Ensuring effective implementation: A fidelity assessment system for comprehensive medication management

Abstract

Measuring the extent to which an intervention is implemented with fidelity (ie, as intended) is critical to its success. Comprehensive medication management (CMM) is an established pharmacy practice intervention in outpatient settings. However, there is no standardized approach to measuring its implementation fidelity. This article describes a fidelity assessment system that includes measures and tools for use by pharmacists and others involved with the practice of CMM. This system is a comprehensive but modular approach to assessing fidelity designed to facilitate measurement along three fidelity dimensions: context (ie, infrastructure needed to support CMM), content (ie, adherence to CMM), and competence (ie, skillset needed to deliver CMM). Practical recommendations with examples are also provided to facilitate application of the system in real‐world settings. These recommendations are designed to assist with prioritization of the fidelity dimensions to consider timing of the assessments, use of the resulting data, interpretation of the data, and translation of results into actionable decisions. Incorporating fidelity measurement into any CMM implementation effort is key to ensuring consistent care delivery and impactful clinical outcomes.

Describing the delivery of clinical pharmacy services via telehealth: A systematic review

“…Because is important to ensure that CMM standards are implemented with fidelity to achieve consistent outcomes regardless of who is implementing the service, programs should consider developing an approach to assessing fidelity 14 . This can be accomplished through the development of implementation teams, by administering a self‐assessment to pharmacists who conduct CMM on a reoccurring basis, or by utilizing a fidelity assessment system specific to CMM 91,92 …”

Current and future state of quality metrics and performance indicators in comprehensive medication management for ambulatory care pharmacy practice

“…7,20 In the 4 ensuing years, the CMM in Primary Care Study team identified and evaluated 35 CMM practices with embedded clinical pharmacists across the country, with two general focus areas: how to effectively and efficiently implement CMM with fidelity and how to measure the impact of CMM on clinical and economic outcomes. 21,22 In July 2018, the research team released "The Patient Care Process for Delivering CMM," a seminal publication that defined CMM as an intervention and articulated a common language to include a philosophy of practice, five essential functions, and operational definitions, coupled with a practitioner assessment of fidelity to the CMM model. 20 Establishment of a clear definition of CMM as an intervention has been critical to ensuring a standardized approach to medication optimization in team-based care and further assessing quality of care.…”

Implementation and evaluation of comprehensive medication management in telehealth practices

“…Table 1 provides def-initions and examples of how these indicators have been measured for CMM practices. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https:// dissemination-implementation.org/. 33 The Active Implementation Framework (AIF) has formally been applied to CMM in primary care practices.…”

“…Few validated frameworks have been applied to CMM practices. Table provides definitions and examples of how these indicators have been measured for CMM practices . A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https://dissemination-implementation.org/…”