The Role of Veterans Health Administration Intensive Primary Care in Optimizing Medication Regimens: A Qualitative Study of Patient and Provider Perspectives.

Abstract

Objective: To identify actionable steps from a Veterans Health Administration (VA) Intensive Primary Care (IPC) pilot in five VA sites that primary care teams and health care systems can take to optimize medication regimens in high-risk patients, many of whom have polypharmacy and poor medication adherence.

Methods: We conducted semi-structured, qualitative interviews between 2014 and 2018 with 27 IPC providers and 16 IPC patients. Interviews were analyzed using inductive and deductive approaches to thematic analysis.

Results: Patient respondents were an average of 67 years old and more likely to be male (94%), divorced (44%), Black (50%), hypertensive (88%), and have two or more comorbidities (81%). IPC patients and providers described IPC as helping to identify and/or address specific medication adherence barriers that were not adequately understood or addressed in usual primary care. IPC providers' greater understanding of adherence barriers allowed them to optimize patient medication regimens, closing the gap between care provided and patient needs. IPC program elements that enabled care improvements included interdisciplinary care teams, care team accessibility, home visits, and close provider-patient relationships.

Conclusions: Primary care teams can adopt some IPC program elements to help patients optimize medication regimens, such as greater involvement of extended team members, increasing accessibility of care teams through telephone and secure messaging, utilizing home visits for assessment of patients' needs, and developing strong provider-patient relationships.