Adherence to treatment: practice, education and research in Danish community pharmacy

Main Article Content

Lotte S. Haugbølle
Hanne Herborg


Medication Adherence, Pharmacists, Denmark


Objective: To describe the practice, education and research concerning medication adherence in Danish community pharmacy.

Methods: The authors supplemented their expertise in the area of medication adherence through their contacts with other educators and researchers as well as by conducting searches in the Danish Pharmacy Practice Evidence Database, which provides annually updated literature reviews on intervention research in Danish pharmacy practice.

Results: Practice: Medication adherence is the focus of and/or is supported by a large number of services and initiatives used in pharmacy practice such as governmental funding, IT-supported medicine administration systems, dose-dispensing systems, theme years in pharmacies on adherence and concordance, standards for counselling at the counter, pharmacist counselling, medication reviews and inhaler technique assessment. Education: In Denmark, pharmacy and pharmaconomist students are extensively trained in the theory and practice of adherence to therapy. Pharmacy staff can choose from a variety of continuing education and post-graduate programmes which address patient adherence. Research: Nine ongoing and recently completed studies are described. Early research in Denmark comprised primarily smaller, qualitative studies centred on user perspectives, whereas later research has shifted the focus towards larger, quantitative, controlled studies and action-oriented studies focusing on patient groups with chronic diseases (such as diabetes, asthma, coronary vascular diseases).

Conclusions: Our analysis has documented that Danish pharmaceutical education and research has focused strongly on adherence to treatment for more than three decades. Adherence initiatives in Danish community pharmacies have developed substantially in the past 5-10 years, and, as pharmacies have prioritised their role in health care and patient safety, this development can be expected to continue in future years.


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1. Herborg H, Haugbølle LS, Sørensen L, Rossing C, Dam P. Developing a generic, individualised adherence programme for chronic medication users. Pharm Pract. 2008;6(3):148-157.

2. WHO. Adherence to long-term therapies - evidence for action. Noncommunicable diseases and mental health adherence to long term therapies project. Report. Geneva: World Health Organisation; 2003.

3. The Nordic Pharmacy Association. The Added Value of Nordic Pharmacies. Documentation examples. A report from the Nordic Working Group on Professional Responsibility in Pharmacy (PAPA). The Nordic Pharmacy Association February 2008.

4. Dam P, Herborg H, Rossing C. Evidensrapport 9 - Interventioner til forbedring af compliance og concordance i forbindelse med lægemiddelbehandlinger - Version 2.1. [Evidence report 9 - Interventions for improving compliance and concordance in relation to drug treatment - In Danish]. Report. Pharmakon 2008.

5. Agergaard M, Rossing C, Herborg H. Evidens for Apotekets Rådgivning [Evidence for pharmacy counselling. Report. In Danish]. Rapport. Version 1.1. 2009. Pharmakon.

6. The Danish Pharmaceutical Association. The annual reports of the Danish Association of Pharmacies. URL: http://www. (Accessed September 29, 2009)

7. Chronic Conditions - Patient, Healthcare and Community. Summary and recommendations. National Board of Health, Denmark, April 2006. URL:, (Accessed 22 October 2009)

8. Dansk Selskab for Patientsikkerhed. Strategi 2007-2010 for Dansk Selskab for Patientsikkerhed [Strategy for the Danish Society for Patient Safety 2007-2010.In Danish]., 2009 (Accessed October 21, 2009).

9. Thomsen MH, Bolvig T, Damsø LB, Fonnesbæk L, Herborg H. Pseudo customers in Danish Pharmacies. World Congress of Pharmacy and Pharmaceutical Sciences, 68th Congress of FIP, Basel, Switzerland 3-4 September 2008. (abstract and poster)

10. Kortlægning af praksis for medicinering i den kommunale hjemmepleje [Mapping of medication practice in local authority home care. Report. In Danish] Den digitale taskforce & Devoteam Fischer & Lorenz A/S, September 2003. (accessed 22 October 2009)

11. Brug medicinen bedre - Perspektiver i klinisk farmaci. Rapport fra Lægemiddelstyrelsens arbejdsgruppe om klinisk farmaci juni 2004 [Use medicine better – perspectives in clinical pharmacy. Report from the working group on clinical pharmacy. In Danish. Danish Medicines Agency, June 2004] (Accessed on October 21 2009)

12. Committee on Medicine Reimbursement. Medicine reimbursement and correct use of medicine. Report. Copenhagen. 2004.

13. Institut for Rationel Farmakoterapi [Institute for Rational Pharmacotherapy]. Compliance – om afvigelser mellem lægers ordinationer og patieternes aktuelle medicinindtag.[Compliance – about deviations between prescribing and actual medicine use. Report. In Danish]. Rapport, April 2006.

