Development and acceptance of a new adherence monitoring package to identify non-adherent patients with polypharmacy in primary care: a feasibility study

Abstract

BackgroundAdherence to pharmacotherapy is crucial to prevent symptom deterioration in chronic diseases. However, non-adherence to chronic treatments is prevalent, especially in polypharmacy. Practical tools to assess adherence to polypharmacy in primary care are missing.AimsWe aimed to develop an Adherence Monitoring Package (AMoPac) for general practitioners (GPs) to identify patient non-adherence. We tested the feasibility and acceptance of AMoPac in the primary healthcare setting.MethodsAMoPac was developed based on peer-reviewed literature. It consists in (1) electronic monitoring of patients’ medication intakes for 4 weeks, (2) receiving feedback on intake behaviour by the pharmacist and (3) generating an adherence report to communicate to the GPs. A feasibility study was conducted with heart failure patients. GPs’ acceptance of AMoPac was explored with semistructured interviews. Electronic transmission of the reports into the GP’s electronic health record along with laboratory reports stating N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was analysed.ResultsWe developed AMoPac and tested its feasibility with six GPs and seven heart failure patients. GPs were satisfied with the adherence report including the pharmaceutical-clinical recommendations. Integrated transmission of adherence reports to GPs was not feasible due to technical incompatibilities. Mean taking adherence was 86.4%±12.8% and three patients had low correct dosing-days (69%, 38% and 36%, respectively). NT-proBNP ranged from 102 to 8561 pg/mL and four patients had elevated values (>1000 pg/mL).ConclusionAMoPac is feasible in the primary healthcare setting, excluding the integrated transmission of adherence reports to GPs. The procedure was highly accepted by GPs and patients. AMoPac fills a gap by combining clinical values with adherence data, and therefore, delivers a multifaceted picture of the patient’s behaviour. In case of unmet adherence, our tool might facilitate the selection of patient-centred approaches to optimise pharmacological therapies in chronic heart failure patients.Trial registration numberNCT04326101.

Adherence Monitoring Package (AMoPac) in patients suspected of non-response to antihypertensive treatment: perceived usefulness by general practitioners

“…AMoPac is a tool to assess, evaluate and report patients’ medication adherence to a healthcare professional. It consists of (1) electronic adherence monitoring, (2) feedback on patients’ intake behaviour given by a pharmacist, (3) analysis of adherence data and (4) adherence report with adherence metrics including clinical-pharmaceutical recommendations to the GP 10 11…”

“…We developed the Adherence Monitoring Package (AMoPac) for monitoring, evaluating and reporting adherence. The feasibility and the acceptance of AMoPac among GPs have previously been assessed in a pilot study among patients with heart failure 10. Although the feasibility and acceptance could be proven in the pilot study, it also revealed technical problems with the integrated transmission of the adherence report into GPs’ electronic health records.…”

“…The feasibility and the acceptance of AMoPac among GPs have previously been assessed in a pilot study among patients with heart failure. 10 Although the feasibility and acceptance could be proven in the pilot study, it also revealed technical problems with the integrated transmission of the adherence report into GPs’ electronic health records. Based on our experiences from the pilot study, we made two adaptations for the AMoPac-HYP (‘ A dherence Mo nitoring Pac kage to identify non-adherence in ambulatory HYP ertensive patients’) Study.…”

Medication adherence: measurement methods and approaches

“…Dietrich et al, conducted a feasibility study on newly developed adherence monitoring package (AMoPac) to identify non-adherent patients with polypharmacy in primary care, highlighting the strengths and limitations of a multi-assessment approach to adherence with a potential to look deeper into the non-adherent patients (75). AMoPac was developed based on peer-reviewed literature, encompasses three essential elements: (1) electronically tracking patients' medication intake over a four-week period, (2) providing intake behavior feedback via pharmacists, and (3) generating an adherence report intended for communication with general practitioners (GPs).…”

“…With the utilization of AMoPac, GPs have the option to incorporate an adherence monitoring period prior to making adjustments to the therapy. This enables them to gain insights into non-response and non-adherence issues (75,76). In a multi-approach setting, where non-adherence to medication can be attributed to a diverse range of factors, encompassing both unintentional and intentional aspects, Tab.…”