Prof. Dr. Samuel Allemann Prof. Dr. Gianluca Miglio Prof. Dr. Clara Cena
Background: Cardiovascular diseases (CVDs) remain the leading cause of death in Italy for which dyslipidemia presents a major risk factor. Especially patients with high levels of low-density lipoprotein cholesterol (LDL-C) require drug treatment to reduce the risk of a cardiovascular event. Despite the known benefits, many patients show a low persistence to lipid-lowering drug therapy. This Thesis aims to analyze the prevalence statin and ezetimibe use, as well as the persistence to these drugs in elderly patients residing in the Aosta Valley (Italy).
Methods: The analysis was conducted using drug dispensing data of community pharmacies in the AUSL Valle d’Aosta. Treatment-naive patients over the age of 65 years who filled at least one prescription of simvastatin, atorvastatin, rosuvastatin, ezetimibe or a fixed-dose combination thereof in the years 2017 or 2018 were included. The persistence was observed over a period of 3 years for all drugs combined and for each one separately. Furthermore, the overall persistence was analyzed by gender and age. Persistence was estimated using the ”refill gap method” with a permissible gap of 1.5 times the duration of the last filled prescription.
Results: Prevalence of patients taking either statins and/or ezetimibe in 2017 and 2018 was 7.71%, respectively 7.79% of inhabitants. After 3 years, 21% (242) of the 1,148 patients were still on lipid-lowering drug treatment with a median persistence of 152 days. In a comparison between the statins, patients taking atorvastatin showed the longest persistence with 19% (200) of patients on treatment after 3 years. Male patients remained on treatment longer than female patients with a median persistence of 240 days compared to 120 days.
Discussion: The persistence to all the study drugs showed a steep decline in the first weeks and month after treatment initiation. The observed results suggest that many patients are not receiving appropriate treatment according to current recommendations. Reasons for this could not be determined conclusively in this thesis and require further research.
PD Dr. Isabelle Arnet, Prof. Dr. Samuel Allemann
Background: Patients with atrial fibrillation have an increased risk of stroke. Direct oral anticoagulants (DOAC) are now used as the first choice for stroke prophylaxis. There are no precise guidelines for the use of the 4 substances under certain medical conditions.
Objectives: The primary objective of this master’s thesis is to analyse the prescriptions of DOAC from the MAAESTRO study with a focus on patient demographic and clinical variables as well as adherence. The secondary objectives are: (1) investigation of an association between adherence and DOAC *without* the intake aid (observational phase) and *with* the intake aid (reminder phase and pillbox phase); (2) investigation of DOAC preferences among prescribing physicians; (3) experiences of prescribing physicians regarding DOAC and clinical events.
Methods: The patients from the MAAESTRO study were divided into 4 groups, depending on which DOAC they were prescribed. The statistical analysis was performed using Fisher's exact test or the Kruskal-Wallis test. For multiple comparisons, the Dunn-Bonferroni post hoc test was also used. An online survey was conducted among practising physicians at the University Hospital Basel (USB) and the Felix Platter Hospital (FPS).
Results: The data from 84 study participants from the MAAESTRO study and the analysis of my survey showed that apixaban was prescribed most frequently (51.2% vs. 64.7%). Apixaban was more frequently prescribed to older patients with poorer renal function compared to dabigatran (78.4 ± 7.3 years vs. 70.0 ± 10.5 years; p=0.021 // 65.7 ± 19.2 ml/min vs. 84.2 ± 11.9 ml/min; p=0.001). The CHA2DS2-VASc score is significantly higher in patients with apixaban than in patients with dabigatran (5.7 ± 1.3 vs. 4.6 ± 1.0; p=0.024). Patients with rivaroxaban have higher taking and timing adherence values in the observation phase than patients with apixaban (96.0 ± 3.8% vs. 83.8 ± 18.1%; p=0.013 // 94.4 ± 4.2% vs. 82.1 ± 18.1%; p=0.029).
Conclusion: This work has shown that physicians prefer to prescribe apixaban. Individual factors such as age, renal function and CHA2DS2-VASc score appear to influence physicians’ choice of DOAC. It was also shown that adherence was highest with the once-daily administration of rivaroxaban, followed by edoxaban.
PD Dr. Markus Lampert, Dr. Matthias Hoffmann
Background/Aim: Bone and joint infection (BJI) is a complication which can occur during surgery in 0.5%-2.0% of cases. Patients with BJI are usually treated for 12 weeks with rifampicin and another oral antibiotic. Rifampicin has many side effects and induces Cytochrome-P450- 3A4, P-Glycoprotein and other enzymes which make it prone to interact with other drugs. Research on patient care and self-management of these patients is sparse with only two studies conducted in France. Both studies show an improvement in patient safety and rehospitalization rate when pharmacists are involved in the treatment process. The aim of this thesis is to analyze the process surrounding rifampicin-treatment of BJI patients currently established at the Kantonsspital Olten and to uncover problems which lead to rehospitalizations or deviate from guidelines. Further, the thesis aims to improve selfmanagement of patients in handling adverse events.
