Implementation of a New Model of Care for Supporting Long-term Medication Adherence (Phase A) (myCareStart-I)

Implementation of a New Model of Care for Supporting Adherence in People Starting a New Medication for a Long-term Condition (myCare Start-I Project) - An Implementation Science Study - Phase A

The overall objective of the myCare Start-I project is to adapt, implement and evaluate the myCare Start service within the Swiss pharmacy-physician network to enhance medication adherence during the initiation of a new long-term treatment. The study will use an implementation science approach. The myCare Start service is based on the New Medicine Service (NMS) that was developed in the United Kingdom.

Study Overview

• Status: Active, not recruiting
• Conditions: Medication Initiation for Long-term Conditions
• Intervention / Treatment: Behavioral: myCare Start

Detailed Description

Phase A:

1. To conduct a contextual analysis of the current Swiss primary care ecosystem as related to pharmacy-physician interprofessional health services for patients with long-term diseases (i.e., contextual analysis).
2. To engage key stakeholders within the Swiss primary care ecosystem to contribute to the co-creation of a Swiss interprofessional myCare Start service (i.e., stakeholder involvement).
3. To design a contextually adapted myCare Start for use within Swiss community practice using contextually appropriate implementation strategies (i.e., intervention development/selecting implementation strategies).

4. To conduct feasibility testing on the contextually adapted intervention and implementation strategies and to develop an implementation research logic model (i.e., feasibility testing).

   Phase B: Please note Phase B will be carried out at a later date with further ethics committee approval.

5. To implement a contextually adapted Swiss myCare Start intervention in the pharmacy-physician network community and evaluate it in terms of medication adherence and cost-effectiveness outcomes.
6. To evaluate implementation outcomes and the implementation pathway of myCare Start.

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

Study Locations

• Switzerland
  • Basel, Switzerland, 4056
    • University of Basel
  • Geneva, Switzerland, 1211
    • Universite de Geneve

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Phase A: contextual analysis

Community pharmacists and technicians General practitioners or internal medicine physicians Patients with a long-term treatment International research groups

Phase B: effectiveness-implementation study Patients with a long-term treatment for five long-term conditions (cardiovascular disease (incl. hypertension and thromboprophylaxis), diabetes, hyperlipidaemia, depression and respiratory illness (asthma, COPD))

Description

Phase A: contextual analysis

Inclusion Criteria:

• Community pharmacists and technicians of 5 participating pharmacies in the French-speaking part of Switzerland and 5 in the German-speaking part of Switzerland
• Primary care physicians working in collaboration or in the neighbourhood of the participating pharmacies
• Patients with long-term treatments, who are a regular patients of the included pharmacies
• International research groups who have implemented NMS within their countries or similar interventions.

Exclusion Criteria:

• Patients not willing to participate
• Patients that do not speak French or German

Phase B: hybrid type 2 effectiveness-implementation study

Patients are eligible for the myCare Start-I phase B study if :

• They are taking part in the myCare Start service
• They have been newly prescribed one or more new long-term medications in accordance with one of the five defined long-term conditions (cardiovascular disease (incl. hypertension and thromboprophylaxis), diabetes, hyperlipidaemia, depression and respiratory illness (asthma, COPD))
• They are 18 years or older
• They have mandatory basic health insurance in Switzerland
• They are able to self-manage treatment (i.e. they live at home without any support to manage their medication, exception: patient uses a pill dispenser and fills it in by him-/herself).
• They understand language spoken by pharmacy staff and are able to read and understand study documents (ge, fr)
• They are able to understand and willing to consent to the myCare Start study (including the agreement on self-reported questionnaires and collection of health care data via their health insurance company)

Exclusion criteria:

• Patients participating or having participated in an education program about their disease or treatment in the last 3 months, led by healthcare providers such as physicians, nurses, pharmacists or other (e.g. education provided by nurses for type I diabetes patients).

myCare Start definition of a new medication:

A new medication is a medication that has not been previously dispensed to the patient. This includes one or more new medications for a new diagnosis and or new medications for pre-existing diagnosis of a long-term condition.

Operational definition of a new medication:

• Active ingredient is indicated for one of the five long-term conditions (cardiovascular disease (incl. hypertension and thromboprophylaxis), diabetes, hyperlipidaemia, depression and respiratory illness (asthma, COPD)).
• Patient has never had this active ingredient dispensed before or restarts an active ingredient after a period of interruption of at least 12 months.

