Category: Federal Forum Posters
Purpose: Increasing access to care for rural veterans through integration of mental health and pain clinical pharmacy specialist (CPS) providers affords greater access to comprehensive medication management and quality of care to rural Veterans. The CPS is an advanced practice provider with prescriptive authority to provide comprehensive medication management across the spectrum of chronic diseases encountered in mental health and pain.
Methods: Between October 2016 to October 2017, there were a total of 40 Mental Health and 31 Pain CPS Providers hired through a $136 million 5-year grant to improve access to rural veterans. CPS were evaluated on encounters monthly, number of Veterans served, and the type of interventions provided. Encounters and Veterans served were collected via a national database. CPS interventions were tracked utilizing a standardized template within VA’s electronic health record called the Pharmacists Achieve Results with Medications Documentation (PhARMD) tool. This allowed the CPS to efficiently document select interventions made during patient care encounters. A robust infrastructure to ensure success and provider real time support to facilities included standardization of foundational components, workload/productivity metric goals, deployment of a consultative visit process to promote practice sharing, comprehensive CPS mentorship program, and leadership and clinical bootcamps.
Results: From October 1, 2016 to May 30, 2019, the Mental Health CPS Providers served a total of 29, 607 Veterans, 54.5% of which were rural, through 89, 519 encounters and documented a total of 213,157 interventions. The Pain CPS Providers served a total of 26, 409 Veterans, 55.7% of which were rural, through 66,615 encounters and documented a total of 167,723 interventions. Patient care encounters were accomplished through multiple modalities including face-to-face, telephone, clinical video-telehealth, and video to the Veteran’s home. The top disease states managed by the Mental Health CPS Providers included depression, anxiety, post-traumatic stress disorder (PTSD), insomnia and pain management. For the Pain CPS Providers, the top disease states included pain management, PTSD, diabetes mellitus type II, depression and anxiety. The Mental Health and Pain CPS Providers collectively had interventions in substance used disorders (731), opioid use disorder (792), alcohol use disorder (2,178) and alcohol withdrawal (18).
Conclusion: With the shortage of providers for mental health and pain accompanied by the need for access within rural settings, the CPS Provider in mental health and pain demonstrated increased access in underserved rural Veterans by providing comprehensive medication management through multiple modalities. Strong centralized program support allows for standardization of practice across the system to ensure Mental Health and Pain CPS Provider function in a consistent, optimized role.