Christina M. Madison, PharmD, FCCP, AAHIVP

Public health means “the health of the many versus the health of the one,” i.e., focusing on the health and wellness of the population rather than the individual patient. It's distinguishable from clinic medicine because of its emphasis on communicable disease prevention rather than curing disease.

One of the most successful examples of population health in modern medicine is the invention of routine recommended vaccinations for the prevention of communicable diseases. Prior to this modern miracle, thousands of children and adults died every year from vaccine-preventable diseases.

Pharmacists working in the community setting are practicing public health pharmacy practice on a daily basis, but probably just didn’t have a name for it. Preventing illness and disease by educating patients about preventive health screenings, chronic disease prevention, harm reduction strategies, and vaccinations.

Different types of public health interventions include epidemiology and surveillance, health teaching, outreach, policy development, screening, and social marketing.

Monitor health status to identify and solve community health needs.

Diagnosis and investigate health problems and health hazards in the community.

Inform and educate the community about public health problems.

Mobilize community partners to identify and solve health problems.

Develop polices and plans that support individual and community health efforts.

Enforce laws and regulations that protect health and ensure safety.

Link people in need to personal health services.

Assure competent public and personal health care workforce.

Evaluate the effectiveness, accessibility, and quality of personal and population-based health services.

Research for new insight and innovative solutions to health problems.

Traditional pharmacists’ roles in public health have been associated with the federal government as a commissioned pharmacist officer with the US Public Health Services through the US Department of Health and Human Services and in other federal agencies and programs, Indian Health Services, and the US Federal Bureau of Prisons. There are also pharmacists who work directly for the Centers for Disease Control and Prevention as a Public Health Fellow, FDA, and Drug Enforcement Agency.

With the expanded scope of pharmacy practice authorized by the US Department of Health and Human Services (HHS) via the Public Readiness and Emergency Preparedness Act (PREP Act) for pharmacists, pharmacy technicians, and pharmacy interns, the need for ambulatory care, community pharmacists, and outpatient pharmacists to be more involved in the provision of public health interventions became even more of a priority.

The Expanded Access to COVID-19 Therapeutics HHS PREP Act Declaration 9th Amendment adds coverage to include trained professionals to administer covered COVID-19 therapeutics, providing a pathway for increased access to COVID-19 therapeutics, particularly in surge states with rising numbers of COVID-19 cases and in rural areas where access to inpatient and outpatient services may be more limited. This is in addition to previous amendments that allowed pharmacists, qualified pharmacy interns, and pharmacy technicians to provide pediatric vaccination administration (3 years of age and up) in all 50 states, as well as ordering/administration of COVID-19 testing and vaccinations.

Misinformation has been declared a “Public Health Threat” by the US Surgeon General Vivek Murthy, MD, MBA. Unfortunately, there have been too many lives that have been lost during this pandemic due to misinformation, including anti-vaccine and anti-mask rhetoric. Pharmacists are in a unique position to help with this public health threat as a pillar of the community who patients like, know, and trust. This doesn’t have to end at the pharmacy counter and can be shared community advocacy and outreach.

There are many examples of ways that pharmacists can help with public health or population health. These include adult and pediatric vaccination services; disaster preparedness (mass prophylaxis and vaccination); COVID-19 testing and vaccination; HIV prevention (PEP and PrEP); hormonal contraceptive services, which include emergency contraceptives and medical abortion; maternal child health through prenatal care and lactation/breastfeeding support services; harm reduction strategies (needle exchange and access to condoms, *which are covered by Medicaid); LGBTQ care (gender affirmation and hormone therapy); substance use disorder services (Naloxone education and dispensing); viral hepatitis management (testing and treatment for hepatitis C viral infection); and tuberculosis prevention (latent tuberculosis infection management).

The COVID-19 pandemic has brought renewed attention to the practice of public health and why it’s so important that we get it right. This has shed more light on existing health disparities and inequities. Public health works best when you don’t know that it’s there.

Public health advocates work behind the scenes to prevent the transmission of communicable diseases, advocating for safe streets, clean air, and clean water. Pharmacists are one of the most trusted and accessible health care professionals. Most patients can access COVID-19 vaccination/testing less than 5 miles from their home because of the efforts that pharmacies and pharmacists have made during this pandemic.

Public health is not only good medicine, but is also good for the community. Improving access to health care and preventative care services will improve health outcomes and decrease overall health care costs.

Health equity should be a priority for the underserved and the most vulnerable of our population to address the health disparities that the pandemic has exacerbated. Most public health services are billable and reimbursable through Medicaid billing codes that have been updated to keep up with the expansion of telehealth, telemedicine, and remote patient monitoring.

There are so many possibilities for the profession of pharmacy and for pharmacists to be able to practice at the top of their licensure while making a lasting and meaningful impact in their communities. Public health matters and should be prioritized.

Articles

Pharmacists working in the community setting are practicing public health pharmacy practice on a daily basis, but probably just didn’t have a name for it. 