Feasibility Study of the Medication Review With Follow up Service for Patients With Polypharmacy in Swiss Community Pharmacies

1. Background

1.1. Role of the pharmacist: The role of the community pharmacist includes an increasing number of responsibilities. Whereas in the past the aspects related to the manufacture and sale of medicines were predominant, the 2000s saw the emergence of other roles for the pharmacist in Switzerland, primarily in order to control rising health care costs. With the implementation of the remuneration based on services (RBP for the french acronym) in 2001, a step forward was taken in the direction of pharmaceutical services, for example by the remuneration of the pharmaceutical record during the delivery of prescribed medicines. Since 2001, the RBP has been amended several times in order to respond to the health care system needs and the activities of community pharmacists in relation to patients' needs (adherence, poly-medication, etc.).

According to the Federal Council, pharmacists could still take on additional tasks in the field of primary care, as they offer easier access to health advice. Since 2016, the "Grand Conseil du Canton de Vaud" has been supporting the implementation of a shared medication plan concerning "medication safety throughout the care process". The aim is to evaluate the implementation of a collaborative management of patients' treatment based on the e-health platform for the canton of Vaud on poly-medicated patients with multiple carers (general medical practitioners -GP-, community pharmacies -CP- and nursing homes). In this context, new opportunities exist to strengthen the role of the pharmacist in the care process. In addition to prescribed medications, pharmacists also advise patients when they self-medicate. Self-medication is "the selection and use of medication, including herbal and traditional products, by individuals to treat symptoms or diseases that they have identified themselves". Community pharmacists are often the first health professionals to be contacted by patients with minor ailments. In order to ensure responsible self-medication with non-prescription medication, pharmacist advice is necessary.

Therefore, community pharmacists are in a privileged position to have an overview of all the medicines taken by patients (prescription and non-prescription). A study carried out in the Canton of Vaud in 2017 with diabetic patients showed that 79% of them had visited only one pharmacy in the last 12 months (96% two pharmacies maximum).

1.2. Drug-related problems (DRPs): The Pharmaceutical Care Network Europe (PCNE) describes a DRP as "an event or circumstance involving drug therapy that actually or potentially interferes with the expected optimal outcome of medical care". The PCNE has developed a classification of DRPs that has evolved over time and among investigators. Thus, the variation in classifications makes it difficult to standardize this topic, especially on a more accurate description of the clinical and economic burden of DRP.