Basma Y. Kentab MSc. Department of Clinical Pharmacy May 2014

Objectives Define public health Identify the concept underlying public health activities Describe levels of public health services List examples on individualized patient care vs. public health efforts Discuss the pharmacist role in public health Identify barriers to pharmacist provided public services Discuss the Healthy People initiative as an example of public health activities

References American 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’’ 4 ASHP. Am J Health-Syst Pharm. 2008; 65:462–7

The Concept Underlying Public Health Activities Is ……………… 5 Prevention

Types of Prevention Primary 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) 6

Levels of Public Health Services Public health services have been characterized as occurring on two levels: The planning (“macro”) level The implementation (“micro” or “provider”) level 7

Levels of Public Health Services Macro Level Services Focus 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 8

Levels of Public Health Services Macro Level Services Such services include: Working with community representatives in identifying health- related community problems Setting community health priorities Formulating community health programs and policies Managing, administering, & evaluating programs Researching, presenting, and publishing information about public health activities 9

Levels of Public Health Services Micro Level Services Include 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 10

Levels of Public Health Services Micro Level Services Examples of such services include: Disease screening Immunization Counseling for at-risk populations Tobacco-cessation programs Monitoring & responding to adverse drug events 11

Is There A Public Health Need Requiring Pharmacist Involvement ? Population is living longer Prevalence of chronic diseases is increasing Use of medications is increasing Adverse drug events continue to be one of the leading causes of injury & death Healthcare costs are rising 12

Individualized Patient Care Vs. Public Health Efforts: Examples Providing 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 13

Individualized Patient Care Vs. Public Health Efforts: Examples Identification 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 14

Pharmacists’ Role In Public Health Providing 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 15

Pharmacists’ Role In Public Health Developing 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 16

Pharmacists’ Role In Public Health Developing disease prevention and control programs (including medication safety programs) Advice on healthy eating & lifestyle modifications Prevention & management of drug abuse, misuse & addiction Provision of smoking cessation services Prevention & risk assessment of osteoporosis Promoting cardiovascular health & blood pressure control Screening & education for diabetes 17

Pharmacists’ Role In Public Health Developing 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 Health Collaborating 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 Health Engaging in population-based research and initiating campaigns to disseminate new knowledge 20

Barriers To Pharmacist-Provided Public Health Services Availability of private counseling area Lack of time, staff Lack of patient demand (willingness to discuss problems & accept pharmacists’ recommendations) Patients’ reactions Reimbursement for public health services Level of skill & confidence of pharmacists 21 Eades et al. BMC Public Health 2011, 11:582

The Healthy People Initiative An 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 23

The Healthy People Initiative - Goals Attain 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 - Topics Some of the topics include: Cancer Chronic Kidney Disease Diabetes Heart Disease and Stroke HIV Nutrition and Weight Status Older Adults Oral Health Physical Activity Respiratory Diseases Sleep Health Substance Abuse Tobacco Use

The Healthy People Initiative Example of Pharmacists’ Involvement Healthy 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) 28