Last updated 2022-12-19T22:39:57Z

Increasing Access to Primary Care Using Pharmacist Providers

Through a multi-modal approach, a team at the Madison VA positioned our pharmacist providers to offload 27% of primary care provider appointments, increase referrals through education, improve team satisfaction, and save primary care providers 20 minutes on average for new patients, which they were then able to reallocate time to necessary patient care needs.

Origin:

September 2014, William S. Middleton Memorial Veterans' Hospital (Madison)

Adoptions:

22 successful

Awards and Recognition:

VHA Shark Tank Winner

Partners:

Clinical Pharmacy Practice Office, Diffusion of Excellence, Office of Primary Care, Office of Rural Health

Overview

Problem

Access to care is a critical need and significant predictor of health outcomes. Current and future shortages of primary care providers, limited time, and high numbers of complex patients make access to care a major challenge.

Solution

Pharmacist Providers are medication experts on the primary care team and can manage many chronic disease states (diabetes, hypertension, hyperlipidemia, alcohol use disorder, tobacco treatment, COPD, heart failure, gout, vitamin deficiencies, BPH, post-bariatric surgery management, etc) thereby shifting this care and opening appointments for the PCP. The PC ... Pharmacist Providers are medication experts on the primary care team and can manage many chronic disease states (diabetes, hypertension, hyperlipidemia, alcohol use disorder, tobacco treatment, COPD, heart failure, gout, vitamin deficiencies, BPH, post-bariatric surgery management, etc) thereby shifting this care and opening appointments for the PCP. The PCP is then provided time to assess conditions patients that require diagnosis or extensive physical assessment, rather than filling all the appointment slots with chronic disease management. See more

Results

Pharmacist Providers opened up 27% of Primary Care Provider appointments, thereby significantly increasing access to care. Pharmacist Providers also saved Primary Care Providers 20 minutes for every new Veteran.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

First time that this PACT team (including the pharmacist provider) was all in the same room together discussing how they would conduct team meetings and provide more proactive team based care.

A critical component of this practice is engaging front-line staff actually doing the work in co-design of the processes. In this picture, you can see leadership together with front-line pharmacists, LPNs, MSAs, RNs, and PCPs designing how the new processes will work.

Director of El Paso at the time, Gail Graham was heavily engaged in the implementation of this practice and provided unrelenting support. Her collaborative and supportive mindset helped set the stage for adoption of this practice.

Videos

A conversation with Dr. Ryan Vega and Dr. Ellina Seckel about the Diffusion of Excellence Gold Status Practice - Increasing Access to Primary Care Using Pharmacist Providers

Implementation

Timeline

2 weeks

Engage front-line PACTs in education of PACT CPS role and full PACT CPS team integration (including weekly team meetings)
2-4 weeks

Ensure full ancillary support provided (LPNs performing vitals, schedulers performing scheduling)
Initial design of grids 2 weeks, implementation of new grids 6 weeks

Re-vamp PACT CPS grids to be consistent with CPPO guidance and bookable hours requirements
8 weeks

Implement population management strategies to address facility strategic priorities (SAIL ACSC, HEDIS, shifting appointments from PCP to CPS, etc)
6 months

PACT CPS tracks impact (access, quality measures, team satisfaction) and reports out to facility leadership
6 months

Additional resource request submitted IF needed to meet minimum PACT Handbook ratios
12 months and onward

Expansion/Sustainment of practice model

Departments

Pharmacy
Geriatrics
Administration
Primary care

Core Resources

Resource type	Resource description
PEOPLE	Associate Chief of Pharmacy, Chief of Pharmacy, Chief of Primary Care, Chief of Nursing, Chief of MAS

Files

Article describing the practice and how Pharmacist Providers open access to care. CPS Improving Access in Primary Care - Pharmacy Practice News

Description of Pharmacist Provider practice model. Get the Medications Right

Description of Team Based Care and Pharmacists' role in comprehensive medication management. CMM Practice in Real Life

Links

Pharmacy Society of Wisconsin article describing the Gold Status Practice. Description of the Gold Status Practice

Resources for Clinical Pharmacy Managers. Clinical Pharmacy Managers Homepage

Webcast interview of the teams in Madison and Kansas City with implementing optimal use of Pharmacist Providers to open access to care. Improving Access through Pharmacist Providers

Risks and mitigations

Risk	Mitigation
Resistance to change from PCPs	Engage PCPs in co-design of process and adjust approach to solve PCP problems
Lack of ancillary support due to staffing shortages	Engage front-line LPNs and MSAs in co-design of process and show how pharmacist can be another provider resource for LPNs/MSAs
Resistance to change from PACT Pharmacist Providers	Understand practice gaps, ensure PACT Pharmacist Providers feel heard, provider appropriate training, ensure competency through assessments

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email Ellina.Seckel@va.gov with questions about this innovation.

About

Origin story

In 2014, access issues rose to the forefront across all VA facilities. To address these issues locally, Pharmacy Leadership at the Madison VA developed a multimodal approach to increase access to primary care through integration of clinical pharmacy specialists (CPS).

Original team

Ellina.Seckel@va.gov

Gold Status Fellow

Kyleigh.Gould@va.gov

Implementation Fellow

Julie.Groppi@va.gov

Clinical Pharmacy Practice Office

Michael.McFarland2@va.gov

Clinical Pharmacy Practice Office

Search tags

Medication Management Pharmacy Primary Care

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