Methods: This was done through retrospective data extraction from electronic patient records (n=92) as well as qualitative interviews conducted with orthopedic residents (n=5) and BJI patients (n=3). Additionally a focus group of hospital pharmacists was formed to discuss possible solutions to the discovered problems.
Results: It was discovered that rehospitalization rate in this cohort was much higher (35.9%) compared to normal rehospitalization rate of arthroplasty (12.2%). Infect-related, medication-related nor non-related causes all contributed approximately the same amount of rehospitalizations. Correlation between variables extracted from electronic patient files which could lead to the patient’s high rehospitalization rate could not be found. However deviations from guideline-based treatment were found: Critical information about interactions in the patient’s medication was not transferred consistently from the stationary setting to the next point of care, patients underwent too little laboratory testing after discharge and had too few follow ups with an infectious disease specialist (IDS), orthopedic residents were inexperienced with handling rifampicin and patients were overwhelmed with the flood of information received at discharge. On the basis of these findings, solutions to the problems were worked out.
Discussion/Conclusion: A patient folder containing information about antibiotics and how to deal with adverse events was created, in order for patients to have a means of reading up on information given to them at discharge and improve self-management. The focus group of hospital pharmacists discussed the probability of implementing a pharmacist lead discharg
Prof. Dr. Rhonda Clifford, Prof. Dr. Samuel Allemann, PD Dr. Isabelle Arnet, Assoc Prof. Dr. Liza Seubert , Dr. Amy Page, Assoc Prof. Kirsty Freeman, Dr. Jacinta Johnson, Ms Deborah Hawthorne, Ms Julia Weber
Background: Non-technical skills are increasingly recognised as crucial in healthcare professions. The importance of non-technical skills is also shown in pharmacy, because they can contribute to better patient safety outcomes. In this context, digital simulation is becoming increasingly important as it provides learners an opportunity to practice these essential skills before transitioning to practical experiences. However, the number of computer-based simulation programs in pharmacy education that address non-technical is currently low.
Aim: The aim of this Master’s thesis is to explore pharmacy students’ self-assessed performance in developing non-technical skills with a digital simulation platform.
Methods: An experimental post-test study was conducted with first- and second-year Master of Pharmacy students from The University of Western Australia. First, they had the opportunity to engage with a simulated patient scenario about non-adherence on the digital simulation platform MyDispense. A week later, they were invited to complete an online questionnaire to self-assess their performance in non-technical skills. The data analysis was performed using descriptive statistics and responses to both closed and open-ended questions were evaluated quantitatively.
Results: In total 38 students met the eligibility criteria and were included in the data analysis. The median of students’ self-assessed non-technical skills performance statements was 3 (IQR: 0-1), based on 4-point Likert scale.
Conclusion: Afterpractising with the MyDispense scenario participants perceived an overall improvement in their non-technical skills, especially in differentiating between open and closed questions, decision-making and problem-solving. There was also agreement that communication skills and empathy (understanding the perspective of the patient) improve, but overall, these had lower mean agreement compared to the other non-technical skills statements. Further research is needed to understand potential of digital platforms like MyDispense in teaching non-technical skills.
PhD Florine Marianne Wiss, PD Dr. Markus Leopold Lampert
Background: Personalised medicine, including pharmacogenetic therapy, will play an increasingly important role in the future. Pharmacogenetic guidelines exist for some antidepressants, which make recommendations for dose adjustments based on pharmacogenetic markers. There are no such guidelines for trazodone. A better knowledge of the influence of the pharmacogenetics of trazodone could help to reduce adverse drug reactions and treatment failure in the future.
Aim: The aim of this study is to investigate the influence of genetic factors (CYP2D6, CYP3A5 and ABCB1) and other factors (dose, gender and age) on the occurrence of adverse drug reactions and treatment failure.
Methods: This retrospective exploratory case study analysed data from two pharmacogenetic studies on patients treated with trazodone. The data were analysed using the chi-square test and binomial logistic regression.
Results: A greater probability of trazodone side effects was shown for patients with CYP2D6 PM&IM phenotype with reduced activity (φ = 0.314, p =0.005) and CYP2D6 IM (φ = 0.283, p =0.016) compared to patients with CYP2D6 EM status. The comparison of the CYP2D6 activity score <2 compared to 2 (φ = 0.354, p =0.001) also leads to an increased probability of trazodone side effects. For the occurrence of treatment failure, only the dose of trazodone could be identified as a reducing effect (0.992 (95% CI [0.986, 0.998]), p = 0.010).
