We assessed the services provided by our pharmacists by conducting a field survey of pharmacists assigned to PACT in 2010. We identified a high demand to provide clinical pharmacy practice refresher courses. In response to that demand, we developed knowledge and case-based Clinical Pharmacy Services Boot Camp Training Programs to assist pharmacists as they become integral members of our Patient Aligned Care Teams.

The goals for the boot camps are to provide evidence-based educational training in seven specific clinical practice areas which are integral to primary care in support of the PACT initiative; establish an educational network infrastructure to provide ongoing training and education for VA clinical pharmacy specialists; share best practices and standardized guidance in clinical pharmacy practice areas; and teach integrated models of care that maximize the skills of the CPS. The program’s interactive, case-based presentations create a uniform framework for disease state management training in osteoporosis, diabetes, hypertension, hyperlipidemia, pain management, hepatitis C and smoking cessation.

This training provides local facilities with the ability to have additional experienced personnel available to provide comprehensive medication management services to veterans. This improves access to care, decreases the burden for physicians and achieves optimal patient outcomes and lower overall healthcare costs.

The PhARMD Project

Clinical pharmacy clinic workload data provides a basis for determining the number of clinical pharmacy visits that occur in VA. It is unable, however, to describe the types of patients and impact of the interventions made by the CPS on a day-to-day basis. A need existed to develop a nationwide, standardized system for documenting and tracking clinical pharmacy interventions made by our CPS workforce during direct patient-care visits that demonstrates the impact of clinical-pharmacy care on the healthcare system.

We began the PhARMD project (Pharmacists Achieve Results with Medications Demonstration) as a grassroots project at two separate VA medical centers — Kansas City and West Palm Beach VA Medical Centers. Working together, they developed a tool for tracking CPS interventions using the computerized patient record system and a clinical-reminder template with embedded health factors. This new “reminder” tool assists our CPS professionals in documenting their progress notes during direct patient-care activities and tracking their key interventions.

This tool documents clinical pharmacy interventions made by the CPS in key disease states in PACT (diabetes, hyperlipidemia, hypertension, heart failure, smoking cessation, bone health, hepatitis C and anticoagulation) as well as additional pharmacotherapy interventions that have demonstrated the potential to reduce harm to patients and avoid costs to the healthcare system.

The reminder tool has point-and-click functionality and can be used easily by the CPS to document therapeutic interventions made, goals achieved due to medication management by the CPS and specific pharmacotherapy interventions, such as prevention or management of an adverse drug reaction or allergy, management of a drug-drug interaction or treatment of a previously untreated existing diagnosis.

We’ve also developed the ability to retrieve the clinical-pharmacy interventions logged by the CPS at the local medical center through database extracts, therefore demonstrating the impact of the CPS at a national level. During six months — from April to September 2012 — more than 35,000 clinical pharmacy interventions were made by CPS personnel at the nine expansion pilot sites. Once the expansion pilot has been completed, the reminder tool will be available for other VA medical centers to utilize.

National rollout of this tool is anticipated for fall of 2012 and throughout 2013. Use of this tool by our CPS workforce in the outpatient setting will provide VA with clinical-pharmacy interventions that can be used for benchmarking clinical outcomes for the profession of pharmacy as a whole.