CMOCs for final programme theory
| CMOCs—participation | |||
| Context | Mechanism | Outcomes when M present | Outcomes when M not present |
| 1. Recruitment: time point and location (community pharmacy (CP), hospital, clinic) of patient recruitment for participation. Organisational support for recruitment. | M1: mandate, perception of benefit by recruiters. M3: patients trust HCPs who recommends MR. M10: pharmacists or designated recruiters take responsibility for identifying and consenting patients. | O1: patients provide informed consent to participate in MR.17–19 53 65 66 | O2: patient recruitment/participation rates are low.37 42 |
| 2. Patients’ experience and attitudes to pharmacists’ clinical role. | M3: trust in pharmacist skill. M5: perception of benefit from pharmacist-led MR by patients. | O1: acceptance of referral to and participation in pharmacist-led MR.37 | O2: low rates of referral to and participation in pharmacist-led MR.36 46 53
O3: patients seek out specialists, GP or community pharmacist to address concerns or concerns are not met.37 |
| 3. Awareness of MR programmes and referral pathways by healthcare professionals. | M4: recognition of pharmacists’ clinical and professional role by HCPs. M5: pharmacists, doctors, other HCPs perceive benefit of an MR. | O4: increased referral to and/or uptake of MR.49 51 57 65 66 | O5: low referral and/or uptake of MR.37–39 53 71–73 |
| 4. Systems and organisational structures support MR and facilitate its role integration. | M1: mandate to perform MR. M4: recognition and acceptance of MR by pharmacists as professional role. M5: pharmacists’ perceive benefit from MR for patients and their professional standing. | O6: pharmacists perform MR as part of their routine practice.18–21 45 48 53 57 | O7: pharmacists do not perform MR as part of routine practice.40 42 |
| 5. Location of MR appointment. | M2: less effort required. M6: patient preferences. | O1: patients participate in MR.17 23 76 | O2: patients decline to participate in MR.37 38 40 41 52 74 75 |
| 6. Life after hospital has to be reorganised, regained. | M7: patients’ weigh priorities against perceptions of benefit. | O1: patients participate (schedule and attend) in MR.37 | O2: patients do not participate (schedule or attend) in MR they agreed to in hospital.18 19 37 50 51 53 78 |
| CMOC related to participation and process | |||
| 7. Communication, collaboration, coordination and networks | M2: less effort required. M8: invitation to collaborate by pharmacists to doctors, or doctors to pharmacists. | O1: patients are more likely to participate.17 48 53 65
O4: doctors refer to MR.53 56 65–67 O8: all or most issues, for example, medication-related problems or patient problems, are identified and strategies to resolve them suggested or actioned.17–19 45 48 60 O10: pharmacists performing MR are aware when people are discharged.18–20 46 48 57–59 79 80 89 | O9: issues may be missed and strategies to resolve issues cannot be easily actioned.22 23 75 80
O11: pharmacists or patients do not schedule appointments after discharge.40 41 72 O12: pharmacists are not aware when people have left hospital.39 42 44 |
| CMOCs process | |||
| 8. Information available to pharmacist before and during the MR | M8: invitation to collaborate by other HCPs. M9: pharmacists enabled to employ clinical skills and judgement. | O8: all or most issues, for example, medication-related problems or patient problems, are identified and strategies to resolve them suggested or actioned.17–19 45 48 60 65 | O9: issues may be missed and strategies to resolve issues cannot be easily actioned.22 23 57 75 77 80 |
| 9. Regulations and standards guiding MR | M10: pharmacist takes responsibility for MR outcomes. | O13: MR becomes more than an assessment-focused service. 17–19 46 48 | O14: MR constitutes an administrative rather than clinical assessment of medicines, limiting positive process and patient outcomes.22 23 57–59 75 80 |
CMOC, CMO configuration; GP, general practitioner; HCP, healthcare professional; MR, medication reviews.