Conclusion: After Bonferroni correction, only the comparison of the CYP2D6 activity score <2 compared to 2 is statistically significant (φ = 0.354, p = 0.029). A limitation of the study is the sample size and patients with unknown side effects. This retrospective study has provided clues to increasingly consider the pharmacogenetic markers involved in clinical practice in the event of adverse drug reactions during trazodone therapy. In order to obtain results based on this work, a larger-scale, prospective study would be advantageous.
PD Dr. Isabelle Arnet, Prof. Dr. Samuel Allemann
Background: There is an established need for tailored adherence-interventions to improve patients health outcomes and lower cost for healthcare systems. Community pharmacists can effectively deliver these interventions and may use self-report tools to assess patients’ adherence as they are easy to use, cost-effective and provide an acceptable estimate. To build the necessary evidence for interventions like these to be implemented in routine care, research in primary care is indispensable. However, these trials often face recruitment difficulties.
Goal: To define which elements on the health care provider- and system-levels enable a successful recruitment strategy for adherence-related research in the community pharmacy.
Methods: For recruitment, different prompts with a fixed wording were developed and evaluated. The selected prompts were used to ask patients in a community pharmacy to participate in a study by filling out a self-report questionnaire on adherence consisting of the first five items of the 15-STARS. After the patients filled out the questionnaire or refused to, they were asked about their reason to do so. Patient answers and characteristics were recorded and evaluated using a qualitative research approach.
Results: In ten half-days, 13 patients were approached, 12 agreed to fill out the questionnaire, one refused (acceptance rate: 92.3%). 11 patients stated a reason why they filled out the questionnaire: wanting to support studies (n=6), because the recruiter offered it (n=3), wanting to be sure that they do not have any difficulties (n=1), it is useful and has no bad consequences (n=1). Along with that further reasons were mentioned in conversation. Five patients had adherence difficulties that were detected with the questionnaire. Five key elements of successful recruitment and recommendations were identified.
Conclusion: The defined prompts and the proposed key elements lead to successful recruitment, and patient adherence was assessed using a self-report tool. We suggest using these key elements for recruitment and to inform patients about participation in research. The study is limited by its size, and further research is needed to investigate whether the findings are applicable in other settings.
MSc Selina Barbati, PD Dr. Isabelle Arnet
Background: Medication adherence is a major challenge in chronic diseases worldwide. There is a lack of suitable methods to identify these patients in everyday pharmacy practice. The validated 15-STARS questionnaire (Screening Tool for Adherence to medicineS) was developed as a screening tool to identify modifiable factors for potential non-adherence.
Goal and Aims: The goal of this work is to find out whether the 15-STARS questionnaire is suitable for recording factors of non-adherence in patients with chronic inflammatory bowel disease (IBD) and to derive adequate interventions. The aims are I) to identify the factors that contribute to non-adherence, II) to review the written answers to the questionnaire and to identify adequate interventions to improve adherence.
Methods: The 15-STARS questionnaire was quantitatively evaluated by patients with IBD from the multicentre 5C-study (2022/2023 and 2023/2024) using descriptive statistics. Study participants with suspected non-adherence were contacted for a qualitative telephone survey. The sensitivity of the questionnaire was analyzed by checking the non-adherent indications. The data collection took place between 15th November 2023 and 15th April 2024. The telephone surveys were analyzed inductively using thematic analysis according to Braun and Clarke (2006).
Results: A total of 143 questionnaires were analyzed (97 of 2022/2023; 46 of 2023/2024). Potentially non-adherent behavior was identified in 49.7 % (71 of 143) questionnaires (45 of 2022/2023; 26 of 2023/2024). The mean age was 36.9 ± 13.6 years, 49 (69.0 %) were male. Forgetfulness was the most frequently mentioned factor (22, 31.0 %), followed by problems with the use of at least one medication (19, 26.8 %). The telephone interviews were conducted with 55 (77.5 %) patients (37 of 2022/2023, 18 of 2023/2024). Of the non-adherent references counter-checked, the study participants remembered the situation including specific circumstances in 75 (67.2 %) cases. The remaining references were selected by mistake (34, 30.9 %) or the study participants no longer remembered (2, 1.8 %). The questionnaire showed a sensitivity of 0.7 (68.5 %). The most common interventions carried out independently were therapy-simplifying interventions, educational interventions, or the use of reminder systems.
