Adherence: a review of education, research, practice and policy in Switzerland.

Nonadherence to medication treatment regimens is a major preventable risk behavior in both acute and chronic diseases. Community pharmacists are facilitators in community care for promoting medication adherence and they should implement interdisciplinary medication adherence programs. To do so, pharmacists should be educated in medication adherence, and new pharmaceutical care policies should be implemented. The healthcare system should evolve to better meet the specific needs of patients. AIMS: this article describes what has been undertaken in the last decade in medication adherence in terms of education, research, practice and policy in Switzerland. METHODS: Medline was searched, with the search limited to Switzerland. The three Swiss pharmacy schools were also contacted to collect information about the medication adherence content of both their courses and research programs. National policies related to medication adherence were also reviewed for relevant content. EDUCATION: two pharmacy schools offer courses devoted specifically to medication adherence. The number of hours dedicated to the topic varies between 4 to13. RESEARCH: a total of 16 studies met the inclusion criteria. Chronic patients were the focus of 9 studies. Medication adherence was the primary outcome of all studies; 10 studies also measured clinical outcomes. Nine studies evaluated the prevalence of medication nonadherence; three studies evaluated the feasibility of new technologies for monitoring adherence; three studies evaluated medication adherence enhancing programs. Policies: three cognitive pharmaceutical services are reimbursed by healthcare insurers, which are directly related to medication adherence. CONCLUSIONS: Pharmacists in Switzerland have been actively involved in medication adherence research since the mid '90s. Specific medication adherence courses have entered the curriculum of pharmacy schools, and policies in Switzerland are slowly beginning to meet needs of chronic patients by the introduction of pharmaceutical cognitive services and reimbursement fees.

Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton.

OBJECTIVES: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents. DESIGN AND METHODS: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed. RESULTS: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring. CONCLUSION: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. It should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents.

Adherence: a review of education, research, practice and policy in Switzerland / Cumplimiento: revisión de la educación, investigación, práctica y política en Suiza

Non adherence to medication treatment regimens is a major preventable risk behavior in both acute and chronic diseases. Community pharmacists are facilitators in community care for promoting medication adherence and they should implement interdisciplinary medication adherence programs. To do so, pharmacists should be educated in medication adherence, and new pharmaceutical care policies should be implemented. The healthcare system should evolve to better meet the specific needs of patients. Aims: this article describes what has been undertaken in the last decade in medication adherence in terms of education, research, practice and policy in Switzerland. Methods: Medline was searched, with the search limited to Switzerland. The three Swiss pharmacy schools were also contacted to collect information about the medication adherence content of both their courses and research programs. National policies related to medication adherence were also reviewed for relevant content. Results: Education: two pharmacy schools offer courses devoted specifically to medication adherence. The number of hours dedicated to the topic varies between 4 to13. Research: a total of 16 studies met the inclusion criteria. Chronic patients were the focus of 9 studies. Medication adherence was the primary outcome of all studies; 10 studies also measured clinical outcomes. Nine studies evaluated the prevalence of medication nonadherence; three studies evaluated the feasibility of new technologies for monitoring adherence; three studies evaluated medication adherence enhancing programs. Policies: three cognitive pharmaceutical services are reimbursed by healthcare insurers, which are directly related to medication adherence. Conclusions: Pharmacists in Switzerland have been actively involved in medication adherence research since the mid '90s. Specific medication adherence courses have entered the curriculum of pharmacy schools, and policies in Switzerland are slowly beginning to meet needs of chronic patients by the introduction of pharmaceutical cognitive services and reimbursement fees (AU)

El incumplimiento de los tratamientos farmacológicos es un comportamiento de riesgo serio prevenible tanto en enfermedades agudas como crónicas. Los farmacéuticos comunitarios son son facilitadores en atención primaria para promover la adhesión a la medicación y deberían implantar programas interdisciplinarios de cumplimiento medicamentoso. Para ello, los farmacéuticos deben ser educados en adhesión a la medicación y deben implantarse nuevas políticas de atención farmacéutica. El sistema sanitario debería evolucionar para cumplir mejor las necesidades específicas de los pacientes. Objetivos: este artículo describe lo que se ha realizado en la última década sobre adhesión a medicación en términos de educación, investigación, práctica y política en Suiza. Métodos: Se buscó en Medline, limitando la búsqueda a Suiza. Se contactó a las tres facultades de Farmacia de Suiza para recoger información tanto sobre sus cursos como sobre sus programas de investigación. También se revisaron las políticas nacionales a la búsqueda de contenidos relevantes. Resultados: Educación: Dos facultades de farmacia ofrecieron cursos específicamente dedicados a adhesión a la medicación. El número de horas dedicado a estos temas varió de 4 a 13. Investigación: 16 estudios cumplieron los criterios de inclusión. Los pacientes crónicos fueron el foco de 9 estudios. El cumplimiento de la medicación fue el resultado principal de todos los estudios; 10 estudios también midieron resultados clínicos. 9 estudios evaluaron la prevalencia del incumplimiento; 3 estudios evaluaron la viabilidad de las nuevas tecnologías para el seguimiento de la adhesión; 3 estudios evaluaron programas de aumento de cumplimiento. Políticas: • servicios cognitivos farmacéuticos están siendo remunerados por las aseguradoras y están directamente relacionados con el cumplimiento de la medicación. Conclusiones: La farmacia en Suiza se ha involucrado activamente en investigación sobre cumplimiento de la medicación desde mediados de los 90. Cursos específicos de cumplimiento de la medicación han entrado a formar parte del currículo de las facultades de farmacia, y las políticas en Suiza están comenzando lentamente a satisfacer las necesidades de los pacientes crónicos con la introducción de servicios cognitivos farmacéuticos y remuneración (AU)