Pharmacist-led CHF clinic for Patients Recently Discharged from CHF Admission

1. Pharmacist-led CHF clinic for Patients Recently Discharged from CHF Admission Providence VA Medical Center Providence, RI Andrea Dooley, Pharm D Wen-Chih Wu, MD

2. Providence CHF Clinic • Collaboration with VISN 1 Patient Safety Center of Inquiry to improve medication management of high risk CHF patients • A newly initiated pharmacist-led outpatient clinic under the Division of Cardiology

3. Target Population • Pts hospitalized with an admission diagnosis of CHF • Pts seen in outpatient Cardiology clinics with CHF that required medication uptitration

4. CHF Clinic: Referral Process • Consult request documented in their progress note • Dr. Dooley as an additional signer in the progress notes acknowledging receipt of the consult

5. CHF Clinic Appointments • Scheduled within 1-2 weeks of referral • ~ 30 min-1 hr appt with clinical pharmacist with training in CHF management

6. CHF Clinic Objectives • Medication reconciliation • Algorithm driven medication titration • Volume status checks • Medication side effect monitoring • Self-care education

7. CHF Clinic Follow-up • Qualified candidates are enrolled in the Telehealth program • Interval visits may range from 2 weeks to 30 days • Available via telephone/pager as needed

8. Process Outcomes • Symptom & Self-Care assessment: • DOE • Orthopnea • PND • Sodium use during past week • Number of pillows used at rest • Recorded daily weights • Independently performs ADLs • Early satiety • Fatigue • Medication Appropriateness • Beers criteria

9. Process Outcomes • Medication Adherence • Patient assessed through the Morisky scale: • Believes takes too many medications • Takes medications too many times during the day • Takes medication that does not work • Any side effects • Understands the purpose of the medications • Problems getting medication from the pharmacy • Forgets to take medication • Knows what medication he should be taking • When feels better stops taking medication • When feels worse stops taking medication

10. Biological Outcomes • NYHA Functional Class • Rehospitalization Rates • Mortality Rates

11. Contact Information: • Andrea G. Dooley, Pharm.D. • Andrea.Dooley@va.gov • Wen-Chih Hank Wu, MD • Wen-Chih.Wu@va.gov