November 14, 2024 • 9 mins
In this episode, APhA Executive Education Fellows and Katie Meyer will discuss the role of mental health clinical pharmacy providers at the Veterans Affairs.
Each month, APhA will release two, 10 to 15 minute podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Welcome to the First Fill.
My name is Nick Bennett-Brush and I’m an executive
fellow in Education at the American PharmacistsAssociation.
We're at the Joint Federal Pharmacy Seminarin beautiful San Diego, California,
where we bring togetherfederal pharmacists and pharmacy technicians
from every branch of the United Statesmilitary and uniformed services to share
knowledge, provide updates and best practices,and get to know our brothers and sisters in arms.
(00:23):
I know as a former Army Reserve and currentAir Force Reserve pharmacy technician
that APhA wants to say,we deeply appreciate your service
and the sacrificesyou make for us day in and day out.
With that in mind, we wanted to focus
today on a programthat started in Veterans Affairs.
The clinical pharmacist practitioner, or CPP.
The VA has been using CPP
(00:45):
to provide mental health care to veteransin outpatient and inpatient settings.
But before we dive into deep to that,I'd like to introduce
my guests today, Katie Meyer and Yara Al Shaer.
Why don't you introduce yourselves?
Hello, everyone.
This is Katie Meyer.
So happy to be here with you today.
I serve as the Senior Director of Content Creationhere at APA.
(01:06):
Hello, everyone. My name is Yara Al Shaer.
I'm the Executive Fellow at the EducationDepartment, and I'm really happy to be here today.
All right. Thank you guys for being here.
With that, this month,we're focusing on the incredible work pharmacists
are doing in supporting mental health care,especially within the VA.
To get this conversation started,I want to ask Yara, can you discuss
the impact of clinical pharmacist practitionersin mental health settings across the VA?
(01:30):
Of course, mental health clinical pharmacistpractitioners, which I will refer to as mental
health CPPs moving forward are crucialin delivering comprehensive medication management
to veterans and the mental health teamas advanced practice providers.
VA CPPshave the authority to independently prescribe
and manage CMM services across various settings.
(01:53):
Mental health CPPs can prescribe,
create therapeutic plans, assess conditions,
use quantitative tools to monitor mental health,order labs and tests,
address drug related issues,refer to specialists and document consent.
Their work emphasizes treatment appropriateness,
effectiveness, safety, and adherencefor mental health and other conditions.
(02:16):
Mental Health CPPsimprove access to mental health care by serving
as primary mental health providers, helpingaddress the nationwide shortage of psychiatrists
and other mental health professionals amidrising demand for mental health services.
Mental health CPPs have an integralrole across care
settings,including primary care, mental health integration,
(02:38):
general Mental Health and Behavioral Mentalhealth, Interdisciplinary program,s
Specialty Mental health, Residential RehabVisitation Treatment programs,
Inpatient Care and SubstanceUse Disorder treatment.
They help meet population goals by managinghigh risk veterans, including those discharged
from hospitals at risk of suicide, ensuring timely
(03:00):
safety plans and providing frequent follow ups.
Overall mental health CPPs improve access
to care and enhancemental health outcomes across VA facilities.
That seems like a pretty big impactthat mental health support can have.
I want to focus on one aspectthat you mentioned, though,
and I'll ask you this question,so don't worry, Katie.
What specific practices domental health clinical pharmacist
(03:22):
practitioners engage in to manage and monitorsuicide risk?
Yeah, sure, Nick.
So mental health CPPs regularly screen for suiciderisk using the Columbia Suicide Severity rating
scale or C-SSRS and the Comprehensive Suicide
Risk Evaluation or CSRE.
The C-SSRS is a questionnairethat was developed by multiple institutions,
(03:46):
including Columbia Universityand is endorsed by SAMHSA
that clinicians use for screeningthrough a series of simple questions.
The questionnaire beginswith just two initial questions
and if that answer to one of eitherone of them is yes, the person
administering the questionnaireasks an additional four questions.
For those that screen positive on the C-SSRS,the VA CSRE is
(04:09):
then administered to determine the levelof severity of risk and impression
of both acute and chronic riskto inform next steps for intervention.
After completing screening,the Mental Health CPP documents results
and works with the Interdisciplinary Teamfor Safety planning based on severity.
If admission is needed, the CPP collaborates
with a psychiatrist or other appropriate provider.
