Related
projects
What do initiation and
adherence mean?
The World Health Organization (WHO) defines medication adherence as “the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.”
Lack of adherence to prescribed treatments can lead to a decline in health and an increase in healthcare expenditure.
Initiation is a type of adherence. Specifically, a person who begins a prescribed treatment for the first time is known as an initiator patient.
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
1. Initiators project
2014 – 2017
Phase 0
PRECLINICAL
2018 – 2019
Phase 1
INTERVENTION MODELLING
2019 – 2020
Phase 2
INTERVENTION PILOTING
2021 – 2025
Phase 3
IMA-cRCT RANDOMISED CONTROLLED TRIAL
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
Initiators is a research project that studies the lack of initiation of medication among adults in Catalonia. This project consists of various phases with specific objectives.
Below is a description of the phases that precede the IMA-cRCT Project:
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
2014 - 2017
2019 - 2020
2014 - 2017
The Pre-clinical Phase took place between 2014 and 2017 with a mixed methodology:
Firstly, there was an appraisal of the prevalence of non-initiation in Catalonia by means of an epidemiological study with Real World Data, data generated automatically in the healthcare system.
This study found that approximately 1 in 6 new treatments prescribed in primary care were not initiated. Specifically, in medications prescribed to treat a chronic disease, the number of treatments not initiated was 1 in 10. This study demonstrated that:
Young people and the immigrant population with a group of specific diseases were less likely to start taking their medication. The same situation occurred when the medication was prescribed by a doctor other than the patient’s usual one. There was also an evaluation of the consequences of not initiating medication on the use of healthcare services, sick days and costs. It was found that, although people who adhered to the treatment made more use of medication than non-initiators, patients who adhered had fewer sick days than non-initiators. It was seen that non-initiation of some medication led to higher financial costs for the system in the short term.
The aim was also to find out what reasons patients had for not starting to take the new medications and, for this purpose, interviews were held with patients who had decided not to initiate a treatment.
It was seen that patients base their decision on a risk-benefit ratio according to their perception of their condition and the treatment prescribed for it. This may be influenced by the relationship that the patient has with their doctor and with other health professionals, such as their pharmacist, the existence of other alternative therapies to the one prescribed, and their level of health literacy.
These results were used to develop the theoretical model of non-initiation.
Funding
This study was funded with help from the Health Research Fund (FIS), of the Carlos III Health Institute (ISCIII) under the Ministry of Health, Consumption and Social Welfare. FIS 14/00052.
Results
Maria Montserrat Gil Gribau, Aznar-Lou I, Peñarrubia-María MT, Moreno-Peral P, Fernández A, Bellón JÁ, Jové AM, Mendive Arbeloa JM, Fernández-Vergel R, Figueiras A, March MA and Rubio-Valera M.
Reasons for medication non-initiation: A qualitative exploration of the patients’ perspective
RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY 2020. 16(5): 663-672. [doi:10.1016/j.sapharm.2019.08.002]
Vilaplana Carnerero C, Aznar-Lou I, Peñarrubia-María MT, Serrano-Blanco A, Fernández-Vergel R, Petitbò-Antúnez D, Maria Montserrat Gil Gribau, March MA, Mendive Arbeloa JM, Sánchez-Viñas A, Carbonell-Duacastella C and Rubio-Valera M.
Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020. 17(10): 3358. [doi:10.3390/ijerph17103358]
Cristina Carbonell-Duacastella, M.ª Montserrat Gil-Girbaub, M.ª Teresa Peñarrubia-Maríac, Maria Rubio-Valeraa, Ignacio Aznar-Loua.
Pacientes no iniciadores de tratamientos
FORMACIÓN MÉDICA CONTINUADA EN ATENCIÓN PRIMARIA 2020. 27(9):476-479. [doi: 10.1016/j.fmc.2019.12.010]
Aznar-Lou I, Pottegård A, Fernández A, Peñarrubia-María MT, Serrano-Blanco A, Sabés-Figuera R, Maria Montserrat Gil Gribau, Fajó-Pascual M, Moreno-Peral P and Rubio-Valera M.
Effect of copayment policies on initial medication non-adherence according to income: a population-based study.
