For clinicians who choose not to use citalopram due to recent Food and Drug Administration (FDA) recommendations, other antidepressants within this class may be considered. When citalopram is not utilized based on risk factors for TdP, use of escitalopram is not likely the safest alternative. Based on current literature, fluoxetine, fluvoxamine, and sertraline appear to have similar, low risk for QT prolongation, and paroxetine appears to have the lowest risk. However, there are significant limitations in interpreting the studies, including varying definitions of significant QT prolongation. Therefore, choice of an alternative SSRI should be based on individual risk factors for arrhythmias and other patient-specific factors.

In primary care, clinical pharmacists often deliver a service called comprehensive medication management (CMM). While research has identified that CMM positively influences most aspects of the Quadruple Aim, it is unclear how CMM-both the service and the role of the pharmacist-may influence the primary care provider's (PCP) clinical work, professional satisfaction, and burnout (described here as PCP's work-life). We aimed to identify how PCPs perceive CMM impacts their work-life. Methods: Sixteen PCPs were interviewed. Interview questions centered on how CMM affects their work-life. After interviews were transcribed, a codebook was developed by 2 researchers and from the codes, themes were identified. Results: PCPs spoke of the pharmacist being an added skillset and resource and a collaborative partner in caring for patients. They also described 7 outcomes of having CMM available that contribute to their work-life. These outcomes were: decreased workload, satisfaction patients are receiving better care, reassurance, decreased mental exhaustion, enhanced professional learning, increased provider access, and achievement of quality measures. Lastly, the PCPs described barriers and areas of opportunity related to CMM. Conclusion: Our findings suggest PCPs believe CMM, in general, positively affects their work-life. CMM's impact on PCPs aligns with many previously identified drivers of burnout and engagement among providers. These results shed light on how CMM may foster achievement of the Quadruple Aim. (J Am Board Fam Med 2019;32:462-473.

Background Significant attention has been given to developing a consistent patient care process for providing comprehensive medication management (CMM). However, little research exists that examines the structures required to effectively manage a CMM practice to achieve quality, consistency and sustainability. Objective The objective of this research was to create a CMM practice management assessment tool to identify and prioritize areas of CMM practice improvement. Methods Thirty‐four pharmacists providing CMM from 35 primary care clinics across five states were divided into three cohorts. Semi‐structured interviews were conducted with pharmacists from Cohort 1. Participants were asked to describe the essential components of CMM practice management and to detail the characteristics of these components in their practice. Themes were identified by two investigators and a descriptive practice assessment tool was developed from emergent themes. Using cognitive interviewing, participants in Cohorts 2 and 3 completed sections of the tool while verbalizing their thought process and providing feedback. This process led to simultaneous development and refinement of the tool, as well as developing evidence of content validity. Throughout tool development, a series of four focus groups with managers overseeing pharmacists providing CMM occurred to obtain their perspectives and feedback on the tool. Results A tool with five domains was developed. Each domain consists of two to three essential components of CMM practice management for a total of 13 components. Each component contains several questions which collectively form a 78‐item descriptive practice management assessment tool. Conclusion A descriptive practice management assessment tool was developed that can be used to aid in CMM practice advancement. This tool can provide direction for quality improvement work as pharmacists and managers seek to make their practices more efficient and sustainable.

Background Practice management (ie, the necessary resources and support to provide comprehensive medication management [CMM] in an efficient and productive manner) is a central part of CMM practice. However, research identifying the key components of CMM practice management was previously lacking. Methods Pharmacists providing CMM from 35 primary care clinics across five states were divided into three cohorts. One‐on‐one semi‐structured interviews were conducted with the lead pharmacist from all clinics in Cohort 1. Participants were asked to describe the essential components of CMM practice management as they applied to their practice. Inductive coding of transcripts led to an initial practice management framework. Participants in Cohorts 2 and 3 reviewed the essential components and participated in individual cognitive interviews. Throughout this process, a series of four focus groups with managers who oversaw pharmacists providing CMM also occurred to obtain their initial perspectives, as well as feedback on the evolving essential components of practice management. Results Thirteen essential components of CMM practice management emerged: leadership support, availability and adequacy of clinic space, billing and revenue systems, methods for identifying patients in need of CMM, scheduling CMM services, care documentation, presence and scope of collaborative practice agreements, interprofessional collaboration, engagement of support staff, measuring CMM data, reporting CMM data and outcomes, quality assurance processes, and practitioner training. These essential components were grouped into five overarching domains: organizational support, care delivery processes, care team engagement, evaluating CMM services, and ensuring consistent and quality care. Conclusion This study defined the essential components of CMM practice management which may be used to guide CMM practice development and advancement.

Introduction Social determinants of health affect all aspects of health, including a patient's ability to access and appropriately use medications. Objective To understand the experience of pharmacists incorporating social determinants of health into their comprehensive medication management visits. Methods Two pharmacists practicing comprehensive medication management in an outpatient behavioral health clinic received regular coaching for 10 months from a social determinants of health consultant on incorporating social determinants of health into their visits. At the end of the project, an interview was conducted with both participating pharmacists to learn about their experience. All coaching calls and the interview were recorded, transcribed, and analyzed qualitatively. Results Fifteen codes emerged to describe the pharmacists' experience incorporating social determinants of health into their visits. The codes were categorized using the steps of the Pharmacists' Patient Care Process. Additionally, there was a category of codes describing larger system issues that posed a barrier to addressing social determinants of health, as well as a category of lessons that pharmacists learned through the process of incorporating social determinants of health into their visits. Conclusion Given the prevalence of social determinants of health and the dramatic effect they have on a patient's health and wellbeing, more work needs to be done to determine how health care teams can incorporate and address social determinants of health into their visits. This work provides an important first step to understanding how incorporating social determinants of health fit into the practice of comprehensive medication management.