Virginia Society of Health-System Pharmacists

VSHP Grants Program

General Information

- All grants will be awarded to VSHP members.

- All grant funds must be used within 12 months of grant's approval date.
- Unused funds must be returned to VSHP.
- Applications will be evaluated based on impact, value feasibility and understanding how the grant fits within the VSHP mission.
- Implementation date, budget update, outcomes reported so far (if applicable) and any pictures (if applicable) must be provided to VSHP every 6 months and a follow-up report to VSHP must be written within one year of disbursement of funds, or when the project has reached a completion milestone, whichever occurs first.

Call for grant applications typically occurs in the Summer and awards are announced in early Fall.

For the past several years, VSHP has set aside a total of $10,000 for grants.

2022 Grant Awards

Affiliation  Describe your proposed program or project, including schedule or timeline as applicable.  Describe how the project aligns with the VSHP mission statement
 Moments of Hope

Moments of Hope Outreach is a ministry that serves Hanover and Henrico counties, and Richmond north of the James River. We began as a one-man outreach in late 2014 and became a 501(c)(3) nonprofit organization in March 2016. Moments of Hope operates a homeless outreach and food pantry, hosts weekly community outreach luncheons with a mobile pantry and health screenings, and provides non-congregate emergency shelter to our homeless neighbors.

Through this project, we hope to provide more information and guidance to healthcare providers on assessing an HIV patient's osteoporosis risk and selecting the proper PrEP therapy. This project would help optimize care for patients undergoing PrEP therapy at an increased risk for osteoporosis. Hence, pharmacists can involve and directly monitor patients to inform physicians and patients about the risk and collaborate on appropriate and optimized treatment plans.
 Inova Health System
 Project: Pre-exposure Prophylaxis (PrEP) for HIV has well-established efficacy but limited long-term safety data since the first FDA approval for a PrEP medication was only 10 years ago. Medications for PrEP include FTC/TAF, FTC/TDF, and LAI-CAB.  LAI-CAB is not expected to have any major impact on bone health but the two oral options, FTC/TAF and FTC/TDF, both contain a form of tenofovir which has a known negative impact on bone mineral density. The full extent of this potential damage is still relatively unknown.  
Despite these potential risks, DEXA scans are not routinely recommended in the 2021 CDC PrEP Guidelines due to the lack of benefit in clinical trials. DEXA scans are an optional test though, as DEXA scans are also cost-prohibitive and require an additional appointment which may deter some patients from choosing to get one.  
I am a VSHP member and a Clinical Pharmacist at the Inova Juniper Program where I manage a variety of patients, including those on PrEP thanks to the recent Virginia statewide protocol that expanded pharmacists' scope of practice in this area. One question that is commonly asked by patients is how I monitor them for safety outcomes of PrEP.  While it’s relatively easy to monitor estimated kidney function, I have unfortunately not been able to give patients a helpful answer regarding the status of their bone health. Recommendations and/or guidelines for osteoporosis screening patients with PrEP therapy are lacking but knowing a patient's osteoporosis risk could guide us in choosing and optimizing PrEP therapy for the patient. It could also help with insurance approvals, as insurance plans often deny FTC/TAF and/or LAI-CAB without a valid reason to switch from the cheaper and generic FTC/TDF (such as proof of bone health).  
I, along with two students who are also VSHP members, would like to propose this project of purchasing and using a peripheral densitometer (essentially a DEXA of the ankle) to evaluate t/z scores in PrEP patients and look for any correlations to evaluate the utility of this potential process. The machine we are hoping to buy is the GE Lunar Achilles machine, which I have experience using already from my PGY1 residency. It is fast and simple to use and requires minimal training.  

