ADHERE INITIATIVE: ADVANCE DELIVERY FOR HEALTH ENHANCEMENT & REGULAR ENGAGEMENT
European Statement
Clinical Pharmacy Services
Author(s)
Naila Aljahdali, Hala Al-Buti, Basem Elbehiry, Mohammed AlZahrani, Hani AlZahrani, Jalal Alharbi, Raien Algaidi, Ali AlZahrani, Wael AlZahrani
Why was it done?
Medication adherence is a global challenge, with nearly half of patients failing to take prescribed therapies consistently. This issue contributes to avoidable hospitalizations, treatment failures, and increased healthcare costs. At King Fahd Armed Forces Hospital (KFAFH) in Jeddah, medication refills are identified as a critical issue affecting both patient outcomes and pharmacy workload, and as key barriers to optimal care. This project aimed to improve patient medication adherence and satisfaction while also reducing pharmacy staff workload.
What was done?
ADHERE Initiative was implemented as value-added services (VAS) include: home medication delivery services (HMDS) integrated with digital health tools (delivery refill tracking, telepharmacy consultations) and streamlined logistics, patient education, and feedback loops. A multidisciplinary team oversaw implementation. Performance was monitored and evaluated.
How was it done?
This Quality Improvement (QI) project was conducted from November 2023 to June 2025, using the Plan Do-Study-Act (PDSA) methodology. Baseline data were collected on patient adherence, satisfaction, and pharmacy workload. Root cause analysis was performed using a fishbone tool. ADHERE Initiative was introduced as an intervention to address identified barriers.
What has been achieved?
The real-world data shows that Patients’ Medication Adherence improved by 51%, and HMDS uptake grew substantially from a negligible start (1%) to sustained levels around 30–44%, surpassing the target in several months. Waiting times improved to around 7 minutes after interventions, indicating reduced in-person demand. Delivery performance was strong inside Jeddah with rapid same-day/24-hour delivery for most patients, while outside Jeddah deliveries reliably reached patients within 2–3 days. Estimated refill-related counter workload reduced by ~40%, freeing staff for clinical duties.
What next?
ADHERE Initiative significantly improves patient medication adherence, enhance patient satisfaction, and reduces pharmacy workload. It highlights the dual benefit of technology-enabled pharmacy services for both patients and healthcare providers. Also, it represents a scalable model for healthcare institutions to transform patient-centered care in Saudi Arabia.
UPSKILLING THE PHARMACY WORKFORCE IN MEDICATION ADHERENCE SUPPORT THROUGH MULTI-SECTOR TRAINING IN NHS SUSSEX
European Statement
Education and Research
Author(s)
Dr Sian Williams, Dr Ella Graham-Rowe, Dr Sarah Chapman and Prof John Weinman
Why was it done?
Non-adherence contributes significantly to preventable harm and waste across health systems. Although pharmacy professionals are well placed to intervene, evidence suggests that current approaches are limited in effectiveness. The aim of this initiative was to provide multi-sector professionals with a shared framework and tools to support adherence, improving patient care and consistency across services.
What was done?
A training programme was developed to improve pharmacy professionals’ confidence and capability in identifying and addressing medication non-adherence. The training was delivered to qualified pharmacists, foundation pharmacists, and pharmacy technicians across NHS Sussex, with a focus on practical skills and evidence-based behavioural change strategies.
How was it done?
The training, developed in collaboration between the University of Brighton and the Centre for Adherence Research and Education at King’s College London, consisted of three components. First, participants completed an online module introducing the causes, types, and consequences of non-adherence. This was followed by a four-hour interactive face-to-face workshop, where attendees were trained in the COM-B (Capability, Opportunity, Motivation – Behaviour) model, the ‘Making Medicines Work for You’ screener, and five practical adherence support strategies based on evidence-based behaviour change techniques. A follow-up online session four weeks later allowed participants to reflect on applying the screener in practice and to share experiences. Cross-sector representation enabled peer learning and discussion of implementation in diverse settings.
