Public Health- Seattle & King County Pharmacy Leadership Summit Thursday, May 20th, 2010

1. Public Health- Seattle & King County Pharmacy Leadership Summit Thursday, May 20th, 2010 10:00 AM – 3:00 PM Public Health: Is it the Future of Pharmacy? Dean Webb, R.PH., M.S. Chief of Pharmacy Public Health – Seattle & King County

2. Public Health ___________________________________________________ Prescription Patient Public Health

3. What is Public Health? ___________________________________________________ “Health care matters to all of us some of the time, public health matters to all of us all the time.” -C. Everett Koop

4. Definition of Public Health ___________________________________________________ “What, we as a society do collectively to assure the condition for people to be healthy.” - Institute of Medicine 2003

5. Public Health- Seattle & King County ___________________________________________________ MISSION: To achieve and sustain healthy people and healthy communities throughout King County by providing public health services which promote health and prevent disease.

6. Public Health ■ Focus on Population ■ Emphasis on prevention ■ Interventions aimed at environment/human behavior/lifestyle and medical care Medicine ■ Focus on Individual ■ Emphasis on diagnosis/ treatment ■ Predominant emphasis on medical care Public Health vs. Medicine ___________________________________________________

7. Public Health ■ Multiple professional identities with diffused public image ■ Emphasis on prevention, health promotion for the whole community Medicine ■ Well established professional with sharp public image ■ Emphasis on diagnosis/ treatment/care for the whole patient Public Health vs. Medicine ___________________________________________________

8. What is Health? ___________________________________________________ Health is more than not being sick. “Health is a resource for everyday living. It’s the ability to realize hopes, satisfy needs, change or cope with life experiences, and participate fully in society.” -Minnesota Public Health

9. Recent Statistics ___________________________________________________ The Health of King County 2006 Jim Krieger, MD, MPH Epidemiology, Planning & Evaluation Unit

10. The Health of King County ___________________________________________________ ■ Comprehensive, Web-based report - Health outcomes - Health-related behaviors ■ Data Sources - Vital records - Surveys - Hospital discharge data - Reportable conditions - US census

11. Other Public Health Reports ___________________________________________________ ■ Core Indicators ■ Communities Count ■ HIV/AIDS Epidemiology Monthly Report ■ Medical Examiners’ Annual Report ■ CD Annual Summary Report ■ Epilog ■ Data Watches ■ Drug Abuse Trends

12. Determinants of Health ___________________________________________________ Public Health Social Environment Health & Disease Behaviors & Biologic Response Physical Environment Genetic Endowment Health Care

13. Chronic Disease Risk Factors (Common and Increasing) ___________________________________________________

14. #1 Chronic Diseases: The Leading Cause of Death and Illness ___________________________________________________ • ■Common chronic diseases include: • ■Cancer • ■Heart disease • ■Stroke • ■Chronic lung diseases (e.g. asthma, COPD) • ■Diabetes • ■21,000 hospitalizations / $531 million in 2004 • ■Cancer, heart disease and stroke alone: 56% of all • deaths

15. #1 Chronic Diseases: The Leading Cause of Death and Illness ___________________________________________________ • ■Affect many residents: • ■Asthma: 9% of adults and 6% of children • ■Heart disease: 5% of adults • ■ Diabetes: 5% of adults • ■ Arthritis: 16% of adults • ■ Will become more common as population ages

16. ■ Prevalence among adults has doubled in the last decade ■ Hospitalizations, which can often be avoided with good diabetes management, are increasing Diabetes ___________________________________________________

17. Chronic Disease: Diabetes ___________________________________________________

20. Show Me the Money: Who is going to Pay You ___________________________________________________ ■Insurance Companies ■The State- Medicaid ■Self-Insured Companies ■Your Patients

21. ■ Highest rate of uninsured populations since data collection began in King County Access to care decreasing ___________________________________________________

22. Access to care ___________________________________________________

23. Health of King County Report link ___________________________________________________ http://www.kingcounty.gov/healthservices/ health/data/hokc.aspx

24. Pharmacy Involvement ___________________________________________________ Pharmacy Related Public Health Initiatives ■Tobacco ■ Immunizations ■ Safe Disposal ■Naloxone ■Emergency Prescription Assistance Program ■ TB ■Biosurveillance

25. Tobacco ___________________________________________________ ■King County awarded two federal grants totaling $25 million dollars ■Approximately $13 million will be allocated towards Tobacco Cessation education and programs ■Organizations can apply for the dollars http://www.kingcounty.gov/healthservices/health/partnerships/CPPW.aspx

26. Tobacco ___________________________________________________ “Reducing access to tobacco: Supporting 100% smoke-free housing, parks, and school and college campuses; and endingtobacco sales at pharmacies.”

