Empowering Veterans: How the VALOR-QI Program Lowers Atherosclerotic Cardiovascular Disease Risk

Rachel Chandra, PharmD, MPH, FASHP, clinical pharmacy practitioner at the Dayton Veterans Affairs Medical Center, spoke with Pharmacy Times at the American Heart Association 2024 Scientific Sessions about VALOR-QI, a quality-improvement focused program with the goal of lowering cholesterol in patients with atherosclerotic cardiovascular disease (ASCVD). The program provides various quality improvement resources to patients in need such as health coaching to aid patients in managing their own care.

Pharmacy Times: What is VALOR-QI?

Rachel Chandra, PharmD, MPH, FASHP: So, VALOR-QI stands for VA lipid optimization reimagined quality improvement. I am one of the VALOR-QI champions for our site at the Dayton, VA. VALOR, overall, is a collaborative approach with the American Heart Association, VA, and Novartis with the goals of lowering patients’ risk with ASCVD.

Pharmacy Times: What is the experience of veterans in the healthcare system? How does VALOR-QI address barriers to treatment?

Hands holding a crochet heart | Image Credit: © StockerThings - stock.adobe.com

Chandra: Every patient population has challenges, as with veteran population, whether they're in the rural areas or urban areas. With regards to lipid lowering treatments, we've experienced some gender disparity and with regards to statin adherence and management in lowering their LDL goals, so the VALOR program is able to provide that tailored approach and address social determinants of health for the respective patients that come through the valor program through the health of individualized care and coaching with a health coach, which is one of the one of the benefits of being in the VALOR program we've been provided with the provision of services for a health coach. So, we are able to provide health coaches that have the additional time and tailored approach whether the patient in a cardiology clinic or in an ambulatory care clinic. Providers are busy seeing patients and may not have the additional time to spend with the patients.

Pharmacy Times: What specific initiatives or pathways in the program improve veteran access to dyslipidemia management?

Chandra: With regards to VALOR approaches, because it is a quality improvement project, with 50 sites across the country, each site is able to tailor their program to be specific to their facilities needs and resources accordingly. And so, at our site, we've been able to connect patients to programs such as MOVE!, which is a weight loss program that can be done face to face, or telemanaged, which is a huge addition for patients in the rural areas.

We've recognized that some of the patients need cooking classes, so we've been able to connect patients with nutrition for access to cooking classes and so that they can have a heart healthy diet as they as they go through the rest of their treatment and manage their own care. So, through the use of a health coach, we're able to provide that pharmacologic and non-pharmacologic interventions that patients need, some of the tools that the skill set that the health coach uses are providing that shared medical decision making, as well as utilizing motivational interviewing to get patients from point A to point B.

We did not realize that that was available to us until we started the program. I started looking at resources what resources we have that we can put in consults, like, “oh yeah, they do cooking classes.” And some cooking classes can be ethnically focused.

Pharmacy Times: What’s the importance of these programs? What is needed to drive them forward in medical institutions?

Chandra: Health care is different everywhere, but what the VALOR program provides is a rich set of data with 50 sites with different types of quality improvement projects and different resources that they've used to help manage patients and lower their risk of ASCVD.

So as a result of that, at the end of the VALOR-QI program, we do have to consider what are the next steps in sustainability. But at the end of this, we also have a rich database of different strategies that have been beneficial in lowering patients’ risk. And almost as important as having the rich data for what programs have been useful, it's recognizing some of those programs and some of those strategies and initiatives that have not worked to factor those in. So therefore, programs can be structured or restructured nationally to be tailored as such, to have programs that work well in lowering patients’ risk with ASCVD.