BMJ QUALITY & SAFETY 2018. 27(11): 878-891. [doi:10.1136/bmjqs-2017-007416]
Aznar-Lou I, Maria Iglesias Gonzalez, Maria Montserrat Gil Gribau, Serrano-Blanco A, Fernández A, Peñarrubia-María MT, Sabés-Figuera R, Murrugarra-Centurión AG, March-Pujol M, Bolívar-Prados M and Rubio-Valera M.
Impact of initial medication non-adherence to SSRIs on medical visits and sick leaves.
JOURNAL OF AFFECTIVE DISORDERS 2018. 226: 282-286. [doi:10.1016/j.jad.2017.09.057]
Aznar-Lou I, Fernández A, Maria Montserrat Gil Gribau, Sabés-Figuera R, Fajó-Pascual M, Peñarrubia-María MT, Serrano-Blanco A, Moreno-Peral P, Sánchez-Niubó A, March-Pujol M and Rubio-Valera M.
Impact of initial medication non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain.
BRITISH JOURNAL OF GENERAL PRACTICE 2017. 67(662): 614-622. [doi:10.3399/bjgp17X692129]
Aznar-Lou I, Fernández A, Maria Montserrat Gil Gribau, Fajó-Pascual M, Moreno-Peral P, Peñarrubia-Teresa MT, Serrano-Blanco A, Sánchez-Niubó A, March-Pujol MA, Jové AM and Rubio-Valera M.
Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients.
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY 2017. 83(6): 1328-1340. [doi:10.1111/bcp.13215]
Impact of initial mediation non-adherence on use of healthcare services and sick leave: a longitudinal study in a large primary care cohort in Spain
Aznar-Lou, I; Fernández, A; Gil Girbau, M; Sabés-Figuera, R; Fajó-Pascual, M; Peñarrubia-Maria M.T; Serrano-Blanco, A; Moreno-Peral, P; Sánchez-Niubó, A; March-Pujol, M; Rubio-Valera, M.
Oral presentation and prize for best article on health economics
Jornadas Nacional AES 2018
Las Palmas de Gran Canaria, Spain
21 to 22 June 2018
Initial medication adherence: the patients’ perspective
Peñarrubia-María, M.T; Gil-Girbau, M; Fernández, A; Moreno-Peral, P; March-Pujo, M; Serrano-Blanco, A; Fajó-Pascual,M; Rubio-Valera M.
Oral presentation
Initial medication non-adherence: prevalence, risk factors and associated costs
Rubio-Valera, M; Aznar-Lou, I; Peñarrubia-María, M.T; Gil-Girbau, M; Serrano-Blanco, A; Fernández, A; Sabés-Figuera, R; Fajó-Pascual, M; Moreno-Peral, P; March-Pujol, M.
Oral presentation
The impact pf pharmaceutical copayment in initial medication adherence in distinct income-profile populations
Aznar-Lou, I; Pottegård, A; Fernández, A; Peñarrubia-Maria, M.T; Serrano-Blanco, A; Sabés-Figuera, R; Gil-Girbau, M; Fajó-PascuaL, M; Moreno-Peral, P; Rubio-Valera, M.
Oral presentation
ESPACOMP 2017
Budapest, Hungary
30 November to 2 December 2017
The costs associated with the non-initiation of pharmacological treatment
Aznar-Lou I, Fernández A, Gil-GirbauM, Peñarrubia-Maria M, March Pujol M, Sabés-Figuera R, Serrano-Blanco A, Rubio-Valera M
Poster
Infarma Barcelona 2017. European Pharmacy Congress.
Barcelona, Spain
21, 22 and 23 March 2017.
Prevalence and factors associated with the non-initiation of pharmacological treatment
Aznar Lou, I, Gil Girbau M, Peñarrubia María MT, Fernández Sánchez , Jové Massó AM, Moreno Peral P, Fajó Pascual M, Serrano Blanco A, Rubio-Valera M.
