Research project DR/02 (Research action DR)
Project manager: Belgian Pharmaceutical Association ( APB )
Subject:
Analysis of the overall national situation of methadone delivery through community pharmacists in Belgium.
The study not only highlights epidemiological aspects of present methadone use, but also qualitative dimensions of the doctor-patient-community pharmacist relationships.
It will offer a qualitative evaluation of the patients situation practical orientation towards improving the quality of life of patients and professionals involved.
A "Substitution therapy observatory" (OCS : "Observatoire des cures substitutives") will be set up on the basis of recorded data from community pharmacists throughout Belgium oriented toward a follow-up of patients.
The survey is patient oriented, proposing to community pharmacists to evaluate patients buying prescribed methadone in their pharmacy. This evaluation (a target sample of 1000 patients is set, to allow comparison between Belgium’s 11 provinces) will assess basic epidemiologic data, and some key behavioral and relational dimensions and global evaluation of the patient’s present state and evolution. The study will underscore the role of dispensing community pharmacists, in contact with opiates dependent patients and according to their involvement to independently evaluate the therapeutic process. Such an independent evaluation by pharmacists is a methodological novelty in belgian treatment evaluation at least in methadone therapy evaluation, until now performed by doctors on their patients.
In accordance with a national map of methadone provisions that will thus be drawn up, a representative local selection of OCS-member community pharmacists will allow data collection on patients and doctors involved in substitution therapy or maintenance and, above all, a process developed for the continuous assessment and follow-up of patients with regard to treatment retention, decrease of heroin use and psychosocial dimensions.
Resources:
Initially, all APB/OPHACO-affiliated community pharmacists in Belgium (n = 5000) are informed of the study and receive a set of instruments to:
1. Quantify their supply of methadone ("general questionnaire"), chiefly using a patient stability/rotation approach.
2. Qualitative assessment of the situation. In order to allow analysis of patient-doctor-community pharmacist interactions, a research strategy has been developed whereby the community pharmacist will conduct an assessment of the patient’s situation ("specific" questionnaire filled in by the community pharmacist in relation to the individual patient, but also the patient’s view as regards the community pharmacist, his or her doctor and the therapeutic relationship that has been created. An instrument for measuring this therapeutic alliance is proposed in the research questionnaire for completion by patients ("self-administered" questionnaire). The latter, highly detailed, instrument will give patients an opportunity to express themselves and produce a detailed overview of treatment history and their present state. It is worth noting that a therapeutic relationship is also conceivable between the patient and his (or her) community pharmacist, although the contours of this relationship remain undefined to date. A clue as to the relationship with the community pharmacist will therefore be devised and tested in the subsequent OCS survey in 2003. Both approaches chosen in the assessment, by community pharmacists and patients, still await development in Belgium.
3. Allow the compilation of a sample of representative community pharmacists, known as the " Substitution Therapy Observatory ", in order to develop more detailed assessments, primarily patient follow-up whereby each patient will be assessed at regular intervals.
4.The follow-up instruments will be devised in association with OCS community pharmacists.
General comments and difficulties:
This research action, which acknowledges the dispensing community pharmacist’s "pharmaceutical care" role, will aim to clarify the challenges facing the profession from the point of view of pharmaceutical care wherein the community pharmacist devotes time to the patient and does not simply confine himself to supplying the drug.
The supply of methadone on prescription, primarily by a GP, as is practised in Belgium, calls for new and innovative instruments and the development of adapted data collection.
The absence of a model for assessing available substitution care similar to that found in Belgium means that a specific research strategy needs to be devised.
The involvement within the assessment of dispensing community pharmacists, which is still a rarity (trials in Glasgow), marks a "first" in Belgium. Consequently, limits to be placed on the range, within which each dispensary should collect data, remain unclear: up to what point is the community pharmacist capable of producing an assessment of the patient’s situation?
The study therefore contains a very wide range of questions specifically to pinpoint these limits. Accordingly, the study places a considerable workload on the community pharmacist. This will result inevitably in some participation difficulties. Therefore, it will be necessary to assess non-replies to the study. In order to adjust optimally the overall estimation of the number of patients undergoing treatment, non-respondents will be sampled and selected non-respondents contacted once again (in writing and, if appropriate, by telephone). An estimation that takes account of this segment of the population will then be conceivable in order to obtain a reasonable quantitative estimation of the importance of substitute treatments in Belgium.
Over and above the quantifying of methadone supply, the study proposes a qualitative analysis of its impact.
On the one hand, community pharmacists are being asked to specify the effects of the treatment for their patients from the point of view of both their physical and mental state as well as in psychosocial terms. More mundanely, the study proposes an external assessment of patient attitudes and behaviour in the pharmacy and of reactions of the community pharmacist.
Any difficulties encountered with patients will be analysed.
Furthermore, the treatment being followed will be analysed in relation to the patient’s particular characteristics (notably socio-demographics and therapeutic "career") and according to the patient’s involvement with the community pharmacist and prescribing doctor. Finally, patients will be prompted to make their own assessment of improvements experienced in their life.
Following analysis of all transversal and retrospective data collected nationally, OCS will conduct an individual follow-up study of patients. The study’s implementation will involve community pharmacists who are motivated to look at the situation more closely and capable of reacting speedily to any fresh problems they come across.
The emergence of community pharmacist in methadone therapy evaluation reflects the spread of this form of patient management.
A definition of the community pharmacist’s role, his resources and capacities in the care process for drug users or patients undergoing substitute treatment, along with the devising of a protocol on the supply of pharmaceutical care, represent a perspective within the present study. The results of the action research should provide orientation to any changes to be made to the current mechanism with a view to improving patients quality of life and helping community pharmacists and doctors to improve their collaboration.
Evaluation de la Délivrance de Méthadone en Belgique. Recherche-Action sur le rôle du pharmacien d’officine, la mise en place d’un Observatoire des cures substitutives et le suivi de patients
Bruxelles : Politique scientifique fédérale, 2004 (SP1274)
[To download]
Evaluation de la délivrance de méthadone en Belgique : résumé
Bruxelles : Politique scientifique fédérale, 2004 (SP1444)
[To download]
Evaluatie van de methadon verstrekking in België : samenvatting
Brussel : Federaal Wetenschapsbeleid, 2004 (SP1445)
[To download]
Evaluation of APB methadone maintenance in Belgium : summary
Brussels : Federal Science Policy, 2004 (SP1446)
[To download]
