BACKGROUND Pharmaceutical care services have been recognized as the most highly regarded professional pharmacy practice model that allows the identification, intervention, and resolution of drug related problems. This practice provides significant clinical outcomes and can reduce direct and indirect costs for health systems. However, its implementation can be complex and challenging, needing study experiences that aims at overcoming obstacles, especially in free and universal healthcare systems. The objective of this study is to evaluate the implementation of Ambulatory Care Pharmacy services for older adults at Paulista Institute of Geriatrics and Gerontology (IPGG), which is recognized in the city of São Paulo for offering pharmaceutical care services for over 10 years continuously. This initiative and process is independent of external academic interventions or educational institutions. It is hoped that the results may also contribute to advancing the implementation of pharmaceutical care service in similar health systems. DESIGN This is a case study using multiple sources of data. Qualitative and quantitative data were collected from institutional documents, by participant observation and interviews. Initial themes were identified by content analysis and analyzed under the context-mechanism-outcome configurations (CMO Configurations) in realistic evaluation. SETTING Geriatrics and Gerontology Institute of São Paulo (known as IPGG). PARTICIPANTS Eleven health professionals and three pharmaceutical care service users. RESULTS Three CMO configurations were identified and accepted: "Scenario Construction mediated by educational processes", "Contribution to complex needs resolution", and "Organizational Visibility". The CMO (Context-Mechanism-Outcomes) configuration "Logistic activities discourage clinical pharmaceutical services implantation" was denied due to the influence of accepted CMOs. CONCLUSIONS Educational processes which value transdisciplinary knowledge exchanges provide resources required to overcome important obstacles present during pharmaceutical care implementation. Thus, providing and seeking knowledge to build and offer context-consistent clinical health services as well as fulfilling organizational environment requirements can be the key to implement pharmaceutical care service.

中文翻译：

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在巴西公共卫生系统中对老年人实施药学服务：案例研究和现实评估。


背景技术药学服务已被公认为最受推崇的专业药学实践模式，它允许识别、干预和解决药物相关问题。这种做法提供了显着的临床效果，并可以减少卫生系统的直接和间接成本。然而，其实施可能是复杂且具有挑战性的，需要旨在克服障碍的研究经验，特别是在免费和全民医疗保健系统中。本研究的目的是评估保利斯塔老年病学和老年学研究所 (IPGG) 为老年人提供的门诊药房服务的实施情况，该机构因连续 10 多年提供药房护理服务而受到圣保罗市的认可。这一举措和过程独立于外部学术干预或教育机构。希望研究结果也能有助于推进类似卫生系统药学服务的实施。设计 这是一个使用多个数据源的案例研究。通过参与观察和访谈从机构文件中收集定性和定量数据。通过内容分析确定初始主题，并在现实评估中根据背景-机制-结果配置（CMO 配置）进行分析。设置 圣保罗老年病学和老年学研究所（称为 IPGG）。参与者 11 名卫生专业人员和 3 名药物护理服务用户。结果 确定并接受了三种 CMO 配置：“由教育过程介导的场景构建”、“对复杂需求解决的贡献”和“组织可见性”。 CMO（背景-机制-结果）配置“后勤活动阻碍临床药学服务植入”由于已接受的CMO的影响而被拒绝。结论 重视跨学科知识交流的教育过程提供了克服药学服务实施过程中存在的重要障碍所需的资源。因此，提供和寻求知识以建立和提供与环境一致的临床健康服务以及满足组织环境要求可能是实施药学服务的关键。