Evaluation of a consultant pharmacist-delivered comprehensive medication management service
Background In 2010, a pilot program was implemented by the Medication Assessment Consultants (MAC) to provide comprehensive medication management (CMM) services to patients in the community of Saskatoon, Saskatchewan. Clinical pharmacists working as consultants, independent of any retail pharmacy or health system organization, delivered the program. The goal of the MAC CMM service was to optimize therapeutic outcomes for individual patients through improved medication use, and to reduce the risk of adverse drug reactions (ADRs). Purpose The purpose of this study was to evaluate the independent consultant pharmacist model for delivering comprehensive medication management (CMM) services employed by the Medication Assessment Consultants (MAC) pilot program. Methods A program evaluation was performed on MAC, consisting of a document review of program materials (e.g., MAC Policy and Procedure Manual, electronic patient records) along with stakeholder interviews. The document review consisted of the collection of existing MAC documents, followed by an analysis of the information contained within each document. Patients, physicians and MAC staff were interviewed using a semi-structured interview approach. Patient and physician interviews were conducted by phone and by an interviewer external to the study. Interviews were continued until saturation was reached. The MAC staff was interviewed in person by the investigator. All interviews were recorded and transcribed verbatim. Thematic analysis was used to identify common themes by having three individuals independently review each group of stakeholder interview transcripts. Results During the 17-month pilot, 53 patients were referred to MAC, mostly from family physicians (79.2%). Patients were elderly (mean 71 years) and mostly female (67.9%). On average, patients were taking 13.3 medications and had 9.2 medical conditions. For the 42 patients for whom an assessment was completed, an average of 5.1 drug therapy problems (DTPs) per patient was identified. The document review revealed that MAC did not achieve all of its internal program objectives (e.g., to generate a consistent flow of patient referrals; to promote the service to physicians and patients; and to improve medication-related short-term outcomes for patients). All three interview groups reported a high level of satisfaction and support for the program. Interviewees described various ways in which they felt that they benefitted from the program, including medication regimen optimization (patients), support in dealing with complex medication regimens (physicians), and a strong sense of personal and professional satisfaction and fulfilment (MAC staff). The evaluation of the MAC program resulted in the identification of several program strengths (e.g., a strong, well-defined patient care process; an accessible service location; MAC pharmacist mentorship and support program), along with opportunities for improvement (e.g., expanded promotional activities; administrative support for the program; implementation of a formal satisfaction survey to obtain regular feedback from key stakeholders). Conclusion The results of this study suggest the independent consultant pharmacist model for the provision of CMM services has potential to be utilized as a new service delivery model (in addition to community pharmacies and primary health care teams) to provide CMM services in the primary health care system (PHCS). The study findings have identified several strengths and opportunities for improvement, which may be useful for future attempts at implementing the CMM service model.
DegreeMaster of Science (M.Sc.)
DepartmentPharmacy and Nutrition
CommitteeBerenbaum, Shawna; Blackburn, David
Copyright DateOctober 2014
comprehensive medication management