What has been achieved?
The initial training reached 26 pharmacy professionals who completed pre- and post-surveys on confidence and practice in identifying and supporting adherence. Analysis showed improved perceived skills and access to tools. A follow-up session revealed early successes alongside barriers, including time pressures in busy settings and challenges embedding the tool into systems that support routine practice.
What next?
This initiative provides an evidence-based model for embedding adherence support into pharmacy practice. It is transferable across integrated care systems and healthcare settings. Future plans include ongoing evaluation and extending training to other clinical teams and policy decision-makers.
EMBEDDING ADHERENCE SCREENING AND BEHAVIOUR CHANGE TRAINING INTO UNDERGRADUATE PHARMACY EDUCATION AT THE UNIVERSITY OF BRIGHTON, UK
European Statement
Education and Research
Author(s)
Ella Graham-Rowe, Sian Williams, Sarah Chapman and John Weinman
Why was it done?
Non-adherence to prescribed medicines remains a global problem, associated with poor health outcomes and increased healthcare costs. Despite pharmacists’ central role in addressing adherence, undergraduate education often lacks practical, evidence-based training. This initiative aimed to equip students early in their professional development with the skills and confidence to identify and support patients with adherence challenges.
What was done?
A structured programme on medication adherence was developed and embedded into the second year of the Master of Pharmacy (MPharm) degree at the University of Brighton. The training introduced students to an adherence screening tool, key behavioural frameworks, and practical support strategies, with opportunities to practise in simulated scenarios and while on placement.
How was it done?
Academic staff were first trained by the Centre for Adherence Research and Education (King’s College London) to deliver their structured programme. The training was then delivered to undergraduates over three two-hour face-to-face workshops. Workshop one explored types and causes of non-adherence using the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Workshop two introduced five evidence-based behaviour change strategies. Workshop three allowed students to apply these skills using the ‘Making Medicines Work for You’ screener in simulated consultations. Learning materials and scenarios were co-developed with practising pharmacits to reflect authentic pharmacy practice.
What has been achieved?
All second-year students completed the training in the 2024–2025 academic year and were assessed in end of year OSCEs. Feedback highlighted notable improvements in students’ consultation and communication skills, along with greater empathetic engagement with patients. Learners described the tools and exercises as engaging and supportive, boosting their confidence in supporting patient adherence.
What next?
This initiative demonstrates that evidence-based adherence training can be effectively integrated into the undergraduate pharmacy curriculum. The approach is transferable to other institutions and may improve medicines optimisation in future clinical practice. In 2025–2026, these students will apply their learning during practice placements across multiple sectors. Further evaluation will explore impact on student performance during placements.
IMPLEMENTATION OF A MULTIDISCIPLINARY PROTOCOL FOR CAB/RPV IM IN HIV CARE
European Statement
Patient Safety and Quality Assurance
Author(s)
A. VARAS PEREZ1, MJ. LOPEZ MUÑOZ1, C. RODRIGUEZ MORETA1.
1HOSPITAL SERRANIA DE RONDA, FARMACIA, RONDA, SPAIN.
Why was it done?
Long-acting injectable antiretroviral therapy represents a major advancement in HIV management. This method of administration is novel, and as such, a process must be defined that involves different healthcare professionals and that must provide the patient with the training related to the administration in the best way. The intramuscular combination of cabotegravir and rilpivirine (CAB/RPV IM) offers an alternative to daily oral regimens, potentially improving adherence and patient quality of life. To ensure safe and efficient implementation, a multidisciplinary protocol was developed in a primary hospital.
What was done?
A coordinated protocol was established for the prescription, validation, dispensing, and administration of CAB/RPV IM, involving hospital pharmacy, nursing, and medical teams. Outcomes were assessed after one year of implementation.
How was it done?
