Veterans Affairs - A Colorful History
1918 (end of WWI): Military hospitals were too burdened to keep all veterans through recovery.
1921: Veterans’ Bureau created.
1930: Budget included $786 million and served 4.6 million veterans.
1944: GI Bill of Rights was passed to benefit WWII veterans with home loans and education.
1946: Under leadership of Major General Paul Hawley, resident and teaching fellowships were created in VA hospitals in addition to hospital-based research programs.
1975: Vietnam veterans came home to underfunded, run down hospitals.
1995: Transformation of VA system included a shift to outpatient care from inpatient care, and an emphasis on measuring health-care performance on the outcome of patient treatment.
1997: VA began establishing community-based outpatient clinics across the country.
2005: VA’s 75th anniversary, and a budget of $63.5 billion serving nearly 25 million veterans. Currently, there are roughly 909 ambulatory care and community-based outpatient clinics, 135 nursing homes, 47 residential rehabilitation treatment programs, 232 Veterans Centers and 108 comprehensive home-care programs.
Past newspaper headlines referring to the U.S. Department of Veterans Affairs (VA) have read, “Third-Rate Medicine for First-Rate Men,” “The VA’s War on Health,” and “The Worst Health Care in the Nation.” The latter two were from the 1990s. Today, the VA system is a model for 21st-century health care reform. How did that happen?
One of many important changes was the implementation of the Veterans Health Information Systems and Technology Architecture (VistA). Built to combine patients’ different forms of information into one electronic health record, VistA enhanced technology systems at the VA and improved communication between providers.
Through VistA, health care professionals such as pharmacists and nurses were, able to access complete patient information to provide better care. This helps the growing number of clinical pharmacists who are incorporated into medicine teams at VA hospitals. With the goal of providing optimal patient care, the medicine team includes the attending physician, medical resident, medical intern(s), medical student, social worker, case manager, pharmacist, and the student pharmacist. I was on rotation on one of these medicine teams from May to August.
From “Zero to Hero”
My professo’s parting words were, “You can consider yourselves professional 1-year-olds, so don’t be too hard on yourselves initially, and let your skills develop with experience.” His warning was appropriate because at the beginning of my rotation, I definitely felt like a professional “infant.”
Initially during rounds, when I was asked questions, I would recognize that I had learned the answer at some point during my coursework. The didactic learning environment of a classroom is very different from the clinical world, however, I eventually created a routine for myself every morning and gained the confidence I needed to participate actively in patient discussions. Also, with the guidance of my excellent preceptors, I was comfortable offering drug therapy recommendations to the medicine team.
I was consulted on many topics, including the need to bridge a patient with heparin, drug-drug interactions, length of treatment for complicated urinary tract infections, appropriate medication regimens for various disease states, medication dosages, mechanism of action of drugs, and much more. Over time, I felt like I was really contributing to the team effort.
Blogging My Experiences
As I researched certain topics throughout my rotation, I feared that I would quickly forget the details. Thus, I started a blog to capture everyday experiences while on my rotation. The blog is also serves as a good learning tool for other students whose rotation sites are not geared towards treating an elderly population. The blog is a great learning tool for me as well; it allows me to review at home what I learned during the day. You can read my blog at http://pharmdrotations.blogspot.com.
Future Directions
The VA healthcare system is one of servereal practice settings leading pharmacy toward patient-centered care. I hope that in the near future, patients will be assigned to their own pharmacists, just like any other clinician. Whatever new ways the pharmacy profession incorporates itself into the VA healthcare system, I am sure that pharmacists will stay true to the VA motto spoken by President Abraham Lincoln: “Care for him who shall have borne the battle and for his widow, and his orphan.”
References
1. “VA History in Brief.” Department of Veterans Affairs.
2. Longman, Phillip (2010). Best care anywhere (2nd ed.). Sausalito, CA: PoliPointPress.
3. My Blog - http://pharmdrotations.blogspot.com/
You are amazing
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