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Background: In October 2013, a New Medicines Service (NMS) was introduced in community pharmacies in Belgium to support asthma patients who are novice users of inhaler devices with corticosteroids. The protocol-based intervention used the Asthma Control Test (ACT) and the Medication Adherence Report Scale (MARS) to assess asthma control and medication adherence. The NMS is the first initiative that puts advanced pharmaceutical care into practice in Belgium. The present study evaluated the degree to which the NMS program is delivered as intended, drawing on the concept of implementation fidelity (IF)., Methods: The main dimensions of IF and potential moderating and facilitating factors for the implementation of NMS in community pharmacies were evaluated using telephone interviews with pharmacists (n = 497), semi-structured interviews with patients eligible for NMS (n = 30), focus groups among general practitioners (n = 72) and lung specialists (n = 5), and a work system analysis in community pharmacies (n = 19)., Results: The uptake of NMS in Belgian community pharmacies remains low. In addition to practical barriers, pharmacists found it difficult to identify new asthmatic patients when they were not informed about the diagnosis. A lack of commitment from physicians, patients and pharmacists was noted in the early start-up phase of the program. Many pharmacists did not see how NMS differed from existing pharmaceutical care. Physicians considered this service as part of their own tasks and discouraged ACT for asthma follow-up in the community pharmacy., Conclusions: The introduction of the NMS program was not sufficiently embedded in the Belgian health care organization, causing low uptake and resistance to its implementation by pharmacists, patients, and other health care professionals. To increase the uptake of this type of service and its possible extension to other patient groups, more collaboration among the different health care professionals during design and implementation is necessary, as well as systematic data collection to monitor the quality of the service, better training of pharmacists, and more information for patients and physicians., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Since October 2013, pharmacists can offer a new medicines counselling service (NMC). to asthma patients, who start a treatment with an inhaled corticosteroid. Although this individualized service can be organized at the request of the general practitioner (GP). the patient or the pharmacist, the uptake remains quite low. The limited involvement of GPs has already been identified as one of the obstacles to the successful implementation of this project., Objective: To explore the attitudes and opinions of GPs and pulmonologists about NMC., Method: Focus group discussions with GPs were organized during eight meetings of local quality groups in the province of Antwerp, at which a total of 72 physicians were present. Also, five pulmonologists and two GPs with expertise in organization of primary healthcare participated in an interview., Results: A large group of GPs was not aware of the existence of NMC and only a small number of them had experience with it. Nearly all pulmonologists and GPs agreed that repetition of the inhalation technique and follow-up of the adherence are useful. However, there was disagreement about the importance of taking the Asthma Control Test and explaining the pathology by the pharmacist. We could find five barriers that made physicians withhold support for the NMC. The most important obstacle seemed to be that the pharmacist is not obligated to communicate with the physician about the service. In addition, mainly GPs believed that the remuneration is too high and too focused on the number of NMC services performed and that pharmacists enter their domain with delivering this service. Both pulmonologists and GPs were concerned about how the pharmacist will include patients in a NMC, because it isn't always clear what the indication is of the prescribed inhaled corticosteroid. Furthermore, everyone was convinced that the inclusion criteria should be extended, since each patient using inhalation therapy, would benefit from additional support. Finally, some physicians had an objection to the fact that pharmacists are not obliged to follow an additional course before providing the service., Conclusion: The opinions of GPs about NMC were mixed and rather critical, while pulmonologists were somewhat more enthusiastic about the initiative. Although all physicians agreed that there is room for improvement of the concept, some GPs are willing to prescribe BNM for certain patients.