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.