BETHESDA, MD 23 Nov 2016—At Gulf Coast Veterans Health Care System in Biloxi, Mississippi, a Department of Veterans Affairs (VA) initiative to promote the sharing of best practices has been a gateway for providing pharmacy services in the primary care setting.
The project, one of 13 "gold status" programs being shared through VA's Diffusion of Excellence initiative, allows a clinical pharmacy resident to provide primary care services one day per week to veterans with diabetes.
It's a small but important step, said Michelle Richard, clinical pharmacy specialist in behavioral health and director of the 716-bed medical center's postgraduate year 1 (PGY1) pharmacy residency program.
"Right now, the only clinical pharmacists we have in primary care are in anticoagulation," Richard explained.
She said that through the project, which began this past summer, a clinical pharmacy specialist from the anticoagulation service spends one day a week in a primary care clinic. That pharmacist supervises a PGY1 resident who helps veterans improve their diabetes control.
"Their goal is to see five to eight patients each day," Richard said.
Another goal, she said, is for the resident, after a period of supervision, to handle the visits solo and then report to the clinical pharmacy specialist.
"And then they will decide on the treatment and the goals . . . and follow up and schedule the patient to come back in," Richard said.
Richard said veterans with uncontrolled diabetes often have hypertension and hyperlipidemia, and the resident addresses those conditions as well.
She said that through these appointments, veterans' access to care is increased and the resident gains confidence and learns critical patient care skills.
"The residency is all about learning to take care of a patient or a veteran," Richard said. "And we need [residents] to be learning how to make decisions."
She said the primary care experience also teaches the resident "how and when to refer to other services," such as smoking cessation, weight management, and classes taught by dietitians or diabetes educators.
So far, she said, two residents have participated in the project, and a few kinks remain to be worked out, especially with the electronic documentation of the clinic visits.
"Hopefully by next year at this time the clinic will be well established and up and running and the next resident will be able to just jump right in," Richard said.
The resident's work is part of a larger primary care access model that was developed by the Central California VA Health Care System in Fresno. That model and several other gold status projects were featured during VA's August 15 conference on the Diffusion of Excellence initiative, held in Washington, D.C.
The Biloxi facility decided to pilot test the Fresno medical center's gold status model as a way to improve veterans' access to same-day primary care services. The overall project addresses scheduling procedures and staff roles, including the implementation of VA's Patient Aligned Care Team (PACT) initiative principles.
The PACT initiative is a mechanism for professionals other than primary care providers to be included as discipline-specific members of healthcare teams at VA medical centers. But Richard explained that her facility's PACT rollout was incomplete and didn't include clinical pharmacy specialists.
The pilot project also supports PACT components related to nursing services and patient's concerns about nontraditional care models, according to information presented at the August VA conference.
Another gold status project described during the conference focuses exclusively on pharmacists' services within the PACT initiative. The project originated at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, and was pilot tested in Texas at the El Paso VA Health Care System.
According to data presented by El Paso VA Health Care System Clinical Pharmacy Specialist Larry Salvatti during the August conference, the integration of clinical pharmacy specialists into PACT programs has trimmed 15 minutes of overall PACT care provider time from each new patient appointment.
Salvatti's data indicated that 76% of patients who saw a pharmacist before their scheduled appointment with another PACT clinician went on to cancel that appointment. During the first four weeks of the pilot project, the time savings associated with the pharmacists' services created openings for 13 new primary care appointments for veterans.
According to Salvatti's presentation, the medical center plans to expand the pilot initiative next year and anticipates that the project will result in 1883 newly available primary care appointments for veterans annually. To support the rollout, the medical center has approved the hiring of four additional clinical pharmacy specialists.
A third gold status project, developed by Certified Pharmacy Technician Kristine Gherardi of VA Boston Healthcare System's Jamaica Plain campus, focused on "code tray redesign" for improved safety and efficiency during emergency code responses. The project was pilot tested at the VA Loma Linda Healthcare System in California and is scheduled for deployment at three more VA medical centers, according to information presented at the conference.
VA launched the Diffusion of Excellence initiative this year to engage frontline employees and solicit their ideas for improving care for veterans. According to VA, more than 250 projects were submitted for evaluation as gold status best practices.