Integrating comprehensive medication management in specialty clinics: A feasibility study

Abstract

Introduction: Patients dealing with complex medical conditions requiring specialty care and polypharmacy therapy experience many challenges, including the lack of adequate medication optimization services. Pharmacists within specialty clinics are uniquely positioned to improve patient care by offering comprehensive medication management (CMM) services.Objectives: This study explores the feasibility of CMM delivery by clinical pharmacists within specialty clinics. More specifically, it aimed to (1) assess the pharmacists, pharmacy managers, and clinic team members' experience with CMM implementation; and (2) evaluate preliminary evidence of treatment effectiveness.Methods: Seven specialty clinics within an academic medical center were recruited to prepare for, implement, and evaluate CMM over an 18-month period, with two additional clinics joining mid-project. This exploratory feasibility study used mixed data to understand levels of service adoption, evaluate changes in feasibility indicators (acceptability, appropriateness, practicality, intent to continue use, and satisfaction), collect implementation feasibility insights, and evaluate treatment outcomes, both perceived and based on medication therapy problem (MTP) resolution rates. Data sources included administrative data, surveys, interviews, and MTP documentation.Results: Service uptake was highly context dependent, with three of the five clinics discontinuing participation doing so because of challenges with service fit (appropriateness). For the four clinics implementing CMM throughout the study, the benefits were evidenced by the positive changes in the feasibility indicators ratings, perceived improved patient care, and a 96.2% MTP resolution rate. Gaining an understanding of CMM as a service and its potential role within a specialty clinic, ensuring buy-in from clinics and management, identifying implementation strategies such as preparation of workflows, and using a standardized MTP documentation form were highlighted as critical to successful implementation. Conclusion:Providing CMM as a service option for complex patients in specialty care clinics was deemed feasible and beneficial, providing alignment with the clinic culture, patient care approach, and pharmacist role.