title: Evaluating the implementation fidelity of New Medicines Service for asthma patients in community pharmacies in Belgium.
abstract: In October 2013, a New Medicines Service (NMS) was introduced in community pharmacies in Belgium to support asthma patients who are novice users of inhaler devices with corticosteroids. The protocol-based intervention used the Asthma Control Test (ACT) and the Medication Adherence Report Scale (MARS) to assess asthma control and medication adherence. The NMS is the first initiative that puts advanced pharmaceutical care into practice in Belgium. The present study evaluated the degree to which the NMS program is delivered as intended, drawing on the concept of implementation fidelity (IF).
  
  
  
  The main dimensions of IF and potential moderating and facilitating factors for the implementation of NMS in community pharmacies were evaluated using telephone interviews with pharmacists (n = 497), semi-structured interviews with patients eligible for NMS (n = 30), focus groups among general practitioners (n = 72) and lung specialists (n = 5), and a work system analysis in community pharmacies (n = 19).
  
  
  
  The uptake of NMS in Belgian community pharmacies remains low. In addition to practical barriers, pharmacists found it difficult to identify new asthmatic patients when they were not informed about the diagnosis. A lack of commitment from physicians, patients and pharmacists was noted in the early start-up phase of the program. Many pharmacists did not see how NMS differed from existing pharmaceutical care. Physicians considered this service as part of their own tasks and discouraged ACT for asthma follow-up in the community pharmacy.
  
  
  
  The introduction of the NMS program was not sufficiently embedded in the Belgian health care organization, causing low uptake and resistance to its implementation by pharmacists, patients, and other health care professionals. To increase the uptake of this type of service and its possible extension to other patient groups, more collaboration among the different health care professionals during design and implementation is necessary, as well as systematic data collection to monitor the quality of the service, better training of pharmacists, and more information for patients and physicians.
authors.affiliation: Research Group Medical Sociology and Health Policy, University of Antwerp, Belgium. Electronic address: Jessica.fraeyman@uantwerpen.be.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fraeyman
authors.affiliation: Clinical Pharmacology and Pharmacotherapy, University of Leuven, Belgium.
authors.forename: Veerle
authors.initials: V
authors.lastname: Foulon
authors.affiliation: Pharmaceutical Care Unit, Ghent University, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Mehuys
authors.affiliation: Pharmaceutical Care Unit, Ghent University, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Boussery
authors.affiliation: Association of Pharmacists in Belgium (APB), Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Saevels
authors.affiliation: Faculté de Pharmacie, Université Libre de Bruxelles, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: De Vriese
authors.affiliation: Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Belgium.
authors.forename: Olivia
authors.initials: O
authors.lastname: Dalleur
authors.affiliation: Psychological Sciences Research Institute (IPSY), Université catholique de Louvain, Belgium.
authors.forename: Marie
authors.initials: M
authors.lastname: Housiaux
authors.affiliation: Research Group Clinical Pharmacology & Clinical Pharmacy (KFAR), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium.
authors.forename: Stephane
authors.initials: S
authors.lastname: Steurbaut
authors.affiliation: Clinical Pharmacology and Pharmacotherapy, University of Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Naegels
authors.affiliation: Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium.
authors.forename: Guido Ry
authors.initials: GR
authors.lastname: De Meyer
authors.affiliation: Department Farmaceutical Sciences, Pharmaceutical Care, University of Antwerp, Antwerp, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: De Loof
authors.affiliation: Research Group Medical Sociology and Health Policy, University of Antwerp, Belgium.
authors.forename: Guido
authors.initials: G
authors.lastname: Van Hal
authors.affiliation: Psychological Sciences Research Institute (IPSY), Université catholique de Louvain, Belgium.
authors.forename: Stephan
authors.initials: S
authors.lastname: Van den Broucke
mesh_terms: D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001530:Belgium; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D055118:Medication Adherence; D010595:Pharmacists / Q000458:organization & administration*; D010820:Physicians / Q000706:statistics & numerical data; D024382:Professional Role; D016730:Program Development; D000078329:Workforce
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Belgium; Implementation fidelity; New medicines service; Pharmaceutical care; Protocol-based care