PALM BEACH GARDENS, FL—A tool developed by the VA has raised the profile of pharmacists as critical members of patient care teams at the VA, leading to a doubling of the number of pharmacists serving as providers.
While the scope of the pharmacy profession has substantially evolved in the last two decades—and nowhere more than at the VA—pharmacists had difficulty communicating exactly how the VA and patients benefit from clinical pharmacists working as advanced-practice providers.
The Pharmacists Achieve Results with Medications Documentation (PhARMD) Project solved the problem, according to a research report in the American Journal of Health-System Pharmacy.1 The project created the PhARMD electronic template tool to enable pharmacists to record their interventions during patient encounters as a component of the veteran’s electronic health record. Pharmacists can just point and click on preset boxes in the progress note documentation.
Simplifying documentation of pharmacist interventions and integrating it into the primary record used by all providers significantly increased visibility of the activities of clinical pharmacists.
“The data from the PhARMD tool has been used to describe the types of key interventions made by clinical pharmacists and clinical pharmacy specialists across the spectrum of practice settings where these pharmacists provide comprehensive medication management services in VA today,” explained Julie A. Groppi, PharmD, FASHP, VA Pharmacy Benefits Management program manager, Clinical Pharmacy Practice Policy and Standards.
“When this data is paired with patient care encounters and clinical pharmacist prescribing data, the impact of the clinical pharmacist in overall patient care becomes apparent,” Groppi told U.S. Medicine. The system links to economic data, as well, readily demonstrating the cost-benefit value of employing clinical pharmacists in a wider range of settings, she noted.
As a result, more VA programs have justified hiring additional clinical pharmacists. That has led to a 99% increase in pharmacy providers since the PhARMD project began in 2012, said Heather Ourth, PharmD, BCPS, BCGP, VA Pharmacy Benefits Management program manager, Clinical Pharmacy Practice Program and Outcomes Assessment.
Pharmacists have become important members of patient care teams and address a range of issues. “We have seen tremendous growth of pharmacist providers providing direct patient care across a number of practice settings such as primary care, pain management, mental health, hepatitis C, acute care and other areas where medication management services are provided,” Ourth told U.S. Medicine.
Burgeoning Interventions
As of Fiscal Year 2018, 140 VA facilities participated in the voluntary PhARMD program. The 5,348 pharmacists who currently use the tool represent a 12% increase in the last year and an 86-fold increase since its initial rollout. In total, they recorded more than four million interventions.
The interventions go well beyond clinical pharmacists’ historical involvement managing anticoagulation clinics, providing education on anti-diabetic agents and addressing chronic conditions such as hypertension, heart failure and dyslipidemia in ambulatory settings.
While these activities represented the bulk of the options available in the template when it was first introduced, each update to the template added more diseases and interventions to better reflect the expanding role of clinical pharmacists within the VA. Now the tool includes hepatitis C, osteoporosis/bone health, antimicrobial stewardship, chronic kidney disease, transplantation, women’s health, mental health and more.
Prescribing activity has risen markedly since the program launched, with a sharp uptick in recent years. “VA prescribing data has shown a 30% increase in pharmacist provider prescribing from FY15 to FY18, as well as increased diversity in prescribing where pharmacist providers prescribed greater than 20% of all prescriptions in seven drug classes in FY18,” Groppi said.
The PhARMD tool provides clear evidence of the contributions made by clinical pharmacists outside of prescribing and medication management, too. Last year, the system recorded nearly 57,000 interventions for comprehensive health education in connection with mental health visits. Pharmacists also performed almost 46,000 suicide risk assessments, screenings and education interventions and made more than 11,000 mental health referrals.
In the area of pain management, pharmacists documented 21,000 high-risk assessments, 23,000 toxicology screens and nearly 33,000 health education and 25,500 opioid education and naloxone distribution interventions in addition to management of both opioids and nonopioid medications.
The Pharmacy Benefits Management Clinical Pharmacy Practice Program and Outcomes Assessment group can query the data uploaded by pharmacists around the country and stored in the VA’s corporate data warehouse to produce reports showing pharmacist utilization and trends on a facility, regional and national level. The interventions also can be associated with patient demographics, biomarkers, medications and comorbidities to evaluate their impact on outcomes.
By describing these interventions made by a pharmacist as an advanced-practice provider, it has led to the clinical pharmacy specialist being recognized as a provider who improves access, medication use and clinical outcomes by physicians, team members and veterans alike,” Ourth said. “We are exceedingly proud of our VA pharmacists and the contributions they make to improving the care of our veterans, as evidenced through the descriptions outlined through this tool.”
The tool also demonstrates how clinical pharmacists are helping the VA meet one of its most-significant challenges—improving access. Ourth, Groppi and their colleagues see it as something that could benefit many other health systems, too.
“Access remains a top priority for healthcare organizations, and the appropriate integration of pharmacists into the patient care team is of critical importance,” Groppi said. “We urge other organizations to adopt similar approaches to promote optimization of their pharmacist providers into team-based care to ensure patients have access to their medication expertise and services.”
1. Groppi AM, Ourth H, Morreale AP, Hirsh JM, Wright S. Advancement of clinical pharmacy practice through intervention capture. Am J Health Syst Pharm. 2018 Jun 15;75(12):886-892.
