A pilot integrated qualification program to improve medication use in a long-term care facility: a hybrid effectiveness-implementation study

Felipe Augusto dos Santos Oliveira  Lima; Mariana Martins Gonzaga Nascimento; Cristiane de Paula Rezende; Marina Dias dos Santos; Luciana Raid Farnese; Samilla Dornellas Faria; Aline Silva de Assis Santos; Sabrina Gonçalves Ferreira; Gabriela Oliveira Buzelin-Doria; Djenane Ramalho-de-Oliveira

Felipe Augusto dos Santos Oliveira Lima Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica (PPGMAF), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil https://orcid.org/0000-0003-2106-1980
Mariana Martins Gonzaga Nascimento Departamento de Produtos Farmacêuticos (DPFA), Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil. https://orcid.org/0000-0003-2183-4365
Cristiane de Paula Rezende Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica (PPGMAF), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil https://orcid.org/0000-0001-7457-4187
Marina Dias dos Santos Far-me Farmacoterapia Otimizada, Belo Horizonte, Minas Gerais, Brasil
Luciana Raid Farnese Far-me Farmacoterapia Otimizada, Belo Horizonte, Minas Gerais, Brasil
Samilla Dornellas Faria Far-me Farmacoterapia Otimizada, Belo Horizonte, Minas Gerais, Brasil
Aline Silva de Assis Santos Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica (PPGMAF), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil https://orcid.org/0000-0002-2652-1977
Sabrina Gonçalves Ferreira Centro de Estudos em Atenção Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil https://orcid.org/0000-0003-1743-9354
Gabriela Oliveira Buzelin-Doria Centro de Estudos em Atenção Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil https://orcid.org/0000-0002-6195-927X
Djenane Ramalho-de-Oliveira Departamento de Farmácia Social (DPFA), Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil https://orcid.org/0000-0002-5548-8184

Keywords: Aged, Medication systems, Implementation science, Medication Therapy Management, Long-term Care

Abstract

Objective: to describe the implementation and to assess the effectiveness of a pilot integrated qualification program to improve the medication use in a long-term care facility (LTCF). Methods: This was a type 1 hybrid effectiveness-implementation study. A pilot integrated qualification program to improve the medication use in a LTCF was carried out by implementing a new drug distribution system and a comprehensive medication management (CMM) service according to the following four steps: I) implementation of the drug distribution system followed by the evaluation of the health team’s opinion; II) prescription review with the identification of potential drug therapy problems (PDTPs); III) provision of the CMM service according to the framework of Pharmaceutical Care practice within one year; and, IV) evaluation of the effectiveness of the program through the comparison of clinical and laboratory parameters (blood pressure, glycated hemoglobin and lipid fractions) using the t-test or Wilcoxon signed-rank test. Results: In step I, the distribution system was fully outsourced to a company that furnished all solid oral dosage forms in individual boxes containing a plastic coil with multiple envelopes for 30 days. In step II, 180 PDTPs were identified, and all patients presented with at least one of them. In step III, after the first assessment of the CMM Service, 43 actual drug therapy problems (DTPs) were identified. After one year of service provision, 96 DTPs were identified and 75.8% of them were resolved (n=72). In step IV, a statistically significant difference was observed between the initial and final minimum and maximum systolic and diastolic blood pressure (p<0,05). Conclusions: The pilot integrated qualification program had a positive impact on the clinical parameters. The global population is rapidly aging, making this type of study important to exemplify a multifaceted strategy to improve the quality of drug therapy for institutionalized patients.