(04:32):
Thanks, Katie.
So what I'm hearing is that mental health CPPshave a pretty huge role in screening
and referring veterans to the appropriate teambased on the C-SSRS and the CSRE.
Anything I think we can do to connect patientswith the resources they need is so,
so helpful.
Yara how exactly do mental health CPPs
enhance the quality of mentalhealth care in the in the VA?
(04:56):
Yes, mental health, CPPs support,mental health quality
through the impact on quality metricsby improving quality measures, enhancing access
continuity of care, suicide risk screeningand the overall patient experience through
the VA's Strategic Analytics for Improvementand Learning model, also known as SAIL.
Additionally, mental health CPPsalso provide specialized care
(05:20):
for female veterans of reproductive age,especially those planning pregnancies,
are pregnant or breastfeeding,guiding them on safe medication use.
Mental health CPPs, prescribecontrolled substances in states where authorized
collaborate with mental health providers,when controlled substances are component
of medication regimens, and serveas expert resources in psychopharmacology.
(05:42):
In states where they don't haveprescriptive authority, they work collaboratively
with the mental health providersby providing therapeutic recommendations
when controlled substances are componentof the medication regimen for the individual.
Veteran.
Mental health CPPscontribute to quality through leadership
(06:03):
and through this psychotropic drug safetyinitiative, also known as the PDSI.
They lead efforts in safepharmacologic treatments include benzodiazepine
reduction clozapine managementand effective care for high risk veterans.
Thanks Yara.
It's clear that mental healthCPPs are pretty integral in maintaining high
(06:24):
standards of mental health care for our veterans,even beyond those more traditional settings.
Katie, can you tell us a little bitabout some of the innovative ways that mental
health CPPs are being used within the VA to expandmental health care access for veterans?
Sure, Nick.
So there are a couple of really unique thingsthat I found that CPP's
are doing to improve access to care for veterans,which I'll highlight here.
(06:47):
The first thing is that mentalhealth CPPs are delivering care through a variety
of different modalities,from in-person to telephonic,
video and e-consulting encounters.
To give you just an idea of the numbers,in 2023, mental health CPPs
served over1.5 million veterans across 4.5 million patient
(07:08):
care visits, with more than 120,000 encountersper quarter documented.
The majority of these were deliveredvia virtual care.
Another amazing thingthat our VA mental health CPPs are doing
is contributingto the next generation of pharmacy.
The VA graduates approximately 87
PGY 2 psychiatric pharmacy residents annually
(07:30):
and is the largest trainer of PGY2psychiatric pharmacy residents.
One exampleof how these PGY2 residents are being used within
the system is at the South TexasVeterans Health Care System.
PGY2 residents were integratedinto a homeless patient aligned care team
and decrease wait time for psychiatric medication
(07:51):
management from eight weeks down to 4 to 6 weeks.
Outcomes related to this programresulted in an estimated cost
savings of more than $33,000for the homeless veteran population.
These are just a couple of unique waysthat both mental health CPP's
and their pharmacy residents are increasing accessto care for our veterans.
(08:14):
Thank you so much,Katie and Yara for your insights
into the vital role of mental health CPPsin supporting veterans mental health.
It is really, really amazing to me that pharmaciescan provide such comprehensive services
within the VA and really use all of their clinicalskills and abilities to benefit our veterans.
So in summary, mental healthCPPs in the VA provide crucial support
(08:36):
through comprehensive medication managementservices, enhancing access to mental health
care for veterans by serving as primary mentalhealth care providers within the VA.
With the authority to order lab tests,prescribe medications, create therapy plans,
and use quantitative toolsto assess those patients.
Their roles are incredibly versatile,including suicide prevention,
(08:58):
adherence to medicationsafety protocols with medications like clozapine
and controlled substances, and filling workforcegaps across various mental health care settings
by using telehealth technologies to reach patientswhere they are.
Again, it is really amazing
to see the great work that pharmacies can providefor patients in every practice setting.
All right. That's all the time we have for today.
(09:18):
We just want to reiterate, happy Veterans Dayto all those who have served this country.
Your service is deeply appreciated by all of usat the American Pharmacists Association.
Tune in next week for more of the firstfill podcast, where Katie will be talking to Dr.
Jeff Gold about their roleas a mental health CPP at the VA.
And last but not least, don't forget to head overto the Learning Library at learn.pharmacist.com
(09:40):
to earn your CE for this month's podcast.
