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Introduction Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the adoption of care delivery models that alleviate unmet needs through screening, referral, and tracking of patients in health care settings, yet the overall impact of such models has remained unexplored. This review addresses an existing gap in the literature regarding the effectiveness of these models and assesses their overall impact on outcomes related to experience of care, population health, and costs. Methods In March 2020, we searched for peer-reviewed articles published in PubMed over the past 10 years. Studies were included if they 1) used a screening tool for identifying unmet health-related social needs in a health care setting, 2) referred patients with positive screens to appropriate resources for addressing identified unmet health-related social needs, and 3) reported any outcomes related to patient experience of care, population health, or cost. Results Of 1,821 articles identified, 35 met the inclusion criteria. All but 1 study demonstrated a tendency toward high risk of bias. Improved outcomes related to experience of care (eg, change in social needs, patient satisfaction, n = 34), population health (eg, diet quality, blood cholesterol levels, n = 7), and cost (eg, program costs, cost-effectiveness, n = 3) were reported. In some studies (n = 5), improved outcomes were found among participants who received direct referrals or additional assistance with indirect referrals compared with those who received indirect referrals only. Conclusion Effective collaborations between health care organizations and community-based organizations are essential to facilitate necessary patient connection to resources for addressing their unmet needs. Although evidence indicated a positive influence of screening and referral programs on outcomes related to experience of care and population health, no definitive conclusions can be made on overall impact because of the potentially high risk of bias in the included studies.

Funding informationAmerican College of Clinical Pharmacy (ACCP) and the ACCP Research InstituteThe implementation system described in this article is a customizable blueprint for delivery of comprehensive medication management (CMM) and other medication optimization services.This system is the result of merging implementation science expertise with lessons learned from the parent study, the "CMM in Primary Care" grant. This system is comprised of a number of components, including implementation steps and strategies (ie, activities, practical resources such as assessments and informational materials, and learning supports). While these components are integral to any implementation effort, this project describes their unique operationalization for delivery of CMM in a primary care context. Application of this system is illustrated through an example focused on improving the delivery of CMM by pharmacist-led teams in primary care settings. K E Y W O R D Scomprehensive medication management, implementation science, implementation system, pharmacy practice

Measuring the extent to which an intervention is implemented with fidelity (ie, as intended) is critical to its success. Comprehensive medication management (CMM) is an established pharmacy practice intervention in outpatient settings. However, there is no standardized approach to measuring its implementation fidelity. This article describes a fidelity assessment system that includes measures and tools for use by pharmacists and others involved with the practice of CMM. This system is a comprehensive but modular approach to assessing fidelity designed to facilitate measurement along three fidelity dimensions: context (ie, infrastructure needed to support CMM), content (ie, adherence to CMM), and competence (ie, skillset needed to deliver CMM). Practical recommendations with examples are also provided to facilitate application of the system in real‐world settings. These recommendations are designed to assist with prioritization of the fidelity dimensions to consider timing of the assessments, use of the resulting data, interpretation of the data, and translation of results into actionable decisions. Incorporating fidelity measurement into any CMM implementation effort is key to ensuring consistent care delivery and impactful clinical outcomes.

IntroductionComprehensive Medication Management (CMM) is a collaborative patient‐centered approach to medication optimization. We recently implemented telephonic CMM as part of a multidisciplinary team within a team‐based at‐home care program. The objective of this study was to describe the type and frequency of medication therapy problems (MTPs) identified by pharmacists delivering CMM as part of this program, as well as the acceptance rates of the recommendations made to rectify them.MethodsWe conducted a retrospective chart review of all patients receiving CMM within the program between December 12, 2018 and December 31, 2019. We identified and classified MTPs based on the framework developed by the Pharmacy Quality Alliance. Descriptive statistics were used to determine the quantity of MTPs, as well as the acceptance rates of the recommendations.ResultsWe identified 307 patients who received CMM. Of these patients, 58% were female (178/307) and 96% identified as White (296/307). Average age was 72 years old (SD 13). On average, pharmacists identified 4 MTPs/patient with a 35% acceptance rate (431/1228) for their recommendations. Of those accepted, pharmacists were able to resolve 185 (43%) of these MTPs on their own while providers resolved the remaining 246 (57%) MTPs. Acceptance of MTPs was more likely if patients were spoken to (38.4% vs 29.5%, relative risk [RR] = 1.30, 95% CI 1.10‐1.54, P = .002).ConclusionsPharmacists were able to identify several MTPs when conducting telephonic CMM within a team‐based at‐home care program. These MTPs and their associated recommendations however, often failed to be resolved. Recommendations were more likely to be resolved if patients were spoken to, highlighting the importance of engaging the patient as part of CMM. Future studies should examine ways to improve intervention acceptance as well as the clinical and economic impact of changes made as a result of telephonic CMM and MTP identification.

Ensuring fit between a service and the implementing context is a critical but often overlooked precursor of implementation success. This commentary proposes five key considerations that should be evaluated when exploring fit: alignment with needs and metrics; alignment with organizational resources and capabilities; alignment with organizational priorities and culture; alignment with reimbursement mechanisms for long-term sustainability; and alignment with the regulatory environment. Successful uptake and implementation hinges on careful planning and, most importantly, appropriate fit between the service and the implementing environment.

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Background: Pharmacists' interventions, particularly in the primary care setting, have demonstrated positive outcomes on patient care, but rarely translate into impact and scale when reviewed systematically. Specifically, comprehensive medication management (CMM) is often poorly understood, not well defined, and lacks a measure of fidelity. A consistent approach to delivery of CMM is critical to ensure impact. One way to achieve this is to establish the usability of an intervention, so practitioners have a common language around implementation of CMM to ensure fidelity and facilitate positive outcomes on patient care. Objective(s):The goal of this study was to establish a common language for the CMM patient care process.Methods: This study applies an established implementation science methodology and the Usable Innovation Framework to define and operationalize CMM through a network of 40 diverse primary care practices across the United States. This approach to the development of a CMM patient care process common language document included three phases: (a) Review and synthesis of the literature, (b) Vetting and consensus building, and (c) Usability testing. Results:The end product is the CMM patient care process-a common language document that describes both the five essential functions (ie, core components that must be present to carry out CMM) as well as operational definitions (ie, specific steps, activities, or tasks that must be carried out to achieve each essential function).Conclusions: Establishing a common language for the CMM patient care process ensures consistency in delivery of CMM and establishes a set of expectations across key stakeholder groups including patients, pharmacists, physicians, other health care providers, and payers. This research provides a framework and a common set of essential functions and operational definitions to guide the implementation of CMM delivery in primary care and facilitate replication, scale, and positive impact.