14. Lindberg M. Compliance: Hvilke interventioner virker? Foreliggende evidens ud fra randomiserede undersøgelser [Which interventions are effective? Evidence from randomised trials. Paper. In Danish]. Institut for Rationel Farmakoterapi, juni 2008. (accessed 22 October 2009)

15. Institut for Rationel Farmakoterapi. Metaanalyse – Ingen klinisk forskel på kopipræparater og originalpræparater [Metaanalysis – no clinical difference between generic products and original products. In Danish]

16. The Association of Danish Pharmacies. Annual Report. www. (Accessed September 29, 2009) Report 2006-2007

17. The Association of Danish Pharmacies. Annual Report. www. (Accessed September 29, 2009) Report 2007-2008

18. Lægemiddelstyrelsen. Lægemiddelbekendtgørelse nr. 80 af 04/02/2003. Bekendtgørelse om dosisdispensering af lægemidler [Danish Medicines Agency. Executive order no. 80 of 4 February 2003 on dose dispensing of drugs. In Danish]. 2003.

19. Herborg H, Haugbølle LS, Lee A. Automated Dose Dispensing in Danish Primary Health Care: a Technology under Construction. Pharm Pract. 2008;6(2):103-112.

20. Andersen LS, Sørensen L, Haugbølle LS. Anvendelighed af den personlige elektroniske medicinprofil (PEM) til beregning af patienters compliance med lægemiddelbehandlingen [Using the personale electronic medication profile (PEM) for calculating medication compliance – In Danish]. Marts 2009, Ugeskrift for Læger: 899-903.

21. Dydensborg CB, Krabbe T. Komplians hos hypertensionspatienter undersøgt ved hjælp af medicinprofilen på [Compliance among hypertensive patients investigated by the personale electronic medication profile on Paper. In Danish]. Ugeskrift for Læger 2007;169:4347-50.

22. National Strategy for Digitalization of the Danish Healthcare Service 2008-2012. Digital Health 2007. (accessed 22 October 2009)

23. Rubak SLM, Andersen MLE, Mainz J et al. Hvordan vurderer praktiserende læger lægemiddelsubstitutionsordningen? [How do general practitioners assess the generic substitution scheme? – In Danish]. Ugeskr Læger 2000; 162: 6070-3.

24. Rubak SLM, Andersen MLE, Mainz J et al. Hvordan vurderer apotekere og farmaceuter lægemiddelsubstitutionsordningen? [How do pharmacy owners and community pharmacists assess the generic substitution scheme? – In Danish]. Ugeskrift for Læger 2000; 162: 6074-7.

25. Rossing C, Sørensen L, Herborg H. Adherence problems among type 2-diabetics. Abstract and poster for PCNE working conference. Gothenburg 2007., (accessed 22 October 2009).

26. Dam P, Rossing C. Afdækning af kunders holdning til og erfaringer med substitution [Mapping customer´s attitude towards and experiences with substitution. Presentation. In Danish]. Temauge for Apotekerne i Ribe Sønderjyllandskredsen. Pharmakon 2007. (Accessed 22 October 2009)

27. Kaarill L, Børsting A, Dyssegaard A, Fonnesbæk L: Inhalation Technique Assessment. The first health service in Danish pharmacies reimbursed by the government. Abstracts 2000, World Congress of Pharmacy and Pharmaceutical Sciences 2005:98.

28. Klinke B, Fonnesbæk L. Tjek på inhalation - afprøvning af ydelsen [Inhaler technique service – testing the service. Evaluation report. In Danish]. Evalueringsrapport. Danmarks Farmaceutiske Universitet og Pharmakon 2005.

29. Herborg H, Soendergaard B, Froekjaer B, Fonnesbaek L, Jorgensen T, Hepler CD, Grainger-Rousseau TJ, Ersboell BK. Improving drug therapy for patients with asthma. Part 1: Patient outcomes. J Am Pharm Assoc. 2001;41:539-550.

30. Bernsten C, Björkman I, Caramona M, Crealey G, Frøkjaer B, Grundberger E, Gustafsson T, Henman M, Herborg H, Hughes C, McElnay J, Magner M, van Mil F, Schaeffer M, Silva S, Søndergaard B, Sturgess I, Tromp D, Vivero L, Winterstein A; Pharmaceutical care of the Elderly in Europe Research (PEER) Group. Improving the Well-Being of Elderly Patients via Community Pharmacy-Based Provision of Pharmaceutical Care: A Multicentre Study in Seven European Countries. Drugs Aging. 2001;18(1):63-77.

