Rear Admiral Scott F Giberson
US Public Health Service Commissioned Corps Chief
US Public Health Service (PHS) pharmacists often refer to our pharmacy program as the profession’s “best kept secret.” For 2011 and beyond, PHS Pharmacy will position itself to no longer be a secret to the profession, but rather a model to emulate. Consistent with the mission of the PHS, pharmacists and other PHS professionals play a vital role in protecting, promoting, and advancing the health and safety of our nation. The diversity of PHS pharmacists’ responsibilities and expanded roles, coupled with unique inter-professional partnerships, position us to help lead health systems into a new paradigm of care. We will maximize contributions of our profession to improve outcomes toward a healthier nation.
As the PHS Chief Professional Officer (CPO) of the Pharmacy Category, it is a privilege to share such a promising PHS Pharmacy outlook for 2011 and beyond. Within the next few years, PHS pharmacists will take part in pioneering reform and ensuring healthcare for the entire nation. The inimitable pharmacy practice environments we share in federal healthcare have allowed us to adapt to and create the very changes that advance the profession, through improving health outcomes for patients and optimizing health systems.
The PHS Pharmacy Category is comprised of approximately 1,100 Commissioned Corps pharmacist officers and over 400 civilian and tribally hired pharmacists spread across 15 federal agencies, including nine agencies within the US Public Health Service. A majority of PHS pharmacists practice in clinical roles within the Indian Health Service (IHS) and Bureau of Prisons (BOP). However, there are hundreds more assigned within all agencies of the Department of Health and Human Services (HHS) including the Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), and other HHS agencies. There are also a significant and growing number assigned to the Department of Homeland Security (DHS) and United States Coast Guard (USCG). Pharmacists have played a vital role in the PHS over the last 100 years, influencing health policy, research, and impacting health safety and clinical practice. Today, our pharmacists continue these roles and have furthered their responsibilities in public health and health leadership.
As we enter the era of health reform, there will be additional challenges in clinical care and public health. The Association of Schools of Public Health stated the public health workforce will diminish over time and estimates that 250,000 more public health workers will be needed by 2020. These challenges offer significant opportunities for PHS pharmacists to develop new models that effectively contribute to the public’s health. This may be in the form of innovation in patient centered care, population-targeted care, comparative effectiveness research, payment reform, and workforce solutions to name a few.
Pharmacists are healthcare providers, public health professionals, and each community’s trusted and most accessible health professional. The question becomes, ‘how will PHS Pharmacy respond to health reform?’ In brief, we will leverage our diverse experiences and practice environments to shape and broaden models of care through collaborative efforts and novel approaches. We will continue to advance our roles in public health and maximize our scope of clinical practice consistent with training, licensure, and expertise to optimize customer and health system outcomes. Thus, our long-term outlook includes PHS Pharmacy as an essential part of the solution to healthcare reform.
Because PHS pharmacists are engaged across a broad spectrum of agencies and missions, evidence of this response is already under way. Accordingly, three focus areas must be addressed in 2011 and beyond to help further the response:
- continued expansion and maximization of a pharmacist’s licensure, roles, and contributions—this includes positioning the PHS Pharmacy Category within health reform to demonstrate novel models of care ,
- expanded partnerships within the PHS and with external stakeholders, and
- recruitment and development of future pharmacy leaders.
Within each of these areas, there are a number of initiatives that can illustrate how we are addressing change and leading for the profession into the future of healthcare.
Advance the Profession to Optimize the Nation’s Health
PHS Pharmacy remains dynamic. By utilizing pharmacists in multidisciplinary and public health leadership roles, PHS pharmacists have demonstrated substantial success in promoting and supporting public health and clinical pharmacy practice. The Institute of Medicine Report on Health Professions enumerates five core competencies that help bridge our professional education to quality services. From delivering patient centered care, to working as a part of interdisciplinary teams, to utilization of health information technology, and focusing on quality improvements, PHS pharmacists have mirrored these competencies. We continue to build upon these concepts and operationalize them across our agencies as seen with the initiatives highlighted below.
