Between a third and a half of all medicines prescribed for long-term conditions are not taken as recommended. This may represent a loss to patients, the healthcare system and society.Adherence to medicines is defined as the process by which patients take their medications as prescribed. Non-adherence may limit the benefits of medicines, resulting in lack of improvement (or deterioration) in health. Causes of non-adherence are manifold but they fall into two overlapping categories: intentional (that is, when the patient decides not to take the medication or to take it in a way that differs from the recommendations) and unintentional (that is, when the patient is prevented from taking the medication by factors beyond his control e.g. forgetfulness, language barriers). Addressing non-adherence should explore patients' perspectives of medicines and why patients may not want or are unable to use them.

Two main questions have shaped the research group in the last decade: How to assess non-adherence to prescribed medicine accurately and how to address medication adherence during pharmacy consultation, and offer an intervention, knowing that no specific intervention can be recommended for all patients. With successful results from various studies, we are now ready to develop the “Adherence++Factory” as a pharmacy-based service. Our vision is to provide pharmacy teams with a strategy and tailored tools in view of targeting patients in need of an adherence consultation, and offering a tailored intervention.

Non-adherence in anticoagulated stroke outpatients (Valerie Albert since JUL 2015)
Adherence to anticoagulants such as DOAC (Xarelto®, Eliquis®, Pradaxa®, Lixiana®) is decisive because these medicines are unforgiving, meaning that a high level of adherence is needed to reach the therapeutic benefits. In case of non-adherence, patients put themselves at risk of critical events such as pulmonary embolism or stroke. In this project, intake behavior of 130 acute stroke patients is assessed electronically with the smart card Time4MedTM over 12 months after discharge from the University Hospital Basel. The effect on adherence of a pharmaceutical care intervention tailoring intake times will be measured [ClinicalTrials.gov identifier: NCT03344146, Swiss National Clinical Trials Portal: SNCTP000002410].

Barriers to the oral intake of antibiotics (Melanie Haag since FEB 2017)
Irregular intake and premature stopping are frequent among patients taking oral antibiotics, with a prevalence for non-adherence of 21-38%. This is comparable to the rate of 43% non-adherence to long term treatments for preventing coronary heart disease after 24 months. To improve medication adherence, understanding patient individual barriers to treatment is crucial. In this project, we developed the self-report questionnaire BIOTICA to assess barriers to the intake of oral antibiotics in outpatients, and validated it in Swiss German community pharmacies [EKNZ ID: 2020-69].

Implementation strategy for community pharmacy services (Pascal Baumgartner since DEC 2017)
Community pharmacies are in the best position to provide services to the population such as counselling on medication therapy management, vaccinating, or improving medication adherence, among others. In the last years, two major services have been cancelled in Europe: the MUR (Medication Use Review) in the UK and the PMC (Polymedikation-Check) in Switzerland, questioning the success of nationwide implementation. In this project, a strategy for the individualized implementation of services on pharmacy-level has been developed. It is currently tested in TopPharm community pharmacies with an adherence software application aimed at reminding patients to refill their medicine on time.
 
Adherence report from chronic heart failure outpatients (Fine Dietrich since FEB 2019)
Patients with heart failure (HF) need multiple guideline-directed medications to control the systolic and/or diastolic ventricular dysfunction. To support the clinical decision and to guide treatment at every stage of HF, the measurement of the biomarker NT-proBNP has been recommended. Knowledge of the exact intake behavior (adherence) is likely to be of benefit. In this project, intake of multiple regimen will be electronically recorded with the smart card Time4MedTM over 4 weeks. After downloading the data on a tablet computer (without intermediate storage on a server) and discussing them with the patient, a summary of the monitoring data (adherence report) is sent to the physician [EKNZ ID: 2019-01248; ClinicalTrials.gov identifier: NCT04326101].

The Adherence++Factory - development of an adherence consultation in Swiss community pharmacies (Selina Barbati since NOV 2020)

Patient preferences for vitamin D3 oral intake (Dr Jean-Pierre Rothen since JAN 2017)
A usual diet and normal exposition to sun light in temperate latitudes render vitamin D supplementation indispensable in the wintertime. Beside various frequencies (daily, weekly, monthly) of recommended equivalent cumulative doses, pharmaceutical formulation (solid, liquid) can influence adherence. In this project, we investigated preferences for intermittent administration (weekly vs monthly) and formulation (solid vs liquid) in 106 outpatients with vitamin D deficiency, under electronic monitoring of all intakes [EKNZ-Nr. 2017–00300; doi: 10.1186/s40360-020-00430-5]. In a following study, we are evaluating the benefits of an individualised vitamin D3 loading regimen on achieving optimal vitamin D serum values [EKNZ-Nr. 2019-00749; ClinicalTrials.gov ID: NCT03920150].