Pharmacists in Public Health: A Call to Action

April 2014, Vol 2, No 2 - Inside Healthcare
Jennifer L. Bacci, PharmD

The US healthcare system is plagued by high costs, variable quality, and limited access to care.1 The passage and enactment of the Patient Protection and Affordable Care Act was facilitated by the transition of focus from quantity to the provision of high-quality, interdisciplinary care, and prevention of costly diseases.2 Prevention requires a focus on public health and population-based care. The Institute of Medicine defines public health as “fulfilling society’s interest in assuring conditions in which people can be healthy.”3

There will be a shortage of public health professionals by the year 2020. This shortage will require other healthcare professionals, including pharmacists, to embrace public health responsibilities in order to meet the health needs of the United States and global populations. Organizations both within and outside of the pharmacy profession are now seeking to promote pharmacist involvement in public health activities. The American Public Health Association outlined public health functions that could be performed by pharmacists.4 Public health is now included in the American Association of Colleges of Pharmacy Center for the Advancement of Pharmacy Education outcomes.5 In addition, public health has been recognized as a competency that employers expect of new pharmacy graduates.6 The Centers for Disease Control and Prevention (CDC) has recognized how pharmacists can affect public health efforts through the prevention and control of disease.7 Furthermore, Healthy People 2020 states that pharmacists can assist in prevention efforts because of their direct access to patients.8

The American Society of Health-System Pharmacists has identified public health activities in which health-system pharmacists should be involved: population-based care, disease prevention and medication safety, health education, public health policy, and research and training.4 All pharmacists should be participating in these public health activities regardless of their practice setting. Community and ambulatory care pharmacists have already implemented interventions aimed at primary and secondary prevention. Primary prevention targets education and awareness, whereas secondary prevention targets early detection and treatment.

Pharmacists are now authorized to administer the influenza vaccine in all 50 states.9 The CDC reports that a pharmacy was the second most common place of vaccination among adults aged >18 years during the 2011-2012 influenza season based on data from the Behavioral Risk Factor Surveillance System and the National Flu Survey.10 Some pharmacies now provide travel health clinics where certified pharmacists administer travel vaccines and preventive medications through collaborative practice agreements (CPAs). Pharmacists are also actively involved in educating the public on syringe exchange, illness prevention, and safe medication disposal.

One study demonstrated that these programs are able to expand the public’s access to clean syringes because they reach different populations of injection drug users.11 Secondary prevention efforts by pharmacists revolve around screening. Pharmacies have implemented screenings for colorectal cancer and diabetes.12 In addition, the CDC has created the “Get Smart” campaign to educate the public on appropriate antibiotic use.13 The CDC is targeting outpatient healthcare providers, inpatient healthcare providers, and community pharmacists to be involved in this campaign. The activities mentioned above are all microlevel. Microlevel activities are activities that occur at a provider or implementation level.4 These examples demonstrate that pharmacists have been able to successfully implement public health activities within their practices.

Public health activities also occur on a macrolevel, or planning level. Macrolevel activities include assessing and prioritizing a community’s health needs, formulating public health priorities, and conducting research about public health activities.4 Pharmacists should be participating more in the development of public health policy. As medication experts, pharmacists should be contributing to policies regarding:

  • Emergency planning, service delivery, and pharma­ceutical inventories
  • Handling and disposal of hazardous drugs
  • Prescription drug monitoring programs
  • Immunization practices and registries
  • Needle exchange programs
  • Collaborative drug therapy management and CPAs
  • Disease prevention and management.

Many tools are publicly available to guide health-program planning and evaluation. These tools include:

  • The State Program Evaluation Guides, by the CDC Division for Heart Disease and Stroke
    Prevention14
  • The Community Tool Box15
  • Redesigning the Health Care Team: Diabetes Prevention and Lifelong Management, by the National Diabetes Education Program16
  • A Framework for Program Evaluation, by the CDC.17

How can you get involved? There are plenty of opportunities for you to get involved, whether you are a practitioner or an academic. Work with management and other pharmacists at your practice to develop and implement patient education programs such as medication safety, medication adherence, disease prevention and control, tobacco cessation, exercise, healthy nutrition, and/or poison prevention. Become a certified immunization provider by completing the American Pharmacists Association training program. Educate your community leaders about public health initiatives. Serve on your local National Disaster Medical System assistance team, National Pharmacy Response Team, or Medical Reserve Corps. Advocate for public health policy through state and national professional associations, state and local boards of health, and State Boards of Pharmacy.4 Pursue advanced educational opportunities and certifications in public health. There are residency and fellowship programs in public health and policy throughout the country and several schools and colleges of pharmacy offer a dual Doctorate in Pharmacy and Master in Public Health (MPH) degree program. Graduate degree programs in public health include the MPH, Master of Health Administration, and Master of Science in Public Health. There are 2 public health certifications currently offered: Certified Health Education Specialist or Certified in Public Health (CPH). Pharmacists who obtain a graduate degree from an accredited public health school or program can obtain their CPH through examination from the National Board of Public Health Examiners.18

