RESUMO
Medications can cause bodily changes, where the associated benefits and risks are carefully assessed based on the changes experienced in the phenomenal body. For this reason, the phenomenology of Merleau-Ponty is an important theoretical framework for the study of experience related to the daily use of medications. The aim of this study was to discuss the contribution of a recently developed framework of the general ways people can experience the daily use of medications-resolution, adversity, ambiguity, and irrelevance-and present reflections about the little-understood aspects of this experience. However, some issues raised throughout this article remain open and invite us to further exploration, such as (1) the coexistence of multiple ways of experiencing the use of medications, by the same individual, in a given historical time; (2) the cyclical structure of this experience; (3) the impact of habit and routine on the ways of experiencing the daily use of medications; and (4) the contribution of the concept of existential feelings to this experience and its impact on patients' decision-making. Therefore, the experience with the daily use of medications is a complex and multifaceted phenomenon that directs the decision-making process of patients, impacting health outcomes.
RESUMO
BACKGROUND: Comprehensive medication management (CMM) is a clinical service based on the theoretical and methodological framework of pharmaceutical care. Service blueprint is one of the most widespread visual tools of service design. It enables description of the processes involved in service provision that ultimately define patient experience. Although studies have shown the clinical, humanistic and economic benefits of CMM, its provision still involves several challenges, which can be minimized with the proper mapping of this service. However, this initiative has not yet been described in the literature using this specific tool. OBJECTIVES: To develop, apply and improve a blueprint for CMM services delivered in the ambulatory setting. METHODS: This qualitative study was organized in two phases. In phase 1, two expert panels were carried out to jointly create a generic service blueprint-model for CMM on ambulatory care involving nine specialists with diverse experiences in the area. In phase 2, the generic model was applied and improved in a public rheumatology clinic. The outcome of phase 2 was defined as the final generic service blueprint-model for CMM in the ambulatory setting. RESULTS: The final generic blueprint-model created has 21 customer actions, of which 2 are considered critical (with great potential for failure and to compromise the patient's experience with the service): "seeking and accepting the service invitation" and "accepting the care plan co-created with the pharmacist". Fifteen backstage actions (without the patient's awareness) were identified, and the most critical occurred in the post-service, such as collection of indicators. The need for 7 support processes was also identified, and 3 of which were critical. Nineteen physical pieces of evidence for the user of CMM service were defined, with consultation room as the only physical piece of evidence considered critical. CONCLUSIONS: The developed service blueprint can improve the patient's experience with CMM and facilitate communication with decision makers and other stakeholders. The model is proposed as a reference that can be customized to different ambulatory care settings.