27. Tobacco ___________________________________________________ The five pharmacies in Fall River have each chosen to not sell Tobacco products as part of their commitment to the health of their customers.

28. Immunizations ___________________________________________________ This is an area where pharmacies are playing a vital, key role in the health of the community: ■ HEP A ■ HEP B ■TIV ■ H1N1 ■ Pneumococcal ■ TD ■ Tdap ■ Meningococcal ■ HIB ■ Varicella ■ Zoster ■ MMR ■ Polio ■Typhoid ■HPV

29. Immunizations- Potential Next Steps ___________________________________________________ ■How are Immunizations being tracked? Child Profile- Can Pharmacies utilize it more effectively? ■ Are Pharmacy efforts limited to adults? ■ Can Pharmacists play a role in advocating for immunizations in their communities?

30. Environmental Issues ___________________________________________________ Safe Disposal of Medications What is the role of Pharmacy in helping to collect and dispose of medications? Pilot with Group Health, Bartell Drugs, Board of Pharmacy, and Public Health- Seattle & King County.

31. Disposal of medications ___________________________________________________ Why is this a Public Health issue? ■ Contamination of the environment ■ Can lead to medication errors ■ Can contribute to the increase in diversion of prescription medications

32. Naloxone ___________________________________________________ Prescribe/Dispense Naloxone Senate Bill 5516 on Naloxone legislation goes into effect on June 10, 2010. It states: “ A person acting in good faith may receive a Naloxone prescription, possess Naloxone, and administer Naloxone to an individual suffering from an apparent opiate-related overdose.”

33. Naloxone ___________________________________________________ ■Washington State at the top of States with deaths from opiate related drugs ■King County statistics: 1997: 26 deaths 2008: 153 deaths A role for Pharmacist? Collaborative Agreement?

34. Emergency Prescription Assistance Program (EPAP) ___________________________________________________ This is a federal program which “provides an efficient way for pharmacies to process claims for prescription medications and limited durable medical equipment” to patients who: ■ are from a disaster area declared by the President ■ do not have any form of health insurance

35. Emergency Prescription Assistance Program (EPAP) ___________________________________________________ Patients need one of the following: ■ a new prescription ■ current prescription bottle ■ a phoned-in prescription ■ proof of an existing prescription

36. TB: Direct Observed Therapy ___________________________________________________ Non-contagious TB patients would come to a pharmacy to take their daily dose(s).

37. Biosurveillance ___________________________________________________ Biosurveillance is an attempt to quickly detect significant disease outbreak. Allows for quick action to try to contain disease. The approach…collect data from many sources: ■ Emergency room visits ■ Purchase of OTC meds ■ School absences ■ Pharmacy sales And recognize statistical anomalies…

38. Reporting to King County Public Health ___________________________________________________ Pharmacists should recognize their role and make sure they are connecting with the Public Health Department if they see a trend. Public Health Phone Number: 206-296-4774 Hours: Monday-Friday 8-5pm

39. Ongoing Public/Pharmacy Initiatives ___________________________________________________ ■Dispensing Plan B ■Providing Flu Vaccines ■Providing H1N1 Vaccines ■Dispensing Partner Packs for STD Contacts ■Selling Needles to Injectable Drug Users

40. Healthy People 2020 ___________________________________________________ “Healthy People 2020 is a comprehensive set of national 10 year health promotion and disease prevention objectives aimed at improving the health of all Americans.” www.healthypeople.gov/hp2020

41. Healthy People 2020 ___________________________________________________ D HP2020-13 Improve glycemic control among the population with diagnosed diabetes: ■ Reduce the proportion of diabetic population with A1c value >9 percent ■Increase the proportion of diabetic population with A1c value <7 percent

42. The Time is Now ___________________________________________________ Is this finally the time to move from the Prescription to the Patient?