Public Health Service Pharmacy 2014: Embracing Leadership

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By Rear Adm.Scott F. Giberson
Acting Deputy Surgeon General U.S. Public Health Service

For well over 200 years, the U.S. Public Health Service (PHS) flag has flown side-by-side with our fellow uniformed service members.  As we look forward to opportunities in 2014, it is also a time to reflect and discuss PHS pharmacy advancements in honor of the 50th anniversary of U.S. Medicine.  Although the PHS has grown to assign officers into an unprecedented 11 U.S. Departments and 25 Agencies and Operating Divisions, it has not changed in terms of its fundamental mission to protect, promote, and advance the health and safety of the nation. The 6,800 officers within the Commissioned Corps of the PHS have demonstrated successful public health leadership, partnership building and transformation in many ways.  The 1,200 PHS pharmacists are part of a rich tradition and history of career diversity, innovation and progressive practice.

Back to the Future

Cmdr. Aaron Middlekauff uses a pharmacy counting and verification system. U.S. Coast Guard photo by Lisa Novak.

Cmdr. Aaron Middlekauff uses a pharmacy counting and verification system. U.S. Coast Guard photo by Lisa Novak.

The early 1960s presented a paradigm shift for our profession in the way that pharmacists practiced in the PHS. Within the PHS, the Indian Health Service (IHS) developed a clinical practice like no other in the country. Corps pharmacist pioneers like Allen Brands transformed from a solely dispensatory model (assess, count and label) to a patient-centered, counseling approach. Pharmacists cared for patients utilizing full health record, counseled patients on the correct use of their medications, used private offices for patient encounters, and provided medicine directly to patients based on clinical protocols.

In the 1970s there was an increased need for patient care, and pharmacists further expanded their roles by providing some facets of primary care – inclusive of chronic care. This was supported by many physicians in the IHS and represented a very early look at a team-based approach to increase access to care. In the ‘80s and ‘90s, PHS/IHS Pharmacy continued to solidify its progressive clinical practice. With the development of IHS Standards of Practice, the National Clinical Pharmacy Specialists Program and sought-after training programs, PHS demonstrated continued innovative excellence. Yet, 50 years later there is still a challenge to scale that successful model outward adequately beyond the walls of federal medicine. Thus, more work needs to be done. Can we (or have we) maximized the value of our profession? A look back may in fact be a look at our future.

Milestones and Progress

Across the last five decades, the PHS has experienced several significant milestones.  In 1968, the Food and Drug Administration (FDA) was made a part of the PHS, thus involving pharmacists more intimately in the area of regulation.  The U.S. Coast Guard established its first site in which a PHS pharmacist was detailed to the clinic at the Coast Guard Academy. Now we have pharmacists in over 15 Coast Guard stations across the country. Similarly, the first pharmacist detailed to the Springfield Bureau of Prisons (BOP) in the 1960s has grown to include pharmacists assigned to 117 BOP institutions.

PHS Pharmacy also continued to expand its role in disaster response. Pharmacy officers have repeatedly demonstrated their expertise, readiness and rapid deployability in response to pandemic flu and SARS, natural disasters such as hurricanes (i.e., Rita, Katrina, and Sandy), terrorist attacks such as 9/11, and provision of acute care at national security events such as U.S. Presidential Inaugurations.

More recently, the PHS published the Pharmacy Report to the Surgeon General, now a well-referenced report that has helped states and the profession advance pharmacy practice for the betterment of patient health. In addition, PHS Pharmacy – with its partners, the Department of Defense and Veterans Administration – facilitated the first-ever Federal Pharmacist Vision and Scope of Practice. This helped to unify concepts of patient care and practice roles across all of federal pharmacy.

Looking Ahead to 2014

The coming year represents unprecedented opportunity. Millions of Americans will have new healthcare coverage. Pharmacists can help transition this seamlessly to healthcare access. The majority of healthcare in the U.S. statistically continues to be post-diagnosis. Over 76% of physician visits are chronic care.[1] It can also be said the primary treatment method in the nation is undoubtedly through the use of medications, which incurs tremendous costs. Consider the following:

  • Pharmacists are the most highly trained healthcare professionals based on years of formal education, second only to physicians.
  • The focus of our curriculum is mainly post-diagnosis in whom medications are the primary forms of treatment.
  • Pharmacists demonstrated an average return on investment (ROI) of 4:1. This means for every dollar spent, an ROI of four dollars is realized.
  • An estimated 270 million people visit a pharmacy each week. We are accessible everywhere and among the most trusted health professionals in communities.
  • Pharmacists have decades of evidence demonstrating improved outcomes when given the opportunity to expand our scope.[2]

By pioneering new healthcare delivery paradigms, PHS pharmacists can help ensure access to care and preventive care across the nation. Thus, our long-term outlook includes PHS Pharmacy – and pharmacy in general – as an essential part of healthcare change.

For four years, until March 2014,  it was an honor to represent our pharmacists as the Chief Professional Officer of the PHS Pharmacy Category. From July 2013 until March 2014, I also was afforded the privilege to serve as the Acting U.S. Deputy Surgeon General under the leadership of Acting Surgeon General, Rear Adm. Boris Lushniak.

As Acting U.S. Deputy Surgeon General, I support RADM Lushniak to communicate the best available scientific information to the public regarding ways to improve the health of the nation.  In addition, we oversee the operations of the Commissioned Corps, which include 11 health disciplines serving in 800 locations worldwide.

Being officers and pharmacists in the PHS exemplify an energy and camaraderie, very similar to our sister services; qualities that are very difficult to capture with words.  I believe our officers have chosen to be commissioned in PHS Pharmacy to serve a mission and to pioneer change. I challenge you to accept and embrace these responsibilities. It is an extraordinary time for pharmacists to demonstrate our commitment to advance our profession and the health of the nation. It is time to lead.

[1] Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General. 2011. Available online at:  http://www.usphs.gov/corpslinks/pharmacy/documents/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf

[2] Improving Patient and Health System Outcomes through Advanced Pharmacy Practice: A Report to the U.S. Surgeon General. 2011. Available online at:  http://www.usphs.gov/corpslinks/pharmacy/documents/2011AdvancedPharmacyPracticeReporttotheUSSG.pdf

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