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

Background: Access to high-quality care is a US Department of Veterans Affairs (VA) top priority. The VA utilized the principles of the Patient Centered Medical Home model to design the Patient-Aligned Care Team (PACT) to deliver primary care to our nation's Veterans. The PACT model was introduced in the VA in 2009 and was implemented across the health care system in 2010. Objective: This review will highlight how the VA clinical pharmacy specialist (CPS) have been integrated throughout the VA to provide clinical care services in the primary care setting. CPSs in PACTs provide comprehensive medication management (CMM) in between typical PACT provider visits to initiate, modify, or discontinue medications, as well as providing disease management in foundational and high-volume areas such as anticoagulation, pain management, diabetes, hypertension, anemia, chronic obstructive pulmonary disease, heart failure, hepatitis C, and hyperlipidemia. Conclusions: Within the VA, CPSs work autonomously but collaboratively under a global or practice area-based scope of practice (SOP) with prescriptive authority. VA CPS serving as a provider in primary care increase access and quality of care to veterans through the provision of CMM. This model has the opportunity to be leveraged in other health care systems.