Abstract
Objective: To understand and describe the implementation process of a comprehensive medication management (CMM) service in a public speciality pharmacy in Brazil.Methods: Ethnographic study conducted over 17 mo (September 2014 to February 2016) in a public speciality pharmacy. Semi-structured interviews were conducted with twelve participants. Notes on field journals, resulting from participant observation conducted by the two pharmacists directly responsible for the service implementation, were also used as a source of data.Results: Ten important conditions to improve the success of CMM service implementation were identified: manager support; evaluation of physical and material resources; evaluation of human resources practitioners’ characteristics and knowledge about the theoretical framework of CMM services; time dedicated to CMM services; redefining the work process; defining patient eligibility criteria to CMM service; defining patient flow to CMM service; communication with healthcare team; integration with the staff; and marketing the service internally.Conclusion: The results unveiled by this article can be used by pharmacists and managers as a tool to optimize the implementation of CMM services in different healthcare settings. These conditions do not consist the only aspects necessary to ensure the success of the service; however, they can contribute to optimize the implementation process of the practice
Highlights
Comprehensive medication management (CMM) services [1,2,3] emerged in response to a social demand that traditional health services have demonstrated, which is the difficulty in resolving the marked increase in morbidity and mortality associated with the use of medications [4,5,6,7,8,9]
Pharmacists in the public specialty pharmacy program in Brazil are in a strategic position to offer clinical services that can positively impact the outcomes of drug therapy
The extended fieldwork and the interviews revealed ten categories. They were grouped under a central category entitled “Optimising the implementation of CMM services: conditions to improve the success of the process”
Summary
Comprehensive medication management (CMM) services [1,2,3] emerged in response to a social demand that traditional health services have demonstrated, which is the difficulty in resolving the marked increase in morbidity and mortality associated with the use of medications [4,5,6,7,8,9]. CMM services have shown positive clinical, economic, and humanistic outcomes in many different settings around the world [10,11,12,13,14,15,16]. Given the need for this service driven by social demand, its implementation in different healthcare settings can be seen as imperative. Pharmacists in the public specialty pharmacy program in Brazil are in a strategic position to offer clinical services that can positively impact the outcomes of drug therapy. Incorporation of CMM services can result in financial savings for the health care system [10, 12]. In a 10-year study conducted in a large integrated healthcare system in the United States, pharmacistestimated cost saving was US$ 86 per encounter, and the total cost of CMM was US$ 67 per encounter [10]
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