Poster
The problem with non-initiation of pharmacological treatment: Preliminary results of a qualitative study
Gil-Girbau M, Aznar-Lou I, Peñarrubia-Maria M, Fernández A, Fajó-Pascual M, Moreno-Peral P, Jové AM, March Pujol M, Rubio-Valera M
Poster
VII Congreso Nacional de Farmacéuticos Comunitarios
Zaragoza, Spain
26 and 28 May 2016
Problems with adherence at the Start of Treatments for Cardiovascular Disease and Diabetes
Retrieved on: 17/09/2020
Author: Vilaplana Carnerero, Carles
Organisation: UNIVERSITY OF BARCELONA
The problem with non-inititaion of pharmacological treatment: evaluation with qualitative methods
Retrieved on: 14/01/2020
Author: Gil Girbau, Maria Montserrat
Organisation: UNIVERSITY OF BARCELONA
The problem with non-inititaion of pharmacological treatment: evaluation with quantitative methods
Retrieved on: 29/06/2017
Author: Aznar Lou, Ignacio
Organisation: UNIVERSITY OF BARCELONA
During the intervention modelling phase, between 2018 and 2019, a qualitative study was conducted with discussion groups that included primary care doctors and practice nurses, community pharmacists and social workers, to find out the perception that health professionals have about non-initiation.
This study confirmed the theoretical model of non-initiation developed in the preliminary stages of the initiators project. Other factors that influenced the patients’ final decision about initiating a treatment were also added, such as, for example, the influence of other health professionals, such as nurses, and the stigma associated with the use of certain groups of medications.
This study defined the components of an intervention to improve the initiation of treatments for cardiovascular diseases and type 2 diabetes mellitus based on shared decision-making.
Funding
Phase 1 was funded with a research grant from the Parc Sanitari Sant Joan de Déu and the Fundación Sant Joan de Déu.
Results
Peñarrubia-María MT, Maria Montserrat Gil Gribau, Maria del Carmen Gallardo González, Aznar-Lou, Ignacio, Serrano-Blanco A, Mendive Arbeloa JM, Garcia-Cardenas, Victoria, Sanchez-Vinas, Alba and Rubio-Valera M.
Non-initiation of prescribed medication from a Spanish health professionals’ perspective: A qualitative exploration based on Grounded Theory
HEALTH & SOCIAL CARE IN THE COMMUNITY. 2022; 30:e213-e221 [doi:10.1111/hsc.13431]
Intervención en Atención Primaria y Farmacia Comunitaria para mejorar la no iniciación farmacológica en la Diabetes y la Enfermedad Cardiovascular
Gil-Girbau,M; Peñarrubia-María, T ; Carbonell Duacastell, C; Gallardo González, MC; ; Planchuelo Calatayud, D; Jiménez Muñoz, B; March Pujol, M; Rubio-Valera, M.
Oral presentation
Infarma Barcelona 2019. European Pharmacy Congress.
Barcelona, Spain
19 y 21 de marzo del 2019
2019 - 2020
In order to check the viability and acceptability of the intervention designed to improve initiation, during 2020 a pilot study was conducted in primary care centres (CAPs) in the metropolitan area of Barcelona. The assessment was carried out using mixed research methodology. Quantitative methods were used to assess the viability of the phase 3 clinical trial, as well as qualitative methods in the form of interviews with professionals and patients to assess the feasibility and acceptability of the IMA intervention. This study served to detect limitations in the test phase and appraise the feasibility of conducting a clinical trial.
The IMA intervention had to be adapted to the current situation resulting from the COVID-19 pandemic.
Funding
The pilot study of a complex intervention to improve initiation in medicinal treatment was awarded a research grant from the Barcelona College of Pharmacists during the 2019-2020 academic year.
Results
Improving adherence to cardiovascular and diabetes treatments in primary care: pilot of a complex intervention
Corral-Partearroyo C, Sanchez-Viñas A, Gil-Girbau M, Peñarrubia-María MT, Aznar-Lou I, Gallardo-González MC, Rubio-Valera M
Poster
ESPACOMP 2021
Online
8 to 19 November 2021
2. KIDS initiators project
At present, there is no evidence about lack of initiation in the paediatric population in Catalonia. Following the steps of the initiators project in adults, this project consists of several phases:
The Pre-clinical Phase is being carried out using a mixed methodology: on the one hand, its objective is to determine the prevalence of initiation of the most prescribed and relevant medicinal treatments in the paediatric population, to estimate the economic consequences of the lack of initiation, and to identify the risk factors of the lack of initiation. To do this, an observational cohort study is being conducted with databases that obtain information from the electronic clinical history of patients.
