Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams.

INTRODUCTION: To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH). METHODS: An H-PACT MH pharmacy resident clinic was created and managed by a postgraduate year-2 psychiatric pharmacy resident. Improvements in access to MH care, Veterans Health Administration performance metrics, and estimated cost savings associated with resident interventions were reviewed to evaluate clinic utility. RESULTS: Over the 6-month clinic time frame, there were a total of 40 patient encounters in which 21 veterans had MH medication evaluation on at least 1 occasion. The average wait time for Veterans previously followed by the H-PACT psychiatrist was approximately 8 weeks. The H-PACT MH pharmacy resident clinic enabled veterans to be evaluated every 4 to 6 weeks. Interventions made by the resident included identification of medication administration errors, medication adjustments, adherence education, reduction in polypharmacy, and referral to other services. Estimated cost savings from clinic interventions totaled $33 613.67. DISCUSSION: The H-PACT MH pharmacy resident clinic allowed for an improvement in wait time for psychiatric pharmacotherapy follow-up for homeless veterans, with interventions that were associated with significant estimated cost savings.

Implementation and evaluation of an opioid overdose education and naloxone distribution (OEND) program at a Veterans Affairs Medical Center.

BACKGROUND: In recognition of the importance of safe and effective pain management, the Department of Veterans Affairs and the Office of the Under Secretary for Health have encouraged implementation of opioid overdose education and naloxone distribution (OEND) programs at Veterans Affairs Medical Centers (VAMCs). METHODS: An OEND program was developed in August 2015 and implemented in September 2015 at a VAMC which allowed for pharmacist-lead individual and group patient education. An OEND consult service was developed to streamline referrals of patients for naloxone education and distribution. At the conclusion of the class, participants were ordered a naloxone auto-injector or nasal spray kit. To evaluate the utility of this quality-improvement initiative, data was collected from September 2015 until May 2016. Examples of data collected included participant satisfaction with education, risk for accidental overdose, and number of naloxone kits dispensed to participants. RESULTS: Of a total of 243 consults placed, 71 individuals participated in OEND education. A large quantity of consults were discontinued due to patients no-showing education. Sixty-four consult referrals were identified to have a mental health diagnosis. Most participants who received education had a risk for accidental opioid overdose of 14%. Sixty-nine education participants were provided a naloxone kit. Based on the OEND class survey, participants felt that their knowledge of accidental opioid overdose increased and were generally satisfied with the education. CONCLUSION: OEND educated 30% of the Veterans referred into the program via the consult service, the majority of whom were at a relatively low risk for opioid overdose.