Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care. Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service. Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24%) and patient notpresent during consultation (11%). A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists' comfort level performing medication reconciliation improved through the 13 weeks of the study. Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.   Type: Original Research

An ever-changing landscape for environmental health (EH) requires in-depth assessment and analysis of the current challenges and emerging issues faced by EH professionals. The Understanding the Needs, Challenges, Opportunities, Vision, and Emerging Roles in Environmental Health initiative addressed this need. After receiving responses from more than 1700 practitioners, during an in-person workshop, focus groups identified and described priority problems and supplied context on addressing the significant challenges facing EH professionals with state health agencies and local health departments. The focus groups developed specific problem statements detailing the EH profession and workforce’s prevailing challenges and needs according to 6 themes, including effective leadership, workforce development, equipment and technology, information systems and data, garnering support, and partnerships and collaboration. We describe the identified priority problems and needs and provide recommendations for ensuring a strong and robust EH profession and workforce ready to address tomorrow’s challenges.

Electronic medical record data may be an important tool for providing more comprehensive information regarding medication usage. Medication usage assessed by electronic medical records, even among the youngest cohort, appears to be greater than other sources of medication usage indicate. Higher levels of medication use were associated with a number of factors, including gender, body mass index, number of patient encounters, and comorbid conditions.

Collaboration with accountable care organizations resulted in the successful funding of ambulatory care clinical pharmacy services. These services resulted in improved chronic disease control and provider satisfaction.

The other obvious danger of jumping onto the PCMH bandwagon without reformed payment models is that the intense amount of work that is done in care management or non-offi ce-based care (ie, e-visits, phone visits) will go unrewarded. It is clearly in the interest of the insurance industry to encourage family physicians to fully embrace the PCMH model without having to pay for it. If we allow this to happen, we will doom ourselves to a practice model that is high demand but we will not be able to shrink our panel sizes or visit volumes to manageable levels and still keep our offi ce open unless we are paid in a different way.If we step back and look at what kind of payment model would best motivate physicians and their health care teams to perform at the highest level in the care of their patients, it would not be a fee-for-service model. The closer we tie the responsibility for the outcomes of care to both physician and patient, the greater the accountability. Developing primary care capitation payments to family medicine clinics based on population management with specifi c incentives for patient experience markers (a strong correlate to quality) and for key disease management and prevention measures would be our best blend of incentives for payment reform. Our European counterparts have experimented with multiple models and have found that having the bulk of a payment to physicians being a primary care capitation with careful incentives creates an optimal balance. The only way to resource clinics to carry out the work of an effective medical home is to shift more resources into the clinic via payment enhancements but how those payments are structured is critical to getting what we all wantaccessible, rational, quality primary care delivered by care teams led by family physicians.How does this impact residency training? The simple answer is that if the PCMH is the model of care for now and the future, then we need to train residents in an environment that fulfi lls that model. However, given the high stress and high burnout risk, we need to couple our PCMH implementation with education on change management, burnout prevention, and leadership skills. In doing this we will position the next generation of family medicine graduates to be the PCMH leaders of the future.