Category: Federal Forum Posters
Purpose: Launched in October 2016, the Clinical Pharmacy Specialist (CPS) Rural Veteran Access (CRVA) Initiative employed a multi-dimensional approach to increase access to support rural veteran healthcare needs. Pharmacy Benefits Management Service (PBM) partnered with the Office of Rural Health (ORH) and was awarded $136 million over 5 years to expand the use of CPS in advanced practice provider roles. Funding was provided for the placement of 180 CPS positions at 63 VA facilities and their rural outpatient clinics. The CPS positions are focused on improving access in 3 areas of identified need: primary care, pain management, and mental health.
Methods: The PBM Clinical Pharmacy Practice Office (CPPO) developed an infrastructure designed to ensure CRVA initiative success that included forming a steering committee to standardize and operationalize implementation of this enterprise-wide initiative (EWI). Comprehensive database systems were established to measure facility CPS hiring status and track the workload, metrics, and interventions of every pharmacist involved with the program. 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. Finally, CPPO developed and presented Clinical Pharmacy Leadership Boot Camps through a series of virtual teleconferences from September to October 2017 and Clinical Pharmacy Boot Camps which were face-to-face programs. The Leadership Boot Camp series focused on the implementation, promotion, and maintenance of expanded Clinical Pharmacy programs through a succession of topic specific presentations to facility Clinical Pharmacy Champions. The Clinical Pharmacy Boot Camps provided clinical training for the CPS hired as part of the program through the development of two curriculums, one for primary care CPS and one for pain and mental health CPS.
Results: This EWI has demonstrated significant increases in access to care. During the period from October 1, 2017 thru May 30, 2018, CPS providers have performed 268,734 patient care encounters for 102,159 veterans of which 69% were considered rural. In the primary care practice area, CPS performed 125,371 encounters for 41,101 veterans. In mental health there have been 41,041 encounters for 16,436 veterans and in pain management there have been 31,307 encounters for 13,571 veterans. In addition, the CRVA CPS have documented disease state interventions totaling 300,243 in primary care, 96,943 in mental health and 74,212 in pain management. CPPO conducted 21 consultative visits in FY18 with more anticipated during FY19. The mentoring program has paired 54 mentor/mentee matches and is expanding into a group mentoring program. The five Clinical Pharmacy Boot Camp programs trained 186 CPS in clinical practice topics determined to have the largest knowledge gaps for participants based on a gap analysis assessment. A post-training analysis showed the percentage of participants who rated their knowledge as “No/Minimal” decreased by 83% and the percentage of participants who rated their knowledge as “Mastery” increased by 334%.
Conclusion: The implementation of this CPS rural health program has significantly improved access to care for over 100,000 veterans in the initial year of the program. This is care that would have not have been delivered without these advance practice pharmacists. In addition to the improved patient access, the project has been instrumental in improving the training of both the CPS as well as Clinical Pharmacy Champions at the 63 facilities involved and has helped develop lasting infrastructure and cultural change which will help support future clinical pharmacy practice initiatives.
Heather Ourth– National Program Manager: Clinical Pharmacy Program and Outcomes Assessment, Department of Veterans Affairs, Ackworth, IA