Community and retail pharmacists possess significant skills that can be useful during an emergency response, including vast knowledge about pharmaceutical effects and interactions and the ability to clinically assess illness. Pharmacy involvement in emergency preparedness and response varies between jurisdictions due to differences in state statutes that define how far a pharmacist's clinical reach can extend.
During 2009-2010, the Seattle-King County Advanced Practice Center (SKC-APC) conducted a variety of activities to incorporate retail pharmacies into public health disaster preparedness programs. The goal of bringing together pharmacists, pharmacy associations, and public health officials was to develop a series of tools that would help local health departments integrate pharmacies into their response efforts by means of a Collaborative Drug Therapy Agreement (CDTA). A CDTA is an agreement between pharmacists and authorized prescribers (e.g., doctors, Physician Assistants, Nurse Practitioners) that allows pharmacists to prescribe, modify, or discontinue medication therapy for a patient, without the patient having to be seen by a physician.
CDTAs, when developed as the result of a strong and sustained partnership between public health and pharmacies, can be significantly beneficial to emergency response efforts in several ways. They can reduce the number of patients seeking care from clinics and public health agencies by transferring prescribing authority to pharmacists. CDTAs can also increase access to care for people who may not be able to go to a clinic or hospital during an emergency, as retail and community pharmacies are prevalent in communities across the country. CDTAs are recognized legally in 43 states, and all states include provisions to expand the capabilities of pharmacists via an emergency order.
Meetings with pharmacists and pharmacy organizations prior to the development of SKC-APC's CDTA toolkit helped to define the types of information and materials necessary to support effective pharmacy-public health partnerships. SKC-APC held a Pharmacy Leadership Summit to bring together 35 local organizations, such as public health; commercial, independent, hospital, and ethnic pharmacies; and medical supply companies. The APC also formed a Pharmacy Operations Advisory Committee to lead discussions around ways that pharmacies could become more involved during public health emergencies. These activities built sustained partnerships between public health and pharmacy organizations, and discussions provided valuable information on how CDTAs could be a viable strategy for assuring that medication is provided quickly and reliably during a disaster.
SKC-APC's CDTA toolkit is designed to be applicable to all local health departments, while taking into consideration the laws and guidelines that pharmacists in different jurisdictions must follow. Development of materials was the result of partnerships between SKC-APC, Public Health-Seattle & King County, the Northwest Center for Public Health Practice, the Washington State Pharmacy Association, and the Washington State Board of Pharmacy. Rather than simply provide examples that may have limited applicability, the toolkit walks through development of a CDTA in a step-by-step way that accounts for planning and policy development.
The CDTA toolkit is fairly extensive and is intended to serve as a guide for public health during the full process of developing agreements with pharmacies. To this end, it provides numerous materials and guidelines for keeping a record of steps taken to develop a CDTA or a Memorandum of Understanding that states the roles pharmacies will play in event of a disaster. The toolkit also asks local public health agencies to develop strategies with pharmacists that clearly define how medication and vaccine will be distributed during an emergency. Specific tools include:
- Background information on how and why CDTAs are used to meet increased demand for medications in various types of emergencies, such as natural disasters, terrorist attacks, or infectious disease outbreaks;
- An array of information to help health departments begin the planning process, including information about how to identify pharmacies that could legally participate in a CDTA and how to adapt CDTAs to a specific state or local jurisdiction; identification of appropriate medications that could be in demand during a disaster; development of training programs; and advice on how to collaborate with a wide range of health professionals;
- Planning tools for pharmacists who have entered into a CDTA, including a flow chart for deciding whether and what type of treatment is needed; a screening form for patient complications, contraindications, and presence of severe disease; informational handouts for patients; forms to document medication dispensing and whether medication is obtained from national or regional stockpiles;
- Materials for activating and operating the CDTA during an emergency, including information on establishing networks and communication mechanisms; formalizing partnerships; and creating, testing, and activating a response plan; and
- Tools and resources for establishing pharmacies' leadership roles, distributing pharmaceuticals during an emergency, and sample pharmacy response plans.
Public health efforts in Seattle-King County have demonstrated the utility of the toolkit. As of February 2011, 74 retail pharmacies had signed an MOU with the local health department, while 134 pharmacies were in the process of reviewing an agreement. CDTAs were used in Washington during the novel H1N1 outbreak so that pharmacists could dispense antivirals to patients, and more than 130 pharmacies have CDTAs to administer vaccines for Hepatitis A and meningococcal meningitis. Presently, SKC-APC and pharmacy partners are planning to develop a CDTA that would allow pharmacies to prescribe and dispense the antibiotics ciprofloxacin and doxycycline during an anthrax attack.