Optimizing the primary care clinical pharmacy specialist: Increasing patient access and quality of care within the Veterans Health Administration

McFarland, M. Shawn; Nelson, Jordan; Ourth, Heather; Groppi, Julie; Morreale, Anthony P.

doi:10.1002/jac5.1177

Cited by 24 publications

(31 citation statements)

References 8 publications

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“…In this role, they can improve access, lower costs, and reduce PCP burden. 19,47 By contrast, consultative integration is partial integration. While a CPS who is seen as auxiliary support for PCPs might free up PCP time by answering questions rapidly, 48 positioning CPS as medication consultants uses only part of their skillset.…”

Section: Discussionmentioning

confidence: 99%

“…18 CPS are advanced practice providers with the authority to prescribe and modify medications, but they do not diagnose, so PCP-pharmacist collaboration is essential. 18,19 CPS have worked in the VHA since the early 1990s, primarily managing diseases (eg, diabetes, hypertension, and lipids) in isolation, or specific medications (eg, warfarin). [20][21][22] However, CPS' training also prepares them to manage patients' multiple disease states using comprehensive medication management (CMM), which includes assessing patients' medication needs, adding drug therapies as necessary, titrating doses to achieve therapeutic levels, and assessing the appro-priateness, effectiveness, and safety across all their medications (prescription, nonprescription, alternative, traditional, vitamins, and nutritional supplements).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

et al. 2021

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Background: With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration.Methods: We examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts.Results: We characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management).Conclusions: CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

et al. 2021

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“…Starting in FY2017, virtual care encounters began to outpace in‐person encounters each year with the most dramatic increase in FY 2020. Previous literature has shown that VA CPS practicing in primary care have been increasingly utilizing virtual care modalities which accounted for 59% of patient care encounters in 2019 11 …”

Section: Clinical Pharmacy Practice Integration Of Virtual Carementioning

confidence: 99%

Virtual care revolution: Impact on clinical pharmacy practices in the Department of Veterans Affairs

Ourth

Heyworth

Galpin

et al. 2021

J Am Coll Clin Pharm

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For nearly two decades, the Department of Veterans Affairs (VA) has invested in the development and implementation of telehealth services which comprises video, store and forward services, and remote patient monitoring. Virtual care includes telehealth services along with telephone care and e‐consults. These efforts proved critical in 2020 due to the coronavirus disease 2019 (COVID‐19) pandemic. Expanding implementation of telehealth to the home became an access and safety imperative. This article highlights VA efforts and infrastructure for expansion of telehealth into the home and clinical pharmacy practice integration of virtual care. The acceptance of technology coupled with advancements in legislation, policy, and technologies has resulted in expanded applications within the health care system. While continued expansion of virtual care seems inevitable, there remain challenges to ensuring both access to virtual care and the safety and effectiveness of the care delivered. Looking to the future, there will be a continued need for future research on outcomes associated with virtual care, exploration of the benefits of video capability over telephone care, and cost‐effectiveness.

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“…Soon after, a CDTM law was passed in Washington state in 1979 and prescriptive authority for pharmacists was adopted by the Veterans Health Administration (VHA) 17 . Since then, the number of pharmacists with prescriptive authority practicing in the VHA system has grown to 4259 as of 2019 18 …”

Section: Collaborative Practice Agreementsmentioning

confidence: 99%

Current status of prescriptive authority by pharmacists in the United States

Sachdev

Kliethermes

Vernon

et al. 2020

J Am Coll Clin Pharm

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Introduction: While pharmacists in other countries have broad independent prescribing privileges, pharmacists in the United States are making progress. Pharmacist prescriptive authority in the U.S. occurs on a continuum with four identified models: patient-specific collaborative prescribing through collaborative practice agreements (CPAs), population-specific prescribing through CPAs, statewide protocols, and classspecific prescribing. States have implemented pharmacist prescriptive authority across this spectrum. As approximately 90% of Americans reside within two miles of a community pharmacy, prescriptive authority of pharmacists leads to improved public health access points and outcomes.Objective: This paper is intended to provide insight into the current landscape of pharmacist prescriptive authority in the United States through 2019 in order to provide historical context and identify opportunities for state policy considerations. This was done through a review of published literature, national professional association resources, individual state pharmacy practice acts, and state legislation and regulations. Conclusion: Significant variability regarding what medications pharmacists can prescribe exists per state statutes. According to data collected from the National Alliance of State Pharmacy Associations (NASPA), 147 bills related to pharmacist provider status were introduced in 39 states during the 2019 legislative session. The interest in pharmacist prescribing stems from current and future challenges within the U.S. health care system: access to care, cost of care, and the anticipated shortage of physicians. The challenge to standardize prescriptive authority across states presents a unique opportunity for future considerations.K E Y W O R D S collaborative practice, collaborative practice agreement, independent prescribing, pharmacist prescribing, prescriptive authority In 2015, the National Association of Boards of Pharmacy (NABP) TaskForce on Pharmacist Prescriptive Authority recommended the inclusion of language in state pharmacy practice acts regarding initiation of medications by pharmacists. Three features for pharmacist prescribing were specifically mentioned in the report: a diagnosis should either not be needed or be readily determined; a formulary listing or protocol be considered; and communication is essential between the pharmacist, patient, and primary care provider. 1 Some groups, primarily from the medical community, argue that pharmacist autonomous prescribing will result in fragmentation of care for patients. 2 Collaboration

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Optimizing the primary care clinical pharmacy specialist: Increasing patient access and quality of care within the Veterans Health Administration

Cited by 24 publications

References 8 publications

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

Virtual care revolution: Impact on clinical pharmacy practices in the Department of Veterans Affairs

Current status of prescriptive authority by pharmacists in the United States

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