Evaluation of an enhanced service for medication review in Swiss community pharmacies “Médicaments à Jour?”: study protocol

BACKGROUND: In Switzerland, it is estimated that 20,000 people are hospitalized each year as a result of drug related problems (DRP). There are many sources of DRPs, such as incorrect storage or missing dosages from packages. Community pharmacies (CP) are well positioned to identify and manage such DRPs in a timely manner. In Switzerland, no pharmacy service that focus on the management of DRPs is currently recognized and remunerated. A new service, "Médicaments à Jour?" (MaJ?), has been developed. It is focused on DRPs related to self-medication and medication management at home and it includes a systematic review of the patient’s treatment.

OBJECTIVE: To evaluate the impact of the MaJ? service for adults with polypharmacy in Swiss CP for the identification and management of DRPs.

METHODS: A pre-post intervention study will be carried out in CPs in the canton of Vaud for 15 months. Volunteer pharmacists will include adults with a prescription for at least four chronic and systemic drugs for at least three months. Trained pharmacists will conduct structured consultations with patients at three points (T0, T6, T12) to deliver the service. The primary outcome of the study is the identification and management of DRPs. Secondary outcomes are patients’ knowledge about their treatments, number of expired or untaken medications and description of pharmaceutical interventions.

RESULTS: the study has been approved and will be supported by health authorities ("Direction générale de la santé") and local pharmacists association ("Société Vaudoise de Pharmacie"). The Ethics Committee (CER-VD) concluded that the study does not fall under the Human Research Act. It will begin in spring 2022 in 19-35 pharmacies that will recruit at least 162 patients after randomization of eligible patients through a sequence of computer-generated random numbers. Ad-hoc tools (medication management plan) and validated tools (PharmDISC tool, patient knowledge tool) will guide pharmacists throughout the consultation. Educational training and support for pharmacists will increase quality of service provision and fidelity of study protocol. An intention to treat (ITT) analysis will be undertaken for those patients with less than three consultations during the study period.

CONCLUSIONS: this study will evaluate the impact of a new service that includes validated, structured and standardized interventions, training and supervision for CP staff, self-medication evaluation and use of home-based patient records. MaJ? is an enhanced service designed to overcome those barriers found in the implementation process of medication review services. It also follows WHO and NICE recommendations.