A retrospective, cross-sectional descriptive study was conducted, analyzing CAB/RPV IM administrations recorded since March 2024. Inclusion criteria included virologic suppression, stable oral regimen, absence of resistance mutations to CAB/RPV, no hepatitis B coinfection, and patient commitment to scheduled visits. Electronic prescribing via Farmatools® triggered appointments with pharmacy and nursing. Pharmacists provided individualized care and scheduled doses within the ±7-day window, aligned with nursing availability. Patients received automated email reminders; missed appointments prompted follow-up calls. Delays beyond seven days were reported to the physician. Data on administration dates, discontinuations and reasons, viral load, and dosing intervals were extracted from the External Patient Module PRISMA and electronic health records.
What has been achieved?
A total of 518 doses were administered to 138 patients. Nine patients (6.5%) discontinued treatment due to adverse effects, personal/work conflicts, pregnancy, anticoagulation, or lack of appropriate needles. No virologic failures occurred. All doses were administered within the ±7-day window (mean deviation: -1.9 ± 2.0 days). The average number of doses per patient was 3.6 (range: 1–7). Nursing intervened in 4.5% of follow-up visits due to missed appointments. Email reminders reached 81.9% of patients. The protocol enabled integrated care, improved adherence, and ensured safe delivery of CAB/RPV IM therapy.
What next?
Expansion of the protocol to new candidates is planned, along with enhanced interprofessional coordination and digital tools for active follow-up. This experience may serve as a model for other centers implementing CAB/RPV IM in HIV care.
DESIGN AND IMPLEMENTATION OF A PROGRAM FOR THE ADMINISTRATION AND FOLLOW-UP OF PHARMACOTHERAPEUTIC DRUGS IN PATIENTS WITH LONG-ACTING ANTI-HIV DRUGS
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
MARTÍNEZ LLIBERATO, A; COMPANY ALBIR, MJ; VICENTE ESCRIG, E; VALLEJO GARCÍA, R; RUBIO ORTOLÁ, L; GARCÍA MONTAÑÉS, S; BELLÉS MEDALL, MD; FERRANDO PIQUERES, R
Why was it done?
It was carried out to ensure the best monitoring, traceability and conservation of long-acting antiretroviral drugs, as well as to improve adherence and patient quality of life and reduce stigma in HIV patients.
What was done?
A program was developed for the administration and pharmacotherapeutic monitoring of patients who are candidates for long-acting antiretroviral treatment (LA-ART), coordinated with the infectious diseases unit (IDU) and the Hospital Pharmacy Outpatient Unit (HPOU).
How was it done?
After the inclusion of the drugs in the pharmacotherapeutic guide, the following program was designed:
1. Identification and communication to the HPOU by the IDU of patients who are candidates for LA-ART and electronic prescription.
2. Initial visit (week 0):
• Review and validation of the treatment by the pharmacist: indication, dosage regimen, interactions, contraindications.
• Planning of the annual administration calendar, providing two dates within the window period allowed by these drugs. Patients are scheduled for pharmaceutical care (PC) and administration on working Thursdays, in the HPOU Health Education Consultation agenda, which has a nurse.
• Information to the patient by the pharmacist, orally and in writing, about administration and adverse reactions. In addition, the annual appointment schedule is provided.
• Appointment of the patient for the first successive visit, if the patient accepts the start.
3. SMS sent the day before, to remind the patient of the follow-up visit. If the patient cannot attend the scheduled appointment, he/she will contact the HPOU to schedule an alternative date according to the calendar.
4. Successive visits (week 4 and every 8 weeks):
• PC
• Intramuscular administration by a nurse.
In all visits, the information is recorded in the patient’s computerized medical history.
What has been achieved?
Of 18 candidate patients in 18 months, 15 accepted ART after the initial visit. 89 PC and administration consultations have been carried out. Adherence was 100%, all reported local discomfort at the injection site between 1 and 7 days after administration and only 1 patient reported pyrexia.
What next?
A program applicable to all HPOU that have nursing and a Health Education consultation to implement adherence in these patients.
