Public health: A new priority at pharmacy schools

In Birmingham, Ala., faculty and students from the Samford University McWhorter School of Pharmacy regularly work in the adult care clinics of the local health department. They provide pharmacotherapy recommendations and patient education, manage travel medicine, administer immunizations, hold smoking-cessation clinics, and help in other areas.

Then, one day a week, a faculty member and two students drive 80 miles south to very rural Perry County to hold a hypertension clinic. The school is also doing diabetes research and education in that area.

In Pittsburgh, Duquesne University's Center for Pharmacy Care provides free disease management for the campus family, with lectures, screening, and follow-up for high-incidence conditions such as hypercholesterolemia, hypertension, diabetes, and tobacco use. It's been so successful that the faculty is expanding services into the community, working with senior centers, employers, and others.

At its interim meeting, held in Washington, D.C., last month, the American Association of Colleges of Pharmacy showcased the work of several schools that are introducing pharmacy students to the concepts of public health. This is part of AACP's new push to make that discipline a major priority. The public health emphasis is noticeable both in the schools and in the community, said Lucinda Maine, AACP executive VP. "Pharmacists are increasingly being recognized as the healthcare providers who really are positioned to contribute a great deal to advancing the public health objectives of the country," she said.

Pharmacy students, Maine noted, "need to be trained to make a contribution to public health, and they need to be purposely trained," not trained only if faculty remembers and if it fits in the curriculum.

The push for public health in pharmacy education was solidified last year when AACP brought together several major pharmacy organizations to revise the CAPE (Center for the Advancement of Pharmaceutical Education) Educational Outcomes publication. That document now lists public health as one of the three priorities for pharmacy education, along with pharmaceutical care and systems management.

But the public health-pharmacy connection is one that has been emerging for some time, Maine told the audience. For example, in one profound change in the past 10 years, she noted, "We've trained armies of pharmacists as immunizers. The schools have really jumped on that, and many of them now prepare their students to graduate as immunizing pharmacists."

Meanwhile, pharmacy schools have also taken on projects to detect and impact chronic diseases and have had various collaborations with schools of public health. And community pharmacists, said Maine, have become increasingly involved in the detection and monitoring of diseases such as diabetes and hypertension, for which the screening is at the population level, but the care is at the individualized level.

In addition, the new visibility of pharmacy in public health is partially due to crises like the diabetes epidemic, bioterrorism, and emergency response needs, Maine said. "You must be able to put all hands on deck," she explained. Although R.Ph.s are not involved in some classic dimensions of public health such as sanitation and clean water, their community accessibility and knowledge base are being recognized as a resource, she observed.

Where will resources come from to sustain focus on public health? Although Maine admitted that's a big question, she believes they can flow through several avenues. Contracting with public health agencies may pay part of the costs, she said. In addition, patients are showing their willingness to pay pharmacists for services, just like they pay other health professionals. Medicare may be a source of funds, she continued. Also, private healthcare payers are showing more interest in finding early or unmanaged chronic diseases as a way to control costs, although, she added, "that understanding is only beginning to dawn."