Timeline: 3-4 months
September: order densitometer  
September (and onwards): start utilizing densitometer with patients
November: present at VSHP Fall Seminar
December: present at ASHP Midyear Meeting 
 Through this project, we hope to provide more information and guidance to healthcare providers on assessing an HIV patient's osteoporosis risk and selecting the proper PrEP therapy. This project would help optimize care for patients undergoing PrEP therapy at an increased risk for osteoporosis. Hence, pharmacists can involve and directly monitor patients to inform physicians and patients about the risk and collaborate on appropriate and optimized treatment plans.  
 Riverside Center for Excellence in Aging and Lifelong Health (CEALH)  The Riverside Center for Excellence in Aging and Lifelong Health (CEALH) offers a unique combination of clinical and health services research to pilot innovative programming to improve the quality of life for older adults. CEALH is committed to identifying community needs and to working with partners to enhance home, community-based, and long-term care services to better serve individuals living with dementia and their family and professional caregivers. 
To this end, our team of clinicians and gerontologists developed and piloted a comprehensive medication management (CMM) program at CEALH starting in 2019. Since then, the CMM program has served more than 400 persons living with dementia and their family caregivers. Our program was oriented similar to a geriatric clinic with an emphasis on dementia care. Due to the highly positive feedback and significant outcomes from this program to date, we propose to expand the CMM to primary care practices in the Riverside Health System as a considerable amount of medical care for patients with memory loss occurs in primary care settings. With a steadily growing geriatric population, it is imperative to develop programs that provide resources and support for patients and their family caregivers.
The main purpose of a CMM program is to increase safety and reduce polypharmacy. Polypharmacy, where multiple drugs may have been prescribed to treat the same or similar conditions, is commonly experienced by individuals living with dementia (  Pharmacists play an integral role in reducing polypharmacy as they most often recommend changes to patients with a documented adverse drug event, patients taking a suboptimal drug, or those who show patterns of poor adherence.
Patients are eligible to receive the CMM based on certain factors, including probable or definitive dementia, taking five or more medicines, including prescription and over-the-counter (OTC), and having two or more chronic conditions. Patients who have dementia and who live alone have also been targeted to receive the medication review due to their additional vulnerabilities in managing their medications.
During the medication review and management session, the pharmacist, with additional credentials in geriatrics, discusses the patient's medications, determines the patient's medication literacy, and provides ways to safely reduce the number of medications taken, thereby reducing adverse reactions. This review includes input from and education for the family caregiver. The pharmacist's recommendations are communicated to the patient's primary care provider. Also, a summary sheet is provided to the patient and caregiver highlighting the key recommendations that were made and the importance of a timely follow-up with the provider to discuss potential changes based on the recommendations. The patient is re-assessed during a six-month follow up. Here, the pharmacist can determine if recommendations were accepted and if changes to the medication regimen had a positive impact in reducing the number of medications and the presence of polypharmacy.  
Funding from VSHP will allow for this pilot to commence in October 2022 with the engagement of at least one primary care physician (PCP) who has already indicated her commitment to participate. This PCP carries a panel of 1,215 patients age 60 years or older with 72% (874) eligible for a CMM. During the first quarter (October - December 2022), we will finalize a practice agreement and establish a workflow including identification of high-risk criteria that would flag a patient for a CMM. This workflow will incorporate a process that is most efficient for the PCP and the geriatric pharmacist. For example, patients with chronic conditions are generally seen in the primary care practice every three to six months. This frequency allows for the PCP to identify which patients meet the criteria for a CMM or who are challenged with managing their medications. These patients will be referred for a follow-up appointment, in the same practice setting, with the pharmacist. The family caregiver will be encouraged to attend in cases where the patient has identified memory loss. Also, during the first quarter, a brief (20-minute) educational lesson will be prepared by the pharmacist to help build awareness among PCPs about the CMM and the value it affords their patients. During the second quarter (January - March 2023), the workflow will be refined as at least 10 older patients will complete the CMM. The educational sessions will be offered at least three times, both in person and virtually, to at least 10 PCPs. For the third and fourth quarters, we will coordinate initial (15 additional) and follow-up CMM appointments with patients referred by their PCP, allowing this pilot to support at least 25 eligible patients.
 A CMM enables individuals to receive one-on-one education and tailored advice from a pharmacist. Following the review, the pharmacist communicates with the patient's medical provider, sharing recommendations and encouraging a partnership in the best interest of the patient. As this is completed alongside other clinical assessments by the PCP, patients receive holistic, high-quality care that directly benefits persons with dementia and their family caregivers in our community. 
We have prepared a community integration manual that is available by request. Utilizing this manual and then refining our process to work specifically within primary care settings, allows us to effectively share our model and our experiences with other health system pharmacists around the Commonwealth. Our team is also interested to learn from other health system pharmacists completing medication reviews about their experiences in supporting persons with memory loss in the community. In addition to forming partnerships, Riverside's CMM places emphasis on the identification of and reduction in polypharmacy in improving dementia care. Deprescribing often improves quality of life by preventing adverse drug events and simplifying medication management. Further, our CMM extends beyond a prescription medication lens and carefully considers the impact of OTC products, including herbal remedies, and their interaction with the overall regimen. This process allows us to offer a more holistic approach to care with the pharmacist an integral part.

