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Silva RDOS, Macêdo LA, Santos GAD, Aguiar PM, de Lyra DP. Pharmacist-participated medication review in different practice settings: Service or intervention? An overview of systematic reviews. PLoS One 2019; 14:e0210312. [PMID: 30629654 PMCID: PMC6328162 DOI: 10.1371/journal.pone.0210312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 12/20/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction Medication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results. Aim To examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings. Methods A literature search was undertaken in Biblioteca Virtual em Saúde (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews. Results Seventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11). Conclusion There is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.
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Affiliation(s)
- Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Genival Araújo Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Patrícia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Hussainy SY, Crum MF, White PJ, Larson I, Malone DT, Manallack DT, Nicolazzo JA, McDowell J, Lim AS, Kirkpatrick CM. Developing a Framework for Objective Structured Clinical Examinations Using the Nominal Group Technique. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:158. [PMID: 28090107 PMCID: PMC5221840 DOI: 10.5688/ajpe809158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 05/22/2023]
Abstract
Objective. To use the nominal group technique to develop a framework to improve existing and develop new objective structured clinical examinations (OSCEs) within a four-year bachelor of pharmacy course. Design. Using the nominal group technique, a unique method of group interview that combines qualitative and quantitative data collection, focus groups were conducted with faculty members, practicing pharmacists, and undergraduate pharmacy students. Five draft OSCEs frameworks were suggested and participants were asked to generate new framework ideas. Assessment. Two focus groups (n=9 and n=7) generated nine extra frameworks. Two of these frameworks, one from each focus group, ranked highest (mean scores of 4.4 and 4.1 on a 5-point scale) and were similar in nature. The project team used these two frameworks to produce the final framework, which includes an OSCE in every year of the course, earlier implementation of teaching OSCEs, and the use of independent simulated patients who are not examiners. Conclusions. The new OSCE framework provides a consistent structure from course entry to exit and ensures graduates meet internship requirements.
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Affiliation(s)
- Safeera Y Hussainy
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew F Crum
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul J White
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian Larson
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Daniel T Malone
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - David T Manallack
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Joseph A Nicolazzo
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jennifer McDowell
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Angelina S Lim
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Carl M Kirkpatrick
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Mansoor SM, Krass I, Costa DSJ, Aslani P. Factors influencing the provision of adherence support by community pharmacists: A structural equation modeling approach. Res Social Adm Pharm 2015; 11:769-83. [PMID: 25749550 DOI: 10.1016/j.sapharm.2015.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-adherence to medication represents an important barrier to achieving optimum patient outcomes. Community pharmacists are well placed to deliver interventions to support adherence. AIMS To investigate community pharmacists' activities in supporting patient adherence; and identify factors influencing pharmacists' provision of adherence support. METHOD A random sample of 2020 Australian community pharmacies was mailed a questionnaire investigating their provision of adherence support. The self-completed, structured questionnaire consisted of eight sections, five of which were relevant to this study: strategies used to identify non-adherent patients, strategies used to support patients' adherence to medications, pharmacists' attitudes toward provision of adherence support, perceived barriers to provision of adherence support, and demographics. Structural equation modeling (SEM) was used to determine potential influencing factors. RESULTS A response rate of 31% was achieved (n = 627). Pharmacists reported using strategies to identify non-adherent patients for less than half (45%) of the prescriptions dispensed. A mean of 8.4 ± 14.9 (mean ± SD) strategies was used by respondents in the 7 days prior to survey completion. Dose administration aids was the most commonly used strategy (provided by 96.5% of respondents). Time pressure for patients (68%) was perceived by pharmacists as the main barrier to adherence support. SEM identified "stakeholders/skills" and "number of full time equivalent staff" as influencing provision of adherence support strategies. CONCLUSION Provision of adherence support by pharmacists was episodic and infrequent, impeded by a number of barriers. By addressing barriers, it is possible to enable pharmacists to become more proactive and effective in supporting patient adherence.
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Affiliation(s)
- Sarab M Mansoor
- Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia
| | - Ines Krass
- Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Lifehouse Building (C39Z), Sydney, NSW 2006, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building, A15, Sydney, NSW 2006, Australia.