Conclusion: It was shown that the 15-STARS questionnaire captures modifiable factors in IBD patients with adherence problems with a high sensitivity. Qualitative interviews were used to corroborate the results. Further research is needed to investigate the use of the 15-STARS questionnaire in daily pharmacy practice.
Prof. Dr. Rhonda Clifford, Prof. Dr. Samuel Allemann, PD. Dr. Isabelle ArnetAssoc Prof Dr Liza Seubert, Assoc Prof. Kirsty Freeman, Dr. Jacinta Johnson, Dr. Amy Page, Ms Deborah Hawthorn, PhD Candidate Julia Weber
Background: Newly graduated pharmacists need to be proficient in crucial non-technical skills like communication in addition to their technical expertise. Universities, however, have difficulties teaching these skills, which play a vital part in professional health care. Technological developments in simulation-based learning could provide a solution to close gaps in teaching non-technical skills. One notable development in this area is the digital simulation platform MyDispense. This study explores how learning non-technical skills using digital simulations is accepted by pharmacy students, and how they perceive MyDispense as a tool for acquiring such skills.
Aim: To explore pharmacy students’ perception of learning non-technical skills with digital simulation tools.
Methods: In this experimental post-test study, first- and second year Master of Pharmacy students enrolled at the University of Basel were recruited and invited to play an adherence-specific scenario on the digital simulation platform MyDispense. This study involved administering an online questionnaire to gather data regarding students’ perception of learning non-technical skills, such as communication through MyDispense. The research student developed an English questionnaire and employed a validated method to translate it into German for Swiss students. Moreover, the research student performed a quantitative analysis using descriptive statistics in Microsoft Excel and applied a conceptualised content analysis for the obtained free text responses to the questionnaire’s open-ended questions.
Results: Data from 23 students were included in this study’s analysis. Except for the statement that the adherence scenario on MyDispense adequately prepared students for real life patient interactions, which received a median score of 2 on the administered 4-point Likert scale (strongly disagree, disagree, agree, strongly agree), all other statements yielded a median score of 3. This indicates that students generally agreed with these statements. The content analysis results revealed that the safe learning environment MyDispense offers and the opportunity to prepare for real life patient interactions are the features students liked the most about MyDispense. Nonetheless, some students also expressed their displeasure with the phrasing of the questions in the scenario and the system itself, which could benefit from further development. Lastly, students generally perceived that the best time for implementation of such adherence-specific scenarios in the curriculum would be before they started their internship.
Conclusion: Students of this study perceived the learning experience with MyDispense as overall positive. Additionally, they appreciated the realistic environment the platform offers, and generally enjoyed this learning format. Furthermore, students perceived the safe learning environment as useful for learning communication, showcasing the future relevance of MyDispense for the pharmacy curriculum. However, the students highlighted the need for improvements in both the scenario and the system itself.
Diana Studerus, Prof. Dr. Samuel Allemann
Introduction: The use of wheat starch in medications for celiac disease is a poorly researched topic. Previous studies have been primarily descriptive, with only one identifying the maximum tolerable gluten content of 10mg per day. Gluten-containing medications are not legally required to be labelled as they are not subject to food regulations. In Switzerland, there is no definitive list of gluten-containing medications, often necessitating contact with pharmaceutical companies. The safety of medications containing wheat starch for individuals with celiac disease is uncertain. This study examines the role of wheat starch in medications for celiac disease and develops a potential recommendation for action.
Method: Qualitative interview research using semi-structured interviews was conducted to illustrate the topic from various perspectives. Different professional groups were interviewed, including specialist physicians, patient representatives, analytical experts, pharmacists, and employees from pharmaceutical companies. Additionally, a compendium search was performed to find medications containing wheat starch available in Switzerland.
Results: The role of wheat starch in medications was considered minor. In Switzerland, 29 medications containing wheat starch were identified. Of these, 18 have quantified gluten content. There are inconsistent recommendations regarding the use of gluten-containing medications: pharmacists are more cautious, while specialist physicians, patient representatives, and analytical experts do not strictly reject their use and generally consider them safe. An important finding was that none of the professionals want to take full responsibility for recommendation, as they all lack transparency regarding the gluten levels from pharmaceutical companies.
Discussion: The results suggest that the medications available in Switzerland are safe for individuals with celiac disease. However, improved transparency regarding gluten levels would be desirable to enhance trust. While creating a list of medication is desirable, it involves significant effort, and responsibility for updates and associated costs is unclear. On the other hand, labelling glutencontaining medications is deemed unnecessary due to minimal glute levels in these pharmaceuticals.