The Agency for Healthcare Research and Quality (AHRQ) oversees the Comparative
Effectiveness Research (CER) program for the Department of Health and Human Services. The IHS, with a rich tradition of innovative care delivery that utilizes its pharmacists as patient care providers, developed a CER funding proposal. The project will examine the comparative effectiveness of diabetes management provided within the IHS’s advanced practice pharmacy model as compared to that provided by other health professionals. Patient centered programs have been shown to increase access to care, quality of care, and are supported by physicians and the health system. This collaboration between the IHS Pharmacy, Office of Information Technology, and Diabetes Programs was awarded CER funding for the project.
The IHS also conducts a National Anticoagulation Training Program (ATP), a multidisciplinary, three day certificate training program providing specialized training in anticoagulation and disease management. To date, 360 attendees have been trained through 40 programs, representing 46 sites and 23 states. While the ATP was developed primarily for pharmacists, additional healthcare providers including physicians, nurse practitioners, physician assistants, dentists, and nurses have attended regularly. Other federal partners have been represented including the Department of Veterans Affairs (VA), the BOP, and Department of Defense (DoD). This is another example of the benefit of maximizing pharmacists’ utility in collaboration with other providers to optimize care.
The Bureau of Prison’s pharmacists have also been progressive in efforts to increase collaboration. One example of success is illustrated through results of the HIV Clinical Pharmacist Consultant Program. Under this program, the ongoing review of approximately 1,300 HIV positive patients taking antiretroviral therapy has made an indelible mark on patient outcomes and the practice of team medicine. The percentage of patients with an undetectable viral load across the BOP has more than doubled, increasing from 32% in 2005 to 66% today. The BOP Pharmacy Program delivers pharmacy services with the mantra, “It takes a team to raise an outcome.”
In each of the initiatives discussed above and in many more, PHS Pharmacy will position itself through these progressive and novel approaches to contribute to shaping health reform.
Expand Partnerships both Internal and External to PHS Pharmacy
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), led by HRSA’s Office of Pharmacy Affairs, is a novel program to improve the quality of healthcare across America by integrating evidence-based clinical pharmacy services (CPS) into the care and management of high-risk, high-cost, complex patients. In its third year, the PSPC is continuing the rapid spread of leading practices that effectively improve patient safety and health outcomes in a health home model. PSPC builds on its successes while expanding the work to a greater national scale. There are over 130 community-based teams across the country. Currently, teams from PSPC 2.0 are generating patient outcomes through an integrated team approach. Collectively, over 54% of PSPC patients have improved their health condition from “out of control” to “under control”, the rates for potential adverse drug events fell 60%, and the rates for adverse drug events decreased by 50%. PSPC teams are transforming the primary healthcare delivery system by establishing effective, interdisciplinary teams of care providers and integrating CPS into a patient centered health home. PSPC has fostered vibrant partnerships among providers in the community that previously did not exist.
PHS Pharmacy is committed to initiatives across the network of pharmacy organizations, federal pharmacy partners, and beyond. Recently, the PHS and other federal pharmacy leads including the US Army, Navy, and Air Force Chief Pharmacy Consultants, and VA pharmacy leadership agreed to partner to gain broader consensus on the current and future scope of federal pharmacy practice. This initiative is in its early stages but will help enumerate the comparative advantages of our federal health systems’ success that demonstrate improved patient outcomes through expanded physician-pharmacist (and other provider) collaboration. Partnering with other health professionals has been paramount to our success.These models of care have been sustained for many years with physician support, which suggests maximizing the scope of the pharmacist in partnership with other providers is successful and supports a new paradigm of clinical care.
With the coming changing winds of health reform, there is no better a time for PHS Pharmacy to embrace our responsibility to expand and grow the partnerships with health leadership in both the Office of the Surgeon General and the Department of Health and Human Services. Ongoing and potentially new partnerships with the Department of Defense, including our involvement in the US Navy ship-based missions, continue to progress. In 2011, we will look to engage our leadership on specific pharmacy initiatives that can accelerate many of the goals discussed in this outlook.
Recruit and Develop Public Health Leaders
The diversity of PHS pharmacists’ roles necessitates a wide range of expertise not necessarily limited to clinical roles within healthcare delivery. In 1980 and as recently as 2006, the American Public Health Association issued policy statements supporting pharmacists’ role in public health. To fulfill these roles, we will recruit and develop pharmacists as both clinicians and public health leaders. PHS pharmacists’ future contributions to the public health of the nation will be readily identifiable and ‘reforming.’
