title: Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study.
abstract: BACKGROUND
  Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6™).
  
  
  OBJECTIVE
  To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total.
  
  
  METHODS
  Community pharmacies in French-speaking Switzerland.
  
  
  METHODS
  Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher.
  
  
  METHODS
  Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme.
  
  
  RESULTS
  Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians.
  
  
  CONCLUSIONS
  A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.
authors.affiliation: Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Julien
authors.initials: J
authors.lastname: Marquis
authors.forename: Marie P
authors.initials: MP
authors.lastname: Schneider
authors.forename: Brenda
authors.initials: B
authors.lastname: Spencer
authors.forename: Olivier
authors.initials: O
authors.lastname: Bugnon
authors.forename: Sophie
authors.initials: S
authors.lastname: Du Pasquier
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010595:Pharmacists; D024382:Professional Role; D016730:Program Development; D036301:Qualitative Research