By Kate Cozart, M.Ed., Pharm.D., BCPS, BCGP, BCACP; Aleia Judd, Pharm.D., BCACP; and Dr. Paula Newberry, Pharm.D., BCPS, BCGP, BCACP
Let’s take a look at a day in the life of 3 pharmacists working together at a VA community-based outpatient clinic:
Dr. Cozart:
My day starts at 0700 and begins by reviewing the day’s patients and schedule. Today I have eleven virtual patient visits, a meeting with the VA Education Advisory Committee, and planning for our local Preceptor Development Seminar.
Dr. Newberry:
My day also starts at 0700 and begins with reviewing the scheduled patients for the day. Today, I am spending 1 of my 2 scheduled days on site at the clinic. I have 8 scheduled patients, 2 of whom are coming in for in-person visits, and 6 that will be telephone calls. 1 of the in-person visits is a patient coming to learn how to use a continuous glucose monitoring system (CGM) so will require lots of hands-on teaching and assistance with technology.
Dr. Judd:
My day starts a little later at 0730 but also begins with working up my patients for today. Part of working as a member of a large pharmacy team sometimes includes helping cover clinics when another pharmacist is out. This is part of what I am doing today. In addition to my own phone and in person patients, I will be seeing patients at clinic that is physically 3 hours from my location. This is done by utilizing a secure video system at both clinic sites. The advantages of this system over doing a video patient at home is the patient will still get his vital signs as if he were in my office (weight, BP, and glucometer download). I am also helping cover Women’s Health consults. Women Veterans are the fastest growing population at the VA so we are adapting our clinics and services to better serve this population. I currently have a consult asking for a medication review for a patient who is actively breastfeeding. Depending on the medications the patient is currently taking, I may have to reach out to her primary care provider to make medication changes for the veteran’s and infant’s safety.
As Clinical Pharmacy Practitioners (CPP) in Primary Care, our primary clinical role is independent management of chronic disease states. Most of the patient visits focus on diabetes management, as well as on concomitant disease states that infer cardiovascular risk like hypertension, hyperlipidemia, and tobacco use. Since the COVID-19 Pandemic many of the visits are virtual so each day is a mix of telephone and VA Video Connect (VVC) visits, interspersed with some face-to-face visits on designated clinics days on site. During the visit, we review recent blood glucose readings, blood pressures, current medications, and interval medical history with each patient. Our status within the VA as independent providers with prescriptive authority allows us to then formulate a plan and prescribe and renew medications as indicated. Each visit finishes with documenting the plan in the patient’s electronic medical record.
Another part of our role as a CPP is precepting/mentoring. Students from multiple schools of pharmacy rotate through our site, so some months leading topic discussions, facilitating patient encounters, and mentoring are part of the daily job. Other times, our role may also involve mentorship of residents- as part of the Teaching and Learning Program, precepting resident clinics, participating in resiliency committee, or collaborating on resident research projects.
Dr. Cozart:
Today, my focus is on organization of our Preceptor Development Seminar to be sure everything is in place with our recruited speakers, continuing education, and virtual platform to allow for viewing by national attendees.
Provision of education to other clinicians is another part of our job as CPPs. This may involve planning of lectures or writing newsletters for clinical staff. At our clinic we distribute a newsletter with a clinical pearl for staff every 1-2 months. I also serve on the VA’s Education Advisory Committee (EdAC) and in this capacity I am involved in planning, reviewing, and delivering educational content related to the Board Certification Lecture Series for BCPS/BCGP/BCACP – the three board certifications I actively hold– and the VA Diabetes Management Certificate Program. Today’s EdAC meeting will focus on the remainder of this year’s series, any known changes for next year’s program, and assessment tools for distribution and review after the series is completed.
Dr. Newberry:
Today, my focus is on patient care, including completing some chart reviews for the weight management clinic.
Collaboration with other healthcare providers is an integral part of what we do as CPPs. In addition to collaborating with other primary care clinicians on the patients I see in my pharmacotherapy clinic, I also collaborate with preventative medicine providers to review complex patients wanting to start medication to assist with weight loss. I review the patient’s past medical history, current medications, and labs, and make recommendations for what medications to prescribe for weight loss. The provider then uses those recommendations to formulate an individual plan for weight loss.
Dr. Judd:
I have been working with a few pharmacy residents on their research project this year. We are attempting to implement a clinical reminder to help prevent hypoglycemia events in elderly or high risk patients. My focus today is reviewing the training material they are sending out to the pharmacists who have volunteered to help with the project.
Precepting and mentoring residents, as well as pharmacy students, is an important part of our responsibilities as CPPs. Though it takes time out of my day to do this, it’s something that has to occur in order to show the next generation of pharmacists the impact that they can have as part of a healthcare team. This residency research project helps residents learn what it’s like to start an initiative from the ground up and see what it’s like to implement a practice change—potentially something that can help impact patient care going forward. It’s this kind of real world impact that is meaningful and allows us to keep pushing the profession of pharmacy forward.
Each day as a CPP varies, depending on the schedule of the components described above. However, what doesn’t vary is that each day provides the privilege of caring for veterans and independently managing chronic disease states, thereby allowing us to significantly contribute to the patient’s overall healthcare as a member of the primary care team.
Kate Cozart, M.Ed., Pharm.D., BCPS, BCGP, BCACP (left)
Clinical Pharmacist Practitioner, Primary Care
VA Tennessee Valley Healthcare System – Clarksville
Paula Newberry, Pharm.D., BCPS, BCGP, BCACP (center)
Clinical Pharmacist Practitioner, Primary Care
VA Tennessee Valley Healthcare System – Clarksville
Aleia Judd, Pharm.D., BCACP (right)
Clinical Pharmacist Practitioner, Primary Care
VA Tennessee Valley Healthcare System – Clarksville/Dover
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