ASHP InterSections ASHP InterSections

December 1, 2008

Cutting-Edge Care at the VA

Having worked for the U.S. Department of Veterans Affairs (VA) for a quarter century, Jan Carmichael, Pharm.D., FCCP, BCPS, has witnessed its evolution into a technologically savvy institution.

Key among those innovations is the VA’s centralized patient information system, which pharmacists use to access patients’ entire medical histories.

“There is power in that because you can identify problems in larger groups,” said Carmichael.

 A pharmacy executive with one of the VA’s 21 Veterans Integrated Service Networks and past president of ASHP, Carmichael believes there are many benefits of working with the nation’s largest healthcare system. For instance, VA pharmacists can evaluate and prescribe medications on collaborative healthcare teams. This ability makes the institution a magnet for pharmacy students and residents who want to dive into clinical pharmacy, she said.

Cutting-Edge Patient Care

The VA is just one of several distinct organizations operated by the federal government, including the Indian Health Service, National Institutes of Health, U.S. military, federal prisons, and the U.S. Department of Homeland Security’s Division of Immigration Health Services, where you’ll find ASHP members taking part in forward-thinking practices that emphasize clinical patient care, education, and counseling.

Over the years, ASHP has supported federal pharmacists with special continuing education forums at its Midyear Clinical Meeting and programs like free membership for pharmacists serving in Iraq. The Society also recently launched a staff committee to explore ways in which federal pharmacists could be prominently recognized for their professional promotions.

Carmichael points to the advocacy of Kenneth W. Kizer, M.D., MPH, who served as the VA under Secretary for Health in the 1990s, as a powerful catalyst for change at the VA.

“People attribute his tenure to changing the philosophy from a chaotic large organization to an organization that focuses on primary patient care and delivering high-quality care through performance measures,” Carmichael said. ASHP recognized Kizer’s achievements with a Board of Directors Award of Honor in 2002.

The VA’s reach in the U.S. is staggering. The organization estimates that about one-quarter of the nation’s population—74.5 million people—are potentially eligible for VA benefits because they are veterans or are either a family member or survivor of veterans. Comprised of 155 medical centers, the health system employs nearly 250,000 people who work with a growing patient population.

The VA has been the only organization where Kristina De Los Santos, Pharm.D., BCPS, has worked since receiving her doctor of pharmacy degree in 1999.

Improving Outcomes and Safety

De Los Santos is a pharmacy program manager for clinical services and the first-year pharmacy residency program director at the Southern Arizona VA Healthcare System in Tucson. When she worked in clinical practice, De Los Santos gave medical guidance to nurse practitioners and physicians and reviewed medication orders.

“I sometimes caught potential mistranslations of doses,” she said. “Pharmacists at the VA are in a position to really improve patient outcomes and safety.”

Robert Pittman, MPH, has dual roles as a federal pharmacist. He’s chief pharmacy officer for the U.S. Public Health Service, a position in which he advises the U.S. Surgeon General, and director of health professions for the Indian Health Service.

Pittman emphasizes the importance of having electronic access to his patients’ entire medical records.

“We have diagnoses, results of lab tests, notes from physicians. That’s all available for us to decide appropriate therapy” for the estimated 1.5 million American Indians and Alaska Native people treated at more than 300 clinics and 48 hospitals, Pittman said. “We think it’s the model for pharmacy in the future.”

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