2025 Southeastern Residency Conference

UTILIZATION OF PATIENT ALIGNED CARE TEAM CLINICAL PHARMACIST PRACTITIONERS TO DECREASE ENDOCRINOLOGY COMMUNITY CARE CONSULTS


Kaile Allen, Amanda Carlisle, Bridget Roop
Birmingham VA Health Care System- Birmingham, AL


The United States has a large percentage of individuals with at least one chronic disease state. It has been reported that about 37 million Americans are diagnosed with diabetes. Clinical Pharmacy Practitioners (CPPs) are some of the most accessible healthcare providers for managing chronic disease states, such as diabetes. The Birmingham VA Healthcare System (BVAHCS) utilizes multiple community-based outpatient clinics (CBOCs) with designated CPPs to serve its Veteran population. The purpose of this project is to increase utilization of CPPs before considering endocrinology referrals for patients with Type II diabetes.




The project will consist of a retrospective chart review to obtain data in regard to endocrinology referrals and the appropriateness of the referral. The retrospective data will be from FY 2023-2024 and collected on a specific data collection form. BVAHCS Veterans will be included if they are diagnosed with type 2 diabetes and referred to an endocrinologist. A post-intervention analysis will consist of reviewing patients referred to a CPP and endocrinology after the education on CPP consults is provided to the CBOC providers. The data will be reviewed by means of descriptive statistics to identify trends in A1c, renewed community care referrals once A1c goal is achieved, and the number of patients referred to CPPs pre-and post-interventional education and the number of endocrinology consults pre- and post-intervention.


178 patients were included in this project from FY23-FY24. The average A1c prior to endocrinology referral for FY23 and FY24 was 9.0% and 8.9%, respectively. The average A1c post-endocrinology referral was 7.8% for both FY23 and FY24. 42% of patients from FY23 after seeing endocrinology had an A1c of <7% and 84% of those patients continued to see endocrinology regardless of achieving a target A1c goal. 40% of patients from FY24 after seeing endocrinology had an A1c of <7% and 94% of those patients continued to see endocrinology regardless of obtaining a target A1c goal. 58% of patients from FY23 and 60% of patients from FY24 had an A1c of >7%. 83% and 90% of those patients from FY23 and FY24, respectively, continued to see the endocrinologist and continued to have an uncontrolled A1c. FY24 data in regard to CPP consults revealed 17 consults within a 6 month period averaging about 3 consults per month. Post-intervention, the data revealed 21 new CPP consults in a 3 month period, averaging about 8 consults per month. Post-Intervention CPP Consults increased by about 40% or around 5 consults per month. Due to the time limitations of this study, a change in the number of endocrinology consults was not observed.


We observed an increase in CPP utilization after provider education was provided by our academic detailing pharmacist on the utilization of CPPs prior to placing community care endocrinology referrals. We also observed that many patients continue to see these specialized providers regardless of obtaining an A1c at goal. This was an important discovery and the renewal process for endocrinology consults is an area that revealed promise for process improvement. Future directions could include investigating the criteria for community care renewals, especially for chronic disease states that can be managed by VA CPPs and the monetary impact of CC at the BVAHCS.

Resident email: kaile.allen@va.gov