We'd love to hear your feedback on how you likethe new set up.
Take care and thanks for tuning in.
Welcome to the First Fill.
My name is Nick Bennett-Brush and I’m an executive
fellow in Education at the American PharmacistsAssociation.
We're at the Joint Federal Pharmacy Seminarin beautiful San Diego, California,
where we bring togetherfederal pharmacists and pharmacy technicians
from every branch of the United Statesmilitary and uniformed services to share
knowledge, provide updates and best practices,and get to know our brothers and sisters in arms.
(00:23):
I know as a former Army Reserve and currentAir Force Reserve pharmacy technician
that APhA wants to say,we deeply appreciate your service
and the sacrificesyou make for us day in and day out.
With that in mind, we wanted to focus
today on a programthat started in Veterans Affairs.
The clinical pharmacist practitioner, or CPP.
The VA has been using CPP
(00:45):
to provide mental health care to veteransin outpatient and inpatient settings.
But before we dive into deep to that,I'd like to introduce
my guests today, Katie Meyer and Yara Al Shaer.
Why don't you introduce yourselves?
Hello, everyone.
This is Katie Meyer.
So happy to be here with you today.
I serve as the Senior Director of Content Creationhere at APA.
(01:06):
Hello, everyone. My name is Yara Al Shaer.
I'm the Executive Fellow at the EducationDepartment, and I'm really happy to be here today.
All right. Thank you guys for being here.
With that, this month,we're focusing on the incredible work pharmacists
are doing in supporting mental health care,especially within the VA.
To get this conversation started,I want to ask Yara, can you discuss
the impact of clinical pharmacist practitionersin mental health settings across the VA?
(01:30):
Of course, mental health clinical pharmacistpractitioners, which I will refer to as mental
health CPPs moving forward are crucialin delivering comprehensive medication management
to veterans and the mental health teamas advanced practice providers.
VA CPPshave the authority to independently prescribe
and manage CMM services across various settings.
(01:53):
Mental health CPPs can prescribe,
create therapeutic plans, assess conditions,
use quantitative tools to monitor mental health,order labs and tests,
address drug related issues,refer to specialists and document consent.
Their work emphasizes treatment appropriateness,
effectiveness, safety, and adherencefor mental health and other conditions.
(02:16):
Mental Health CPPsimprove access to mental health care by serving
as primary mental health providers, helpingaddress the nationwide shortage of psychiatrists
and other mental health professionals amidrising demand for mental health services.
Mental health CPPs have an integralrole across care
settings,including primary care, mental health integration,
(02:38):
general Mental Health and Behavioral Mentalhealth, Interdisciplinary program,s
Specialty Mental health, Residential RehabVisitation Treatment programs,
Inpatient Care and SubstanceUse Disorder treatment.
They help meet population goals by managinghigh risk veterans, including those discharged
from hospitals at risk of suicide, ensuring timely
(03:00):
safety plans and providing frequent follow ups.
Overall mental health CPPs improve access
to care and enhancemental health outcomes across VA facilities.
That seems like a pretty big impactthat mental health support can have.
I want to focus on one aspectthat you mentioned, though,
and I'll ask you this question,so don't worry, Katie.
What specific practices domental health clinical pharmacist
(03:22):
practitioners engage in to manage and monitorsuicide risk?
Yeah, sure, Nick.
So mental health CPPs regularly screen for suiciderisk using the Columbia Suicide Severity rating
scale or C-SSRS and the Comprehensive Suicide
Risk Evaluation or CSRE.
The C-SSRS is a questionnairethat was developed by multiple institutions,
(03:46):
including Columbia Universityand is endorsed by SAMHSA
that clinicians use for screeningthrough a series of simple questions.
The questionnaire beginswith just two initial questions
and if that answer to one of eitherone of them is yes, the person
administering the questionnaireasks an additional four questions.
For those that screen positive on the C-SSRS,the VA CSRE is
(04:09):
then administered to determine the levelof severity of risk and impression
of both acute and chronic riskto inform next steps for intervention.
After completing screening,the Mental Health CPP documents results
and works with the Interdisciplinary Teamfor Safety planning based on severity.
If admission is needed, the CPP collaborates
with a psychiatrist or other appropriate provider.
(04:32):
Thanks, Katie.
So what I'm hearing is that mental health CPPshave a pretty huge role in screening
and referring veterans to the appropriate teambased on the C-SSRS and the CSRE.
