Stephanie (Garza) Valdes, PharmD, CDCES, is a clinical pharmacy specialist at the VA Texas Valley Coastal Bend HCS in Laredo, TX.
I currently work in South Texas as a Department of Veterans Affairs (VA) Clinical Pharmacy Specialist, a title that will soon be replaced with Clinical Pharmacist Practitioner.
My prescriptive authority is a bit different than many pharmacists’ because I am “scoped” within the VA and not Texas, meaning my prescriptions cannot be dispensed at a non-VA Texas pharmacy.
The Texas State Board of Pharmacy has its own requirements for prescribing pharmacists: continuing education with each license renewal and a signed collaborative agreement identifying the disease states for which the pharmacist is authorized to prescribe.
The online list of Texas pharmacists authorized to sign prescriptions allows dispensing pharmacists to look up a prescribing Texas pharmacist to determine if a specific medication is under their scope of practice.
My VA scope of practice is “outpatient comprehensive medication management of primary care,” without specified disease states. This provides flexibility and allows me autonomy to use my clinical judgment when deciding what I feel comfortable managing and prescribing within the VA system.
As a scoped VA practitioner, I am peer-reviewed twice monthly, undergo a professional practice evaluation every 6 months, and am required to recertify my scope of practice every 2 years.
My VA outpatient clinic sits on the Mexican border, which results in a unique patient population comprised of more than 90% Hispanic U.S. veterans.
Hispanic adults are 70% more likely to have diabetes than non-Hispanic white adults, making comprehensive medication management for this chronic condition an imminent need I am able to meet by utilizing a thoughtful combination of my clinical training, compassion, and rapport.
It’s important to me that my clinic is a safe space to embrace diversity; this involves a willingness to discuss and understand cuisines, customs, and belief systems my patients hold dear. I find that I make the most significant impact on a patient’s health when I prioritize establishing a genuine connection with them and integrating their priorities into their care.
In my first few months of practice, one veteran enrolled in my clinic for type 2 diabetes with a diagnosis duration of over 20 years and an A1C level consistently >9.5% for the previous 10 years.
I made the effort to connect with him over a couple appointments, and he eventually trusted me to optimize his pharmacotherapy. For the first time in over 10 years, he achieved an A1C level <8%. While this was not the ultimate health goal for the patient, I provided him with a certificate of achievement to celebrate this milestone. Tears welled up in his eyes and I later found out the certificate was posted on his home refrigerator.
I was unsure how my veteran population would perceive the certificates, but it quickly became a hit and has become something patients look forward to earning.
Living with a chronic condition is a marathon. As providers, we are well positioned to serve our patients as both their coach and cheer section to remind them they are still in the race.