title: Strategies for safe medication use in ambulatory care settings in the United States.
abstract: OBJECTIVE
  This study aims to identify strategies for safe medication use practices in ambulatory care settings, with a special focus on clinical pharmacy services.
  
  
  METHODS
  We conducted case studies on 34 organizations, more than half of which were safety net providers. Data included discussions with 186 key informants, 3 interim debriefings, and a technical expert panel. We analyzed qualitative data using inductive analysis techniques and grounded theory approach.
  
  
  RESULTS
  Ambulatory care organizations practice a broad range of safe medication use strategies. The inclusion of clinical pharmacy services is a culture change that supports efforts to improve patient safety and patient-centered care. Organizations integrated clinical pharmacy services when they introduced such services in a purposefully paced and gradual manner. Organizations sustained such services when they collected and reported data demonstrating improvements in patient outcomes and cost savings. Clinical pharmacy services were generally accompanied by strategies that helped organizations to provide patient-centered care; collect and measure process, safety, and clinical outcomes; promote leadership commitment; and integrate care delivery processes. These strategies interacted within organizations in synergistic rather than hierarchical or linear way. Organizational ability to provide safe, patient-centered, and efficient care that is supported by measurable data largely depends on leadership commitment and ability to integrate care processes.
  
  
  CONCLUSIONS
  Ambulatory care organizations use multiple strategies for safe medication use systems. Understanding processes that promote such strategies will provide a helpful road map for other organizations in implementation and sustainability of safe medication use systems.
authors.affiliation: RTI International, Research Triangle Park, Durham, North Carolina 27709, USA. asorensen@rti.org
authors.forename: Asta V
authors.initials: AV
authors.lastname: Sorensen
authors.forename: Shulamit L
authors.initials: SL
authors.lastname: Bernard
mesh_terms: D000554:Ambulatory Care Facilities; D003266:Continuity of Patient Care; D054521:Cultural Competency; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D008508:Medication Errors / Q000517:prevention & control*; D018802:Patient-Centered Care; D010607:Pharmacy Service, Hospital; D017751:Safety Management / Q000379:methods*; D014481:United States