Development and validation of a logic model for comprehensive medication management services.

OBJECTIVES: To develop and validate a theoretical logic model for comprehensive medication management (CMM) services. METHODS: The components of a logic model were constructed after a literature review and interviews with 4 CMM professionals. To validate the logic model, a panel of 17 CMM experts participated in three online Delphi method rounds to achieve consensus on the model. The consensus between the experts on each component of the logic model was evaluated using the Content Validity Index and Inter-rater Agreement in each of the rounds. KEY FINDINGS: A logic model for CMM services containing 51 items was constructed and validated. Both the items of each component of the model and the linkage between the main components were agreed upon among the experts. CONCLUSIONS: A logic model for CMM services was developed and validated. It is an innovative tool that, if used as a theoretical framework for the implementation of CMM, can ensure greater reproducibility of CMM services in different scenarios of practice and levels of care.

Impact of a medication therapy management service on the clinical status of patients with chronic obstructive pulmonary disease.

Background At this moment, there is no information in the literature showing the impact of comprehensive medication management (CMM) service delivered to patients with chronic obstructive pulmonary disease. Objective This study aims to present the clinical outcomes of this service provided to patients with chronic obstructive pulmonary disease. Settings Public specialty pharmacy where high cost drug treatments are provided for medical conditions not covered by the primary care such as COPD, located in Minas Gerais State, Brazil. Methods A retrospective analysis was conducted for 83 patients. The dependent variable in this study was the sum of the drug therapy problems detected during the first and second consultation. The independent variables were age, number of diseases and medications, diagnosis of hypertension, dyslipidemia and diabetes, and tabagism. Univariate and multivariate analyses were performed using Pearson's Chisquare test. A level of significance of 5% was adopted for all analyses. Main outcomes Number, types and proportion of resolved drug therapy problems. Results Two hundred seventy seven drug therapy problems were identified, of which 53.1% were resolved. The most frequent drug therapy problem was the "use of unnecessary drug therapy" (n = 55; 19.8%). The identification of three or more drug therapy problem was higher among patients using five medications or more and among those using ten or more (p < 0.05). After the delivery of medication therapy management, the proportion of patients presenting "stable" clinical status was raised from 27 to 54% (p = 0.001). Conclusion CMM service demonstrates a positive impact on clinical outcomes of patients with chronic obstructive pulmonary disease and should prioritize patients with polypharmacy because they might have a higher number of drug therapy problems.