Supporting the patient: The Belgian pharmacist’s role in medication adherence

You see it every day in your pharmacy: patients who struggle to stick to their treatments, misunderstand their prescriptions, or feel overwhelmed by their medication regimen.

These aren't just minor inconveniences. They can lead to worsening health conditions, avoidable complications, and even hospitalizations, particularly for those managing chronic respiratory diseases like COPD and asthma.

But what if you had a structured, reimbursed way to actively guide these patients toward better health outcomes?

This post explores precisely that: the proper use of medication (PUM) service. We’ll delve into how this vital program empowers you, the Belgian pharmacist, to significantly improve medication adherence, enhance patient quality of life, and contribute to a more efficient healthcare system.

Ready to unlock the potential of your pharmacy?

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Why Belgian pharmacists are uniquely positioned to improve adherence

Successfully implementing the proper use of medication service isn't just about better patient care; it's about reinforcing your role as a key health partner and leveraging opportunities for reimbursed services.

In fact, you are more than a dispenser: you’re a cornerstone of adherence.

As a pharmacist, you are one of the most trusted and accessible healthcare professionals in the community. Patients see you regularly, often more frequently than their general practitioner (GP).

This consistent contact places you in a unique and powerful position to:

• Identify adherence challenges early on.
• Monitor how patients are actually using their medication.
• Provide timely, expert advice tailored to their specific needs.

 Your unique insight into medication-taking behaviors, potential side effects, and patient concerns is invaluable. The proper use of medication (PUM) service provides the framework to translate this insight into structured, impactful action.

Demystifying the proper use of medication (PUM) service

 So, what exactly is this service designed to achieve in the Belgian context?

 The PUM service is a specific pathway focused on improving the understanding and use of medication for patients with certain chronic conditions, initially focusing on COPD and asthma, through dedicated pharmacist counseling and follow-up.

Who is eligible?

• COPD
  
  
  • Diagnosed ambulatory patient with COPD.
  • Aged 50 years or older (unless the PUM path is initiated by the GP, then the age criteria doesn't apply).
  • Have a COPD treatment prescribed by a GP, with at least one box delivered by your pharmacy in the past 12 months (the treatment can be with LAMA and / or LABA).
  • Note: The pathway can be initiated by the GP, the pharmacist, or the patient themselves

• Asthma
  
  
  • Diagnosed ambulatory patients with asthma
  • Patients prescribed inhaled corticosteroids (ICS) for the first time within the last 12 months, or patients chronically using ICS whose asthma remains insufficiently controlled.
  • Note: The pathway can be prescribed by the GP, the pharmacist, or the patient themselves.
    
    

The best part? Reimbursement!

• For Patients: The service is completely free, removing any financial barrier to accessing this valuable support.
• For Pharmacists: You receive an INAMI/RIZIV fee of €25.94 for each qualifying appointment (initial and follow-up).
  • Crucial Step: Remember to complete the Telenet e-form to ensure you receive your reimbursement!

What does the proper use of medication service involve?

The PUM pathway includes two touchpoints between the pharmacist and their patient:

1. First interaction

• • Timing: Take 5 to 10 minutes immediately after the first delivery of medication, or upon identifying an eligible COPD/Asthma patient.
    
    
  • Preparation: Check the patient's medical history beforehand to have a better overview and undertsanding of their condition.
    
    
  • Consent: Obtain the patient's written signature if you are not already their designated house pharmacist.
    
    
  • Key focus:

• • • • Assess the patient's state of health with the ACT (Asthma Control Test) test
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      • Explain how to use the inhaler with a video or a demo device
        
        
      • Fill knowledge gaps (e.g., difference between reliever/crisis medication and controller/background treatment)
        
        
      • Evaluate current asthma control or COPD impact.
        
        
      • Address corticophobia using facts, countering online misinformation if you feel any reluctance.

2. Follow-up appointment

• • Timing: Typically scheduled for the next medication renewal or within 3-6 weeks after the initial interview
    
    
  • Key focus:

• • • • Assess inhalation technique, measure the effectiveness.
        

• • • • Evaluate medication compliance and overall adherence.
        
        
      • Discuss the patient's experience and feelings about their treatment plan.
        
        
      • Address broader lifestyle factors if not covered previously (e.g., healthy living, smoking cessation).

Official documentation: For detailed protocols and criteria, always refer to the official RIZIV/INAMI and APB guidelines.

Mastering counseling & follow-up: Techniques for impact

Effective PUM delivery hinges on strong communication and practical support:

• Ask, don't just tell: Use open-ended questions ("How have you been feeling since starting this inhaler?") and practice active listening to understand the patient's perspective.
  
  
• Leverage tools:
  
  
  • Medication schedules: Provide clear, simple medication schedule cards.
    
    
  • Digital reminders: Suggest reminder apps or explore pharmacy software with reminder functionalities.
    
    
  • Simplified Instructions: Break down complex information. Use visual aids or resources like targeted emails or videos (e.g., Salvus Health's GGG tool)
    
    

• Address the barriers: Directly tackle common adherence issues:
  
  
  • Memory: Link medication taking to daily routines.
    
    
  • Complexity: Simplify the regimen where possible (in collaboration with the prescriber).
    
    
  • Side effects: Educate on management and when to seek advice.
    
    
  • Cost: While the PUM service is free, be mindful of overall medication costs.
    
    
  • Language/Literacy: Adapt communication using simple language, visuals, and culturally sensitive approaches. Ensure health literacy is considered.

Stronger together: Collaborating within the care network

You're not alone in supporting the patient. Effective PUM involves collaboration:

• Connect with prescribers: Proactively communicate with the patient's GP and specialist (e.g., pulmonologist).
  
  
• Share valuable insights: With the patient's consent, share observations about their adherence, technique, or concerns. This provides the prescriber with a real-world view they might not otherwise get.
  
  
• Promote integrated care: Ensure consistent messaging across the healthcare team to avoid confusing the patient and reinforce the treatment plan.

A chance to create long-lasting relationships with your patients

The medication adherence service presents a valuable opportunity for pharmacists to build strong, lasting relationships with returning patients. These patients visit the pharmacy regularly and engage in meaningful conversations about their condition with a trusted pharmacist. As a result, they receive from you:

• Continuous support: View PUM interviews as part of a longer-term relationship.
  
  
• Reinforcement for success: Acknowledge and praise positive steps the patient takes.
  
  
• Routines: Use refill times or monthly check-ins as opportunities for brief follow-ups.
  
  
• Empowerment: Help patients feel knowledgeable, supported, and in control of their health

Build on trust, drive better outcomes

Through skilled counseling, practical tools, and collaborative care enabled by the BUM service, you directly help patients stay on track with their therapy.

This service is more than just a protocol; it's a powerful way to showcase the expanding clinical role of the Belgian pharmacist. And implementing it effectively can be streamlined.

The Proper Use of Medication service is a cornerstone of modern pharmaceutical care in Belgium. By actively engaging with PUM, you solidify your critical role in optimizing treatment success and patient well-being.