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.