IMPLEMENTATION OF A PHARMACEUTICAL CARE CIRCUIT FOR LONG-ACTING ANTIRETROVIRAL TREATMENTS IN HIV PATIENTS IN A REGIONAL HOSPITAL
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
AGUILAR GUISADO, CAROLINA. PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
SANCHEZ SUAREZ , SUSANA.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
GARCIA GIMENO, M MERCEDES.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
OTERINO MOREIRA, IVAN.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
FIORANTE EMILSE SILVANA. INTERNAL MEDICINE SERVICE.EL ESCORIAL UNIVERSITY HOSPITAL
BARCIA MARTIN M ISABEL.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
SAAVEDRA QUIROS VIRGINIA.PHARMACY SERVICE. EL ESCORIAL UNIVERSITY HOSPITAL
Why was it done?
Current antiretroviral therapies are effective, but adherence can be difficult for some patients, so innovation in parenterally administered antiretroviral treatments can help with adherence, as well as reducing the burden on patients with chronic HIV infection.
What was done?
Aim and Objectives: to implement a pharmaceutical care circuit for dispensing long-acting antiretroviral treatments in adult HIV patients.
How was it done?
Expected Improvements: Optimize antiviral use, enhance patient satisfaction, address adherence and maintain clinical effectiveness.
Circuit Design and Stages: In 2023, Pharmacy and Therapeutics Committee introduced intramuscular antiviral treatment with cabotegravir and rilpivirine, and established use criteria, in collaboration with the Internal Medicine service and Nursing consultation involved in the administration(NP):
1. Adults with undetectable Viral Load (VL) for at least 12 months
2. Treatment duration of 6-12 months
3. No prior resistance to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors
4. Absence of HBV co-infection
5. Not pregnant or planning to conceive
6. Good treatment adherence
Pre-Treatment Circuit:
1. Medical Consultation: Clinical assessment and criteria evaluation.
2. Treatment Request: Physicians submit requests electronically.
3. Pharmacy Evaluation: Assessment of adherence to criteria with communication to the physician. Approved requests result in electronic prescriptions, ensuring correct dispensing.
In-Person Pharmaceutical Care Consultations (FCC):
• The first two visits confirm patient commitment and deliver dosing schedules.
• Medications are dispensed by pharmacy technicians and administered at Nursing practice
• From the third dose, consultations are conducted remotely to monitor adherence and effectiveness.
Nursing practice tasks:
• Confirm patient attendance the day before administration.
• Request medication from the pharmacy for the patient.
• Administer treatment and schedule future appointments based on the established calendar.
Implementation: The program began in November 2023.
What has been achieved?
8 patients were included, achieving 100% compliance from all services involved. Patient satisfaction is high, with undetectable VL maintained for 6-12 months post-treatment change. Mild flu-like symptoms were reported by 2 patients, and 2voluntarily discontinued due to mood concerns. 3 patients are awaiting treatment changes. All patients included underwent face-to-face FCC for the first and second doses, and telematic consultation for successive doses.
Limitations: small sample size.
What next?
This pharmaceutical care circuit can be adapted to various pharmacy services, providing a promising approach for HIV treatment adherence.The sample size needs to be enlarged for further studies.
RutiCar: an outpatient medication dispensing point
Pdf
European Statement
Clinical Pharmacy Services
Why was it done?
This service emerged as a result of the COVID-19 pandemic, when the collection of hospital medication posed patients, many of whom were immunocompromised, at higher risk for COVID-19 and other infections, as they had to enter the hospital facilities. Over time, it was observed that this service was not only beneficial during periods of high SARS-CoV-2 transmission. RutiCar enabled medication pickup from the patient’s own private vehicle, avoiding necessity for parking as well as entering the hospital.
What was done?
In June 2021, the Pharmacy Department of Germans Trias i Pujol University Hospital(HUGTP) established an outpatient medication dispensing point located outside the hospital premises, “RutiCar”. This initiative facilitated patients in collecting their chronic treatments without entering the hospital, enabling direct access from their vehicles.
