Category: Federal Forum Posters
Purpose: Creation of a Centralized Anticoagulation Services Hub (CASH) is an important step in the evolution of efficient and effective telepharmacy care to veterans, especially those in rural areas. The initiative is a hub and spoke model that delivers virtual warfarin management services in a highly efficient manner. This model frees up physician and nurse time at facilities where Clinical Pharmacy Specialists (CPS) are not managing warfarin patients. Additionally, it provides efficiencies for facilities without centralized programs and where virtual care isn’t optimized. This allows for the redeployment of facility CPS staff into other critically needed gap areas.
Methods: The VA Pharmacy Benefits Management Clinical Pharmacy Practice Office partnered with four Veterans Integrated Service Networks (VISN) who are part of the Midwest Consortium to develop the pilot hub. A board of directors was formed to guide the project and provide the vision for future expansion. The staffing for the hub includes both CPS and clinical pharmacy technicians (CPT). The care provided by the hub is 100% telephone/telehealth visits. The hub staff developed a standardized workflow with clearly delineated roles and responsibilities. They also developed and deployed standardized templated materials, operating procedures, note templates, task labor maps, business rules for referrals, along with other processes that create a uniform national structure for future expansion. Finally, a dashboard database was developed to assist with patient identification and efficient daily triaging of workload along with a suite of reports to track metrics and quality monitors.
Results: Patient enrollment began in September 2018. As of June 2019, over 1,000 patients have been enrolled in the hub over an 8-month period of time from three different VA medical centers spread across 6 states. The initial staff hired included three CPS and two CPT with additional staff being hired in the next several months. Workload thus far consists of telephone care for all enrolled patients, consults for all new patients enrolled in the hub, information sharing consults, and sending letters to patients. In May 2019, the CPS completed 799 encounters and the CPT signed 719 notes. Workload will continue to increase as additional patients are enrolled until we reach a predicted patient capacity of ~3,300 patients. The time in therapeutic range (TTR) has been consistently above 70% for the initial sites enrolled and has improved for two of the sites since patients enrolled in the CASH.
Conclusion: The CASH, which utilizes a centralized telepharmacy model to build a regional solution to warfarin management services, can free up significant staff time at individual VA medical centers. The project is already achieving its goal to improve access, operational efficiency, clinical outcomes, and lower costs while freeing up providers and CPS to take on roles in areas of high need.