31. Søndergaard B, Herborg H, Jørgensen T, et al. Forebyggelse af lægemiddelrelaterede problemer gennem Apotekets Ældre Service. Et forsøgsprojekt på danske apoteker 1996-1999 [Prevention of drug-related problems via phamacy based elderly service. A pharmacy project 1996-1999. Report. In Danish]. Report 2001.

32. Søndergaard B, Thorleifsson S, Herborg H, Frøkjær B, Hepler CH, Ersbøll BK. Kvalitetssikring af astmapatienters lægemiddelbehandling. Sundhedsøkonomisk analyse [Quality assuring astma patient´s medications – a health economic analysis. Paper. In Danish]. Ugeskrift for Læger 2000; 162: 480-6.

33. Pultz K, Salout M. Ydelsen ”Medicingennemgang på plejehjem og i hjemmeplejen” afprøvet på 5 plejehjem [The service ´Medication review at nursing homes and in home care´ tested at 5 nursing homes. Evaluation report. In Danish]. Pharmakon and Association of Danish Pharmacies. 2003.

34. Glintborg D, Bonnichsen B. Bedre medicinsk behandling af ældre på plejehjem og i hjemmeplejen [Improved medical treatment of elderly in nursing homes and local authority home care. Report. In Danish]. Forebyggelsesrådet i Frederiksborg Amt. December 2006.

35. Pultz K, Søndergaard B, Herborg H. Farmaceutisk rådgivning til plejehjem [Pharmaceutical counselling at nursing homes. Evaluation report. In Danish]. Evalueringsrapport 2003.

36. Haugbølle LS, Sørensen EW. Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma – results from interviewing the patients at home. Pharm World Sci. (2006);28:239-247.

37. Sørensen EW; Haugbølle LS. Using an action research process in pharmacy practice research: A cooperative project between university and internship pharmacies. Res Soc Admin Pharm. 2008;4(4):384-401.

38. Education of (Accessed 17 October 2009)

39. Gram-Hansen M. Rådgivning på APOTEK - en undersøgelse af forbrugernes forventninger til apotek og til apotekets faglige rådgivning [Counselling in pharmacy – a study of user expectation to pharmacy and pharmacy counselling. Master thesis. In Danish], masterprojekt 2007, Det Farmaceutiske Fakultet, Københavns Universitet.

40. Kristoffersen ITS. Medicingennemgang i Ny Thisted Kommune - et udviklingsprojekt [Medication review in Ny Thisted Municipality. Master thesis. In Danish], masterprojekt 2007, Det Farmaceutiske Fakultet, Københavns Universitet.

41. Agerholm H. Udvikling af apoteket ved registrering af lægemiddelrelaterede problemer - Et aktionsforskningsprojekt [Development of pharmacy by registrering drug-related problems – an action-research project. Master thesis. In Danish]. masterprojekt, 2006, Danmarks Farmaceutiske Universitet.

42. Larsen B O, Hansen EH. The Active Medicine User. Scand J Prim Health Care. 1985;3:55-59.

43. Hansen EH, Launsø L, Morgall J. Samarbejde mellem brugeroraganisationer & apoteksfarmaceuter om lægemiddelanvendelse – arbejdsrapport [Cooperation between user organisations and community pharmacists concerning medication use. Working report – In Danish], Institut for Samfundsfarmaci 1989.

44. Hansen EH, Launsø L. Experiments with Collaboration between Patient Associations and Pharmacists. Acta Pharmaceutica Suecica 1986;(suppl 1):163-173.

45. Almarsdóttir AB, Björnsdóttir I, Traulsen JM. A lay prescription for tailor-made drugs – focus group reflections on pharmacogenomics. Health Policy. 2005;(71):233-241.

46. Hansen EH. Technology assessment in a user perspective – experiences with drug technology. Int J Tech Assess Health Care 1992;8:150-165.

47. Knudsen P, Hansen EH, Traulsen JM. Perceptions of young women using SSRI antidepressants – a reclassification of stigma. Int J Pharm Pract. 2002:10:243-252.

48. Haugbølle LS, Devantier K. Frydenlund B. A user perspective on type-1 diabetes: sense of illness, search for freedom and the role of the pharmacy. Patient Educ Couns. 2002:47:361-368.