How was it done?
A new preparation and dispensing circuit was established. The patients specify their preferred date for medication pickup by telephone, e-mail or by a form after scanning a QR code. Pharmacy technicians undertake the responsibility of scheduling the appointment and preparing the medications one day prior to the designated dispensing day. The prepared medications are transported early in the morning to a temporary medication storage facility situated within the hospital’s parking area. Finally, the patient arrives at RutiCar at their scheduled appointment time and, without the need to exit their vehicle, collects their medication.
This service is aimed at patients with chronic treatments who have been on their medication for an extended period (>6 months) and show adherence. Pharmacists play an important role in this context, by ensuring that patients meet the criteria to initiate RutiCar service, reviewing treatments to validate their continuation and overseeing medication pickups to enhance patient adherence.
What has been achieved?
This service has led to an improvement in the medication dispensing process, assisting 10.46%(282) of the monthly average of patients who collect hospital medication(2695) and extending the hours for medication pickup, facilitating the work-life balance for patients and enhancing access to patients from remote areas.
What next?
In the future, improvements can be considered, such as implementing reminders for patients who have not yet scheduled their appointments and are projected to run out of medication soon, or automated appointment systems.
Assessing patient behaviour after calling a drug information telephone centre (MiS): what impact on the proper use of medicines?
European Statement
Clinical Pharmacy Services
Author(s)
Vanessa Gomes, Jonathan De Gregori, Greta Dusabe, Hélène Feyeux, Cyril Boronad
Why was it done?
MiS is a telephone service that provides free, reliable information about medicines to all patients and their caregivers. Requests are handled by experienced hospital pharmacists. It is important to know how patients behave after calling MiS in order to assess the benefits of this service on the proper use of medicines.
What was done?
The aim of this study was to assess patients’ behaviour regarding their medication after calling the MiS.
How was it done?
After prior agreement, patients were called back 7 days later to answer a specific survey including six questions: Was the medication changed after the call? Did the patient follow the advice of the MiS pharmacist? Did the patient consult a doctor? or another source of information? Did the patient feel that their health had improved? What are the benefits of this service?
What has been achieved?
Between 2024/03/05 and 2024/03/18, 20 callers completed the survey (65%). Most questions concerned drug interactions (48%), followed by side effects (22%), drug stability (7%), administrative information (7%), indications/contraindications (7%), product availability (3,%), proper use (3%) and dosage (3%). Thanks to the advice of MiS pharmacists, 47% of callers started taking their medication: half of these were prescribed by their doctor and the other half self-administered. Around a third of treatments were continued without change, while 6% were modified. Finally, 12% of treatments were discontinued because of side effects. After calling MiS, 15% of patients consulted a doctor and 15% consulted other sources of information (neighbours, health professionals, etc.). More than half of the patients felt that their health had improved after calling MiS. Lastly, 70% of patients described MiS as safe, 40% as accessible, 35% as available and 30% as a time-saver.
What next?
The demand for MiS shows that patients are looking for more information about their treatments, even if they have already consulted a healthcare professional. The number of treatments prescribed by the doctor that were only initiated after the call also illustrates the benefits of the MiS service. It is an additional service that can reassure callers and contribute to the proper use of medicines by conveying a positive image of treatments and information suited to callers’ knowledge.
Sustainable adherence in the sector transition for schizophrenia patients
Pdf
European Statement
Patient Safety and Quality Assurance
Author(s)
Lene Juhl Biltsted, Louise Stilling Rasmussen
Why was it done?
