myCare Start-Implementation Project (myCare Start-I)

Implementation of a new model of care for supporting adherence in people starting a new medication for a long-term condition

2022-2026
Project Lead
  • Professor Marie-Paule Schneider Voirol (0000-0002-7557-9278)
Our team

University of Geneva

  • Dr. Sarah Serhal (0000-0001-9865-2338)
  • Dr. Cédric Lanier
  • Ms. Karima Shamuratova
  • Ms. Natascha Krauer

Institute of Nursing Science - University of Basel

  • Professor Sabina De Geest (Co-lead) ([https://nursing.unibas.ch/de/personen/sabina-m-de-geest])
  • Dr. Juliane Mielke (0000-0002-9771-2383)
Investigator partners
  • Dagmar M. Haller, Institute for Primary Care Faculty of Medicine, University of Geneva
  • Eva Pfarrwaller, Institute for Primary Care Faculty of Medicine, University of Geneva
  • Stéphane Guerrier, Research Center for Statistics Geneva School of Economics and Management University of Geneva
  • Joachim Marti, Unisanté, University of Lausanne Centre for Primary Care and Public Health
  • Clémence Perraudin, Unisanté, University of Lausanne Centre for Primary Care and Public Health
  • Giulio Cisco, Unisanté, University of Lausanne Centre for Primary Care and Public Health
  • Samuel Allemann, Department of Pharmaceutical Sciences, University of Basel
  • Alice Panchaud, Institute for Primary Health Care (BIHAM), University of Bern
  • Stephen Jenkinson, pharmaSuisse and Institute for Primary Health Care (BIHAM), University of Bern
  • Fanny Mulder, pharmaSuisse and Institute for Primary Health Care (BIHAM), University of Bern
  • Alexandra Dima, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
  • Kabeza M. Kalumiya, Consumer representative
Project background

Medication adherence is defined as the process by which patients take their medications as prescribed by their doctor. Medication nonadherence is a silent epidemic and a major public health issue; it decreases treatment effectiveness, patient security and increases global costs to the healthcare system. One of the best evaluated, evidence-based interventions to reinforce early adherence after medication initiation, is the UK developed patient-centred New Medicines Service (NMS). Based on the NMS, myCare Start was introduced by pharmaSuisse into Switzerland. myCare Start is the first evidence-based, nation-wide health service, conducted by interprofessional primary care teams to support medication adherence in chronically ill patients starting a new long-term treatment in Switzerland. It consists of two 10-minute, semi-structured, tailored education and behavioural based consultations delivered by community pharmacists during the 6 weeks after treatment initiation to strengthen patient’s self-management and provide feedback to physicians.

myCare Start Implementation Project (myCare Start-I)

myCare Start-I is a national implementation science project coordinated by the University of Geneva with the objective to adapt, implement and evaluate the myCare Start service in Switzerland. The project aims to enhance fit of the service in the Swiss context at the patient, provider and societal levels.

Methodology

Using implementation science methodologies myCare Start-I will attempt to strengthen the real-world translation of myCare Start in a two phase process over 4 years.

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Figure 1. Implementation Pathway for myCare Start-I

As shown in Figure 1, the myCare Start-I project includes two phases focusing on adaptation (Phase A), implementation and evaluation (Phase B). Each of these phases were divided in different Work Package (WP).

Phase A (2022-2024)

  • WP1 Stakeholder engagement: to engage key stakeholders within the Swiss primary care ecosystem to contribute to the creation of a Swiss interprofessional myCare Start service.
  • WP2 Understand the context: undertake a comprehensive contextual analysis as a foundational phase to inform subsequent steps of the myCare Start-I project. The contextual analysis will build on existing evidence on implementation barriers in the real-world from international and Swiss studies and better understand the health care context here in Switzerland.
  • WP3 Adapt the intervention and select context appropriate implementation strategies: the existing myCare Start service will be adapted to suit the Swiss context and contextually appropriate implementation strategies will be selected using a process of co-creation with stakeholders.
  • WP4 Feasibility testing: adapted intervention and implementation strategy package will be tested in a small number of pharmacies to ensure fit.

Phase B (2025-2026)

  • WP5 and WP6: Implementation and evaluation of the adapted myCare Start

A monocentric, Hybrid Type 2 effectiveness-implementation (two-arm, stepped wedge cluster randomised control design) will be conducted in 40 community pharmacy-physician clusters in the French- and German-speaking regions of Switzerland. The study will evaluate the myCare Start service in terms of:

  • Effectiveness: clinical effectiveness (medication adherence) and cost-effectiveness of the service.
  • Implementation: multi-levelled (patient, pharmacist, physician) implementation outcomes including acceptability, adoption, appropriateness, fidelity, feasibility, and implementation costs.
Expected Benefit/Relevance

myCare Start will be the first innovative, interprofessional, integrative care model to support medication adherence in chronically ill patients that has been tailored to the Swiss context and developed alongside key stakeholders. Collective efforts to improve patient adherence to long-term therapy may improve patient therapeutic outcomes, safeguard patient safety and alleviate the financial burden on patients and the health system. The project will inform future scale-up.

Learn more about the myCare Start service
Stakeholders

We attach great importance to stakeholder involvement. An interprofessional stakeholder group was developed to provide advice, expertise, and direction for the project and to ensure its long-term viability.

Organisations and individuals represented by the myCare Start-I Stakeholder Group include:

  • Cantonal government representative - Geneva
  • Cantonal government representative - Jura
  • Cantonal government representative - Vaud
  • CARA - Electronic patient records
  • SOKLE - Elecronic medical records
  • Health insurers - SWICA
  • The professional cooperative of Swiss pharmacists (ofac)
  • GSASA
  • Swiss Association of Pharmacists (pharmaSuisse)
  • Pharma Genève
  • pharma24
  • GaleniCare - represent the pharmacies Amavita, Sun Store and Coop Vitality for the development of services.
  • HCI Solutions - represents Triapharm (sales system) and Documedis (documentation system and anamnesis).
  • Representative of Pharmacies Chain - Pharmacie Populaire
  • Société Vaudoise de pharmacie (SVPh)
  • pharmacieplus de l’île
  • Pharmacie des Saules
  • CHUV
  • Community pharmacists
  • Community pharmacy assistants
  • Le Réseau Delta
  • Family physician Representatives
  • University Institute for Primary Care, Faculty of Medicine, University of Geneva
  • University Center for General Practice of Basel, University of Basel
  • Bern Institute for General Practice Medicine (BIHAM), University of Bern
  • Regular consumers
  • Patient Safety Foundation Switzerland
  • The European Patients’ Academy on Therapeutic Innovation (EUPATI), Switzerland
  • Diabetesbern
  • University Representative - ETH Zürich, University of Lausanne
  • The Geneva institution for home support (imad)

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