained (Table 2). to be non-systematic and rare. Due to the small number of responses, we could not assess to what extent DRPs are Relationship analysis between estimated support for registered in either paper or electronic form. In both countries, medication adherence and technical and personnel pharmacists deal with DRPs at a similar rate of frequency, characteristics of pharmacies usually either daily or 2 to 3 times per week (P = 0.052). Just about half of the pharmacists (50.8%) in both countries The survey demonstrated that geographic parameters of register loyal patients and their revisits. Loyal patients location (in relation to the number of inhabitants) or size of represented more than 50% of all patients visiting pharmacies. pharmacies by the number of professional employees, namely, 18 19 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 2. Non-adherence risk reduction from pharmacists-responders´ perspective in the most frequent areas. Reduction of risk Country oR totA l p of non-adherence CZ SK 95% CI 1. Forgetfulness Yes 64 24 88 0.855 0.717 0.387 to 1.861 No 53 17 70 2. n ot complying with the recommended timing of usage of medicines Yes 85 22 107 2.294 0.032 1.022 to 5.091 No 32 19 51 3. Missing dosages of medicines in case of occurrence of adverse or side effects Yes 67 27 94 0.694 0.361 0.304 to 1.541 No 50 14 64 4. Early termination of treatment after achieving the desired therapeutic effect Yes 52 18 70 1.022 > 0.999 0.470 to 2.241 No 65 23 88 Total score value 2.29 2.22 0.739 95% CI -0.350 to 0.492 n 117 41 158 SK and CZ – there is a stronger relationship between the number of years of experience and adherence support in SK (p = 0.029), whereas we could not establish a correlation in CZ (P = 0.175). Moreover, in the SK data set, we also found a strong linear relationship between the number of years of professional experience and medication adherence support (P = 0.0496) (Table 3). We also found a strong correlation between the preferential source of information for pharmacists as the Recommended Procedures authorized by the Czech Chamber of Pharmacists (2010) and support for adherence by CZ pharmacists (P = 0.005), in comparison to SK pharmacists, where a similar source of information was not available. We observed, that majority of pharmacists cooperated with Figure 2. Support of patients’ attitude to follow recommended healthcare practitioners in solving the DRPs in both countries pharmacotherapy. (CZ: 78.6%; SK: 82.9%; P = 0.51; 95% CI 0.253 to 2.023) (Table 4). A close relationship between adherence and DRPs was did not correlate with the estimated degree of support for confirmed in the CZ data set (P = 0.00015) as compared to the medication adherence. SK data set, despite Cramer’s V showing a weak association The CZ and SK sets of pharmacies are equipped with technical (0.334). It is possible, that if data sets were larger, we would equipment, that is, a discrete zone given by law and eventually, not observe the difference between CZ and SK data sets. a consultation room– dedicated for consultancy purpose by law (Table 5). in CZ, not regulated in SK. The SK pharmacists, while using consultation rooms, were engaged more with adherence- dISCuSSIon related issues as compared to CZ (P = 0.037; Cramér’s V = 0.37). On the other hand, the CZ pharmacists use the consultancy Results of the questionnaire survey matched with our rooms – if they are equipped with – more frequently than prediction that pharmacists had been involved in the SK pharmacists, although at the margin of significance medication adherence support, as similarly published by (P = 0.058). other authors (Lau et al., 2010, Santschi et al., 2012, Vlček, et Majority of the survey’s respondents had a qualification in al., 2009). We assume that pharmacists can support patient pharmacy (CZ: 88%; SK: 83%). As far as the number of years adherence and they are able to reduce the risk of patients´ of professional experience (practice) of the pharmacists (i.e., non-adherence, reaching in average the medium degree. the respondents) is concerned, our data showed that the We found that support for medication adherence has respondents mostly had between 20 and 29 years of practice been provided to a greater degree than support for other in both data sets. When it comes to the number of years of forms of patients’ adherence attitudes towards treatment, professional experience, we found a difference between such as persistence and concordance. (Herein, we refer to 18 19 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. Table 3. Association between the number of years of pharmacists´ practice and support for medication adherence. Support