Salem VA Medical Center
Improving the quality of care for Veterans
Every morning starts the same way for Veteran Kenneth Tutt, age 79. At 8:00 a.m. he makes a phone call to Nurse Practitioner Rhonda Weinhold. Weinhold is a VA Home-Based Primary Care provider. She has been working with Tutt for four years. Together they review his weight, blood pressure and sugar levels. “There is no doubt in my mind I would not be here if it was not for this program,” said Tutt.
Home Based Primary Care (HBPC) is a VA program bringing primary health care into Veterans’ homes. HBPC provides integrated, patient-centered care for Veterans with complex medical needs.
Veterans in the program are assigned a primary care provider like Ms. Weinhold, based at the Staunton, Virginia community-based outpatient clinic. “The families, the caregivers in the home, they really depend on us,” she says. “A lot of our patients consider us part of the family.”
Recently, Weinhold began something new for Tutt and several other patients, that has helped reduce their medications and resulted in higher satisfaction with their quality of life. Not long ago, she attended a VA Geriatric Scholars Program class, where she was inspired to develop a medication management program to review patient medication prescriptions.
The idea came in part from a HBPC routine; setting up monthly medication boxes. “We love doing it, but we noticed our patients were on so many medications. We just thought, are there medications we could potentially get rid of that actually might be doing more harm or that are not needed?” She teamed up with HBPC team member Jena Willis, Doctor of Pharmacy (PharmD) to develop the idea.
The review, it turns out, often results in a reduction of medications. Weinhold says it is good because, “Research shows the more medication patients are on, especially for the elderly population, the greater the risk for falls.” In fact, Tutt admits to having fallen at home a few times in the past.
They consolidate the medication de-escalation recommendations, adding them to each patient’s electronic health record (“EHR”).
Tutt, like most HBPC patients, takes a lot of medications, for a variety of health conditions. Weinhold asked Veterans, "How do you feel about trying to get off some medicine?" Tutt thought, “It was a terrific idea.”
The project has helped Tutt feel he’s got a better chance of being the person he’s always been. “I’ve been an outdoor person all my life,” said Tutt, who served in the Navy from 1958 to 1970. “I garden, I raise flowers. I’ve had to cut back, but I’m still mobile.” “Our goal with Home Based Primary Care is patient safety,” said Weinhold. “We're there to keep them safe in the home and to keep them in the home as long as possible.”
As they fine-tuned their process, Weinhold brought others onboard. It was a team effort. Three registered nurses met in person with 80 patients over six months. “We were able to reduce the number of medications an average two medicines per patient,” said Weinhold.
After their success in Staunton, they were able to coordinate with Salem VAMC pharmacy residents’ grand rounds presentation on the de-escalation of therapy for the medical department there. The Salem VA Medical Center is Staunton CBOC’s parent facility. The residents added the information to their presentation as an introduction to the rest of the medical facility. “The most rewarding thing is providing improved quality of life for our patients, whether it's three more days, three more years, or thirty more years,” said Willis.