The Department of Veterans Affairs (VA) Pharmacy Benefits Management (PBM) Clinical Pharmacy Practice Office (CPPO) and Pharmacy Residency Program Office (PRPO) developed and implemented comprehensive strategies to expand advanced clinical pharmacy practice excellence and postgraduate pharmacy residency training. These innovative efforts resulted in greater patient access to care, improved patient safety, identification and treatment of substance use disorders, and enhanced care coordination.
The VA CPPO is responsible for the development of specific interventional and proactive approaches to support and sustain the expansion of clinical pharmacy practice targeting and supporting the VA’s core mission to improve veteran access and quality of care. For nearly a decade, this office has focused on aggressively transforming VA clinical pharmacy practice to demonstrate the impact of clinical pharmacy specialists (CPS).
The VA CPS advanced practice providers are highly trained; over 45 percent of VA pharmacists serve in this advanced practice role. Seventy-nine percent have received residency training and have board certification and other certifications. Through the leadership of the PRPO, the VA trains the largest number of PGY1 and PGY2 residencies in the United States, including a large percentage of PGY2 residencies in ambulatory care and psychiatry and the only neurology residency in the country. As a result of advance training and provision of CPS services, pharmacist prescribing has grown by more than 30 percent in three years with an increased diversity of prescribing. Pharmacists write over 20 percent of all prescriptions in seven drug classes, representing a fivefold increase in three years. The VA has seen tremendous growth in CPS practice in primary care, pain management, mental health, acute care, antimicrobial stewardship, and areas where comprehensive medication management needs exist.
The CPS expansion strategy has increased access to care, including leveraging CPS providers in rural areas and increasing access to care in mental health and pain management. A joint project of the CPPO and Office of Rural Health hired 183 CPS across 63 VA medical facilities focused on improving veteran access in rural settings. Pharmacist encounters have grown steadily, with an estimated 6 million pharmacist encounters in 2018 alone. This expansion demonstrates the VA's commitment to addressing issues of pain management, mental health, and substance use disorders. The VA CPPO and PRPO employed a broad-based, multipronged process that leveraged key relationships, policy, legislation, networking, data infrastructure and technology, research, communication and marketing, and employee development across all practice areas to achieve dramatic patient outcomes.