PD Dr. Isabelle Arnet, PD Dr. Thilo Burkard, PD Dr. Annina Vischer, Prof. Dr. Samuel Allemann
Background: Worldwide, only 32.5% of treated patients have controlled blood pressure. The reasons for inadequate blood pressure values are mainly attributed to insufficient medication adherence of patients and low adherence of physicians to guidelines (so called clinical inertia). In the updated European hypertension guidelines of 2018, simplified treatment strategies for hypertension were recommended to achieve an increased blood pressure control rate. With the new approaches, combination therapy is aimed at increasing adherence in most patients.
Main objective: The annual prescription rate of antihypertensives - at the first consultation of outpatient hypertension patients at the outpatient clinic of the University Hospital Basel (USB) - was analyzed before and after 2018 in the Basel region with a focus on monotherapy and single pill combination (SPC). The present work is a continuation or completion of a master's thesis from 2023.
Methods: The prescription rate from 2017, 2019 and 2022 was analyzed. Patient data was manually extracted from the ISMED hospital database and entered into the REDcape database. Comparisons across the three years were conducted using the chi-square test (for two group variables), and the Mann-Whitney U test, Kruskal-Wallis test, median test or Student`s t-test (for scale and group variables), as appropriate. All analyses were conducted using the statistical software package SPSS. A normal distribution was tested using the Kolmogorov-Smirnov test. A p-value <0.05 was interpreted as statistically significant.
Results: A total of 412 patient cases were included in the study (2017: 119, 2019: 133 and 2022: 160). SPC was prescribed to 45% of patients (in 2017) and 43% of patients (in 2022), with no difference between the years before and after 2018. The blood pressure value was adequate at the first consultation in 19% of the patients analysed. Thiazides and beta-blockers were prescribed statistically significantly less often after 2018.
Conclusion: No differences were observed in the prescription rate of combination therapy following the publication of the new hypertension guidelines in 2018. On the other hand, the prescription of beta-blockers decreased, which is in line with the guidelines. This suggests an inertia regarding the prescription of SPC. Targeted measures to promote the prescription of combination products in inadequately controlled hypertension patients appear to be necessary.
Dr. Jean-Pierre Rothen, PD Dr. Isabelle Arnet
Background: Ulcerative colitis is a chronic inflammatory bowel disease. Good adherence to medication is important. According to the guidelines, first line treatment for proctitis up to left-sided colitis is rectal mesalazine preparations. Last year patient interviews were hold and, in some cases, major adherence problems were identified. Reasons for this included too little support from healthcare professionals and lack of empathy.
Goal: The Goal of this master thesis was to analyse the problems described by patients from the perspective of gastroenterologists, IBD Nurses, pharmacists as well as pharmaceutical companies and to elicit how adherence to rectal dosage forms could be improved.
Methods: To gain the perspective of the professionals, semi-structured expert-interviews were conducted. The script was based on the questions from last year’s patient interviews. Eleven interviews were taken. The data was collected qualitatively, using a descriptive approach, and was analysed by simplified transcription.
Results: In three hospitals surveyed, there was no clinical pharmacist who was familiar with ulcerative colitis. The interviewed community pharmacists rarely had specific know-how of the patients and their disease and relatively little detailed knowledge of the various preparations. The interviewed gastroenterologists had many tips for patients. One Problem for them is the large patient base and the associated time pressure. IBD Nurses had the closest relationship to patients. The pharmaceutical companies only communicate with gastroenterologists.
Discussion: Gastroenterologists often lack the time to motivate their patients to undergo rectal therapy and to discuss their concerns and problems. There are too few IBD Nurses in the region of Basel to care for all patients. Community pharmacists have too little knowledge to provide well-founded explanations. One problem for them is the lack of visual aids. Clinical pharmacists are not involved in the care of CU patients in the hospital. Pharmaceutical companies could provide the other players with more information material tailored to their needs.
Conclusion: To better support the persons affected all specialists need in-depth knowledge of the available forms of therapy and a lot of empathy. Community pharmacists cannot be universal genius, but they need to keep their knowledge broadly up to date. On part of the gastroenterologists, improvements are difficult under the given time pressure.
PD Dr. Isabelle Arnet, Dr. phil. Kenneth Dürsteler
Background: Heroin use disorder is a chronic, relapsing disorder that leads to increased morbidity and mortality if left untreated. Due to the heroin epidemic in the late 1980s and the possibility of opioid agonist therapy, patients on opioid agonist therapy are getting older. Due to their history of use and lifestyle, this cohort is ageing faster and comorbidities are increasing in this patient cohort from an earlier age. Polypharmacy therefore occurs prematurely in this patient cohort compared to a cohort of the same age without opioid agonist therapy.
Aim: Re-evaluation of the pharmacotherapy of patients aged 50 and over in the Basel outpatient addiction centre. Quantitative analysis of co-medication and opioid agonist therapy.
