Background

In 2016, the Swiss government decided to back the implementation of an interprofessional patient support programme to redefine and extent the pharmacist's role in primary care. The programme, called Siscare, includes regular motivational interviews by pharmacists; medication adherence, patient-reported, and clinical outcomes monitoring; and pharmacist-physician interactions.

Objective

To assess, from a pharmacy team's perspective, the implementation of Siscare for patients with type 2 diabetes taking at least one oral antidiabetic treatment, followed for 15 months, in a primary care setting of the French-speaking part of Switzerland.

Methods

This prospective, multicentre, observational, cohort study used a hybrid implementation-effectiveness design and the Framework for the Implementation of Services in Pharmacy (FISpH). Quantitative and qualitative methods assessed outcomes at three levels (process, outcomes and impact) at each stage of the implementation process (exploration, preparation, operation, sustainability).

Results

An advisory board with 10 representatives of key national stakeholders committed to supporting the study and 41 pharmacies were trained for Siscare. Of these, 33 (80%) had at least one of five implementation strategies in place 12 weeks after the start of patient inclusion and 27 (66%) have included ≥1 patient; mean inclusion per pharmacy: 8 (SD 6) patients [range: 1–29] with a total of 212 patients. Nine pharmacies (22%) met the target of 10 patients. An ordered three-step process of the implementation was observed in pharmacies: internal organisation, preparation of interprofessional practice, and relationship building with patients. Influencing factors were pharmacists' skills in motivational interviewing, support from pharmacy owners, pre-existing local interprofessional networks, and profitability of the programme.

Conclusions

This implementation evaluation supports the feasibility and acceptability from the pharmacy team's perspective of Siscare. The programme's implementation on a wider scale is still difficult due to the inertia inherent in any fundamental change in practices and the economic-political uncertainties influencing the actors in primary care.

中文翻译：

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在初级保健机构支持 2 型糖尿病患者的跨专业计划 (Siscare) 的实施评估

背景

2016 年，瑞士政府决定支持跨专业患者支持计划的实施，以重新定义和扩展药剂师在初级保健中的作用。该计划名为 Siscare，包括药剂师的定期激励访谈；药物依从性、患者报告和临床结果监测；和药剂师 - 医生的互动。

客观的

从药房团队的角度评估 Siscare 在瑞士法语区的初级保健环境中对至少接受一种口服降糖药治疗并随访 15 个月的 2 型糖尿病患者的实施情况。

方法

这项前瞻性、多中心、观察性队列研究使用了混合实施效果设计和药学服务实施框架 (FISpH)。定量和定性方法在实施过程的每个阶段（探索、准备、运营、可持续性）的三个层面（过程、结果和影响）评估结果。

结果

一个由 10 名致力于支持这项研究的主要国家利益相关者代表和 41 家药店组成的咨询委员会接受了 Siscare 培训。其中，33 人 (80%) 在开始纳入患者 12 周后至少实施了五种实施策略中的一种，27 人 (66%) 已纳入≥1 名患者；每个药房的平均纳入人数：8 (SD 6) 患者 [范围：1-29]，总共 212 名患者。9 家药店 (22%) 达到了 10 名患者的目标。在药房中观察到一个有序的三步实施过程：内部组织、跨专业实践的准备以及与患者的关系建立。影响因素包括药剂师在动机访谈中的技能、药店老板的支持、预先存在的本地跨专业网络以及该计划的盈利能力。

结论

从药房团队的角度来看，该实施评估支持了 Siscare 的可行性和可接受性。由于实践中任何根本性变化所固有的惯性以及影响初级保健参与者的经济政治不确定性，该计划在更广泛的范围内实施仍然很困难。