Integration of the Clinical Pharmacist Practitioner to Improve Rural Veteran Access and Quality for Chronic Obstructive Pulmonary Disease in Primary Care

PURPOSE: Utilization of the clinical pharmacist practitioner (CPP) providing comprehensive medication management (CMM) has been shown to improve the quadruple aim of healthcare. Unfortunately, rural Veterans often lack access to the expertise of CPP, leading to differences in the quality of care provided as compared to non-rural Veterans. We explored the integration of CPP providing CMM as part of a partnership with the Office of Rural Health funded enterprise-wide initiative. Facilities trained, integrated, and measured CPP regarding quality of care and access to care in a rural Veteran initiative-the Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE). METHODS: Twenty-two primary care CPP at 17 facilities were trained focusing on COPD management in addition to CMM. All data and reports were extracted and derived from the VA Corporate Data Warehouse (CDW). For measurement of access, we evaluated the number of Veterans served as well as the number of total encounters performed, and the modality of care provided by the CPP. The overall percentage of Veterans noted as "rural" was also tracked. The percentage of patients that were seen by a primary care provider or CPP within 30, 60, and 90 days of ED or inpatient discharge were compared for those referred to and not referred to the COPD CARE program. Evaluation of quality adherence metrics, based on guideline directed therapy, compared the CPP COPD managed population to all Veterans with COPD. FINDINGS: From October 2022 through September 2024, COPD CARE CPP performed 71,520 encounters in 21,168 Veterans with a total program rurality of 70.8%. The percentage of patients that were seen by a primary care provider or CPP within 30, 60, and 90 days of ED or inpatient discharge were consistently higher for those referred to the COPD CARE program versus those who were not. By 90 days, 81.7% of those referred were seen versus 53.2% of those not referred. In the 2 years following hiring of primary care CPPs, 7 of the 10 best practices were delivered on over 90% of visits, where 5 of those best practices were delivered on over 99% of visits. CONCLUSION: This study demonstrated improved access and improved guideline directed therapy outcomes for rural Veterans seen by a CPP. Integration of the CPP with a focus on the management of COPD can increase access to CMM and increase overall quality.