Methods: Data from the 2022 cohort (n=82) were extracted from the MedFolio database as of 31 January 2023. Data of the 2023 cohort (n = 116) were extracted from the Kisim database as of 31 January 2023. Data analysis of the 2022 patient cohort incl. opioid agonist therapy and co-medication. Data analysis of the patient cohort 2023 demographic data.
Results: Slow release oral morphine is the most frequently used opioid agonist in the Basel outpatient addiction centre, accounting for 59.0 %. Methadone follows as the second most frequently used opioid agonist with 20.5 %. In terms of co-medication, cardiovascular agents (43.1 %), vitamin/mineral supplements and dietary supplements and sedatives (benzodiazepines (BZD) and Z-substances) (43.0 % each) as well as antipsychotics (41.5 %) and antiepileptics (40.0 %) are used most frequently. The analysis of supply interruptions showed that the proportion of unavailability in 2022 and 2023 increased by at least a factor of 9.8 compared to 2021.
Discussion: The prescribing practice of opioid agonists in the SAM does not correspond to the prescribing practice at national level (slow-release oral morphine 29.0%, methadone 55.0%), a possible reason for this could be the specialisation and integration into the research of the SAM. A next project could deal with the different prescribing practices in opioid agonist therapy. How does opioid agonist therapy in an institution such as the SAM differ from opioid agonist therapy under the supervision of a general practitioner.
PD Dr. Isabelle Arnet, Kirstin Messner, MSc pharm.
Background: The use of mHealth applications has already been proven in various studies to have a positive effect on adherence and symptom progression. The current PIPPI study is investigating whether app-guided therapy could also have a supportive effect in short-term therapy with proton pump inhibitors. Since inadequate recruitment is a major reason for premature study discontinuation, a detailed investigation of the barriers and facilitators in the recruitment process of pharmacies and patients is essential.
Methods: An optimal recruitment interview was developed using a recruitment simulation and a pseudo-patient. Based on the feedback, training and recruitment material was created in the form of a video and a flyer. 60 pharmacies were contacted by phone or email between December 2023 and April 2024 to participate in the study and were also reminded if they did not respond. A semistructured interview guide was created to survey patients' experience of the service and tested on a pseudo-patient. The barriers and facilitators in the recruitment of pharmacies and patients were likewise recorded using semi-structured interviews with pharmacists. All semi-structured interviews were evaluated inductively.
Results: The recruitment rate of pharmacies was 8.33%. The most frequently cited barriers were lack of resources (time, staff, premises) (70.8%) and participation in other projects (16.7%). The facilitators were support for research (75%) and interest in mHealth interventions (25%). The patient recruitment rate was 0%. The most cited barriers to participation were lack of time (25%), advanced age of the patient (50%) and a large amount of study documents (50%). The motivators for patients were mainly interest in the research and the possibility of being able to help a future patient. Barriers to the app were the lack of intuitiveness in navigating through the app and the faulty reminder function, but the reminder function was counted as a success factor, assuming it would work.
Discussion: The successful recruitment of pharmacies and patients depends on the study management, the pharmacy, and the patient themselves. The primary barrier for both pharmacies and patients is lack of time. The use of training and recruitment material could therefore help to optimize the recruitment process and increase recruitment success. Future studies in comparable settings should avoid the existing barriers through careful planning and make targeted use of the facilitators to ensure successful recruitment.
Prof. Samuel Allemann, Dr. Irene Küpfer
Abstract: Swiss pharmacists can perform independent pharmacist prescribing (IPP) of medication, which would ordinarily need a physician’s prescription. There are categories such as B minus, B plus and Justified Exceptional Cases (IPP-JEC). This master’s thesis assesses the implementation of IPP in general and IPP-JEC in particular across Swiss community pharmacies, it looks at how the differentiation of list B plus medication and IPP-JEC is made, it summarizes the frequency, reasons and drug classes of IPP-JEC, it explores the barriers and opportunities of IPP and forms suggestions for systemic and individual improvements. Since published literature about the topic is sparse, key stakeholders in education, politics, authority roles and technical support were contacted in order to map out the existing landscape surrounding IPP in Switzerland. Then, semi-structured interviews were conducted with eleven pharmacies and analysed qualitatively. Additionally, the pharmacies filled out a short questionnaire, which was subsequently analysed quantitatively. The participants had similar approaches to IPP, however, there notable distinctions in how IPPJEC was conducted. Participants saw both advantages and disadvantages of IPP-JEC for the parties involved and expressed ideas for improvement. Despite participants using a wide range of sources for information, some still reported not having specific training for IPP-JEC. While there were discernible trends regarding frequency, reasons, and drug classes of IPP-JEC, the individual participants still differed from each other. All participants had established IPP into their every-day operations successfully. Certain aspects of IPP such as standardised categories, continuous structured education and active follow-ups could be improved upon. A flowchart was created to better represent the real-life process and suggest harmonised Categories. Addressing barriers like patient knowledge of health care costs, a lack of user-friendly algorithms and the pharmacists’ mindset of their own capabilities could improve IPP-JEC services. Furthermore, looking at the big picture, data analysis should become more routine and ideally be gathered into a central institution. Although this thesis was limited by significant biases and confounding factors, it serves as a good stepping stone for further research.
