By Rear Adm. Scott F. Giberson, RPh, MPh, assistant Surgeon General and chief pharmacy officer, U.S. Public Health Service
Pharmacists are the third-largest category (and second-largest professional discipline) of the U.S. Public Health Service (PHS) with more than 1,150 pharmacy officers. Commissioned Corps pharmacists of the PHS have long been a critical component to the provision of public health to the American people — particularly those in medically underserved and vulnerable populations.
The 2012 PHS Pharmacy Outlook noted that corps pharmacists were prepared to lead. This included the ability to foster partnerships both internal and external to the federal government, the capability to innovate through prevention and chronic care strategies and the overall advancement of the profession to improve patient and health system outcomes. Corps pharmacists are part of multiple health systems and agencies (i.e., Indian Health Service, Bureau of Prisons, Food and Drug Administration, etc.). Thus, additional value comes with the network created from our officers assigned to about 25 agencies and 11 different U.S. departments both domestically and abroad.
Due to this diversity, PHS Pharmacy realizes the capacity and responsibility to lead in pharmacy practice. The key focus for 2012 was to seize opportunity and transform to assist with health system challenges. The following PHS Pharmacy initiatives commenced in 2012 with the intent to collect and measure their impact. In 2013, building upon existing success, PHS Pharmacy will continue to facilitate initiatives, partner and innovate — as it accelerates unprecedented transformation of the profession.
On Jan. 9, 2012, PHS Pharmacy submitted a report to the U.S. Surgeon General entitled, “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice.” This first-ever report on pharmacy practice to the U.S. Surgeon General demonstrated through evidence-based outcomes that pharmacists performing in expanded roles improve clinical and administrative outcomes for patients and health system. The report garnered support from the U.S. Surgeon General as well as other physicians from the Indian Health Service and Federal Bureau of Prisons. Additional healthcare providers and physicians provided unsolicited support letters for the report. The report’s direct and indirect impact includes a surge in activities surrounding organizational partnering, state pharmacy association initiatives, state legislative changes and further advancement of federal pharmacy collaboration.
Since its release, the report has received widespread recognition and utilization across the nation and abroad. Stakeholders are utilizing the report as a tool to move forward and ignite an effort to unify our messages, expand our roles and advance as a profession. PHS Pharmacy has been privileged to engage in more than 50 speaking invitations involving more than 30 states and in the global arena. In 2013, PHS Pharmacy will continue to collect and consolidate information on the positive impact as a result of the report.
In concert with the report and the release of the Federal Pharmacist Vision, chief pharmacists from the Department of Veterans Affairs, Army, Navy, Air Force and Public Health Service released a Federal Pharmacist Scope of Practice (http://tinyurl.com/usphs-pharmacist) The scope reflects the state of pharmacy practice when the Federal Pharmacist Vision has been achieved. Many federal pharmacists and partners have already been working on initiatives to actualize the Federal Pharmacist Vision and Scope of Practice — once again accelerating transformation.Lead Externally
PHS pharmacists will continue to engage in many pharmacy-related initiatives within the Department of Health and Human Services and with external customers. In 2012, the Million Hearts campaign was launched for a concerted national effort to target cardiovascular health and prevent one million heart attacks and strokes over five years. Many federal agencies, as well as PHS pharmacists have joined this campaign to help achieve its goals. Pharmacists have a unique capacity — based on the expertise to manage chronic conditions and accessibility within the communities — to function in a vital role in this effort.
PHS Pharmacy also collaborates with external stakeholders to improve the nation’s health. For example, in January 2012, the American Pharmacists Association Foundation convened a consortium on pharmacists’ role in patient care. PHS pharmacists worked with the foundation to develop a white paper, “Consortium Recommendations for Advancing Pharmacists’ Patient Care Services and Collaborative Practice Agreements.” This outlines recommendations for broader integration of collaborative practice agreements and pharmacist-delivered patient services throughout the profession. PHS Pharmacy will continue to partner both internally and externally to transform the profession as we serve our mission to protect, promote and advance the health and safety of the nation.
In 2013, we seek to further PHS Pharmacy’s impact. Our officers have chosen to be commissioned in PHS Pharmacy to lead — to positively impact the health of the nation and not to be impacted by it. In 2013, this commitment will drive us to continue to forge partnerships and be a catalyst to help accelerate transformation in our profession for our patients, the health system and the nation’s health for 2013 and beyond.Build upon Existing Success
PHS pharmacists assigned to the U.S. Coast Guard have been progressive in enhancing pharmacist-delivered patient-care services. Coast Guard Pharmacy serves approximately 43,000 active duty Coast Guard members and 8,000 reservists. PHS pharmacists serving in the Coast Guard coordinate pharmacy activities in more than 150 shore-based ambulatory clinics and ashore/afloat sickbays, spanning from Alaska to Puerto Rico. These PHS pharmacists provide direct patient care, work directly with medical and dental personnel, facilitate corpsman and pharmacy student training and provide oversight and management of the Weapons of Mass Destruction (WMD) stockpile program, budgetary administration and quality improvement program input. Transformation within the Coast Guard has become an everyday occurrence as its mission dictates flexible maneuvering to meet the needs of day-to-day operations.