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Vogler S, Leopold C, Zuidberg C, Habl C. Medicines discarded in household garbage: analysis of a pharmaceutical waste sample in Vienna. J Pharm Policy Pract 2014; 7:6. [PMID: 25848546 PMCID: PMC4366941 DOI: 10.1186/2052-3211-7-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/05/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives To analyze a sample of pharmaceutical waste drawn from household garbage in Vienna, with the aim to learn whether and which medicines end up unused in normal household waste. Methods We obtained a pharmaceutical waste sample from the Vienna Municipal Waste Department. This was drawn by their staff in a representative search in October and November 2009. We did a manual investigation of the sample which contained packs and loose blisters, excluded medical devices and traced loose blisters back to medicines packs. We reported information on the prescription status, origin, therapeutic group, dose form, contents and expiry date. We performed descriptive statistics for the total data set and for sub-groups (e.g. items still containing some of original content). Results In total, 152 packs were identified, of which the majority was prescription-only medicines (74%). Cardiovascular medicines accounted for the highest share (24%). 87% of the packs were in oral form. 95% of the packs had not expired. 14.5% of the total data set contained contents but the range of content left in the packs varied. Results on the packs with contents differed from the total: the shares of Over-the Counter medicines (36%), of medicines of the respiratory system (18%) and of the musculo-skeletal system (18%), for dermal use (23%) and of expired medicines (19%) were higher compared to the full data set. Conclusions The study showed that some medicines end up unused or partially used in normal household garbage in Vienna. Our results did not confirm speculations about a high percentage of unused medicines improperly discarded. There is room for improved patient information and counseling to enhance medication adherence and a proper discharge of medicines.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Geschäftsbereich ÖBIG - Austrian Health Institute, Vienna, Austria
| | - Christine Leopold
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Geschäftsbereich ÖBIG - Austrian Health Institute, Vienna, Austria
| | - Christel Zuidberg
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Geschäftsbereich ÖBIG - Austrian Health Institute, Vienna, Austria ; WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Claudia Habl
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Geschäftsbereich ÖBIG - Austrian Health Institute, Vienna, Austria
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Wiley J, Westbrook M, Long J, Greenfield JR, Day RO, Braithwaite J. Diabetes education: the experiences of young adults with type 1 diabetes. Diabetes Ther 2014; 5:299-321. [PMID: 24519150 PMCID: PMC4065294 DOI: 10.1007/s13300-014-0056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Clinician-led diabetes education is a fundamental component of care to assist people with Type 1 diabetes (T1D) self-manage their disease. Recent initiatives to incorporate a more patient-centered approach to diabetes education have included recommendations to make such education more individualized. Yet there is a dearth of research that identifies patients' perceptions of clinician-led diabetes education. We aimed to describe the experience of diabetes education from the perspective of young adults with T1D. METHODS We designed a self-reported survey for Australian adults, aged 18-35 years, with T1D. Participants (n = 150) were recruited by advertisements through diabetes consumer-organizations. Respondents were asked to rate aspects of clinician-led diabetes education and identify sources of self-education. To expand on the results of the survey we interviewed 33 respondents in focus groups. RESULTS SURVEY The majority of respondents (56.0%) were satisfied with the amount of continuing clinician-led diabetes education; 96.7% sought further self-education; 73.3% sourced more diabetes education themselves than that provided by their clinicians; 80.7% referred to diabetes organization websites for further education; and 30.0% used online chat-rooms and blogs for education. Focus groups: The three key themes that emerged from the interview data were deficiencies related to the pedagogy of diabetes education; knowledge deficiencies arising from the gap between theoretical diabetes education and practical reality; and the need for and problems associated with autonomous and peer-led diabetes education. CONCLUSION Our findings indicate that there are opportunities to improve clinician led-diabetes education to improve patient outcomes by enhancing autonomous health-literacy skills and to incorporate peer-led diabetes education and support with clinician-led education. The results provide evidence for the potential value of patient engagement in quality improvement and health-service redesign.
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Affiliation(s)
- Janice Wiley
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia,
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Cunico C, Picheth G, Correr CJ, Scartezini M. Assessing the adherence to and the therapeutic effectiveness of hypolipidemic agents in a population of patients in Brazil: a retrospective cohort study. Pharm Pract (Granada) 2014; 12:378. [PMID: 25035713 PMCID: PMC4100947 DOI: 10.4321/s1886-36552014000200002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/27/2014] [Indexed: 12/11/2022] Open
Abstract
Objective to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic
agents in clinical practice. Methods A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin,
atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients
assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil.
The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient
adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum
levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after
taking the drug, in an average time of 8.3 months. Results Following the treatment with hypolipidemic agents, it has been observed a reduction of
14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for
triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid
profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the
monitoring period. Adherence rates below 60% were associated with therapeutic failure, while
rates equal to 80% or higher were associated with the best response to the lipid-lowering
drugs. Conclusion Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases
over time, affecting the achievement of therapeutic goals.
