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Role of the US Veterans Health Administration Clinical Pharmacy Specialist Provider: Shaping the Future of Comprehensive Medication Management.

Providing access to high-quality care is one of the top priorities of the US Veterans Health Administration (VHA). The VHA is the largest integrated health care system in the United States, providing care at 1255 health care facilities, including 170 VHA medical centres and 1074 outpatient sites for care of varying complexity. However, substantial shortages of primary and specialty care providers exist across the nation, including within the VHA.1The deployment of clinical pharmacists in various roles may be one way to address gaps in care. As advanced practice providers, clinical pharmacists have improved medication safety, quality of care, and clinical outcomes for veterans, as well as the general population. Hundreds of studies, many of which were conducted in the VHA setting, have been published in the peer-reviewed literature and have demonstrated benefits of pharmacist-directed patient care.2,3 For example, in their comprehensive systematic review, Chisholm-Burns and others4 evaluated 298 studies of the effect of US pharmacists, working as members of care teams, on patient care and found positive results in terms of therapeutic and safety metrics. The most frequently reported therapeutic outcomes included reductions in hemoglobin A1c, low-density lipoprotein, and blood pressure. Clinical pharmacist care has also improved humanistic components of patient care related to patient satisfaction, adherence to therapy, and knowledge of medications. The authors of a 2008 literature review of the economic impact of clinical pharmacist providers endeavoured to quantify the benefit-to-cost ratio.5 Among studies reporting data suitable for determining the benefit-to-cost ratio (n = 15), the pooled median value revealed that for every dollar invested in a clinical pharmacist, US$4.81 was achieved in cost reductions or other economic benefits.5 The current review article highlights the VHA’s efforts to utilize pharmacists as direct patient care providers to increase quality of and access to care for the veteran patient in a valuebased payment model.