Implementation of a New Model of Care for Supporting Long-term Medication Adherence (Phase A)

Implementation of a New Model of Care for Supporting Adherence in People Starting a New Medication for a Long-term Condition (myCare Start-I Project) - An Implementation Science Study - Phase A

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.

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)