The Role of Colleges and Schools of Pharmacy in the Advent of Healthy People 2020

INTRODUCTION

With the growth of existing pharmacy programs, the increasing number of new colleges and schools of pharmacy, and the new ACPE standards on experiential education, many colleges and schools of pharmacy face tight competition to obtain new experiential sites. The ACPE mandate for IPPEs also has increased demands for experiential practice sites.¹ In their quest for more sites, colleges and schools should consider innovative and strategic approaches to meeting students’ experiential needs, including programs that would address the target areas emphasized by Healthy People 2020, such as drug consultations for patients in a nursing home, HIV medication reviews at a free clinic, or blood pressure and glucose checking for an employee-health program. This also maintains professional relevance in serving public health needs in an ever-changing multidisciplinary environment.

Healthy People 2010 provided a national public initiative to increase years and quality of life and eliminate health disparities. Managed by the US Department of Health and Human Services (DHHS) Office of Disease Prevention and Health Promotion, the initiative included citizen, stakeholder, and government input and transparent dialogue, and provided scientifically-based, 10-year national objectives for promoting health and preventing disease. In 2010, Healthy People 2020 was released and is intended to address assessment of major risks to health and wellness, changing public health priorities, and emerging issues pertaining to national health preparedness and prevention, and to provide a framework for addressing risk factors and determinants of our community health, diseases, and disorders.² The overarching goals of the initiative have expanded from 2 goals for Healthy People 2010 to 4 overarching goals for Healthy People 2020: (1) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages.^2,3 The 2 new overarching goals were added to increase recognition of social determinants of health as critical factors. Topic areas that were added include health issues/concerns in adolescents, early and middle childhood; blood disorders and blood safety; dementias (including Alzheimer's disease); genomics; global health; health information technology; healthcare associated infections; lesbian, gay, bisexual, and transgender health; health issues/concerns in older adults; preparedness; sleep health; health-related quality of life and well-being; and social determinants of health.^4-7

Unlike Healthy People 2010 which was primarily released in a printed static form, information on Healthy People 2020 is available through a Web-accessible database. The new Web site has Web-based sections that include evidence-based resources; an online community of LinkedIn, Twitter, and Webinar users; and a Healthy People App Challenge. For example, the MAP-IT (Mobilize, Assess, Plan, Implement, and Track) section provides a template for planning and evaluating a public health intervention to achieve Healthy People 2020 objectives. Each area provides various resources to achieve these goals and would be an essential tool for a pharmacist intern establishing a community public health program or a pharmacy student completing an introductory or advanced pharmacy practice experience (IPPE/APPE). In this paper, we describe examples of such innovative programs that offer IPPEs and/or APPEs that are consistent with Healthy People 2020 goals. Information presented about specific programs came from a review of the literature and an informal survey of pharmacy school experiential directors.

EXAMPLES OF INNOVATIVE PROGRAMS

While institutional and community sites deal with increased shortages of staff members and preceptors, many colleges and schools of pharmacy are creating a variety of innovative programs for students at existing and new sites and to provide quality experiences for their students. In a review of the literature, we identified several articles on health, wellness, and disease prevention programs incorporated into pharmacy practice experiences. Some noteworthy programs include: the Mylan School of Pharmacy Center for Pharmacy Care, which is a pharmacist-coordinated, University-based wellness center that provides services to faculty and staff members as well as the surrounding community; the University of Missouri-Kansas City School of Pharmacy and Kansas City Free Health Clinic partnership, in which students participate in a pharmacist-managed chronic care clinic as well as several different clinics that provide pharmaceutical care to patients with obesity, HIV/AIDS, and sexually transmitted diseases; and Ohio State University Outreach and Engagement Mission, which has several community group partnerships for pharmaceutical care delivery such as Columbus Neighborhood Health Centers, Catholic Social Service, Cardinal/Life Care Alliance, Kroger Patient Care Centers, Faith Mission Free Clinic Columbus Health Department Sexual Health Clinic and TB Clinic and University Health Connection.^8-10

Howard University's College of Pharmacy, Nursing and Allied Health Sciences incorporates public health opportunities longitudinally and throughout the second- to fourth-year IPPEs and APPEs in the form of wellness and disease prevention programs, including health promotion and screenings and lifestyle counseling. Preceptors at the Center for Minority Studies provide learning experiences for students in promoting health and wellness in individuals with HIV. Faculty members collaborate with the university's counseling center to promote patient information materials pertaining to mental health and psychotropic use, as well as the hazards of concomitant psychotropic and substance abuse. Health literacy initiatives also are coordinated by faculty members in the community working to improve medication understanding and use in underserved populations and to address health disparities.

Medication therapy management (MTM) concepts present an important consideration in promotion of public health outcomes and hopefully will become a part of the Healthy People dialogue. Pharmacists, especially those practicing in community settings, are often the most accessible and trusted health providers to the public, and as such are positioned excellently for opportunities to promote health and wellness. Many schools have developed or assisted in development of MTM into their community APPEs. These programs include The University of Virginia's collaboration with local family physicians; a grocery store chain model that incorporated pharmacy wellness centers at 4 sites; and a retail chain model that included a faculty member to work at the pharmacy to incorporate standards of practice guidelines and enhance pharmacists’ communication and counseling skills. The University of Colorado formed 22 partnerships with clinical programs in hospital, community health centers, and community pharmacies to implement and operate new or existing medication management programs. Ohio State University established the Partner for Promotion Program, which expands patient care services in community pharmacies. Howard University's College of Pharmacy, Nursing and Allied Health Sciences runs a host of specialized ambulatory care clinic programs such as HIV, anticoagulation, diabetes, and internal medicine/continuity of care.

Schools of pharmacy typically have broad rotational objectives and guidelines in order to offer a wide range of practice learning opportunities for students. In considering new areas for IPPE/APPE development, a key question is where is the greatest need for pharmacists? Another important question is where is there considerable potential to move into? Existing Healthy People focus and topic areas present opportunities to envision and establish an innovative niche that may drive up demand for pharmacists in new practice settings and provide care for a broader scope of the population. Pharmacy program leaders may consider expanding strategic collaboration with other health disciplines and in the community to establish participatory leadership programs, pharmacy practice experiences, and virtual portfolio and research activities that not only provide health and wellness programs to a populace, but monitor and evaluate the associated outcomes of these efforts. These opportunities, however, may be limited by a lack of trained practitioners in certain subspecialties, lack of sites and preceptors, and poor understanding of pharmacist scope of practice, as well as cultural, social, and political biases. However, through strategic planning, the pharmacy practice sites and experiences we envision today could be a part of health service research and practice electives in the future.

Many US colleges and schools of pharmacy have incorporated practice learning experiences promoting community public health through wellness and disease prevention and/or medication therapy management (MTM). Wellness and disease prevention have been incorporated into IPPEs/APPEs in a number of innovative ways, including, but not limited to promoting health observances, health screenings, immunizations, smoking cessation, and lifestyle counseling. There are areas that remain high public health concerns in Health People 2020, along with new focus areas that present opportunities for further IPPE/APPE rotation site expansion and growth. There is considerable need for more colleges and schools of pharmacy to showcase their public health efforts in the published literature as they reach out to their communities. With newly recognized pharmacist roles as MTM providers, public awareness should be raised about this important aspect of clinical care in the promotion of health and wellness, especially in preventing premature death, achieving health equity, eliminating disparities, and improving health across all population groups. Academic leaders may consider what role exists for pharmacy practice in the Healthy People 2020 focus areas and prioritize for future program and curriculum development.