In anticipation of the shortage of public health professionals in the coming years, pharmacists have the responsibility to contribute to public health efforts by providing population-based care, disease prevention and control programs, and health education, and by contributing to public policy efforts.4 As pharmacy transitions from dispensing to patient care, it is critical that pharmacists expand their services into public health to ensure that the health needs of the US population are met.

References

  1. Giberson S, Yoder S, Lee MP; US Public Health Service. Improving patient and health system outcomes through advanced pharmacy practice. A report to the US Surgeon General. www.usphs.gov/corpslinks/pharmacy/sc_comms_sg_report.aspx. Accessed March 10, 2014.
  2. American Public Health Association. Why do we need the Affordable Care Act? www.apha.org/NR/rdonlyres/19BEA341-A7C3-4920-B2BC-65BDC846B803/0/WhyWeNeedtheACA_Aug2012.pdf. Accessed February 26, 2014.
  3. Committee for the Study of the Future of Public Health. The future of public health. Washington, DC: National Academies Press; 1988:7.
  4. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in public health. Am J Health-Syst Pharm. 2008;65(5):462-467.
  5. American Association of Colleges of Pharmacy. CAPE Educational Outcomes 2013. www.aacp.org/resources/education/cape/Pages/default.aspx. Accessed February 26, 2014.
  6. Vlasses PH, Patel N, Rouse MJ, Ray MD, Smith GH, Beardsley RS. Employer
    expectations of new pharmacy graduates: implications for the pharmacy degree accreditation standards. Am J Pharm Educ. 2013;77(3):47.
  7. Morrison CM, Glover D, Gilchrist SM, et al. Centers for Disease Control and Prevention. A program guide for public health. Partnering with pharmacists in the prevention and control of chronic diseases. www.cdc.gov/dhdsp. Accessed February 26, 2014.
  8. US Department of Health and Human Services. Healthy People 2020 framework. www.healthypeople.gov/HP2020/Objectives/framework.aspx. Accessed March 10, 2014.
  9. American Pharmacists Association and Academy of Managed Care Pharmacy. Pharmacist-provided immunization compensation and recognition: white paper summarizing APhA/AMCP stakeholder meeting. J Am Pharm Assoc. 2011;51(6):704-712.
  10. Centers for Disease Control and Prevention (CDC). Surveillance of influenza vaccination coverage — United States, 2007–08 through 2011–12 influenza seasons. MMWR Morb Mortal Wkly Rep. 2013;62(ss04):1-29.
  11. Rudolph AE, Crawford ND, Ompad DC, et al. Comparison of injection drug users accessing syringes from pharmacies, syringe exchange programs, and other syringe sources to inform targeted HIV prevention and intervention strategies. J Am Pharm Assoc. 2010;50(2):140-147.
  12. Farris KB, Johnson KA. Pharmacists in public health: it’s a good start! J Am Pharm Assoc. 2010;50(2):128-130.
  13. Centers for Disease Control and Prevention. Get smart: know when antibiotics work. www.cdc.gov/getsmart/index.html. Accessed February 26, 2014.
  14. Centers for Disease Control and Prevention. State program evaluation guides. www.cdc.gov/dhdsp/programs/nhdsp_program/evaluation_guides/index.htm. Accessed February 26, 2014.
  15. Community Tool Box. Work group for community health and development. http://ctb.ku.edu/en. Accessed February 26, 2014.
  16. National Diabetes Education Program. Redesigning the health care team: diabetes prevention and lifelong management. http://ndep.nih.gov/publications/Publication Detail.aspx?PubId=113#main. Accessed February 26, 2014.
  17. Centers for Disease Control and Prevention. A framework for program evaluation. www.cdc.gov/eval/framework/index.htm. Accessed February 26, 2014.
  18. Truong HA, Patterson BY. Professional and educational initiatives, supports, and opportunities for advanced training in public health. Am J Pharm Educ. 2010;74(7):122.
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