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Office of Rural Health

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Enterprise-Wide Initiative (EWI) - Specialty Care

Clinical Pharmacy Specialist Providers

Background

The Increasing Access to Care for Rural Veterans by Leveraging Clinical Pharmacist Practitioners (CPPs) Enterprise-Wide Initiative (EWI), supported by the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Rural Health (ORH) aims to provide better care and access for rural Veterans using CPPs. CPPs are advanced healthcare providers who can prescribe, change, or stop medications on their own. Since medication management is complex and involved in 80% of patient treatments, CPPs offer comprehensive medication management (CMM) to ensure Veterans get the best results from their medications. Additionally, the PACT (Promise to Address Comprehensive Toxics) Act of 2022 addressed the pathway of service connection for more than 20 conditions related to toxic exposure and allows CPPs to complete Level 1 Toxic Exposure screenings.

The EWI, also known as the “CPP Rural Veteran Access (CRVA) Diffusion Initiative,” uses various modalities to provide CMM to rural Veterans at VA medical centers (VAMCs), and Community-Based Outpatient Clinics (CBOCs). CPPs expand rural Veterans’ access to comprehensive medication management services and chronic disease management services using multiple approaches such as virtual modalities into the home, within a VAMC or CBOCs from a VAMC.

By working closely with other healthcare providers and teams, CPPs help improve clinical outcomes, access to care, and enhance the overall experiences for Veterans and care teams. The CRVA EWI focuses on increasing access to CPPs for rural Veterans by optimizing their role as part of the healthcare team.

Goals and Objectives

More than 4 billion prescriptions are written annually, and drug related disease and death costs exceed $500 billion annually in the United States. The CRVA EWI aims is to increase Veteran access, improve the Veteran experience and quality of their care while decreasing provider and overall team workload.

The overall goal of the program is to deliver evidenced-based care to rural Veterans by leveraging CPP expertise in primary care, cardiology, neurology, and nephrology

The CRVA EWI will:

  • Increase rural Veteran access by leveraging CPP services.
  • Optimize the provision of comprehensive medication management and disease management services through utilization of CPPs.
  • Support the provision of CPP services to rural Veterans through telehealth modalities (i.e. telephone, clinical video telehealth visits (CVT), VA Video Connect).
  • Increase overall Veteran care and experience with medications.

Methodology

The MoPOC Map The CRVA EWI consists of CPPs at 25 VHA facilities across the enterprise dedicated to expanding care to rural Veterans by increasing access to care, improving quality of care, and decreasing provider burden. There are 19 Patient-Aligned Care Team (PACT) CPPs, 12 Cardiology CPPs, four Neurology CPPs and one Nephrology CPP. Fully integrated CPPs improve primary care and specialty performance quality of care metrics, including diabetes, hypertension, hyperlipidemia, and heart failure metrics for rural Veterans.

The CPPs provide individualized, personalized, comprehensive medication management via a Whole Health approach to make sure each Veteran is getting the best overall outcome from the medications they are taking. This approach results in improvement of quality, an increase in patient satisfaction and an improvement of the provider experience. Twenty seven percent of Primary Care Provider (PCP) return appointments can be shifted to the CPP improving PCP access and ultimately increasing the ability for the VA to bring in new Veterans seeking care.

COPD analysis data

Impact on Rural Veteran Health

  • In fiscal year (FY) 2024, 19 PACT CPPs provided care to 8,103 Veterans with 6,013 (74.2%) being rural. Overall, CPP had 23,791 encounters with an overall quality for diabetes, hypertension and statin metrics 3.2% higher than the National average.
  • Twelve Cardiology CPPs provided care to 4,777 Veterans with 3,336 (69.8) being rural. CPP had 14,839 encounters and performed higher than the national average on metrics pertaining to guideline directed medication therapy in heart failure. (FY 2024)
  • Four 4 Neurology CPPs provided care to 1,812 Veterans with 1,270 (70.1) being rural. Neurology CPP had 3,435 encounters. (FY 2024)
  • One Nephrology CPP saw 812 Veterans with 539 (66.3%) being rural. The CPP had 1,752 encounters. (FY 2024)

Key Takeaways

  • CPP in primary care and specialty areas increase Veteran access to the soonest and best care, aligning directly with VHA High Reliability Organization Priorities, allowing overall improvement in access and quality.
  • CPP practicing in PACT and Cardiology outperform VHA national averages in several quality indicators for the practice area.
  • Making the most of the highly trained CPP clinical workforce, who have advanced skills in medication management and can prescribe and modify medications on their own, allows rural Veterans to get better access and quality of care.
  • Incorporation of CPP aligns with VHA priorities and the needs of the Nation’s Veterans.
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Download the Printable PDF for Healthcare Providers and Researchers.

References

  • Glen T. Schumock, JoAnn Stubbings, Michelle D. Wiest, Edward C. Li, Katie J. Suda, Linda M. Matusiak, Robert J. Hunkler and Lee C. Vermeulen. American Journal of Health-System Pharmacy July 2018, 75 (14) 1023-1038; DOI: https://academic.oup.com/ajhp.
  • Watanabe JH, McInnis T, Hirsch JD. Ann Pharmacother. 2018 Sep;52(9):829-837. doi: 10.1177/1060028018765159. Epub 2018 Mar 26 Reference
  • Groppi Julie, Ourth Heather, Tran Michael, Morreale, Anthony, McFarland MS, et al. Increasing rural patient access using clinical pharmacy specialist providers: Successful practice integration within the Department of Veterans Affairs. Am J Health-Syst Pharm. 2021; 712–719, https://doi.org/10.1093/ajhp/zxab011.
  • McFarland MS, Buck M, Crannage E, Armistead L, Ourth H, Finks Shannon, McClurg, M. Assessing the Impact of Comprehensive Medication Management on Achievement of the Quadruple Aim. The American Journal of Medicine, Volume 134, Issue 4, 456 – 461
  • McFarland, MS, Ourth, H, Seckel, E, Gould, K, Ragan, A, Morreale, A. Identification of the optimal primary care clinical pharmacy comprehensive medication management practice in the veterans health administration. J Am Coll Clin Pharm. 2021; 4: 372– 378. https://doi.org/10.1002/jac5.1330

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