Objective: To understand and describe the meaning of medications for patients. Methods: A metasynthesis of three different, yet complementary qualitative research studies, was conducted by two researchers. The first study was a phenomenological study of patients’ medication experiences that used unstructured interviews. The second study was an ethnographic study of pharmaceutical care practice, which included participant observation, in-depth interviews and focus groups with patients of pharmaceutical care. The third was a phenomenological study of the chronic illness experience of medically uninsured individuals in the United States and included an explicit aim to understand the medication experience within that context. The two researchers who conducted these three qualitative studies that examined the medication experience performed the meta-synthesis. The process began with the researchers reviewing the themes of the medication experience for each study. The researchers then aggregated the themes to identify the overlapping and similar themes of the medication experience and which themes are sub-themes within another theme versus a unique theme of the medication experience. The researchers then used the analytic technique, “free imaginative variation” to determine the essential, structural themes of the medication experience. Results: The meaning of medications for patients was captured as four themes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control. The medication experience is an individual’s subjective experience of taking a medication in his daily life. It begins as an encounter with a medication. It is an encounter that is given meaning before it occurs. The experience may include positive or negative bodily effects. The unremitting nature of a chronic medication often causes an individual to question the need for the medication. Subsequently, the individual may exert control by altering the way he takes the medication and often in part because of the gained expertise with the medication in his own body. Conclusion: The medication experience is a practice concept that serves to understand patients’ experiences and to understand an individual patient’s medication experience and medication-taking behaviors in order to meet his or her medication-related needs.

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)—use of five or more drugs—were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were ‘non-adherence’ (28.1%), ‘need for additional drug therapy’ (21.8%), and ‘low dose’ (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

Resumo Este estudo teve como objetivo compreender os elementos essenciais do processo de sistematização da prática clínica de uma farmacêutica da atenção primária à saúde com base no referencial teórico-metodológico da atenção farmacêutica, que subsidia o serviço clínico de gerenciamento da terapia medicamentosa. Tratou-se de pesquisa qualitativa autoetnográfica, construída de forma colaborativa entre os autores, de outubro de 2014 a outubro de 2015, nos Centros de Saúde da Prefeitura Municipal de Belo Horizonte, onde uma das autoras trabalha. Os dados foram produzidos por meio de observação participante, diários de campo, reflexões e entrevistas semiestruturadas com farmacêuticos que desenvolviam prática clínica na atenção primária à saúde. Os resultados evidenciaram que os principais elementos para sistematização da prática clínica passam pela ‘construção de uma nova identidade profissional na equipe multiprofissional’ e pela ‘incorporação de novas atividades na rotina de trabalho’ que, combinadas, resultam em uma ‘proposta de integração de um serviço de gerenciamento da terapia medicamentosa nos fluxos das unidades de saúde’. Dessa forma, para que o farmacêutico possa legitimar o seu papel no cuidado do paciente, é preciso mudar, transformar, reorganizar e reconstruir a sua prática.

This is a concept analysis of the medication experience with a focus on how it applies to the pharmaceutical care practice framework used by pharmacist practitioners. The medication experience is a vital component of pharmaceutical care practice and of patient-centered care. Although the experience of taking medication has been studied across disciplines for decades, a concept analysis of the medication experience is lacking. Rodgers’ evolutionary concept analysis method was utilized. Ovid Medline, CINAHL, PsycINFO, Sociological Abstracts and Google Scholar databases, references and hand searches were used to compile an international dataset of 66 papers published from 1982 to 2020. As a result of the available literature, the medication experience is defined as one of ambivalence and vulnerability in which the patient is actively engaged in an ongoing process or negotiation, which is pragmatic to the ways in which they live and experience life, contextualized and nuanced within the social construction of their individual realities. The concept of medication experience is an important addition to the scientific literature. The definition of medication experience from the perspective of the patient will help to better explain the concept for future research and theory development to move the discipline of pharmaceutical care practice forward.

The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.