In turn, the aim of this phase is to understand the behaviour of paediatric initiation and lack of initiation from the perspective of minors, their caregivers and the professionals involved in prescribing and dispensing. At present, a qualitative exploratory interpretive study is being conducted.
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
Funding
This study was funded with a grant from the Health Research Fund (FIS), of the Carlos III Health Institute (ISCIII) under the Ministry of Health, Consumption and Social Welfare. FIS 14/00052
Results
Cristina Carbonell-Duacastella, Maria Rubio-Valera, Sílvia Marqués-Ercilla, Maria Teresa Peñarrubia-María, Montserrat Gil-Girbau, Victoria Garcia-Cardenas, Maria Isabel Pasarín, Elizabeth Parody-Rúa, Ignacio Aznar-Lou.
Pediatric Medication Non-Initiation in Spain.
PEDIATRICS. Accepted
Prevalence of non-initiation of treatment with medication in the paediatric population in Catalonia
Carbonell-Duacastella C, Aznar-Lou I, Sanchez-Viñas A, Peñarrubia-María M, Marques-Ercilla S, Gil-Girbau M, Parody-Rúa E, Garcia-Cardenas V, Pasarín Rua MI, Rubio-Valera M.
Poster
IX Congreso Nacional de Farmacéuticos Comunitarios.
Bilbao, Spain
19 and 22 October 2020
Prevalence and explanatory factors of medication non-initiation in the pediatric population
Carbonell-Duacastella, C, Aznar-Lou, I, Marqués-Ercilla, S, Peñarrubia-María, M, Gil Girbau, M, Garcia-Cardenas, V, Pasaín, MI, Rubio-Valera, M
Poster
International Society for Medication Adherence (ESPACOMP)
Brussels, Belgium
November 2020
Medication non-initiation in the pediatric population: prevalence, explanatory factors and costs
Carbonell – Duacastella, C
Oral communication.
Jornada Científica CIBERESP
Madrid, Spain
23 and 25 March 2021
3. Evaluation of the economic and clinical impact of the initiation and adherence to cardiovascular treatments
Cardiovascular diseases (CVD) generate a high healthcare and economic burden in Catalonia, where non-initiation of treatment in primary prevention of CVD is approximately 10%.
In order to estimate the impact of adherence on the control of cardiovascular risk factors (CVR), prevention of CVR and costs, an observational study of a cohort of adults with a new blood pressure-lowering, lipid-lowering or antidiabetic treatment is being carried out in primary care (PC) with Real World Data from the public health service of Catalonia.
This study will provide information on the consequences of non-initiation of treatment for relevant diseases.
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
Funding
This study was awarded a grant from the XIX Ajuts als millors projectes de recerca en medicina familiar i comunitària in Catalonia 2018.
4. Evaluation of adherence to anti-psychotic drugs
Serious mental illnesses (SMI) are associated with relapses and a worse prognosis due to lack of adherence to treatment with anti-psychotic medication.
The aim of this project is to determine the prevalence and the factors associated with the profiles of lack of adherence to anti-psychotic drugs, taking a variety of therapeutic strategies into account, through a retrospective (prospective) observational cohort study with Real World Data from the public health service of Catalonia.
Later on, the economic impact of each of these profiles will be analysed. At present, the project is in the initial stages of data collection and analysis.
Diabetis Tipus 1
És una malaltia autoimmune que es caracteritza per un augment de sucre a la sang donat que el pàncrees deixa de produir insulina. Sol aparèixer durant la infància, l’adolescència i la joventut. La diabetis Tipus 1 representa un 5-10% de tots els casos de diabetis.
Diabetis Tipus 2
És una malaltia que es caracteritza per un augment del sucre a la sang donat que el cos deixa de produir o poder utilitzar la pròpia insulina. A diferència de la diabetis Tipus 1, la diabetis Tipus 2 s’inicia en adults. És la forma més comuna de diabetis, i representa un 80-90% del total de casos.
Funding
This study was funded with help from the Health Research Fund (FIS), of the Carlos III Health Institute (ISCIII) under the Ministry of Health, Consumption and Social Welfare. FIS PI19/00111