Medication Adherence Program for HIV Needs Collaboration Among Physicians, Nurses, and Pharmacists

David Bai

A descriptive, observational study in Switzerland implemented an interprofessional medication adherence program (IMAP) in patients with HIV. The framework for the implementation of services in pharmacy (FISpH) model is described and formulated for other healthcare facilities and professionals to evaluate and execute for themselves.

In 2014, an IMAP was launched in Switzerland to help manage patients with HIV and improve adherence by including community pharmacies through the FISpH model. For this observational study conducted by Lelubre et al, 4 stages of FISpH are described to help define and implement a new clinical setting that other healthcare communities can follow.

The first stage of the FISpH is exploration, a phase where the users decide whether to accept or reject an innovation. In the case at Neuchatel, Switzerland, one infectious disease physician and nurse saw many nonadherent patients and decided to implement the IMAP with the association of community pharmacists. The willingness to set forth the IMAP served as the baseline for exploration and preps the other FISpH stages.
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Once all the groups that play a role in IMAP are identified, the next stage, preparation, takes effect. Preparation is defined as adapting prior to the start of the model. Community pharmacists undergo training through a SISPha development program, to learn the steps for improving medication adherence. In addition, documentation and an interprofessional collaboration meeting among the nurse, physician, and pharmacists was planned prior to moving forward with the model.

When the preparations were complete, the next stage, operation, could be initiated. Operation is interpreted as integrating the ideas in the exploration phase into routine practice. For the group in Switzerland, the nurse and physician’s roles were to refer eligible patients to the pharmacists to implement the IMAP. The pharmacists would then execute the IMAP and send medication adherence documentations back to the physician and the nurse. The research team would then set up meetings held every 6 months to discuss expectations and personal experiences. Problems that were brought up in these interprofessional collaborations were addressed and then reviewed at the next meeting.

The last stage described is sustainability, or the process of maintaining the idea and integrating it into regular practice. In this case, the nurse and the physician involved extended the model toward patients with hepatitis C. Additionally, meetings were held between the members of each group to discuss patient cases where an interprofessional follow-up was appropriate.

Sustainability is important for keeping an intervention for long-term use so that the information gathered can be used in the future.

In this study, the application of IMAP to an interprofessional group was obtained through following the FISpH model. Subsequent follow-up changes to pharmacy services and other healthcare practice can be carried out to reinforce the efficacy of IMAP in select patient populations outside of HIV.

Lelubre M, Clerc O, Grosjean M, et al. Implementation of an interprofessional medication adherence program for HIV patients: description of the process using the framework for the implementation of services in pharmacy. BMC Health Serv Res. 2018;18(1):698. doi: 10.1186/s12913-018-3509-8.
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