to medication adherence (n = number of pharmacists-responders) We inform We provide We recommend We do not Fisher- Number patient information that patient Good provide Freeman- of about and verify creates his or her Other Sum man- P support to Halton practice use of if patient own system of (n) (n) Kruskal adherence exact (years) medicines understands monitoring of use gamma (n) P (n) it (n) of medicines (n) CZ 0 – 9 1 3 7 3 4 18 10 – 19 5 5 17 9 4 40 0.135 20 – 29 2 7 8 11 7 35 0.294 0.175 (0.06 to > 29 2 0 9 10 3 24 0.33) Total 10 15 41 33 18 117 SK 0 – 9 1 4 0 2 0 7 10 – 19 1 1 8 2 1 13 0.348 20 – 29 1 1 0 3 2 7 (0.04 to 0.029 0.024 0.66) > 29 1 3 2 3 5 14 Total 4 9 10 10 8 41 Table 4. Interdisciplinary teamwork between community pharmacists and healthcare practitioners. Cooperation between pharmacist and a healthcare practitioner on dRp s (n = number of pharmacists-responders) CZ SK Cooperation Fisher exact n % n % Total Yes 92 78.6 34 82.9 126 P = 0.51 No 25 21.4 7 17.1 32 95% CI: 0.253 to 2.023 Total 117 100.0 41 100.0 158 Table 5. Adherence support and resolving DRPs by community pharmacists. Association between adherence support and dRp s resolving by pharmacists (n = number of pharmacists-responders) We do not provide Missing Early support to Not complying dosages of termination Fisher- adherence with the Adherence medicines of treatment Freeman- We inform Forgetfulness recommended Sum Cramér’s and in case of after achieving Halton patient (n) timing of (n) V DRPs occurrence the desired exact about usage of of adverse or therapeutic P use of medicines (n) side effects (n) effect (n) medicines (n) CZ Yes 3 14 28 30 17 92 No 7 1 13 3 1 25 0.00015 0.4553 Total 10 15 41 33 18 117 SK Yes 4 7 7 10 6 34 No 0 2 3 0 2 7 0.3561 0.3345 Total 4 9 10 10 8 41 20 21 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. terms and definitions on medication adherence used in the practitioner/clinic setting) has been often highlighted at questionnaire by Vrijens et al. (2012)). As the issues of scientific symposia and discussed by more authors (Pape et persistence and concordance are more complicated – the al., 2011, Rojaz-Fernandez et al., 2014). According to recently processes are more complex and demanding (professionally, published data from SK pharmacies by Masaryková et al., in terms of time or work organization). We estimate that the DRPs most frequently relate to poor treatment efficacy pharmacists supported patients only at a low degree of and therapy costs (2015). Non-adherence very likely intensity in these activities. In general, this degree of support represents the common denominator of these problems. could change if pharmacists were more actively, or even The risk of non-adherence should be detected and resolved pro-actively, engaged in the cooperation with patients responsibly, whereas cooperation between pharmacists and and healthcare practitioners in both countries. It is most healthcare practitioners gives a solid ground for furnishing probably associated with education and further training, effective and prompt solutions to the identified problems. their motivation, as well as availability of specific intervention To examine other possibilities of how to increase support for package/s motivational interviews with patients, patients’ patient adherence, the specific profile of risk patients could education, home medicines review, dose administration aid, be considered, which the pharmacists could focus on. medication use review, etc.), enabling the pharmacists to Our findings indicated that there is a close association improve patient adherence (Lau et al., 2010, Salvo & Cannon- between support for medication adherence and personnel Breland, 2015). capacities (factors) of pharmacy. These factors mostly We found that the location of a pharmacy and the number concern the professional experience of pharmacists and of inhabitants in a location does not influence support for the quality of consultation and counselling, which might be medication adherence in either country (for pharmacies efficiently supported by training and/or authorized sources located in larger cities or smaller municipalities). As far as of recommendations for pharmacists such as Recommended technical factors were concerned, we focused on discrete Procedures of the Czech Pharmacists’ Association available zones and consultation rooms and their use. In SK, where since 2010. Recently, the Association opened new courses discrete zones are mandatory components of pharmacies in DRPs, enabling additional services, which include (Decree No 129/2012), consultation rooms are additional recommendations in terms of dosage and therapeutic regime. spaces