Establishing a common language for the comprehensive medication management patient care process: Applying implementation science to standardize care delivery

Abstract

Background: Pharmacists' interventions, particularly in the primary care setting, have demonstrated positive outcomes on patient care, but rarely translate into impact and scale when reviewed systematically. Specifically, comprehensive medication management (CMM) is often poorly understood, not well defined, and lacks a measure of fidelity. A consistent approach to delivery of CMM is critical to ensure impact. One way to achieve this is to establish the usability of an intervention, so practitioners have a common language around implementation of CMM to ensure fidelity and facilitate positive outcomes on patient care. Objective(s):The goal of this study was to establish a common language for the CMM patient care process.Methods: This study applies an established implementation science methodology and the Usable Innovation Framework to define and operationalize CMM through a network of 40 diverse primary care practices across the United States. This approach to the development of a CMM patient care process common language document included three phases: (a) Review and synthesis of the literature, (b) Vetting and consensus building, and (c) Usability testing. Results:The end product is the CMM patient care process-a common language document that describes both the five essential functions (ie, core components that must be present to carry out CMM) as well as operational definitions (ie, specific steps, activities, or tasks that must be carried out to achieve each essential function).Conclusions: Establishing a common language for the CMM patient care process ensures consistency in delivery of CMM and establishes a set of expectations across key stakeholder groups including patients, pharmacists, physicians, other health care providers, and payers. This research provides a framework and a common set of essential functions and operational definitions to guide the implementation of CMM delivery in primary care and facilitate replication, scale, and positive impact.

Education Standards for Pharmacists Providing Comprehensive Medication Management in Outpatient Nephrology Settings

“…(IV) CMM and Processes of Care Delivery CMM is defined by the American College of Clinical Pharmacy as "the standard of care that ensures each patient's medications (i.e., prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbid conditions and other medications being taken, and able to be taken by the patient as intended." 15,33 CMM is a patient-centered approach to optimize medication use and improve patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. It addresses the quadruple aim of value-based care, which includes improving patient care, reducing health care costs, enhancing the patient experience, and improving provider satisfaction.…”

CMM alphabet soup: Making sense of our ABCs

“…MTPs are the primary outcome in this study and an important part of the CMM process of patient care with respect to medication-related problem identification, resolution, and documentation. 4 The authors indicate use of the Pharmacy Quality Alliance (PQA) framework, which is an important point as it ensures use of a standard framework for identifying and documenting MTPs and is a recommended step of the CMM process of patient care. 12 Also, pharmacists relied on collaborative practice agreements (CPA) in the provision of CMM.…”

“…2 Recent research by Blanchard and colleagues, included in this issue of the journal, has shed light on the importance of a well-defined intervention, and, specifically, the significance of explicitly defining the essential functions and operational definitions of an evidence-based intervention to ensure consistent application and replication of the intervention in real-world practice, and, importantly, impact on patient health outcomes. 3,4 CMM is a patient-centered approach to optimizing medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. 5,6 See Table 1 for the full definition.…”

“…Each of these five essential functions is further described through a series of operational definitions, which explicitly define the steps involved to ensure that CMM is implemented and delivered with fidelity, can be taught, and is assessable. 3,4,8 CMM is not a one-time intervention, but rather occurs longitudinally over time with the frequency of visits dependent on the needs of the patient. CMM is appropriate for any individual taking medications, but is ideally suited for patients with multiple chronic conditions using multiple medications who are at high risk for adverse drug effects, chronic disease morbidity and mortality and those who are high utilizers of the health care system.…”

Readiness as a precursor of early implementation outcomes: an exploratory study in specialty clinics

“…The pharmacist is responsible for developing and managing an individualized medication therapy care plan in collaboration with the patient and the healthcare team, including appropriate follow-up to ensure optimal medication use. This intervention has been clearly defined elsewhere through the articulation of key principles, essential functions, and operational definitions [ 21 , 22 ].…”