Supporting cardiac medication management with telehealth

WHAT THE VPACC ENTAILS

The VPACC model is designed to provide heart failure patients with access to a pharmacist who can support medication management. 

As Quach noted above, GDMT for heart failure involves patients taking a combination of medications from four main drug classes. These are: renin-angiotensin system inhibitors, evidence-based beta-blockers, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors.

Taking these medications at the right doses offers significant health benefits for heart failure patients.

"There is a lot of evidence that supports the optimal use of medications for heart failure, saying that can really impact the outcome of the patients," said Christine Chan, B.S. Pharm, BCCCP, BCPS, pharmacist and clinical director of pharmacy in the Bay Area for Sutter Health.

However, there are many barriers to doing so. Not only do patients react differently to different medications and the varying doses, but the medications may be too costly, resulting in patients skipping medications or taking the wrong doses.

This is where the VPACC model comes in. Under the model, pharmacists connect with patients once every couple of weeks to answer their questions, ensure they understand the importance of GDMT, titrate their medications safely and help them access their medications, Quach explained. The pharmacists connect with the patients via synchronous telehealth or audio-only telehealth tools.

Sutter Health launched a pilot of the model in 2022, and the permanent clinic was established in 2023. Health system researchers also studied the pilot to understand its impact.

WHAT THE RESEARCH SHOWS

The prospective cohort study ran from March 2022 to March 2023, enrolling Medicare recipients with a diagnosis of heart failure with reduced ejection fraction. Quanch noted that they targeted this specific population because patients with this condition are more likely to go to the emergency room and experience a heart failure exacerbation than patients with other types of heart failure. 

The study enrolled 467 patients, 190 of whom received the VPACC intervention and 277 who were controls. Chan, who also served as the principal investigator of the study, explained that they applied a difference-in-difference approach to compare the rates of hospitalization, cardiac hospitalization and emergency department visits between patients who received the telehealth-based intervention versus those who received usual care. The study results were published in JACC: Advances.

The researchers found that the rates of treatment with all four GDMT classes rose from 12% from baseline to 39% within six months postintervention in the intervention group and from 6% to 12% in the comparison group.

Further, the intervention was associated with a 74% reduction in cardiac hospitalizations, which is equal to avoiding 14.2 cardiac hospitalizations per year for every 100 patients enrolled.

"We recognize with this study that because we used a group of pharmacists who are highly trained in cardiology and spend the time and have appointments for their patients every two weeks to fine-tune the medication, get any lab work that is needed, and measure their blood pressure, we were able to -- within a two-to three-month period of time -- we were able to optimize these patients," Chan said.

EXPANDING THE MODEL

The model's positive impact on outcomes prompted Sutter Health to establish and expand VPACC as a permanent clinic.

Quach shared that during the pilot, the VPACC model was offered only in certain areas within the Sutter footprint, but once the permitted clinic launched, all providers and patients across the health system were eligible to participate.

To accommodate more patients, VPACC grew from six pharmacists and two technicians to 10 pharmacists and six technicians.

The health system also developed a dashboard to track outcome metrics to continue to show not only the clinical benefits but also the improvements in patient and provider experience resulting from the model.

"Patients really appreciate having a dedicated expert that they can turn to for questions about their medications, and providers value the collaboration, the support that we can provide them in offering managed complex treatment regimens," Quach noted. "They obviously know what the guidelines recommend and what would be best for the patient, but unfortunately, they might not have the bandwidth to follow up with the patients a week or two weeks later to check on them to see how they're doing."

In addition to employing the VPACC model for heart failure, Quach and Chan underscored the model's potential in other chronic care areas. For instance, the health system is working on expanding the model into diabetes management.

"Diabetes is a chronic disease, and medication is also very important to control diabetes," Chan said. "The medications also need a lot of fine-tuning, and patients need a lot of handholding to make sure that they know how to take their medication and how to measure their blood glucose. So, we're really hoping to expand into diabetes."

Quach added that the health system has a team of pharmacists supporting hypertension in an approach similar to the VPACC model.

The model's adaptability drives home the expansive potential of pharmacist-led telehealth programs.

"Virtual pharmacy is transforming the way patients access care, bringing high-quality, personalized medication management directly into the patient's home," Quach said. "When advanced practice pharmacists are empowered to work at the top of their license, they become a vital asset to the healthcare system, delivering measurable improvements in the patient's outcome and helping with provider efficiency and just overall providing a better patient care experience."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.