Prof. Dr. Samuel Allemann, Dr. Irène Küpfer
Background: In Switzerland, as part of the master’s degree program in Pharmacy, students must complete an internship in a community pharmacy. To date, the university of Basel does not conduct a structured evaluation of the internship.
Aim: The aim of this master’s thesis was to analyse the situation of pharmacy students at the University of Basel who completed their internship in 2023. The analysis should include both the students' and the preceptors' perspectives. In addition, the legal basis and guidelines of the university and pharmaSuisse should be considered.
Methodology: We used a descriptive mixed method. In the quantiative part of the data collection, we conducted a survey with pharmacy students at the University of Basel. In a qualitative part, we interviewed pharmacists from the Basel region who had supervised students in their internship. Furthermore, an exchange took place with stakeholders from the University of Basel, pharmaSuisse and the regional supervisory boards.
Results: The answers provided by the students in the survey especially vary in the areas of practical experience and acquiring specialized knowledge, compounding and supervision. Nevertheless, the majority of the students were satisfied with the experience of their internship. The pharmacists, who were interviewed, stated that a lack of time and a shortage of staff is a main difficulty and limits the supervision. The introduction of an evaluation of the assistantship by the students would be welcomed by both the students and the pharmacists.
Discussion: Due to the heterogeneity of practical training, it would make sense to establish mechanisms that would promote the standardization of the content of the internship. To obtain an up-to-date picture of the situation, an evaluation of the assistantship could be carried out regularly by students and supervisors. In addition, more binding requirements for practical training in the pharmacy could enable a more standardized internship.
Conclusion: A regular evaluation of the internship period by students and preceptors would be useful regarding the findings of this thesis and would be welcomed by both sides.
PD Dr. Isabelle Arnet, Prof. Dr. Laura Sahm, Dr. Margaret Bermingham
Background: Cardiovascular diseasesincluding conditions like myocardial infarction (MI) are one of the leading causes of death in Europe. Even post MI, patients are required to adhere to a lifelong medicine combination therapy for secondary prevention. Adherence to polypharmacy therapy can be a challenge, especially when patients do not fully understand their medication. Patient information leaflets (PILs) are a primary source of information where patients should find complete and easily understandable guidance for their therapy. The readability and understandability of PILs should be guaranteed by the manufacturer and regulated by a legal framework.
Objective: The goal of this master thesis was to describe the readability and understandability of PILs by analyzing five standard medicines commonly used in long term post MI therapy. This was done by assessing PILs in English (Ireland), German (Germany, Switzerland) and French (Switzerland) for readability, understandability and actionability respectively.
Methods: Brand and generic PILs for post MI medicines for all languages were chosen. The readability was measured with the Flesch Reading Ease formula (FRE) and the Flesch Kincaid Grade Level formula (FKGL) for the English PILs. A German adaptation for the FRE and a French adaptation for readability called Scolarius were used to assess the other PILs. For understandability and actionability, the Patient Education Material Assessment Tool for Printable materials (PEMAT-P), specifically made to assess health information, was used. Each PIL was rated with the PEMAT by minimum three independent raters. Readability and understandability were analyzed individually and assessed for statistical correlation before being compared to current guidelines and requirements.
Results: This analysis found that readability of PILs ranged from an average of “fairly difficult” (English PILs) to “hard” (German PILs). None of the averages adhered to the recommendations of being written for a 5 th -7 th grade level. The PEMAT defines a cut-off score of 0.7 as easily understandable and actionable. The mean understandability for all PILs was 0.69 (SD 0.16; CI 95.0% ±0.03), the mean actionability was 0.66 (SD 0.22; CI 95.0% ± 0.04). Interrater reliability with Fleiss Kappa was 0.52 (SD 0.10; CI 95.0% 0.03) for all PILs, suggesting moderate agreement between raters. The results show that not all improvements recommended in various guidelines are being implemented to their fullest potential.