In 2013, opportunities for Coast Guard pharmacists will continue to evolve. Currently, the Coast Guard Health Services is in the process of fully implementing a Patient Centered Wellness Home (PCWH) model with a preventive approach to healthcare. This model supports the quadruple aim (readiness, experience of care, population health and per capita costs) to ensure high quality patient care. In 2013, Coast Guard pharmacists will play a key role in the PCWH model by being engaged in patient’s overall health treatment plan and leading services in smoking cessation, medication reconciliation, immunizations and dietary supplements utilization. Coast Guard pharmacists will serve as physician extenders in delivering these patient care services, thus capitalizing on the astute pharmacist training while assisting with physicians’ workload.
The Bureau of Prisons pharmacy program, under the leadership of Rear Adm. Chris Bina, chief pharmacist, provides pharmacy services to 178,000 inmates at 117 correctional institutions across the nation, plus 39,000 individuals in contract facilities, halfway houses or home confinement. PHS pharmacists in BOP provide primary and specialty patient care at the fullest extent of their education and licensure through collaborative practice agreements (CPAs) with physicians. BOP Pharmacy has spearheaded multiple national and site-specific clinical pharmacy programs to improve patient outcomes, including the National HIV and Hepatitis Clinical Pharmacist Consultant Programs, as well as site-specific programs in areas including antimicrobial stewardship, high-risk medication, preventive TB therapy, anemia and renal/dialysis. Currently, about 70 clinical pharmacy protocols with about 55 pharmacist-physician CPAs are approved and active. The BOP Clinical Pharmacy Services, Collaborative Practice Agreement Technical Guidance released by the BOP Medical Director outline requirements for clinical pharmacy programs, including agreements and protocols, as well as the integration with the IHS National Clinical Pharmacy Specialist credentialing program. BOP also has integrated a pharmacist Medication Mortality Review Workgroup into its mortality-review process. A team of BOP pharmacists review any inmate mortality potentially related to medication use. In 2013, BOP will look to further expand collaboration and improve care for inmates.
The Centers for Disease Control and Prevention, Atlanta, released a guide for public health programs in August 2012 that focuses on the roles of pharmacists in providing team-based care to facilitate public and private partnerships between state health departments, communities and pharmacists. Various stakeholders provided feedback and guidance, including PHS Pharmacy. This guide should assist chronic disease prevention programs in understanding pharmacists’ expanded roles and the various models of care that we can provide.
The Indian Health Service (IHS) continues to advance pharmacist-delivered patient care services for the American Indian and Alaska Native populations. The IHS and VA collaboration on Consolidated Mail Outpatient Pharmacy (CMOP) has grown to 21 IHS facilities providing services to more than 328,000 patients. This service increases pharmacist time available for direct patient care with the overall goal of improving patient outcomes. In addition, the Prescription Drug Monitoring Programs (PDMPs) partnership between IHS, states, and federal entities has expanded to almost all IHS facilities. Soon, all IHS facilities will be connected with state PDMPs for transmitting data to their state PDMPs and allowing nearly all IHS medical and pharmacy staff to access state data. This data sharing will enable enhanced patient care, identify patients at high risk for addiction and prescription drug abuse and provide for early entry into treatment, where needed.
The diverse and unique roles and duties PHS pharmacists take on throughout the expansive network in the federal government present unparalleled opportunities for students. For example, the IHS Pharmacy Program has a national school agreement allowing each college of pharmacy to sign one agreement. This agreement covers all IHS federal student rotation sites, facilitating experiential learning partnerships. Currently 18 pharmacy schools in 17 states from California to Maine have this national agreement. In 2013, we will look to expand again to further accelerate transformation with the next generation of pharmacists.
With pharmacists from across the DoD and VA clamoring for spots in the Clinical Pharmacy Course at Army Medical Department Center and School (AMEDDCS) in Fort Sam Houston, TX, organizers offered back-to-back programs this spring, with another scheduled for August.
Since the launch of the Opioid Safety Initiative in 2012, the VA has implemented a number of steps designed to reduce the use of opioids and the risk of addiction and overdose among veterans.