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 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 A newly initiated pharmacist-led outpatient clinic under the Division of Cardiology

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

4. CHF Clinic: Referral Process Consult request documented in their progress note Consult request documented in their progress note Dr. Dooley as an additional signer in the progress notes acknowledging receipt of the consult 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 Scheduled within 1-2 weeks of referral ~ 30 min-1 hr appt with clinical pharmacist with training in CHF management ~ 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 Qualified candidates are enrolled in the Telehealth program Interval visits may range from 2 weeks to 30 days Interval visits may range from 2 weeks to 30 days Available via telephone/pager as needed Available via telephone/pager as needed

8. Process Outcomes Symptom & Self-Care assessment: 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 Medication Appropriateness –Beers criteria

9. Process Outcomes Medication Adherence Medication Adherence –Patient assessed through the Morisky scale: Believes takes too many medications Believes takes too many medications Takes medications too many times during the day Takes 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 pharmacy Problems 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 medication When feels worse stops taking medication

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

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