Conclusion: This study supports what other studies have found for other countries and languages: Many PILs are not designed with the patient population in mind, especially patients facing literacy and numeracy difficulties. Possible reasons are the vague legal framework from institutions like the European Medicines Agency (EMA) and lack of patient involvement when designing PILs and health care information. Better understanding of patients’ needs could be achieved with conducting a study like this with an actual patient group.
Prof Dr Rhonda Clifford, Assoc Prof Dr Liza Seubert, Prof Dr Samuel Allemann, PD Dr Isabelle Arnet, PhD candidate Julia Weber, Dr Amy Page, Dr Jacinta Johnson, Ms Deborah Hawthorne, Assoc Prof Kirsty Freeman
Background: In recent years, the role of the pharmacist has continuously evolved, and non-technical skills are becoming increasingly important. These skills complement a worker's technical skills, enabling them to perform tasks with maximum effectiveness and satisfaction. Universities have recognised this trend and are responding by integrating lectures and workshops on non-technical skills into their curricula. Notably, the use of simulations allows students to practice in a safe and realistic environment. Digitalisation has paved the way for digital simulations, which are gaining significance in education.
Aim: This study aimed to explore students’ self-assessed performance utilising a digital simulation platform for practising non-technical skills in pharmacy education.
Methods: In this experimental post-test study, first- and second-year master of pharmacy students at the University of Basel, were recruited. They were invited to engage with a scenario regarding adherence on the pharmacy simulation tool MyDispense to practise their non-technical skills. An online questionnaire collected data on the students' self-assessed performance, based on a 4-point Likert scale ranging from “strongly disagree” to “strongly agree”. The research student analysed the collected data quantitatively using Microsoft Excel, employing descriptive statistics.
Results: Data from 24 students met the inclusion criteria and were analysed. The majority of participants reported that their overall communication skills had improved through the use of MyDispense. Across all four categories - communication, empathy, decision-making, and situation awareness – the results indicated a bigger development in non-technical skills for first-year students than for second-year students.
Conclusion: This study demonstrated that digital simulation has the potential to develop non-technical skills in pharmaceutical education. The results underscore the ongoing importance of this topic, which is also confirmed by the current literature.
Esther Spinatsch, eidg. dipl. Pharm, Doktorandin Prof. Dr. Samuel Allemann
Background and Aim: Switzerland is one of the countries in which counselling is mandatory for the dispensing of emergency contraception in pharmacies. This practice is repeatedly called into question and there is a lack of studies demonstrating the added value of counselling when dispensing. In order to make access to emergency contraception as convenient as possible and to offer high-quality counselling, an innovative digital counselling support called «pharMe» was developed at the University of Basel. The aim of this master's thesis was to determine the need for counselling when dispensing emergency contraception and to gain initial experience with the digital counselling support pharMe.
Methods: Two quantitative cross-sectional studies were conducted in which data were collected by means of an anonymous online survey of customers and pharmacists. Customers who had received counselling with pharMe within 66 days were able to take part in the survey. Their answers could be assigned to the corresponding documented consultations. Pharmacists who had conducted consultations with pharMe were able to provide feedback on pharMe once within a period of 21 days. The responses from the surveys were then analysed descriptively and compared with the results of an earlier survey from 2022. Furthermore, a data analysis of the consultations documented with pharMe was carried out over a period of 23 weeks.
Results and discussion: This study analysed feedback from 39 customers and 20 pharmacists who participated in the online surveys, as well as 266 consultations documented with pharMe. With a median counselling time of 6.0min, a time saving was demonstrated compared to the standard procedure with a paper protocol, which is even more important given the increasing shortage of professionals. The majority of customers (71.2%) stated that they did not know which active ingredient was best suited to their current situation prior to the consultation. This highlights the need for a medical history and professional counselling to select the most appropriate medication. The added value of counselling on emergency contraception and other sexual health issues appears to vary greatly from customer to customer, with a quarter (25.7%) of customers considering counselling unnecessary. pharMe was highly valued by customers and pharmacists and appears to be proving its worth in daily practice. Thus, 90.0% of pharmacists would recommend pharMe as a counselling aid and only one customer (2.9%) stated that she would not use pharMe in the future if she needed emergency contraception again. The vast majority of customers did not find the use of the computer or tablet during the consultation disruptive (97.4%) and had no difficulty recording questions about their medical history independently on their smartphone (89.7%).
Conclusion: The added value of a detailed medical history for the selection of the most suitable emergency contraception was demonstrated in this study, but the need for a counselling appears to vary greatly from customer to customer. For this reason, the offer should be better tailored to individual needs in the future. The digital counselling support pharMe is highly appreciated in daily practice by both customers and pharmacists, provides discretion and saves time. The small number of survey participants must be seen as a limitation.
Funding: This Master’s thesis was funded by the University of Basel, Switzerland.