Promoting Community WellnessThe Pharmacist Role In Public Health

Basma Y. Kentab MSc.Department of Clinical PharmacyMay 2014

ObjectivesDefine public healthIdentify the concept underlying public health activitiesDescribe levels of public health servicesList examples on individualized patient care vs. public

health effortsDiscuss the pharmacist role in public healthIdentify barriers to pharmacist provided public servicesDiscuss the Healthy People initiative as an example of

public health activities

ReferencesAmerican Society of Health-System Pharmacists. ASHP statement on the

role of health-system pharmacists in public health. Am J Health-Syst Pharm. 2008; 65:462–7.(Main Reference)

Eades C, Ferguson J, O'Carroll R. Public health in community pharmacy: A systematic review of pharmacist and consumer views. BMC Public Health. 2011; 11: 582.

Public Health Definition“What we as a society do to assure the conditions in

which people can be healthy”

Public health “emphasize the prevention of disease and the health needs of the population as a whole’’

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ASHP. Am J Health-Syst Pharm. 2008; 65:462–7

The Concept Underlying Public Health Activities Is ………………

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Prevention

Types of PreventionPrimary prevention (reducing the actual incidence &

occurrence of disease, injury, and disability)

Secondary prevention (decreasing the severity or progression of the disease, injury, and disability)

Tertiary prevention (treatment or rehabilitation to return the disease, injury, or disability to the initial or baseline state)

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Levels of Public Health ServicesPublic health services have been characterized as

occurring on two levels:

The planning (“macro”) levelThe implementation (“micro” or “provider”) level

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Levels of Public Health Services

Macro Level ServicesFocus on the well-being of the population as a whole

Emphasize the assessment and prioritization of a community’s health-related needs as well as planning to address those needs

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Levels of Public Health Services

Macro Level ServicesSuch services include:

Working with community representatives in identifying health-related community problems

Setting community health prioritiesFormulating community health programs and policiesManaging, administering, & evaluating programs Researching, presenting, and publishing information about

public health activities

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Levels of Public Health Services

Micro Level ServicesInclude all the activities required to implement public

health initiatives

Performed on a provider-to-patient or a program-to-population basis, usually with a specific health related outcome in mind

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Levels of Public Health Services

Micro Level ServicesExamples of such services include:

Disease screeningImmunizationCounseling for at-risk populationsTobacco-cessation programsMonitoring & responding to adverse drug events

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Is There A Public Health Need Requiring Pharmacist Involvement ?Population is living longerPrevalence of chronic diseases is increasingUse of medications is increasing Adverse drug events continue to be one of the leading

causes of injury & deathHealthcare costs are rising

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Individualized Patient Care Vs. Public Health Efforts: ExamplesProviding optimal pharmacotherapy to a single patient

has great value

However

Lessons learned from management of individual patients can have an even greater impact when resulting in practice guidelines that affect the larger population

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Individualized Patient Care Vs. Public Health Efforts: ExamplesIdentification of a specific ADE is an important patient

care service routinely performed by pharmacists

However

The pharmacoepidemiologic study of ADEs across a population, coupled with action to prevent or reduce such events, can have significant impact on public health

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Pharmacists’ Role In Public HealthProviding population-based care

By working with their health care colleagues, pharmacists can contribute to population specific, evidence-based disease management programs tailored to fit the needs of the institutions and communities they serve

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Pharmacists’ Role In Public HealthDeveloping disease prevention and control programs

(including medication safety programs)

Develop screening programs to check immunization status and provide immunizations

Develop programs for monitoring & reporting of ADEs

Develop programs to intercept counterfeit medications

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Pharmacists’ Role In Public HealthDeveloping disease prevention and control programs

(including medication safety programs)

Advice on healthy eating & lifestyle modificationsPrevention & management of drug abuse, misuse & addictionProvision of smoking cessation servicesPrevention & risk assessment of osteoporosisPromoting cardiovascular health & blood pressure controlScreening & education for diabetes

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Pharmacists’ Role In Public HealthDeveloping health-education policies and programs

Develop programs on safe and effective medication use & other health-related topics, e.g. tobacco cessation, exercise

Support education and training of the population at an early age, such as through school health programs

Educate health care colleagues about safe & effective medication use

Educate community leaders (e.g. public officeholders, school officials) about and involve them in public health initiatives 18

Pharmacists’ Role In Public HealthCollaborating with local authorities, to address local and

regional health care needs (including environmental hazard and emergency preparedness programs)

Help in development, implementation, and revision of local emergency operations plans

Involvement in planning for distribution, dispensing & managing drug therapy in emergency situations

Develop policies and initiatives to increase awareness in proper handling and disposal of hazardous drugs 19

Pharmacists’ Role In Public HealthEngaging in population-based research and initiating

campaigns to disseminate new knowledge

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Barriers To Pharmacist-Provided Public Health ServicesAvailability of private counseling areaLack of time, staffLack of patient demand (willingness to discuss problems

& accept pharmacists’ recommendations)Patients’ reactionsReimbursement for public health services Level of skill & confidence of pharmacists

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Eades et al. BMC Public Health 2011, 11:582

http://www.google.com/url?sa=i&rct=j&q=healthy+people+2020&source=images&cd=&cad=rja&docid=clJm8vaCbp2NvM&tbnid=E8r1rn-t3rNGeM:&ved=0CAUQjRw&url=http://www.adammd.org/2010/12/americas-new-health-goals-healthy.html&ei=C86EUY-OI4TFswb9ooC4Bg&psig=AFQjCNH6QWaikdOnnPwJyQ0xWtYfdo7QMg&ust=1367744007308342

The Healthy People InitiativeAn initiative of the U.S. Department of Health and

Human Services

A set of goals and objectives with 10-year targets designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States

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The Healthy People Initiative - GoalsAttain high quality, longer lives free of preventable disease,

disability, injury, and premature death

Achieve health equity, eliminate disparities, and improve the health of all groups

Create social and physical environments that promote good health for all

Promote quality of life, healthy development, and healthy behaviors across all life stages

The Healthy People Initiative - TopicsSome of the topics include:

CancerChronic Kidney DiseaseDiabetesHeart Disease and StrokeHIVNutrition and Weight StatusOlder Adults

Oral HealthPhysical ActivityRespiratory DiseasesSleep HealthSubstance AbuseTobacco Use

The Healthy People InitiativeExample of Pharmacists’ InvolvementHealthy People (a macro-level public health policy) aims

to reduce number of hospital admissions attributable to drug therapy management problems (primary prevention)

Policies implemented by individual hospitals (on the micro level) will allow clinicians to quickly identify such adverse drug events (ADEs) and prevent them from worsening (secondary prevention) , as well as treat the affected patients (tertiary prevention)

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