Improving medication utilization and outcomes by delivering comprehensive medication management services: the experience of Brazil

Introduction: It is well-known that there is a major global problem associated with non-optimized medication use, which costs large sums of money and lives around the world. In addition, in the last 30 years, the profession of pharmacy has been reinventing itself so that it can more significantly impact this problem. It is expected that pharmacists go beyond the distribution of medications to become a professional that works closely with patients and other healthcare providers to guarantee the best possible drug-therapy outcomes. In this context, clinical pharmacy services have been developed, implemented and tested in the last few decades, and the results are promising. More specifically, comprehensive medication management (CMM) services have produced noteworthy clinical, economic and humanistic outcomes. The objective of this presentation is to discuss how CMM has become a major health care innovation worldwide and what the “Center for Pharmaceutical Care Studies -Centro de Estudos em Atencao Farmaceutica-CEAF”, in Belo Horizonte, Brazil, has been doing to foster these services in Brazil. CMM is a service centered on the individual patient in use of medications, is founded upon a robust theoretical framework (Pharmaceutical care practice), and it is usually provided by a clinical pharmacist. The professional uses the clinical method and a rational decision-making process to assess all of a patient’s drug-therapy with the goal to guarantee that all of them are appropriate, effective and safe, given all the patients’ co-morbidities, and that the patient is able and willing to take them as recommended. CEAF is associated with the College of Pharmacy at the Universidade Federal de Minas Gerais. It was founded in 2012 and since then it has focused on four major strategic initiatives: 1. Preparation of competent clinical pharmacists that are able to make rational decisions about drug therapy and work collaboratively with patients and the health care team; 2. Prepare future faculty and researchers that will innovate and further the development of comprehensive medication management services; 3. Support the implementation and development of comprehensive medication management services in public and private health systems; and 4. Conduct research that advance education, service implementation and evaluation and a patient-centered approach to care. Regarding the implementation and sustainability of high-quality CMM services, we have learned that the preparation of pharmacists with a strong understanding and acceptance of a unique philosophy of practice is critical. The traditional pharmacist does not have assimilated this philosophy until she or he is explicitly trained to become a CMM provider. CMM services thrive when pharmacists work collaboratively with other providers, especially in ambulatory clinics. Also, the support of leadership and management is a rate-limiting step for this service to succeed and sustain. Regarding its outcomes, many studies show the significant impact of CMM in patients with multiple chronic conditions and taking many medications. In conclusion, solid evidence suggests that well-trained clinical pharmacists providing CMM services are capable of fixing at least part of the problem associated with morbidity and mortality associated with drug therapy in our societies.