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Pharmacist-led CHF clinic for Patients Pharmacist-led CHF clinic for Patients Recently Discharged from CHF AdmissionRecently Discharged from CHF Admission
Providence VA Medical CenterProvidence VA Medical Center
Providence, RIProvidence, RI
Andrea Dooley, Pharm DAndrea Dooley, Pharm D
Wen-Chih Wu, MDWen-Chih Wu, MD
Providence CHF ClinicProvidence CHF Clinic
Collaboration with VISN 1 Patient Collaboration with VISN 1 Patient Safety Center of Inquiry to improve Safety Center of Inquiry to improve medication management of high risk medication management of high risk CHF patientsCHF patients
A newly initiated pharmacist-led A newly initiated pharmacist-led outpatient clinic under the Division of outpatient clinic under the Division of CardiologyCardiology
Target PopulationTarget Population
Pts hospitalized with an admission Pts hospitalized with an admission diagnosis of CHF diagnosis of CHF
Pts seen in outpatient Cardiology Pts seen in outpatient Cardiology clinics with CHF that required clinics with CHF that required medication uptitrationmedication uptitration
CHF Clinic: Referral ProcessCHF Clinic: Referral Process
Consult request documented in their Consult request documented in their progress note progress note
Dr. Dooley as an additional signer in Dr. Dooley as an additional signer in the progress notes acknowledging the progress notes acknowledging receipt of the consultreceipt of the consult
CHF Clinic AppointmentsCHF Clinic Appointments
Scheduled within 1-2 weeks of referral Scheduled within 1-2 weeks of referral
~ 30 min-1 hr appt with clinical ~ 30 min-1 hr appt with clinical
pharmacist with training in CHF pharmacist with training in CHF managementmanagement
CHF Clinic ObjectivesCHF Clinic Objectives
– Medication reconciliationMedication reconciliation– Algorithm driven medication titrationAlgorithm driven medication titration– Volume status checksVolume status checks– Medication side effect monitoringMedication side effect monitoring– Self-care educationSelf-care education
CHF Clinic Follow-upCHF Clinic Follow-up
Qualified candidates are enrolled in Qualified candidates are enrolled in the Telehealth programthe Telehealth program
Interval visits may range from 2 weeks Interval visits may range from 2 weeks to 30 days to 30 days
Available via telephone/pager as Available via telephone/pager as neededneeded
Process OutcomesProcess Outcomes
Symptom & Self-Care assessment:Symptom & Self-Care assessment:– DOE DOE – Orthopnea Orthopnea – PND PND – Sodium use during past week Sodium use during past week – Number of pillows used at rest Number of pillows used at rest – Recorded daily weightsRecorded daily weights– Independently performs ADLsIndependently performs ADLs– Early satiety Early satiety – Fatigue Fatigue
Medication AppropriatenessMedication Appropriateness– Beers criteriaBeers criteria
Process OutcomesProcess Outcomes
Medication AdherenceMedication Adherence– Patient assessed through the Morisky scale:Patient assessed through the Morisky scale:
Believes takes too many medications Believes takes too many medications Takes medications too many times during the dayTakes medications too many times during the day Takes medication that does not work Takes medication that does not work Any side effects Any side effects Understands the purpose of the medications Understands the purpose of the medications Problems getting medication from the pharmacyProblems getting medication from the pharmacy Forgets to take medication Forgets to take medication Knows what medication he should be taking Knows what medication he should be taking When feels better stops taking medication When feels better stops taking medication When feels worse stops taking medicationWhen feels worse stops taking medication
Biological OutcomesBiological Outcomes
NYHA Functional ClassNYHA Functional Class
Rehospitalization RatesRehospitalization Rates
Mortality RatesMortality Rates
Contact Information:Contact Information:
Andrea G. Dooley, Pharm.D.Andrea G. Dooley, Pharm.D.– [email protected]@va.gov
Wen-Chih Hank Wu, MDWen-Chih Hank Wu, MD– [email protected]@va.gov
