An implementation system for medication optimization: Operationalizing comprehensive medication management delivery in primary care

Abstract

Funding informationAmerican College of Clinical Pharmacy (ACCP) and the ACCP Research InstituteThe implementation system described in this article is a customizable blueprint for delivery of comprehensive medication management (CMM) and other medication optimization services.This system is the result of merging implementation science expertise with lessons learned from the parent study, the "CMM in Primary Care" grant. This system is comprised of a number of components, including implementation steps and strategies (ie, activities, practical resources such as assessments and informational materials, and learning supports). While these components are integral to any implementation effort, this project describes their unique operationalization for delivery of CMM in a primary care context. Application of this system is illustrated through an example focused on improving the delivery of CMM by pharmacist-led teams in primary care settings. K E Y W O R D Scomprehensive medication management, implementation science, implementation system, pharmacy practice

Implementation of medication management services at the primary healthcare level – a pilot study

“…In conclusion, the action research stage of this study illustrates both pre-implementation and early implementation stages of CMM in a primary care practice with all the challenges that we came across and that needed to be taken into consideration while introducing the CMM service. Moreover, it reflects other experiences and learnings from the use of the implementation system utilized for the purpose of this initiative (early implementation) (34,43).…”

“…The implementation stages utilized previously published research as a roadmap (33,34), which was adapted to the Croatian reality as needed. Additionally, the previously proposed implementation system assisted the piloting of the initial implementation of CMM services through two stages: pre-implementation and early implementation (34).…”

“…The implementation stages utilized previously published research as a roadmap (33,34), which was adapted to the Croatian reality as needed. Additionally, the previously proposed implementation system assisted the piloting of the initial implementation of CMM services through two stages: pre-implementation and early implementation (34). The pre-implementation stage encompassed the following components: ensuring a usable innovation (use of a common language for the CMM philosophy of practice and patient care process), building an implementation team, developing practitioners' readiness to provide the service, identifying and ensuring essential practice management support (infrastructure necessary to ensure the capacity to implement CMM), assessing fidelity of the service and establishing a practice-policy loop.…”

Ensuring effective implementation: A fidelity assessment system for comprehensive medication management

“…39,40 Best practice encourages use of fidelity assessments in an ongoing, cyclical way rather than as a one-time measurement strategy. 47 Although they are often non-linear, these stages are associated with a particular set of implementation strategies and activities, including specific uses and goals for fidelity assessments. Implementation stages refer to phases of implementation over time, such as pre-implementation, initial implementation, full implementation, and stabilization.…”

“…Implementation stages refer to phases of implementation over time, such as pre-implementation, initial implementation, full implementation, and stabilization. 47 Although they are often non-linear, these stages are associated with a particular set of implementation strategies and activities, including specific uses and goals for fidelity assessments. For instance, when implementing a new service, the purpose of the fidelity assessment should be to establish the needed CMM infrastructure and ensure consistency of CMM delivery to maximize potential benefits for patients.…”