Key result
The Adherence Monitoring Package (AMoPac) was feasible and highly accepted by GPs and heart failure patients, with a mean taking adherence of 86.4%.
Why the study?
Non-adherence to chronic treatments is prevalent in polypharmacy, but practical tools to assess adherence in primary care are lacking.
Is the Adherence Monitoring Package (AMoPac) feasible and accepted for monitoring medication adherence in heart failure patients in primary care?
Is the Adherence Monitoring Package (AMoPac) feasible and accepted for monitoring medication adherence in heart failure patients in primary care?
A novel adherence monitoring package combining electronic monitoring and pharmacist feedback is feasible and well-accepted in primary care for heart failure patients.
AMoPac feasible and accepted by GPs; leaves open whether it improves adherence before larger trials.
BACKGROUND: Adherence 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. AIMS: We 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. METHODS: AMoPac 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. RESULTS: We 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). CONCLUSION: AMoPac 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 NUMBER: NCT04326101.
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Dietrich et al. (2023) studied heart failure (n=7). Adherence Monitoring Package (AMoPac) was evaluated on Feasibility and acceptance. The Adherence Monitoring Package (AMoPac) was feasible and highly accepted by GPs and heart failure patients, with a mean taking adherence of 86.4%.
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