49. Haugbølle LS, Sørensen EW, Gundersen B, Lorentzen L, Petersen KH. Basing pharmacy counselling on the perspective of the angina pectoris patient. Pharm World Sci. 2002;24(2):71-78.

50. Møldrup, C. Hansen, RR. Danes’ acceptance of drug use for non-disease conditions. Curr Med Res Opin. 2006;22(4):777-780.

51. Møldrup C. No cure, No pay - consumer / patient perspective. J Med Mark 2006;6(1):31-37.

52. Nielsen L, Møldrup C. Lay perspective on pharmacogenetics and application of this in future drug treatment – a Danish quantitative survey. 26,3,309-325, 2007.

53. Nørgaard LS, Laursen M, Lassen S. Knowledge, attitudes and polydrug use among Ecstacy users - a London study. J Soc Admin Pharm 2001; 18 (2): 51-58.

54. Nørreslet M, Larsen JB, and Traulsen JM. The medicine user - Lost in translation? Analysis of the official political debate prior to the deregulation of the Danish medicine distribution system. Soc Sci Med 2005;61:1733-1740.

55. Rehne J, Møldrup, C. Danes’ awareness of and attitude towards direct-to-consumer advertising (DTC-A) of prescription drugs. A quantitative survey of 3000 respondents. J Med Mark. 2007;8(1):31-38.

56. Traulsen JM, Almarsdóttir AB. Pharmaceutical policy and the lay public. Pharm World Sci. 2005:27:273-277.

57. Traulsen JM, Björnsdóttir I, Almarsdóttir AB. “I'm happy if I can help” - public views on future medicines and gene therapy in Iceland. Community Genetics. 2008;(11):2.

58. Traulsen JM, Almarsdóttir AB, Björnsdóttir I. The lay user perspective on the quality of pharmaceuticals, drug therapy and pharmacy services. Pharm World Sci. 2002;24(5):196-200.

59. Herborg H, Sørensen EW, Frøkjær B. Pharmaceutical Care in Community Pharmacies: Practice and Research in Denmark. Ann Pharmacother. 2007;41:681-689.

60. Herborg H, Soendergaard B, Joergensen T, Fonnesbaek L, Hepler CD, Holst H. Improving drug therapy for patients with asthma. Part II: Use of antiasthma medication. J.Am Pharm Assoc. 2001; 41:551-9.

61. Herborg H, Dam P, Rossing C, Sørensen L. Safe and Effective Use of Oral Antidiabetic Drugs: A Controlled Study of an Adherence-enhancing Intervention. Abstract and poster for FIP Congress, Basel 2008.

62. Herborg H, Sorensen L, Rossing C. Safe and effective use of antihypertensives: A controlled study of adherence enhancing interventions. Abstract and poster for FIP Congress, Beijing 2007.

63. Haugbølle LS, Sørensen EW, Gundersen B, Lorentzen L, Petersen KH. Basing pharmacy counselling of the perspective of the angina pectoris patient. Pharm World Sci. 2002;24(2):71-78.

64. Haugbølle LS, Sørensen EW, Herborg H. The perspective of the angina pectoris patient: medication- and illness-related factual knowledge, perceptions and behaviour. Patient Educ Couns. 2002;47:281-289.

65. Sørensen EW, Herborg H, Haugbølle LS, Tomsen D. Improving situated learning in pharmacy internship. Pharm Educ. 2005;5(3/4):223-234.

66. Søndergaard B, Rossing C, Haugbølle LS, Lee A. Litteraturstudie af dosisdispensering som medicinsk teknologi [Literature review of dose-dispensing as a heath technology. Working report. In Danish]. Arbejdsrapport. 2005. Danmarks Farmaceutiske Universitet, Pharmakon, Syddansk Universitet, ISBN 87-90923-64-2.

67. Larsen AB, Haugbølle LS. The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication. Research in Social and Administrative Pharmacy 2007; 3: 265-284.

68. Christensen A. Electronic monitoring of patient adherence in hypertension- Survey and clinical assessments of a reminder and monitoring device. PhD thesis, Copenhagen University, 2009.

69. Haugbølle LS; Søndergaard B, Morgall J. et al. Optimal lægemiddelanvendelse blandt ikke-etniske danskere (del 2) - Gennemførelse af medicingennemgang [Optimal drug use amont non-ethnical Danes (Part 2) – Medication reviews. In Danish].Københavns Universitet. Rapport. Det Farmaceutiske Fakultet. Marts 2009 ISBN 978-87-92199-55-3.

70. Hoffman T. Indvandere importerer lægemidler[Immigrants import medicine – In Danish] 29. September 2009. Available from