Introduction: Pharmacist-physician collaboration has shown positive results in improving patient outcomes. Chronic care management (CCM) is a reimbursable service for Medicare beneficiaries in the community setting which includes comprehensive care management and other activities. The pharmacist contribution to CCM services and their associated impact on patient health outcomes has not been fully explored.Objectives: The objectives of this study were to: (a) implement a collaborative CCM service between a community pharmacy and family medicine clinic for their common hypertensive patients; (b) measure blood pressure change for patients receiving the CCM intervention; and (c) report financial viability for the community pharmacy and family practice clinic partnership.Methods: Single group prospective pilot intervention in an independent community pharmacy and family medicine clinic in a small city in the Midwest United States.Forty-five patients with uncontrolled hypertension who are patients to both community pharmacy and clinic were recruited, and 26 received CCM interventions in person or over the telephone from the community pharmacists to manage medications for hypertension. Our main outcomes were blood pressure values and financial viability.Results: Twenty-six patients received at least one community pharmacist encounter.These patients had an average 7.3 mm Hg decline (P = .006) in systolic blood pressure (SBP) and a 2.4 mm Hg decline (P = .079) in diastolic blood pressure (DBP) at 9 months. The total revenue over the study period was $5842. Total revenue for the community pharmacy and clinic was $2785 and $3057, respectively. Conclusion:The community pharmacy/clinic collaboration resulted in improved blood pressure control, a new source of revenue for the community pharmacy, and increased revenue for the clinic. Further research is needed on CCM revenue sharing between physicians and pharmacists to generalize the results.

Background Scholarly activity is a requirement for accreditation by the Accreditation Council for Graduate Medical Education. There is currently no uniform definition used by all Residency Review Committees (RRCs). A total of 6 of the 27 RRCs currently have a rubric or draft of a rubric to evaluate scholarly activity. Objective To develop a definition of scholarly activity and a set of rubrics to be used in program accreditation to reduce subjectivity of the evaluation of scholarly activity at the level of individual residency programs and across RRCs. Methods We performed a review of the pertinent literature and selected faculty promotion criteria across the United States to develop a structure for a proposed rubric of scholarly activity, drawing on work on scholarship by experts to create a definition of scholarly activity and rubrics for its assessment. Results The literature review showed that academic institutions in the United States place emphasis on all 4 major components of Boyer's definition of scholarship: discovery, integration, application, and teaching. We feel that the assessment of scholarly activity should mirror these findings as set forth in our proposed rubric. Our proposed rubric is intended to ensure a more objective evaluation of these components of scholarship in accreditation reviews, and to address both expectations for scholarly pursuits for core teaching faculty and those for resident and fellow physicians. Conclusion The aim of our proposed rubric is to ensure a more objective evaluation of these components of scholarship in accreditation reviews, and to address expectations for scholarly pursuits for core teaching faculty as well as those for resident and fellow physicians.

Background and Objectives: Although burnout in medicine—particularly medical education—represents an ongoing problem, relatively few studies have established longitudinal connections between burnout and risk factors. Establishment of specific causal links and risk factors will determine important curriculum changes to reduce the risk of burnout in medical learners. Our study aimed to explore links between emotion regulation skill (strategies individuals use to regulate emotional experiences and responses to stress) and vulnerability to burnout using a longitudinal design in one family medicine residency program. Methods: Family medicine residents completed the Difficulties with Emotion Regulation Scale (DERS) and the Copenhagen Burnout Inventory (CBI) at the beginning of each year (July/August). The residency program collected data over the course of 5 years. All residents consented to participate. We used linear regression analyses to examine postgraduate year-1 DERS scores as a predictor of postgraduate year-2 burnout and postgraduate year-3 burnout. Results: In this sample of residents, higher scores on the DERS at the first year of residency predicted personal and work-related burnout on the Copenhagen Burnout Inventory (CBI) at the beginning of the second and third years. Conclusions: Difficulties with emotion regulation predicted personal burnout in this small sample. This finding dovetails with cross-sectional data in the literature. Although further mechanisms contributing to burnout should be explored, this finding suggests that direct instruction in adaptive emotion regulation strategies delivered early in medical education could provide significant downstream benefits for family medicine residents.

IntroductionFor patients using QTc prolonging medications, the health care system is challenged to mitigate the risk of drug‐induced long‐QT syndrome (DiLQTS) and sudden cardiac death (SCD). Community pharmacists (CPs) receive QTc alerts when dispensing but intervene infrequently. Personal electrocardiogram (ECG) monitors are a new, inexpensive technology that could provide additional patient risk information to identify individuals with a prolonged QTc interval in real time.Objectives(1) Describe QTc interval‐prolonging medications, QTc interval calculations, and associated interventions and prescriber responses for a CP‐delivered QTc interval assessment program, and (2) Describe patient satisfaction with the service.MethodsA prospective study of 9‐month duration in three community pharmacies in Iowa. CPs were trained to measure QTc interval using the KardiaMobile ECG monitor. English‐speaking patients aged ≥18 years were recruited to have a 30 seconds ECG tracing if the CP received a computer QTc‐related alert or had concern about QTc effect/interaction. CPs used professional judgment regarding prescriber contact but were required to contact the prescriber if the QTc interval was prolonged (>470 ms males, >480 ms females).ResultsThere were 53 patients who met study criteria and participated in the service. Mean age was 55.1 years, 38 (72%) were female, and 19 (36%) received newly prescribed QTc interval‐prolonging medications. A computer‐generated QTc alert was present for 36 (68%) of participants. CPs contacted a prescriber for 6 (11%) patients regarding concern for DiLQTS (mean QTc 495 ms). Of these six instances, three had QTc prolongation requiring mandatory prescriber contact (mean QTc 529 ms). Prescriber contact resulted in medication changes for 3 (50%) patients.ConclusionCPs were able to measure QTc interval, identify patients at risk for DiLQTS, and make accepted medication therapy recommendations related to QTc prolongation. CP assessment of QTc interval may be a useful approach to improve risk stratification of individuals at risk of DiLQTS and SCD.Trial registration: Clinical Trials.gov Identifier: NCT04000542.