For decades, Pacific alumni have been at the forefront of patient care for veterans through their roles with the U.S. Department of Veterans Affairs.

In the VA system, physicians make diagnoses, but pharmacists have the authority and autonomy to provide comprehensive medication therapy management, including writing prescriptions and ordering lab work. Additionally, over half of more than 11,000 VA pharmacists serve in advanced practice roles, which are known as clinical pharmacist practitioners (CPP). Pharmacists at the VA practice at the top of their license in a wide range of specialties including acute care, antimicrobial stewardship, emergency medicine, mental health, oncology, opioid safety, substance abuse and transitions of care.

“The VA offers a wide range of both direct patient care and indirect patient care opportunities for pharmacists,” said Patricia Chun ’99, PharmD, BCPS, who has more than 20 years of experience with the VA. “One can transition into a variety of patient care settings, such as disease state management in an ambulatory care clinic or serving as a vital member of an acute care team.”

The Veterans Health Administration is the largest integrated health care system in the United States, providing care to more than 9 million veterans at 172 medical centers and more than 1,100 outpatient sites in all 50 states, the District of Columbia and U.S. territories.

“The flexibility of being able to move anywhere in the country, or to transition from one disease state to another or one practice area to another without having to switch employers, is tremendous,” said Anthony P. Morreale ’83, PharmD, MBA, CPEL, BCPS, FASHP. “In my case, I’ve had about 10 different jobs within the VA over my career.”

Dr. Morreale served in various roles at the VA San Diego Healthcare System from 1985 until 2010, when he was selected for the newly created Clinical Pharmacy Practice Office (CPPO) for the U.S. Department of Veterans Affairs. He currently serves as associate chief consultant for clinical pharmacy, policy and pay for VA National Pharmacy Benefits Management in Washington, D.C.

In 2016, CPPO was awarded a multi-year $120 million grant by the Veterans Health Administration Office of Rural Health (ORH) to increase the number of clinical pharmacists engaged with patient-aligned care teams, pain management and mental health. The transformative grant added 175 advanced practice pharmacist positions, underscoring the value of pharmacists serving as medication experts on dynamic, collaborative teams.

One of Dr. Morreale’s goals is to utilize pharmacists to expand health care access for veterans, with an emphasis on reaching high-risk individuals. In 2018, he helped establish the VA’s first centralized anticoagulation hub that delivers pharmacist-managed anticoagulants to veterans in rural communities, and in 2020, his team was awarded another multi-year $10 million grant by ORH to expand the hub nationwide. In 2019, his team received a multi-year $25 million grant from ORH to expand clinical pharmacy services for substance abuse disorders.

Access to care is a critical issue, especially in areas where provider shortages are widespread. As a result, CPPO has focused on several key areas to expand CPP presence, including mental health, pain management and substance use disorders. As a result of these initiatives there has been a 50%, 174% and 37% increase in clinical pharmacist practitioners respectively.

Fellow alumnus Dr. Chun has impacted patient care through her dual role at the VA Long Beach Healthcare System.

“In my role as medication safety officer I am able to implement changes to improve patient safety through critically assessing various points within the medication-use process, whether it lies within prescribing, dispensing or administering medications,” she said. “I also have the privilege of serving as residency program director. I am passionate about education and mentorship and am so grateful that I can incorporate this into my job. My goal is to provide the residents with the skills and tools to be successful in whatever career path they pursue.”

The opportunity to serve veterans continues to inspire Poonam Tzorfas ’95, PharmD, MBA, BCGP, 30 years after she was first introduced to the VA as a student. She finds her role as chief of pharmacy services at the VA San Diego Healthcare System incredibly rewarding.

“The VA’s core values of integrity, commitment, advocacy, respect and excellence (I CARE) says it all,” Dr. Tzorfas said. “If one wants the opportunity to practice these every day, the VA is where you want to be. Veterans deserve the highest quality care for the sacrifices they and their families have made for the freedom we enjoy.”