In Denmark, patients with schizophrenia receive free antipsychotic medication for the initial two years post-diagnosis. Post this period, patients transition to the primary sector and assume the medication costs. Historically, the clinic dispensed larger medication quantities, offering short-term relief but not addressing the issue. This approach risks medication waste. The new workflows empower healthcare professionals to help patients establish stable financial arrangements with local pharmacies, curbing fluctuating medication expenses. This enhances patient safety by reducing at-home medication stockpiles. Financial barriers often undermine patient compliance. Healthcare professionals strive to aid patients, curbing relapses and readmissions, through rational, sustainable medication management that minimises resource wastage.
What was done?
Training improved healthcare professional’s understanding of the Danish medication subsidy system and options for deferment in the primary sector.
The healthcare professionals’ new knowledge has provided the foundation for the development of optimised workflows in the treatment process, ensuring a more sustainable medication management during the transition to the primary sector. The project establishes the framework for reducing the risk of medication waste upon the patient’s completion of treatment at the clinic.
It also created a favourable setting for healthcare providers to collaborate with patients, enhancing adherence.
How was it done?
Healthcare professionals received training on deferment arrangements, subsidies, and compliance, with supervision from clinical pharmacists.
Patient cases were analysed to determine factors for future guidelines.
Guidelines were formulated to aid healthcare professionals during the patients’ transition to the primary sector.
A tool (calculator) was created for assessing the patients’ economic choices regarding medication expenses.
What has been achieved?
Healthcare professionals gained confidence in guiding patients on stable medication expenses.
Enhanced rational and sustainable medication use by incorporating the seven rights.
New guidelines now allow an appropriate quality assurance strategy to ensure sustainability and adherence.
Tool to assess medication costs which improves the patients adherence in the sector transition.
Lowered risk of over/under treatment and improper storage.
Diminished treatment failure risk by predicting patient medication expenses during the primary sector transition
What next?
In the next 6 months, the clinic will trial the established guidelines and routines with patients concluding their 2-year treatment.
Pharmaceutical care for human immunodeficiency virus pre-exposure prophylaxis users
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
NURIA FERNANDEZ PIÑEIRO, CRISTINA GONZALEZ PEREZ, LIDIA YBAÑEZ GARCIA, NATALIA SANCHEZ-OCAÑA MARTÍN, JOSE MANUEL MARTINEZ SESMERO
Why was it done?
In our area all care for PrEP users was centralised in a specialised centre. Here, a multidisciplinary team made up of doctors, nurses and pharmacists integrated in a patient-centred care model. PrEP users are a potentially vulnerable population. Health education and motivation are provided in the PhC consultations to raise awareness about the use of medication and adherence to treatment, which are key to avoiding HIV infection. The use of sex-related drugs is a growing health problem in this population and has been associated with increased HIV transmission risk.
What was done?
Development and implementation of a monographic pharmaceutical care (PhC) consultation for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) users.
How was it done?
On 20 January 2020, the PhC consultation was launched in a monographic STI care centre linked to a tertiary hospital.
– On the same day as the first medical appointment, the user attends a PhC appointment. In this unit the user receives the necessary information to properly take the medication. Possible interactions are reviewed, not only with medications, but also with natural medicine, sports supplements and drugs. All doubts are resolved and the medication is dispensed.
– Every 3 months medical follow-up is carried out and, in the PhC consultation, where not only possible adverse effects are reviewed, but also adherence and related problems are specially monitored. To increase the quality of care, active communication between all health personnel was ensured.
What has been achieved?
Until 30 September 2022, 3,460 initial visits and 13,349 follow-up visits have been made (411 of them through telepharmacy during the lockdown as a result of the global pandemic by SARS-CoV-2). From the users, 98.98% were men who have sex with men (MSM), 0.80% transgender women, 0.04% transgender men and 0.18% were women. 70.3% used sex-related drugs (Chemsex), with the most used substances being Popper (37.1%), mephedrone (28.2%) and gamma hydroxybutyrate (GHB) (24.6%).
What next?
In our experience, the role of hospital pharmacists as a reference health personnel for HIV-PrEP users has become clear, not only as an expert in medication. Given the prevalence of drug use in this population makes the health education that we hospital pharmacists can provide especially important.