A Multidimensional Framework for Pharmaceutical Care to Enhance Medication Adherence and Patient Engagement: The CMO–MAPEX Model

Purpose: This study aimed to develop Capacity–Motivation–Opportunity MAPEX (CMO–MAPEX), a multidimensional, patient-centred and operational framework to guide medication-adherence support in outpatient pharmaceutical care. Methods: A six-stage framework-development process was undertaken. First, a narrative scoping synthesis identified behavioural, experiential and organisational determinants of medication adherence relevant to outpatient pharmaceutical care. Second, key constructs were extracted and coded into a shared analytic matrix. Third, framework analysis was applied to cluster constructs into higher-order domains. Fourth, an integrative synthesis aligned the emergent CMO structure with evidence on adherence, treatment burden, patient experience and hybrid-care models. Fifth, the conceptual architecture was translated into a structured clinical workflow incorporating CMO-based assessment, a three-level complexity stratification system, domain-specific intervention families and hybrid follow-up rules. Finally, a multidisciplinary expert panel reviewed and refined the framework to ensure ecological validity and feasibility in routine practice. Results: The analysis yielded a stable three-domain structure—Capacity, Motivation and Opportunity—capturing patients’ ability to manage treatment, their beliefs and emotional readiness, and the contextual conditions enabling or hindering adherence. These domains were operationalised through assessment indicators, complexity-based stratification, targeted intervention mapping and longitudinal hybrid-care pathways. Patient-reported outcome and experience measures were embedded as core components to monitor treatment burden, preferences and experience, and to support dynamic re-stratification and adjustment of follow-up intensity over time. Conclusion: CMO–MAPEX provides a pragmatic and scalable framework that translates adherence theory into patient-centred pharmaceutical care. By integrating behavioural determinants, patient experience and hybrid-care organisation within a single operational structure, it offers a reproducible approach to tailoring adherence support according to patient preferences and complexity in outpatient settings.