not required by law. The outcomes suggested that The Association is planning to extend its recommendations there is an association between support for adherence (DRPs) into other areas of pharmaceutical professional consultancy. and the usage of consultation rooms, which has been stated Since 2013, the Czech Chamber of Pharmacists offers a mobile by Masaryková et al., 2015 too. In CZ, only pharmacies that application mapping the pharmacies with consultation actively provide consultations and counselling have such rooms. All these initiatives, as mentioned hereby, represent consulting rooms (Decree No 92/2012). Despite strong useful electronic tools that could enable the pharmacists to differences in terms of the legislative requirements in the address patients’ adherence and vice-versa, in more effective two countries, our finding showed that CZ pharmacies way. use consultation rooms more frequently - though the In general, we can assume that the support for medication frequency was only marginally higher than SK pharmacies. adherence is provided in both CZ and SK pharmacies. This finding indicates that legislation is not the unique It reaches a medium degree and develops in the right factor that influences the extent to which pharmaceutical direction – towards concordance in the pharmacist-patient care is provided. In this respect, other factors, both personal relationship. The responses to our survey suggest that the and professional, also have significant importance. The development of interdisciplinary cooperation with other difference in the legislative and societal development of healthcare professionals, mostly medical practitioners, pharmaceutical care in the two countries reveals potential remains challenging (non-systematic and rare registration that we could elaborate upon to increase support for of DRPs). The e-Health system will soon be introduced in medication adherence by pharmacists. both countries, and is expected to become an important From the perspective of personnel characteristics of pharmacy, factor in this dimension, as it will enable connection with the degree of support for adherence was not dependent relevant data and information. It is also recognizable that upon the number of professional workers. However, in the SK recommended practice, education in DRPs and life-long data set, we found that the number of years of professional education of pharmacists represent important pre-requisites experience increase the probability that the pharmacists for further development of pharmaceutical care in medication approach patients, discuss a prescribed treatment and try to adherence support. help to resolve patients’ DRPs. We assume, that SK pharmacies, in comparison to CZ pharmacies, provide such a kind of ConCluSIon consultations that are closely linked to resolving DRPs in collaboration with healthcare practitioners.The importance of We analysed the current state of provision of counselling interdisciplinary cooperation in DRPs (most notably effective and consultation services aimed at supporting medication interaction between community pharmacist and healthcare adherence by community pharmacies through a questionnaire 20 21 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. survey in CZ and SK. Based on the pharmacists’ responses, ACKno WlEdgEMEnt S we assumed a medium degree of support for patient adherence, predominantly provided in order to resolve DRPs We thank the Academia, the Faculty of Pharmacy in Hradec in both countries. We can also point out that education and Králové, Charles University and the Faculty of Pharmacy, experience for pharmacists could be one of the crucial factors Comenius University in Bratislava for their support to address in ensuring support for adherence. Its progress might also be and engaged community pharmacies into the study in both accelerated through the use of information technologies, as the Czech and Slovak Republics. We would also like to thank research in multiple countries has also demonstrated recently. all community pharmacies taking part in the Survey. We conclude that our findings can offer a solid base for further investigations aimed at evidence-based interventions in this area, and so to contribute to pharmaceutical care development. dECl ARAtIonS List of Abbreviations CI: Confidence Interval CZ: Czech or Czech Republic dRp s: Drug-related problems e-h ealth: Electronic and computerized healthcare system FaF uK: Faculty of Pharmacy, Comenius University in Bratislava or Faculty of Pharmacy in Hradec Králové, Charles University oR: Odds Ratio SK: Slovak or Slovak Republic Who: World Health Organization χ : chi-squared test References [1] Czech Chamber of Pharmacists: Counselling in Pharmacies. to antihypertensives: a randomised controlled trial. BMC Health ( h ttps://w w w.lek ar nici.cz/Pro - verejnost/POR ADENST VI--- Services Research. 