implementation of a new model of care for supporting long-term medication adherence (phase a)

Conditions: Medication Initiation for Long-term Conditions

Summary: the overall objective of the mycare start-i project is to adapt, implement and evaluate the mycare start service within the swiss pharmacy-physician network to enhance medication adherence during the initiation of a new long-term treatment. the study will use an implementation science approach. the mycare start service is based on the new medicine service (nms) that was developed in the united kingdom.

phase a: 1. to conduct a contextual analysis of the current swiss primary care ecosystem as related to pharmacy-physician interprofessional health services for patients with long-term diseases (i.e., contextual analysis). 2. to engage key stakeholders within the swiss primary care ecosystem to contribute to the co-creation of a swiss interprofessional mycare start service (i.e., stakeholder involvement). 3. to design a contextually adapted mycare start for use within swiss community practice using contextually appropriate implementation strategies (i.e., intervention development/selecting implementation strategies). 4. to conduct feasibility testing on the contextually adapted intervention and implementation strategies and to develop an implementation research logic model (i.e., feasibility testing). phase b: please note phase b will be carried out at a later date with further ethics committee approval. 5. to implement a contextually adapted swiss mycare start intervention in the pharmacy-physician network community and evaluate it in terms of medication adherence and cost-effectiveness outcomes. 6. to evaluate implementation outcomes and the implementation pathway of mycare start.

Eligibility criteria:
phase a: contextual analysis inclusion criteria: * community pharmacists and technicians of 5 participating pharmacies in the french-speaking part of switzerland and 5 in the german-speaking part of switzerland * primary care physicians working in collaboration or in the neighbourhood of the participating pharmacies * patients with long-term treatments, who are a regular patients of the included pharmacies * international research groups who have implemented nms within their countries or similar interventions. exclusion criteria: * patients not willing to participate * patients that do not speak french or german phase b: hybrid type 2 effectiveness-implementation study patients are eligible for the mycare start-i phase b study if : * they are taking part in the mycare start service * they have been newly prescribed one or more new long-term medications in accordance with one of the five defined long-term conditions (cardiovascular disease (incl. hypertension and thromboprophylaxis), diabetes, hyperlipidaemia, depression and respiratory illness (asthma, copd)) * they are 18 years or older * they have mandatory basic health insurance in switzerland * they are able to self-manage treatment (i.e. they live at home without any support to manage their medication, exception: patient uses a pill dispenser and fills it in by him-/herself). * they understand language spoken by pharmacy staff and are able to read and understand study documents (ge, fr) * they are able to understand and willing to consent to the mycare start study (including the agreement on self-reported questionnaires and collection of health care data via their health insurance company) exclusion criteria: • patients participating or having participated in an education program about their disease or treatment in the last 3 months, led by healthcare providers such as physicians, nurses, pharmacists or other (e.g. education provided by nurses for type i diabetes patients). mycare start definition of a new medication: a new medication is a medication that has not been previously dispensed to the patient. this includes one or more new medications for a new diagnosis and or new medications for pre-existing diagnosis of a long-term condition. operational definition of a new medication: * active ingredient is indicated for one of the five long-term conditions (cardiovascular disease (incl. hypertension and thromboprophylaxis), diabetes, hyperlipidaemia, depression and respiratory illness (asthma, copd)). * patient has never had this active ingredient dispensed before or restarts an active ingredient after a period of interruption of at least 12 months. the new active ingredient can be part of a combo preparation (e.g. a diuretic added to an ace inhibitor into the same preparation) * patient has had no change in active ingredient but has an important change in treatment administration, such as: * change of galenic form (e.g. two different types on inhalators for asthma/copd) * intensification of dosage regimen (e.g. twice a day instead of once a day) * the following change is not considered as medication initiation: * new dosage of already known active ingredient (e.g. dose escalation of antidepressants) * simplification of administration mode (e.g. metformin 1000mg 1-0-0 instead of 500mg 1-0-1; change in antihypertensive drug regimen in elderly patients having vertigo in the morning: 0-0-x instead of x-0-0)

Keywords: medication adherence medication initiation long-term treatment implementation science interprofessional collaboration outpatient care community pharmacy general practitioner cost-effectiveness medication adherence support programme