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Affiliation(s)
- Cássia Cunico
- Municipal Health of the São Miguel do Oeste and State Health Administration of the State of Santa Catarina. Florianópolis ( Brazil )
| | - Geraldo Picheth
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
| | - Cassyano J Correr
- Department of Pharmacy, Federal University of Parana (UFPR) Curitiba, PR ( Brazil )
| | - Marileia Scartezini
- Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil )
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Bell JS, Enlund H, Vainio K. Medication adherence: a review of pharmacy education, research, practice and policy in Finland. Pharm Pract (Granada) 2010; 8:147-61. [PMID: 25126134 PMCID: PMC4127049 DOI: 10.4321/s1886-36552010000300001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 08/17/2010] [Indexed: 11/11/2022] Open
Abstract
AIMS To describe pharmacy education, research, practice and policy related to medication adherence in Finland since the year 2000. METHODS The three universities that provide pharmacy education (Åbo Akademi, University of Eastern Finland, and University of Helsinki) completed a structured pro-forma questionnaire regarding education related to medication adherence. A MEDLINE and EMBASE literature search was performed to identify English language peer-reviewed research that reported medication compliance, adherence or persistence. The Ministry of Social Affairs and Health was invited to nominate policies and documents related to medication adherence. A narrative review of medication counselling practices and professional service delivery through Finnish community pharmacies was undertaken. RESULTS Medication adherence was a theme integrated into obligatory and elective courses for bachelors and masters degree students. The literature search identified 33 English language peer-reviewed research articles reporting medication compliance, adherence or persistence published since the year 2000. Policy documents of the Ministry of Social Affairs and Health recognise that poor medication adherence may lead to suboptimal treatment outcomes, and encourage patient participation in treatment decision making. Adherence practice in Finnish pharmacies has been strongly linked to the development of medication counselling services. CONCLUSIONS Adherence research and education has focused on understanding and addressing the contextual factors that contribute to medication nonadherence. Adherence practice in community pharmacies has tended to focus on medication counselling and programs specific to particular disease states. Medication adherence is a topic that is integrated into courses for bachelor's and master's level pharmacy students in Finland.
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Affiliation(s)
- J Simon Bell
- Research Centre of Geriatric Care, University of Eastern Finland . Kuopio ( Finland ); and Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland. Kuopio ( Finland )
| | - Hannes Enlund
- Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland . Kuopio ( Finland ); and Department of Pharmacy Practice, Kuwait University . Kuwait City ( Kuwait )
| | - Kirsti Vainio
- Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland . Kuopio ( Finland )
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Marie-Schneider P, Aslani P. Adherence policy, education and practice - an international perspective. Pharm Pract (Granada) 2010; 8:209-12. [PMID: 25126142 PMCID: PMC4127057 DOI: 10.4321/s1886-36552010000400001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/18/2010] [Indexed: 11/21/2022] Open
Abstract
Nonadherence to chronic therapy has become a large burden on the healthcare system of many countries. Community pharmacists are well positioned to address nonadherence as part of their overall patient care activities, and contribute to patients’ quality use of medicines. Between 2008 and 2010, a series of narrative, peer-reviewed articles were published in Pharmacy Practice which focused on community pharmacists’ activities in medication adherence, specifically in the areas of the education they receive, their practice, the research conducted and national or local policies. This editorial aims to summarise the key findings presented in the series, and highlight the pertinent issues and gaps in the literature. There is a need to implement global and long-term objectives focussing on enhancing the quality of education and competencies of community pharmacists and the research conducted in medication adherence, to develop guidelines for pharmacists and enhance the uptake of adherence promoting services in routine care.
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Affiliation(s)
- Paule Marie-Schneider
- Community Pharmacy, Department of Ambulatory Care and Community Medicine. University Hospital. Lausanne ( Switzerland )
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney . Sydney ( Australia )
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Fikri-Benbrahim N, García-Cárdenas V, Sáez-Benito L, Gastelurrutia MA, Faus MP, Schneider MP, Aslani P. Adherence: a review of education, research, practice and policy in Spain. Pharm Pract (Granada) 2009; 7:125-38. [PMID: 25143789 PMCID: PMC4139043 DOI: 10.4321/s1886-36552009000300001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/08/2009] [Indexed: 11/11/2022] Open
Abstract
AIMS To describe medication adherence education, practice, research and policy efforts carried out by pharmacists in Spain in the last decade. METHODS A literature review using Medline and Embase was conducted covering the last ten years. Additional pharmaceutical bibliographic sources in Spain were consulted to retrieve articles of interest from the last decade. Articles were included if a pharmacist was involved and if medication adherence was measured or there was any direct or indirect pharmacist intervention in monitoring and/or improving adherence. Articles focusing on the development of tools for adherence assessment were collected. Pre- and post-graduate pharmacy training programs were also reviewed through the Spanish Ministry of Education and Science website. Information regarding policy issues was gathered from the Spanish and Autonomous Communities of Education and Health Ministries websites. RESULTS Pharmacists receive no specific training focused on adherence. There is no specific government policies for pharmacists in Spain related to medication adherence regardless of their practice setting. A total of 24 research studies met our inclusion criteria. Of these, 10 involved pharmacist intervention in monitoring and/or improving adherence and 14 assessed only adherence. Ten studies involved hospital pharmacists working in collaboration with another healthcare professional. CONCLUSIONS At present in Spain, the investigative role of the pharmacist is not well developed in the area of medication adherence. Adherence improvement services provided to patients by pharmacists are not implemented in a systematic way. However, recent efforts to implement new initiatives in this area may provide the basis for offering new cognitive services aimed at improving patient adherence in the near future.
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Affiliation(s)
| | | | - Loreto Sáez-Benito
- Pharmaceutical Care Research Group, University of Granada. Granada ( Spain )
| | | | - María P Faus
- Pharmaceutical Care Research Group, University of Granada. Granada ( Spain )
| | - Marie P Schneider
- Community Pharmacy, Dpt of ambulatory care and community medicine, University Hospital, Lausanne ( Switzerland )
| | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney ( Australia )
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