Processo de tomada de decisão em gerenciamento da Terapia Medicamentosa: Da compreensão ao desenvolvimento de um modelo teórico

Abstract

Medication therapy management (MTM) is a clinical service grounded on the theoretical framework of pharmaceutical care. In this service, the practitioner applies the rational decision-making method on pharmacotherapy, proposed in this framework, in order to identify, solve, and prevent drug therapy problems. The aim of this research was to understand how pharmacists make clinical decisions when providing MTM service. This study was developed using the grounded theory methodology. Data collection included individual semistructured interviews with eleven pharmacists, document analysis, as well as observation of clinical case discussions and MTM consultations offered by the participating pharmacists. From the systematic data analysis, two main categories were built: 1. Understanding the rational decision-making method: the process foundation. 2. Balancing the care equation: objective and subjective, which includes a theoretical proposal explaining the pharmacists decision-making process during MTM and factors that can modify this process. This model reveals that pharmacists use the rational method as a structural basis, yielding a dynamic decision-making process where providers feel more confident. According to the findings of this study, the pharmacotherapy knowledge should guide the anamnesis. Thus, the professional can evaluate indication, effectiveness, safety and convenience of medications used by the patient. After exploring patients medication experiences, pharmacists demonstrated to categorize them for helping the conduct definition. Practitioners often discuss the clinical decision with patients, however, shared decision-making is still incipient in this practice. Several factors were found to influence the pharmacists clinical decision, including: the pharmacists interpretation when considering the patient as a whole; professional autonomy; patients absence at the decision time; pharmacists technical knowledge; patients context, and context of professional insertion. This study provides a broad understanding of pharmacists' decision-making process during the care of patients using medications. It can be applied as a basis for educational interventions to train competent professionals on decision-making when providing MTM services.