Assessing the Components Needed to Support and Operate Comprehensive Medication Management in Primary Care Clinics

Abstract

Background: Significant attention has been given to developing a consistent patient care process for providing comprehensive medication management (CMM). However, little research exists that examines the structures required to effectively manage a CMM practice to achieve quality, consistency, and sustainability. The aims of this study were to (1) determine the essential components of CMM practice management and the extent to which these components are being carried out in practice, and then use these components to (2) develop a CMM practice management assessment tool to assess and prioritize areas for CMM practice management improvement for an individual clinic. Methods: This study was part of a large implementation and outcomes evaluation project involving 35 primary care clinics delivering CMM across five states. Clinics were divided into three similar cohorts. To begin, a focus group was conducted with CMM managers of participating clinics to understand management’s perspective on the essential components of CMM practice management. Then, one-on-one semi-structured interviews were conducted with the lead pharmacist from all clinics in cohort one. Participants were asked to describe what they considered to be the essential components of CMM practice management and describe them as they applied to their practice. Transcripts from the focus group and cohort one interviews were coded inductively by two investigators using NVivo. Initial codes were grouped into categories, which were considered the essential components of practice management. A descriptive CMM practice management assessment tool was developed from emergent categories and codes. A second series of focus groups were held with the same CMM managers to obtain their feedback on the tool, as well as the essential components. Based on feedback from the focus groups, the essential components and their definitions were refined. Using cognitive interviewing, participants in cohorts two and three completed sections of the tool while verbalizing their thought process and providing feedback. This process led to simultaneous development and refinement of the essential components and practice management tool and enhanced the validity of the results. Results: Thirteen essential components of CMM practice management emerged forming five domains: (1) Organizational support, (2) Care team engagement, (3) Care delivery processes, (4) Evaluating CMM services, and (5) Ensuring consistent and quality care. Each domain consists of two to three components and each component contains several questions which form a 78-item descriptive CMM practice management assessment tool. Conclusion: This is the first study to develop a framework for CMM practice management and create an assessment tool that primary care medical practices can use to assess the core domains and essential components of CMM practice management. Understanding CMM practice management and the components that define it is critical to enhancing and expanding the practice of CMM.