The new active ingredient can be part of a combo preparation (e.g. a diuretic added to an ACE inhibitor into the same preparation)

• Patient has had no change in active ingredient but has an important change in treatment administration, such as:

  • Change of galenic form (e.g. two different types on inhalators for asthma/COPD)
  • Intensification of dosage regimen (e.g. twice a day instead of once a day)

• The following change is not considered as medication initiation:

  • New dosage of already known active ingredient (e.g. dose escalation of antidepressants)
  • Simplification of administration mode (e.g. metformin 1000mg 1-0-0 instead of 500mg 1-0-1; change in antihypertensive drug regimen in elderly patients having vertigo in the morning: 0-0-X instead of X-0-0)

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication adherence (objective measure)	Prescription renewal records (objective measure): Medication renewal records will be extracted from pharmaceutical records and analyzed using the "AdhereR" software in R.	6 - 12 months
Medication adherence (subjective measure)	Patient self-assessment (subjective measure): We will use the BAASIS© (Basel Assessment of Adherence to Immunosuppressive Medications Scale), a 6-item scale with demonstrated psychometric properties in transplantation and other chronic diseases, as it assesses adherence according to the ABC taxonomy (Initiation, Medication Implementation, and Persistence. The BAASIS scale has a minimum and maximum value of 6 and 30, respectively. Lower scores on the BAASIS indicate poorer adherence to immunosuppressive medications, while higher scores indicate better adherence. This self-report instrument consists of six items that assess different aspects of medication adherence, including dose taking, drug holidays, timing deviation, reduction of dose, persistence, and timing of dose taking.	6 - 12 months
Cost-effectiveness short-term	Total healthcare utilisation, in terms of total costs per patient, will be evaluated over the duration of the myCare Start follow-up period (12 months) using health insurance data. This will be combined with adherence results to determine the incremental cost-effectiveness ratio between the total costs per patient in the intervention vs. the control groups and the difference in adherence between groups. The survey will be forwarded to the patient at 14 days, 6 months, and 12 months after inclusion into the study via an emailed online survey. The main analysis consists of calculating 1) the incremental cost-effectiveness ratio between the total costs per patient in the intervention vs. the control group and 2.) the difference in adherence between groups and the probability that the intervention is cost-effective when the willingness to pay varies (i.e. the cost-effectiveness acceptability curve), the two classic indicators of cost-effectiveness analyses of health programmes.	12 months
Cost-effectiveness long-term	Long-term potential healthcare cost savings will be evaluated using Markov Modelling. The Markov Modelling approach applied in this study is an adapted version of the models previously used in the UK to evaluate the New Medicine Service, adjusted with parameters tailored to the Swiss context. This approach will enable the projection and estimation of medium- and long-term benefits arising from improved adherence to the prescriptions as a result of the myCare start intervention. In Switzerland, the most commonly prescribed medications for long-term illnesses include cholesterol-lowering therapies, type 2 diabetes drugs, hypertension treatments, and antidepressants. For these four medication groups, specific Markov models have been developed. These calculations will be conducted during the 12-month longitudinal follow-up phase.	12 months
Implementations Outcomes	The myCare start service will be evaluated in terms of acceptability, adoption, appropriateness, fidelity, feasibility, and implementation cost as proposed by Proctor's Implementation Outcomes Taxonomy (Proctor et al., 2019). Cost of implementation will be assessed using the time-driven activity-based cost (TDABC) instrument. This pragmatic method allows investigators to systematically estimate the cost of implementation strategies (e.g. training, reorganisation of practice, regular stakeholder meetings) and the cost of the intervention.	12 months

Collaborators and Investigators

• Sponsor: University of Geneva, Switzerland
• Collaborators: Fundació Sant Joan de Déu; University of Bern; University of Basel; Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland; pharmaSuisse, Switzerland
• Investigators: Principal Investigator: Marie Paule Schneider, PhD, University of Geneva

Study record dates

Study Major Dates

• Study Start (Actual): August 30, 2023
• Primary Completion (Actual): January 16, 2025
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: October 13, 2023
• First Submitted That Met QC Criteria: January 2, 2024
• First Posted (Actual): January 5, 2024

Study Record Updates

• Last Update Posted (Actual): April 18, 2025
• Last Update Submitted That Met QC Criteria: April 14, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: community pharmacy; cost-effectiveness; outpatient care; medication adherence; implementation science; interprofessional collaboration; General practitioner; long-term treatment; medication initiation; medication adherence support programme
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: 2023-01161

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Once fully anonymized, quantitative data will be annotated and structured to make them sharable, and registered in a FAIR-compliant data repository.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No