Reform has enumerated that shaping the health workforce is one area of needed focus. PHS Pharmacy is set to benefit from the Affordable Care Act which includes pharmacy scholarships and new Commissioned Corps policies; however it will need to rapidly and proactively augment those numbers in order to sustain its value to the nation. To that end, PHS Pharmacy has responded with innovative programs that will recruit and attract a new generation of pharmacists and public health leaders who understand the need for expanded pharmacy roles, who are savvy in technology, who have demonstrated adaptability to the inter-professional environment and who have interests in readiness, response, and protecting the nation’s health.
For example, the FDA’s Center for Drug Evaluation and Research (CDER) has demonstrated its academic innovation by sponsoring a CDER Academic Collaboration Program. This joint collaboration between the PHS Commissioned Corps, the University of Florida, and Arizona State University is aimed at attracting health professionals to serve in FDA/CDER. These programs provide participants with two years of advanced graduate education at the masters or doctorate level designed to advance scientific training and analysis. Students selected are full-time students at these universities as well as Commissioned Corps officers. In return, the student must agree to work for FDA/CDER as an officer for two years for each year of paid tuition. This innovation in academic collaboration will help broaden PHS Pharmacy’s expertise in regulatory sciences and increase value to the nation’s health systems.
The Pharmacist Professional Advisory Committee (PharmPAC) is a unique team used to integrate PHS pharmacists input from all our agencies to inform the Surgeon General and CPO on a number of issues. The PharmPAC remains flexible and assists the category with recruitment, career development, and specific initiatives that can resonate with a new generation of pharmacists. For example, in June 2010, the PharmPAC developed and implemented the use of Facebook®. In its early months of release, our Facebook page has already linked us with over 300 students and pharmacists interested in PHS Pharmacy. New social networking tools and media will be explored for implementation in 2011 to maintain “technological fluency” with today’s students and promising health leaders.
As an essential part of protecting the nation’s health, PHS Pharmacy emphasizes deployment readiness and living a healthy and fit lifestyle. Basic readiness status includes elements such as annual physical fitness testing, up-to-date immunizations, readiness coursework completion, and licensure currency. With a recent increased focus on force readiness, the Pharmacy Category has surpassed the 94th percentile marking the highest deployment readiness since tracking of this status began. In today’s joint forces environment, where officers train and deploy with their DoD and DHS colleagues, PHS Pharmacy officers are more fit and are more effectively trained than ever before.
Each of us continues to read and write about unparalleled opportunities for the pharmacy profession. However, it has been said, ‘If you wait for opportunities to occur, you will be one of the crowd.’ This quote and the message today facilitate a call-to-action to collaborate and foster a new paradigm of care that maximizes the use of pharmacists (and all health professionals) for the betterment of the nation’s health. Success will be crafted through expanded roles in advanced clinical pharmacy practice, public health, health policy, emergency and humanitarian response, public health leadership, global health, and much more. Our blended knowledge of biomedical and regulatory sciences and health systems, layered with substantial accessibility and community outreach will assist to prevent, treat, and control disease. These concepts and expanded roles may seem innovative to many, yet in most cases, these models—which maximize the use of pharmacists as clinicians and public health professionals—have existed for decades in both PHS and federal pharmacy.
Evolving and expanding PHS Pharmacy through collaborative efforts can have substantial positive impact for our population and may be the ultimate adjudicator of our success. Accordingly, each one of us must move forward with purpose – to proactively lead for the profession and health of the nation. We must take the additional steps to reach decision-makers and demonstrate the benefits of this new paradigm to health systems and inspire our colleagues to help craft the future. Our PHS pharmacists and pharmacy programs desire to be part of something special, to excel, to lead and to make a difference in the lives and health of people. PHS Pharmacy will continue to be a leader in the profession and advance pharmacy practice within this theme of a call-to-action. In 2011 and beyond, we envision seamless collaboration with health professionals and non-federal colleagues that share in this movement. As such, it is an honor to work with each of you in these dynamic times to improve the health and safety of the patients and nation we serve.