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Office of Rural Health

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Enterprise-Wide Initiative (EWI) - Specialty Care

COPD CARE

Background

The Clinical Pharmacist Practitioner (CPP) Enterprise-Wide Initiative also known as the CPP Increase Rural Veteran Access (CRVA) Initiative, affords greater access to medication management services, as well as chronic disease management services to rural Veterans. CRVA uses multiple approaches such as virtual visits into the home, within a Department of Veterans Affairs (VA) Medical Center (VAMC), or to VA Community-Based Outpatient Clinics from a VAMC. The CPP is an Advanced Practice Provider that has the authority to provide complete medication management services across a range of common disease states. Optimizing the role of the CPP in working with providers, care teams, and Veterans improves medication use and clinical results as well as access to care.

Medication management decisions are increasingly challenging, and medications are involved in 80% of patient care treatments. These skilled practitioners provide a bridge in the gaps in care. This initiative focuses on Increasing access to CPP providers for rural Veterans by optimizing the role of the CPP provider. More specifically, this initiative emphasizes models of care that demonstrate how CPP providers improve clinical outcomes with positive returns for rural Veterans.

This program focuses on integrating primary care and specialty care services to deliver a coordinated and holistic approach to COPD management. COPD CARE (Coordinated Access to Reduce Exacerbations) is a service uniquely positioned to serve rural Veterans as the service delivery model integrates Patient Aligned Care Team (PACT) clinicians working within rural CBOCs across rural America. Given the PACT integration of COPD CARE using the CPP, the service is well positioned to expand using VA Video Connect to reach rural Veterans to manage COPD and other co-morbidities.

Goals and Objectives

One in four Veterans suffer from COPD with Veterans living in highly rural areas experiencing significantly greater death rates compared to their urban counterparts. Best practice standards exist to optimize COPD management and to improve patient outcomes, however just one-third of patients with COPD receive guideline-concordant treatment. COPD CARE is an initiative designed to integrate COPD best practices into primary care using a team-based approach.

The overall goal of the COPD CARE service is to deliver evidenced-based COPD best practices to Veterans after experiencing a COPD exacerbation by leveraging clinical pharmacist expertise. COPD CARE is designed to improve Veteran access to timely primary care while reducing the risk of Veterans experiencing life-threatening COPD complications.

Methodology

COPD CARE was established in 2015 at the William S. Middleton VA, in Madison, Wisconsin. With the support of the Pharmacy Benefits Management Clinical Pharmacy Practice Office (CPPO), Diffusion of Excellence Program, and the Veterans Health Administration (VHA) Office of Rural Health, COPD CARE is active at 50 facilities as of fiscal year (FY) 2025. The CRVA COPD CARE FY2023-2025 cohort consists of 22 PACT CPP spread across 17 unique VA facilities with the goal to utilize CPPs to optimize the care of Veterans with COPD, increase Veteran access to post-COPD exacerbation care with the CPP, and reduce re-exacerbation rates for Veterans with COPD.

Within COPD CARE, Veterans receive: The MoPOC Map

  • Post discharge Telephone Contact by a PACT Registered Nurse for symptom assessment and transitions of care education within 48 hours of exacerbation.
  • COPD CARE Wellness Visit with CPP to review history, assess symptoms, evaluate medication adherence and inhaler technique, optimize medication regimen, provide education and COPD action plan, order spirometry, labs and place other referrals pulmonary rehabilitation, nutrition, tobacco cessation, and others as applicable with 30 days of exacerbation.
  • On-going Follow-up Visits with CPP or Interdisciplinary Team Member for comprehensive medication management and symptom evaluation, and education emphasizing COPD action plan.

COPD CARE integrates the CPP into PACT practice to increase access for rural Veterans and increase quality of care.

Impact on Rural Veteran Health

The MoPOC Map
  • CRVA COPD CARE CPP (FY23-FY25Q1) served over 25K Veterans resulting in over 92K Comprehensive Medication Management Patient Care Encounters with 77% of those being rural, and 9,791 COPD Medication Interventions.
  • CRVA COPD CARE outperforms VA national averages in several guideline directed COPD therapy medication and vaccination quality indicators. There has been statistically significant and clinically meaningful improvement in the COPD Assessment Test (CAT) symptom scores.
  • Initial analysis of COPD CARE pilot sites demonstrated that Veterans enrolled in the program had a statistically significant reduction in all-cause and COPD-related readmissions and death, as well as improved patient access to health care compared with patients receiving standard of care.
COPD analysis data

Key Takeaways

  • COPD CARE is an innovative model that highlights interdisciplinary, collaborative, team-based care strategies for COPD practice integration.
  • Incorporation of the COPD CARE program aligns with VHA priorities and the needs of rural Veterans.
  • Participation in COPD CARE team-based service, led by CPP, resulted in greater access to health care, increase receipt of COPD management best practices, and readmission reduction compared to treatment as usual.
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Download the Printable PDF for Healthcare Providers and Researchers.

References

  • Croft JB, Wheaton AG, Liu Y, et al. Urban Rural County and State Differences in Chronic Obstructive Pulmonary Disease — United States, 2015. MMWR Morb Mortal Wkly Rep. 2018; 67:205–211. DOI: http://dx.doi.org/10.15585/mmwr.mm6707a1*.
  • Mannino, DM, Homa, DM, Akinbami, LJ, Ford, ES, and Redd, SC. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. MMWR Surveill Summ. 2002; 51: 1–16.
  • Hill K, Golstein RS, Guyatt GH, et al. Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. CMAJ. 2010; 182(7):673–8.
  • Ahmad FB, Anderson RN. The Leading Causes of Death in the US for 2020. JAMA. 2021;325(18):1829–1830. doi:10.1001/jama.2021.5469.
  • US Department of Veterans Affairs. 172VA10P2: VHA Corporate Data Warehouse – VA. 79 FR4377. Accessed May 16, 2019.
  • Portillo, Lehmann, Hagan, et al. Integration of patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management. JAPhA. 2023; (63); 212-219.
  • US Department of Veterans Affairs. Pharmacy Benefits Management. Clinical Pharmacy Practice Office. CRVACOPDCARE-Power BI (powerbigov.us) Accessed March 31, 2025.

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