Medication Adherence and Interprofessionality Group

MyCare Start-I:

Implementation of a new model of care for supporting adherence in people starting a new medication for a long-term condition - An implementation-effectiveness science study.

2022-2026

Project Lead:

Marie-Paule Schneider Voirol (0000-0002-7557-9278)
Sabina De Geest (Co-lead) (https://nursing.unibas.ch/de/personen/sabina-m-de-geest

Our team:

UNIGE Team

Sarah Serhal (0000-0001-9865-2338)
Théo Boisier (0009-0008-9265-1463)

INS-Team

Sabina De Geest (Co-lead) (https://nursing.unibas.ch/de/personen/sabina-m-de-geest
Juliane Mielke (0000-0002-9771-2383)

Background

Medication adherence is defined as the process by which patients take their medications as prescribed by their doctor. Medication nonadherence is a silent epidemic and a major public health issue; it decreases treatment effectiveness, patient security and increases global costs to the healthcare system.

One of the best evaluated, evidence-based, interprofessional interventions to reinforce early adherence after medication initiation, is the UK developed patient-centred New Medicines Service (NMS). Based on the NMS, myCare Start was introduced by pharmaSuisse into Switzerland.

The myCare Start-I project.

Presentation

MyCare Start is the first evidence-based, nation-wide health service, conducted by interprofessional primary care teams to support medication adherence in chronically ill patients starting a new long-term treatment in Switzerland. It consists of two 10-minute, face-to-face, semi-structured, tailored educative and behavioural intervention delivered by community pharmacists during the 6 weeks after treatment initiation to strengthen patient’s self-management. MyCare Start-I is a multicentric, national implementation science project conducted in collaboration with six university partners and across 160 community pharmacy-physician networks in Switzerland.

Objectives

The objective of the project is to develop, implement and evaluate myCare Start to enhance medication adherence during the initiation of a new chronic treatment in a sustainable way, at the patient and provider levels.

For this, we will measure:

effectiveness outcomes: i.e. medication adherence and cost-effectiveness of the intervention.
multi-levelled (patient, pharmacist, physician) implementation outcomes: i.e. reach, adoption, acceptability, fidelity, and implementation costs.
service outcomes i.e. evaluate how pharmacists changed their practice towards chronic care and interprofessionality

Method

Based on the implementation science methodology our method will strengthen the real-world translation of myCare Start. As shown in Figure 1, the myCare Start-I project includes two phases focusing on adaptation, implementation (phase A) and evaluation (phase B). Each of these phases were divided in different Work Package (WP).

Phase A

WP1: complete a comprehensive contextual analysis as foundational phase to inform subsequent steps of the myCare Start-I project. The contextual analysis builds on existing evidence on implementation barriers in real-world from international and Swiss studies and it will be carried out according to selected implementation theories and frameworks.1
WP2: adapt myCare Start intervention to suit the Swiss context and develop contextually adapted implementation strategies. These adaptations will be co-created with stakeholders to ensure real-world translation, core and adaptable implementation components will be defined. Educational and behavioural intervention components will be theory driven.
WP3: test the implementation strategies.
A multi-method feasibility study will be conducted in 12-15 pharmacies to pre-test contextually adapted implementation strategies.
Create a logic model indicating the relationship between inputs (determinants), activities (implementation components and implementation strategies), outputs (implementation mechanisms) and outcomes will be developed.

Phase B

WP4: roll out and evaluate myCare Start.

During roll-out, a Hybrid Type 2 effectiveness-implementation (two-arm, multi-centred, stepped wedge cluster randomized control design) will be used. MyCare Start will be implemented and tested in 120 pharmacies in Switzerland, well balanced between the French and German parts of Switzerland.

Evaluation:
- Medication adherence as primary outcome will be measured at 10 weeks, 6 and 12 months using the BAASIS® patient-self report and electronic pharmacy refill records.
- A cost-utility analysis will be performed at 12-month from a healthcare system perspective.
- Implementation outcomes (i.e., reach, adoption, fidelity, acceptability, and implementation costs) will be assessed guided by the NoMAD tool (Normalization Measure Development questionnaire), and the implementation pathway using mixed methods combining quantitative and qualitative data.
A dual evaluation of effectiveness outcomes and the implementation pathway will provide the much-needed scientific basis to understand how and why myCare Start works and results (or not) in the assessed outcomes.

Figure 1. Implementation Pathway for myCare Start-I

Expected Benefit/Relevance

MyCare Start will be the first innovative, interprofessional, integrative care model to support medication adherence in chronically ill patients in Switzerland. Collective efforts to improve patient adherence to long-term therapy may improve patient therapeutic outcomes, safeguard patient safety and alleviate the financial burden on patients and the health system. The project will inform for future adaptations of the intervention and guidance for the implementation in a broad variety of settings for future scale-up.

Stakeholders

We attach great importance to stakeholder involvement. An interprofessional stakeholder group will be initiated to provide advice, expertise, and direction to build a strong foundation for the myCare Start intervention and ensure its long-term viability. Stakeholders will be engaged throughout the different project phases to establish interprofessional collaboration models with physicians, nurses, and patients.

Here is the list of stakeholders, which will continue to evolve as stakeholder involvement is an ongoing process.

Cantonal government representative - Jura
Cantonal government representative- Vaud
CARA
The professional cooperative of Swiss pharmacists (ofac)
HCI Solutions/GaleniCare - represent the pharmacies Amavita, Sun Store and Coop Vitality for the development of services and represent the IT tools Triapharm (sales system) and Documedis (HCI Solution, documentation system and anamnesis).
Regular consumer
Patient Safety Foundation Switzerland
The European Patients’ Academy on Therapeutic Innovation (EUPATI), Switzerland – Représentant des consommateurs.
GP Representatives
Le Réseau de santé Delta
Pharmacy Technicians - Pharma24
PharmaGeneve
Swiss Association of Pharmacists (PharmaSuisse)
University Representative - ETH Zurich
GSASA
Representative of Pharmacies Chain - Pharmacie Populaire
Société Vaudoise de pharmacie (SVPh)
Community Pharmacist
Home nursing care - The Geneva institution for home support (imad)
Organization of chronic diseases - diabetesbern

Project partners

Samuel Allemann, Departement Pharmazeutische Wissenschaften Universität Basel
Alex Dima, Health Services and Performance Research gro University Claude Bernard Lyon 1
Thomas Fassier, University of Geneva
Stéphane Guerrier, Research Center for Statistics Geneva School of Economics and Management University of Geneva
Alice Panchaud, Berner Institut für Hausarztmedizin BIHAM Universität Bern
Clémence Perraudin, Unisanté, University of Lausanne Centre for primary care and public health
Johanna Sommer, Institute for Primary Care Faculty of Medicine University of Geneva

YouTube video

French link: https://www.youtube.com/watch?v=1ygp2ItuRKs
German link: https://www.youtube.com/watch?v=y7ARRqcNX44
Italian link: https://www.youtube.com/watch?v=EOogbeQrqkQ