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Medication adherence evaluated through electronic monitors during the COVID-19 pandemic lockdown in Switzerland

  • At: PPR 2022 (2022)
  • Type: Poster
  • By: BANDIERA, Carole (Geneva University)
  • Co-author(s): Carole Bandiera, Phd Student, School of Pharmaceutical Sciences, University of Geneva, Switzerland
    Jérôme Pasquier, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Swizerland
    Isabella Locatelli, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
    Anne Niquille, Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland
    Grégoire Wuerzner, Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
    Jennifer Dotta-Celio, Service of Oncology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland
    Hanna Hachfeld, Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Switzerland
    Gilles Wandeler, Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland
    Dorothea Wagner, Service of infectious diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Switzerland
    Chantal Csajka
    Anne Zanchi
    Matthias Cavassini
    Marie P. Schneider

  • Abstract:

    Background
    During the lockdown enforced from March to June 2020 by authorities due to the COVID-19 pandemic in Switzerland, patients included in the Interprofessional Medication Adherence Program (IMAP) in Lausanne and Bern continued to use electronic monitors (EM), which register daily doses intake.
    The aim of this study is to use EM data to understand to what extent patients’ medication implementation, described as the extent to which the patient takes the daily prescribed regimen, was impacted by the lockdown. We hypothesize that medication implementation might be lower during and after the lockdown compared to before.

    Methods
    Included participants attending the IMAP were diagnosed with diabetic kidney disease (DKD), solid cancer, HIV and miscellaneous long-term diseases.
    Patients’ implementation was defined through a proxy: if all EM of each patient were at least opened once daily, implementation was considered optimal (=1); and suboptimal (=0) otherwise.
    1) Implementation before (from December 2019 to March 2020), during (March to June 2020) and after (June to September 2020) the lockdown was compared. Subanalyses were also performed according to sub-groups of patients.
    2) As comparison, implementation of included patients using at least one EM the year before, in 2019, during the same time frame, defined as winter, spring and summer periods, was analysed.
    A logistic regression model was used to estimate medication implementation according to the period, using “before the lockdown” or “winter” as the reference. The model was fitted using generalized estimating equation.

    Results
    1) In 2020, implementation of the 118 patients did not differ statistically before and during (OR=0.97, CI: 0.84-1.15, p=0.789), and before and after (OR=0.91, CI: 0.79-1.06, p=0.217) the lockdown. These findings remain stable even when analyzing separately the implementation of patients with HIV (n=61), DKD (n=25) or miscellaneous long-term diseases (n=22). Too few patients with cancer (n=10) were included in the analysis to interpret their results.
    2) In 2019, implementation of the 61/118 (51.7%) patients was statistically significantly lower during summertime compared to winter (OR=0.73, CI: 0.59-0.89, p=0.002).

    Conclusions
    Our results infirm our hypothesis as the implementation remained steady during and after the lockdown in 2020 in comparison to the period before. Still, adherence in 2020 was different compared to 2019 as the decreased implementation during summertime 2019 was not observed after the lockdown in summer 2020.
    Because of the COVID pandemic, many patients slowed down their activities, travelled less, and may have been more cautious in managing their treatment due to the fear of developing a complication of their disease in a difficult sanitary context. Moreover, during the pandemic, continuity of care was ensured by medical teleconsultation between patients and their health care providers, mailing medications to patients’ home by the pharmacy and leading interviews by phone calls for patients included in IMAP. The IMAP before, during and after the lockdown may have supported the adherence of complex patients across the pandemic in 2020. Interprofessional adherence programs should support patients during routine-disturbance periods, such as a lockdown in a pandemic context or during summertime.

Last update 4 October 2019

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