Objective:
The scope of this article is to describe the background for and
content of an adherence counselling programme with a specific
focus on an individualised, multi-dimensional adherence model
for patients with a potential adherence problem (a so-called ‘individualised
systems model’).
Methods: An intervention programme based on WHO’s systems model
for adherence was developed for implementation in primary health
care and tested in a development project in Danish pharmacies
in 2004-2005 in three pharmacies and 4 GP practices by 27 patients.
Data were collected from the participants by registration forms,
questionnaires, and focus groups. Since the programme was to support
patients in the self-management process regarding choice and implementation
of medication treatment, various strategies were used and different
theoretical assumptions and choices made prior to setting up the
study. These strategies include distinguishing between different
types of non-adherence, a model for stages of change, self-efficacy,
narratives, motivating interviewing strategies and coaching techniques.
These strategic and theoretical choices are described in the article.
Results: The strategies and theoretical reflections formed the
platform for the creation of a counselling programme, which was
tested in two forms, a basic and an extended version - provided
by either a pharmaconomist or a pharmacist. The result section
also describes a toolbox of instruments to enable pharmacy staff
and GPs to tailor a counselling programme for patients individually
called ‘Safe and effective use of medicines’. Besides, the results
include a description of how the WHO-model is transformed into
an individualised counselling model.
