2. A Brief History of the IHS The governmental duty to provide health services to Indian tribes derives from a relationship established in 1787, Article I Sec 8 of The Constitution. Contagious diseases, such as smallpox and tuberculosis, threatened the populations of Native American people.

3. The Indian Health Service One of the principal components of the Department of Health & Human Services HHS includes NIH, FDA, CDC, HRSA, CMS, and others The IHS is the only HHS component whose principal mission is to deliver public health services directly to individual citizens.

4. Indian Health Service The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 562 federally recognized tribes in 35 states.

5. Indian Health Service Our Mission: To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level Our Goal: To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people

6. Health Care within the Indian Health Service Medicine Nursing Dentistry Pharmacy Optometry Engineering Behavioral Health Physical Rehabilitation Medical Imaging Medical Technology

7. Predominantly rural primary care system with some urban locations in 35 states Hospital Ambulatory Center Serves 1.9 million clients representing over 560 tribes

8. Where do we practice?  49 hospitals with nearly 80,000 admissions/year  >8 million outpatient visits/year  236 health centers  > 300 other outreach facilities  540 pharmacists serve in over 200 locations

9. Winslow Indian Health Care Center: Serving Navajo and Hopi Tribes- Northern AZ

10. Tuba City Regional Health Care Center Tuba City, AZ

12. Public Health Challenges: Disparities Alcoholism – 770% higher Diabetes – 420 % higher Accidents – 280% higher Suicide – 190% higher Homicide – 210 % higher

13. Public health challenges: Safe water and sanitation

14. Are we making a difference?

15. Public health challenges: Tuberculosis death rates

16. Diabetes Care & Outcomes Audit Glycemic Control 1994-2003 Source: IHS National Diabetes Program Statistics 1994-2003 A1C % *p<0.0001 comparing mean HbA1 levels in FY94 and FY03

17. IHS Pharmacy Overview Comprehensive primary healthcare system Large number of ambulatory sites Identifiable need and health disparities For decades, IHS pharmacists have practiced in expanded clinical roles. IHS is widely known (private sector and academia) for its innovative pharmacy practice IHS serves as a robust example of successful interprofessional practice

18. Innovation in Pharmacy Practice  Pharmacy practice roles in the Indian Health Service have been a force for change for the entire pharmacy profession

19. Innovation: Past and Present 1931 Edwin M. Holt is the first commissioned officer to be assigned to the Office of Indian Affairs, Department of Interior. Allen J. Brands becomes the first CPO for IHS 1955 1962 19691974198319881990 IHS shift from distribution to clinical services. Begin to counsel patients and use health record, not Rx pad. Such practice does not exist before this time IHS Program Planning meeting in Rockville – pharmacists start serving as primary care providers in many IHS facilities IHS begins Pharmacy Practitioner Program – teaching IHS pharmacists physical assessment and disease management IHS establishment of the IHS Clinical Pharmacy Training Program (CPTP ) – training pharmacists in managing chronic disease IHS Standards of Practice to provide pharmaceutical care to patients. Coined the term. IHS distributes Patient Consultation videos to academia nationwide.

20. IHS Clinical Pharmacy Specialists In 1996, the scope of pharmacy practice in the IHS was officially broadened in Dr. Michael Trujillo’s October 18, 1996 memorandum: “Clinical Pharmacy Specialists will be included in the IHS definition of a primary care provider for the purposes of workload reporting, program planning, and reimbursement from all third party payers. An appropriate primary provider code will be assigned to CPS.” In 1996, the scope of pharmacy practice in the IHS was officially broadened in Dr. Michael Trujillo’s October 18, 1996 memorandum: “Clinical Pharmacy Specialists will be included in the IHS definition of a primary care provider for the purposes of workload reporting, program planning, and reimbursement from all third party payers. An appropriate primary provider code will be assigned to CPS.”

22. IHS Standards of Practice The provision of pharmaceutical care follows the six IHS Pharmacy Standards of Practice 1. Assure Appropriateness of Therapy 2. Confirm Understanding 3. Assure Availability, Control and Preparation of pharmaceuticals 4. Provide Education / Drug Info 5. Provide Health Promotion / Disease Prevention 6. Manage Therapy

23. Disease States Management in IHS Anticoagulation Nicotine Dependence Diabetes Dyslipidemia Asthma Hypertension Pain Management HIV/AIDS Family Med (Practitioner)

24. Navajo Reservation Cameron, AZ

25. Turtle Mountain Comprehensive Health Care Center Aberdeen Area

26. Bethel, Alaska

27. Student Opportunities Junior COSTEP  Commissioned Officer Student Training and Extern Program  31 to 120 days  No obligation to serve after graduation

28. Student Opportunities Senior COSTEP  Purpose: to assist students financially  18 month employment- commitment for 9 months of financial support For both programs: http://www.usphs.gov/student/ or call (800) 279-1605 http://www.usphs.gov/student/

29. Student Opportunities Post-graduate Residencies  IHS has ASHP-accredited residencies in 15 locations  Alaska: o Alaska Native Medical Center Alaska Native Medical Center  Arizona: o Phoenix Indian Medical Center Phoenix Indian Medical Center o Tuba City Regional Health Care Corporation Tuba City Regional Health Care Corporation o Whiteriver Indian Health Service Hospital Whiteriver Indian Health Service Hospital

30. Student Opportunities New Mexico:  Albuquerque Indian Health Center Albuquerque Indian Health Center  Gallup Indian Medical Center Gallup Indian Medical Center  Northern Navajo Medical Center Northern Navajo Medical Center  Santa Fe Indian Hospital Santa Fe Indian Hospital North Carolina:  Cherokee Indian Hospital Cherokee Indian Hospital

31. Student Opportunities Oklahoma:  Claremore Indian Health Care Facility Claremore Indian Health Care Facility  Chickasaw Nation Health System Chickasaw Nation Health System  Choctaw Nation Health Care Facility Choctaw Nation Health Care Facility  Hastings Indian Medical Center Hastings Indian Medical Center South Dakota:  Pine Ridge Indian Hospital Pine Ridge Indian Hospital  Rosebud Comprehensive Health Center Rosebud Comprehensive Health Center

32. IHS Residency Information For more information: http://www.ihs.gov/medicalprograms/ pharmacy/ Resident/index.cfm

33. IHS Loan Repayment Program  Purpose: To recruit and retain highly qualified health professionals  $20,000/year for 2 year employment- commitment  http://www.loanrepayment.ihs.gov / http://www.loanrepayment.ihs.gov /

34. IHS Personnel Systems Practice opportunities  3 Personnel Systems o US PHS Commissioned Corps o Civil Service o Direct Tribal Hire

35. Remember The Indian Health Service is a unique practice environment that allows pharmacists many clinical opportunities and practice environments that can offer purpose, opportunity and adventure for an exciting career in the practice of pharmacy.

36. “We’re making a difference in our communities – and in our profession!”

37. Where can I learn more? www.pharmacy.ihs.gov www.careers.ihs.gov www.ihs.gov

38. Recruiter Contact Information Damion Killsback, PharmD 801 Thompson Avenue; TMP 450A Rockville, MD 20852 Tel (301) 443-2472 BBerry (240) 620-1569 Fax (301) 443-6048 Damion.killsback@ihs.gov

39. Traditional Navajo Hogan Navajo Reservation, AZ

40. Coal Mine Canyon Hopi Reservation, Northern AZ

41. Monument Valley, Kayenta, AZ