2021 Grant Awards

Affiliation  Describe your proposed program or project, including schedule or timeline as applicable.  Describe how the project aligns with the VSHP mission statement
Virginia Commonwealth University (VCU) Health System 

To provide optimal care and support to patients who are aiming to make lifestyle changes or manage complex disease states, an understanding of motivational interviewing (MI) is vital to both outpatient and inpatient practitioners.  The University of Massachusetts Medical School offers a semester-long, Certificate of Intensive Training in Motivational Interviewing that encompasses topics such as goal setting, improving medication adherence, facilitating tobacco cessation, and cognitive behavioral therapy, among others. We envision that by allowing the VCU Health System (VCUHS) PGY2 Ambulatory Care Pharmacy Resident to attend this certificate program they would gain the necessary tools to not only enhance their own clinical practice, but to develop training sessions and/or continuing education for other pharmacy residents and pharmacists at VCUHS.
If approved, the ambulatory care resident would attend the course from January 2022 to the end of April 2022. During this time, the resident would be attending lectures as well as actively applying these concepts in online interactive group learning labs and receiving two individualized coaching sessions with a professional experienced MI coach. After the resident has completed the program, they will create an original training session that teaches concepts of motivational interviewing and allow the attendees to apply these skills through interactive activities.

The benefits of MI in the healthcare setting to improve patient outcomes have been documented in the medical literature. One meta-analysis in the Journal of Patient Education and Counseling identified that patients who received MI were 1.55 times likely to improve, most notably within improvements in HIV viral load, body weight, physical activity, alcohol and tobacco use, and self-monitoring. This project aims to develop an MI training session and interactive activities personalized for developing pharmacists in a variety of practice settings. The ultimate goal is to improve patient care and outcomes by facilitating more meaningful patient-pharmacist relationships, establishing comfort in addressing sensitive issues, and empowering patients to begin and maintain change behaviors. 
 University of Virginia Health 
 Naloxone is a life-saving antidote to reverse opioid overdose. Despite efforts to increase naloxone prescribing and availability through the standing order in the state of Virginia, barriers to patient access, specifically high cost, still remain. Our goal is to develop a naloxone distribution program within our emergency department. This will involve distributing naloxone at no cost patients and providing pharmacist-led education on administration prior emergency department discharge. This program will target patients who are in the emergency department for opioid overdose or at considered to be high risk for opioid overdose.
By 9/30/21
Develop written protocol for the program
Educate EM providers, nursing staff, and pharmacists on the program
Develop standard documentation of distribution and education in the electronic medical record
Purchase naloxone supply
Begin distributing intranasal naloxone to patients discharged from the emergency department with chief complaint of opioid overdose or those at high risk for opioid overdose
Examine outcomes. How many patients who received naloxone through the distribution program. Also examine 90 day outcomes of patients who receive naloxone through the distribution program.
Present outcomes to our institution
Fall 2022
Present outcomes at a state level

This program will increase patients with history of opioid overdose or at high risk of opioid overdose access to the life-saving antidote naloxone. It will also ensure these patients are educated thoroughly on naloxone administration. Our ultimate goal will be to reduce opioid overdose related deaths in the community through this program. We hope that sharing our outcomes will encourage our institution as well as other intuitions to devote permanent funding for naloxone distribution in the emergency department.

2021 Grant Updates

Affiliation  Describe your proposed program or project, including schedule or timeline as applicable.  Describe how the project aligns with the VSHP mission statement

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