Anything I think we can do to connect patientswith the resources they need is so,
so helpful.
Yara how exactly do mental health CPPs
enhance the quality of mentalhealth care in the in the VA?
(04:56):
Yes, mental health, CPPs support,mental health quality
through the impact on quality metricsby improving quality measures, enhancing access
continuity of care, suicide risk screeningand the overall patient experience through
the VA's Strategic Analytics for Improvementand Learning model, also known as SAIL.
Additionally, mental health CPPsalso provide specialized care
(05:20):
for female veterans of reproductive age,especially those planning pregnancies,
are pregnant or breastfeeding,guiding them on safe medication use.
Mental health CPPs, prescribecontrolled substances in states where authorized
collaborate with mental health providers,when controlled substances are component
of medication regimens, and serveas expert resources in psychopharmacology.
(05:42):
In states where they don't haveprescriptive authority, they work collaboratively
with the mental health providersby providing therapeutic recommendations
when controlled substances are componentof the medication regimen for the individual.
Veteran.
Mental health CPPscontribute to quality through leadership
(06:03):
and through this psychotropic drug safetyinitiative, also known as the PDSI.
They lead efforts in safepharmacologic treatments include benzodiazepine
reduction clozapine managementand effective care for high risk veterans.
Thanks Yara.
It's clear that mental healthCPPs are pretty integral in maintaining high
(06:24):
standards of mental health care for our veterans,even beyond those more traditional settings.
Katie, can you tell us a little bitabout some of the innovative ways that mental
health CPPs are being used within the VA to expandmental health care access for veterans?
Sure, Nick.
So there are a couple of really unique thingsthat I found that CPP's
are doing to improve access to care for veterans,which I'll highlight here.
(06:47):
The first thing is that mentalhealth CPPs are delivering care through a variety
of different modalities,from in-person to telephonic,
video and e-consulting encounters.
To give you just an idea of the numbers,in 2023, mental health CPPs
served over1.5 million veterans across 4.5 million patient
(07:08):
care visits, with more than 120,000 encountersper quarter documented.
The majority of these were deliveredvia virtual care.
Another amazing thingthat our VA mental health CPPs are doing
is contributingto the next generation of pharmacy.
The VA graduates approximately 87
PGY 2 psychiatric pharmacy residents annually
(07:30):
and is the largest trainer of PGY2psychiatric pharmacy residents.
One exampleof how these PGY2 residents are being used within
the system is at the South TexasVeterans Health Care System.
PGY2 residents were integratedinto a homeless patient aligned care team
and decrease wait time for psychiatric medication
(07:51):
management from eight weeks down to 4 to 6 weeks.
Outcomes related to this programresulted in an estimated cost
savings of more than $33,000for the homeless veteran population.
These are just a couple of unique waysthat both mental health CPP's
and their pharmacy residents are increasing accessto care for our veterans.
(08:14):
Thank you so much,Katie and Yara for your insights
into the vital role of mental health CPPsin supporting veterans mental health.
It is really, really amazing to me that pharmaciescan provide such comprehensive services
within the VA and really use all of their clinicalskills and abilities to benefit our veterans.
So in summary, mental healthCPPs in the VA provide crucial support
(08:36):
through comprehensive medication managementservices, enhancing access to mental health
care for veterans by serving as primary mentalhealth care providers within the VA.
With the authority to order lab tests,prescribe medications, create therapy plans,
and use quantitative toolsto assess those patients.
Their roles are incredibly versatile,including suicide prevention,
(08:58):
adherence to medicationsafety protocols with medications like clozapine
and controlled substances, and filling workforcegaps across various mental health care settings
by using telehealth technologies to reach patientswhere they are.
Again, it is really amazing
to see the great work that pharmacies can providefor patients in every practice setting.
All right. That's all the time we have for today.
(09:18):
We just want to reiterate, happy Veterans Dayto all those who have served this country.
Your service is deeply appreciated by all of usat the American Pharmacists Association.
Tune in next week for more of the firstfill podcast, where Katie will be talking to Dr.
Jeff Gold about their roleas a mental health CPP at the VA.
And last but not least, don't forget to head overto the Learning Library at learn.pharmacist.com
(09:40):
to earn your CE for this month's podcast.
We'd love to hear your feedback on how you likethe new set up.
Take care and thanks for tuning in.
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