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Optimizing the Appropriate Use of Medications for Veterans

MedSAFE—one of QUERI's 15 national programs and part of the VA Palo Alto Health Care System—was created to optimize medication management by using pharmacy networks and decision support tools for patient aligned care teams (PACTs). While VA has implemented many interventions to improve medication safety, medication management has significant room for improvement. For example, several recommendations by the Institute of Medicine, including the wide availability of decision support and more pharmacy involvement in prescribing, have not yet been widely implemented in the VA healthcare system. MedSafe QUERI's work also aligns well with many of the themes and essential strategies outlined in the VA Blueprint for Excellence, such as leveraging information technologies and fostering an environment of continuous learning to improve healthcare and patient outcomes.

The three ongoing MedSAFE QUERI projects focus on improving the use of high-value medications, decreasing low-value medications, and improving the safety of high-risk medication use through:

• Optimization and Expansion of the Medication Use Evaluation Tracker (MUET) of PBM. In this project, QUERI investigators are conducting a national evaluation of the effectiveness of the five MUET programs to determine best practices, including: 1) Dimethyl Fumarate White Blood Cell?? Count Monitoring, 2) Potassium Follow-Up in Heart Failure with New Mineralocorticoid Receptor Antagonist, 3) Prasugrel or Ticagrelor >12 months, 4) Women of Childbearing Age on Warfarin, and 5) Direct Oral Anticoagulants. They are comparing the effectiveness of different implementation strategies employed by pharmacists using MUET at different VA facilities, and will then facilitate the adoption of the most effective strategies at other VA facilities.
• Clinical Decision Support (CDS).This project is supporting evidence-based best practices for managing five common chronic conditions by implementing CDS in the VISN 21 Clinical Dashboard for Patient Aligned Care Teams PACTs. By working with PACTs, MedSAFE QUERI is determining the most effective strategies to integrate CDS use into clinical workflow. The project will develop structures that can be readily adapted to clinical decision-making about additional conditions as new guidelines, clinical consensus, and patient data become available.
• VISN 21 Pharmacy Dashboard. MedSAFE QUERI investigators are targeting PACTs in an evaluation of the effectiveness of the VISN 21 PBM Pharmacy Dashboard designed to improve the safety of four measures: 1) Spironolactone/Eplerenone, 2) Lithium Carbonate (MH), 3) Hypoglycemia Safety, and 4) Oncology Med Monitoring. Investigators are comparing the effectiveness and associated resource use of different implementation strategies employed by the different facilities within VISN 21. As with the national MUET project, they will facilitate adoption of the most promising implementation strategies to all VISN 21 facilities.

The success of MedSAFE QUERI depends upon its strong collaboration with the VA Office of Pharmacy Benefits Management (PBM), VISN 21 (VA Sierra Pacific Network), the VA Office of Specialty Care Services (SCS), and Primary Care Services (PC).

For more information about MedSAFE QUERI, please contact Principal Investigator Paul Heidenreich, MD, MS at Paul.Heidenreich@va.gov .