Improved Care for Veterans in Rural Areas With Clinical Pharmacist Support Program

More than 100,000 veterans in rural areas experienced improved access to care following the implementation of a clinical pharmacist health program, according to a recent study by Heather Ourth, PharmD, of the Department of Veteran Affairs, and colleagues.

The program, Clinical Pharmacy Specialist (CPS) Rural Veteran Access (CRVA) Initiative, was originally launched in 2016. It is a multi-dimensional approach to increase access to support rural veteran health care needs. Additionally, Pharmacy Benefits Management Service (PBM) partnered with the Office of Rural Health—they received $136 million over 5 years in order to expand the use of CPS in advanced practice provider roles.

To better understand how the CPS program improved access to care within primary care, pain management, and mental health, the PBM Clinical Pharmacy Practice Office (CPPO) developed a new infrastructure. It was designed to ensure CRVA initiative success, and in order to do so, the CPPO formed a steering committee to standardize and operationalize implementation of an enterprise-wide initiative (EWI).

“Comprehensive database systems were established to measure facility CPS hiring status and track the workload, metrics, and interventions of every pharmacists involved in the program,” the researchers explained. “A consultative visit process to promote practice sharing and project successes was deployed and during these visits the team focuses on pharmacist professional practice, CPS practice redesign, and optimization of clinical pharmacy services.”

“A comprehensive CPS Mentorship Program was developed that matches new clinicians with established seasoned practitioners (mentors) to accelerate and standardize project practice implementation across all sites.”

The CPPO developed Clinical Pharmacy Leadership Boot Camps. These were done through a series of virtual teleconferences from September to October 2017 as well as face-to-face sessions. The Boot Camp series focused on implementation, promotion, and maintenance of expanded Clinical Pharmacy programs, and it provided clinical training for the CPS hired. Trainings were based on two curriculums—one for primary care CPS and one for pain and mental health CPS.

According to the findings, CPS providers performed 268,734 patient care encounters for 102,159 veterans from October 1, 2017 through May 30, 2018. Of those veterans, 69% were considered rural.

“The EWI has demonstrated significant increases in access to care,” Dr Ourth and colleagues said.

Specifically, within primary care practices CPS performed 125,371 encounters for 41101 veterans, in mental health there have been 41041 encounters for 16,436 veterans, and in pain management there have been 31,307 encounters for 13,571 veterans. Additionally, the CRVA CPS documented disease state interventions that totaled 300,243 in primary care, 96,943 in mental health, and 74,212 in pain management.

The Clinical Pharmacy Boot Camp programs trained 186 CPS in clinical practice topics. The practice topics were determined by an analysis that identified the largest gaps of knowledge for participants.

“The implementation of this CPS rural health program significantly improved access to care for over 100,000 veterans in the initial year of the program,” Dr Ourth and colleauges said. “This is care that would have not been delivered without these advance practice pharmacists.”

These findings were presented at the 2018 ASHP Midyear Meeting.—Julie Gould