2010; doi: 10.1186/1472-6963-10-34. PubMed KONZULTACE.aspx); (in Czech). Revised September 7, 2010. [8] Leporini C, De Sarro G, Russo E. Adherence to therapy and Accessed March 2016. adverse drug reactions: is there a link? Expert Opinion on Drug [2] Czech Chamber of Pharmacists: Pharmacies in Smartphones. Safety. 2014; doi: 10.1517/14740338.2014.947260. PubMed (h ttp://w w w.lek ar nici.cz/P r o - v er ejnost/I nf or mac e -pr o - [9] Masaryková L, Fulmeková M, Lehocká Ľ, Fazekaš T. Identifying verejnost/Lekarny-v-mobilu.aspx); (in Czech). Revised November and solving drug-related problems in terms of the community 15, 2013. Accessed March 2016. pharmacists. Čes slov farm. 2014;63:32-39; (in Slovak). [3] Decree No 92/2012 Coll. on the requirements for the minimum [10] Morisky DE, Green LW, Levine DM. Concurrent and predictive technical and material equipment of health facilities and home validity of a self-reported measure of medication adherence. care contact centers. Ministry of Health. (https://portal.gov.cz/ Med Care. 1986;24(1):67-74. app/zakony/zakonPar.jsp?idBiblio=77185&nr=92~2F2012&rpp= [11] Pape GA, Hunt JS, Butler KL et al. Team-based care approach to 15#local-content); (in Czech). Revised March 15, 2012. Effective cholesterol management in diabetes mellitus: two-year cluster April 1, 2012. Accessed March 4, 2016. randomized controlled trial. Arch Intern Med. 2011;171(16):1480-6. [4] Decree No 129/2012 Coll. on the requirements for good pharmacy PubMed practice. Ministry of Health of the Slovak Republic. (http://jaspi. [12] PCNE - Pharmaceutical Care Network Europe Foundation: justice.gov.sk/jaspiw1/htm_zak/jaspiw_mini_zak_zobraz_skup1. The PCNE Classification V5.01. 2006. (http:// www. pcne. org). asp?skupina=1); (in Slovak).Revised April 12, 2012. Effective May Published 2006. Accessed March 4, 2016. 15, 2012. Accessed March 4, 2016. [13] Rojas-Fernandez CH, Patel T, Lee L. An Interdisciplinary Memory [5] FIP. International Pharmaceutical Federation:FIP/WHO Joint Clinic: A Novel Practice Setting for Pharmacists in Primary Care. Guidelines on Good Pharmacy Practice - Standards for Quality Ann Pharmacother. 2014 Jun;48(6):785-95. PubMed Services. 2011. (http://www.fip.org/www/uploads/database_file. [14] Salvo MC, Cannon-Breland ML. Motivation interviewing php?id=331&table_id=). Accessed March 4, 2016. for medication adherence. J Am Pharm Assoc. 2015 Jul- [6] Kriška M, Gajdošík J, Dukát A, Bernadič M. Zlyhanie farmakoterapie Aug;55(4):e354-61. PubMed – možnosti prevencie. Bratislava: Slovak Academic Press; 2015; [15] Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist (in Slovak). interventions to improve cardiovascular disease risk factors in [7] Lau R, Stewart K, McNamara KP et al. Evaluation of a community diabetes: a systematic review and meta-analysis of randomized pharmacy-based intervention for improving patient adherence controlled trials. Diabetes Care. 2012;35(12):2706-17. Pub Med 22 23 Eur. Pharm. J. 2018, 65 (1): 15-23 Support of medication adherence by community pharmacists in Czech and Slovak Republics ... Molitorisová M. et al. [16] Spinewine A, Fialová D, Byrne S. The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People. Drugs Aging. 2012;29(6):495-510. PubMed [17] Středa L, Hána K. (eHealth and telemedicine). Praha: Grada Publishing; 2016; (in Czech). [18] Sun AP, Kirby B, Black C, Helms PJ, Bennie M, McLay JS. Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study. BMC Pharmacology and Toxicology. 2014; doi:10.1186/2050-6511-15-11. PubMed [19] Vlček J, Malý J, Dosedel M. (Pharmaceutical care of patients with diabetes mellitus and its relationship to clinical pharmacy). Vnitr Lek. 2009;Apr; 55(4):384-8; (in Czech). PubMed [20] World Health Organization (WHO): Chronic diseases and health promotion: Adherence to long-term therapies: evidence for action. (http://www.who.int.). Published 2003. Accessed March 4, 2016. [21] Vrijens B, De Geest S, Hughes DA et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012 May;73(5):691–705. PubMed [22] Taitel M, Jiang J, Rudkin K, Ewing S, Duncan I. The impact of pharmacist face-to-face counseling to improve medication adherence among patients initiating statin therapy. Patient Preference and Adherence. 2012;6:323-329. PubMed 22 23

Journal

Acta Facultatis Pharmaceuticae Universitatis Comenianaede Gruyter

Published: Jun 1, 2018

Keywords: community pharmacy; consultancy; medication adherence; Czech and Slovak Republics

References