Medication Management Frameworks in the Context of Self-Management: A Scoping Review

Abstract

Purpose

Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management.

Methods

Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review.

Results

About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management.

Conclusion

Medication self-management is a complex process and often impacts multiple areas of an individual’s life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains – medical, emotional and role management.

Keywords:

• medication therapy management
• self-management
• framework
• model
• review

Data Sharing Statement

All data analyzed in this scoping review are included in this published article and its supplementary files.

Ethics Approval and Informed Consent

Not applicable.

Acknowledgments

The authors would like to thank the University of Toronto librarian, Glyneva Bradley-Ridout, for her expertise and assistance in developing the search strategy.

Disclosure

The authors report no potential competing interests with respect to the research, authorship and/or publication of this article.

Additional information

Funding

Dr Guilcher is supported by a Canadian Institutes of Health Research Embedded Clinician Scientist Salary Award on Transitions in Care. Kadesha James is supported by the Dean’s Graduate Scholarship (2019-2021) at the Leslie Dan Faculty of Pharmacy, University of Toronto.