Recent public health emergencies in the United States, such as the H1N1 outbreak and Hurricane Katrina, highlighted the important role pharmacists and pharmacies can play in reaching medically at-risk populations. Pharmacists bring a unique set of skills to all-hazards preparedness activities, including accessibility within communities, extended hours of availability, and the ability to identify high-risk patients based on their medication history. Pharmacists are seen as trustworthy health professionals, said Mitchel C. Rothholz, Chief of Staff, American Pharmacists Association (APhA), during a presentation at the 2011 Public Health Preparedness Summit.
The Montgomery County Advanced Practice Center (APC) has developed a toolkit that encourages collaboration between pharmacists and local health departments (LHDs) from an all-hazards perspective. In 2010, Montgomery County APC approached staff from the Palm Beach County Health Department (PBCHD) to learn more about Palm Beach’s involvement with pharmacists in their H1N1 response. What emerged was an online toolkit that serves both as a resource for educational information on engaging pharmacies in preparedness activities and as a clearinghouse for practices and stories about successful LHD-pharmacy partnerships. Following these conversations, PBCHD was selected from a competitive national pool as an APC connector site, or a site dedicated to evaluating and improving Montgomery County's toolkit.
The toolkit, titled "A Prescription for Preparedness," (www.rx4prep.org) is available online. The information and materials it includes have several purposes: 1) providing the impetus for LHDs and pharmacists to work collaboratively on all-hazards preparedness projects; 2) highlighting resources that can illustrate the strengths of each organization and what they can offer to response efforts; and 3) providing tools and resources to make any collaborative effort easy for all partners.
Several resources included in the toolkit are for LHDs and pharmacies in the beginning stages of reaching out to one another. The experiences of Montgomery County and Palm Beach County resulted in strategies for creating an interdisciplinary workgroup, connecting with state and local organizations such as pharmacy and healthcare boards, and involving pharmacies in emergency preparedness exercises. The toolkit also offers a section on networking with recommendations on how LHDs can engage pharmacies, how pharmacies can work effectively within a public health environment, and how both organizations can use social media to enhance their partnerships.
A wide variety of tools from LHDs that have already engaged pharmacists in disaster preparedness compose a significant portion of the toolkit. Users can read about the experiences of several local health departments and download publicly available tools created by joint public health and pharmacy partnerships. Examples of tools available on the Web site include a Seniors and Your Medicines communications campaign, a pharmacy phone survey regarding business continuity planning, a training program for emergency distribution of pharmaceuticals, and a toolkit for developing effective and sustainable medication dispensing strategies during a disaster. Tools on the Web site are examples showing sustainable relationships between and among LHDs, hospitals, healthcare organizations, emergency management agencies, and pharmacies.
Montgomery County APC developed the toolkit with input from public health professionals, pharmacists, and emergency management personnel. As part of the toolkit's development, staff were involved in adult/childhood immunization coalition meetings, local and state pharmacy associations, local business coalitions, and community and hospital-based pharmacy groups.
Partnership with PBCHD as a connector site allowed the Montgomery County APC to observe pharmacy-LHD relationships in practice. PBCHD especially noted the value of working with pharmacies during H1N1. Pharmacists supplied the public with "Flu Ready" cards listing items they should have on hand during a health emergency. The cards were strategically placed at the ends of store aisles, next to over-the-counter "flu ready items" listed on the card like thermometers and hand sanitizers. The goal of the flu ready cards was to disseminate a consistent message about vaccination. PBCHD also involved community pharmacists in a tabletop disaster exercise. Many of PBCHD's efforts to engage pharmacists were conducted via its Healthcare Emergency Response Coalition pharmacy workgroup, a task force composed of community and hospital pharmacists, local health and emergency management professionals, and hospital and healthcare planners.
While the toolkit provides immense assistance to health departments wishing to engage local pharmacies in emergency preparedness, public health must also consider several local issues that affect the role pharmacies can play in all-hazards planning. For instance, states differ in the restrictions they place on pharmacist authority to conduct various activities, such as vaccinations for children. Additionally, it is often difficult to identify those who have authority to make pharmacy-wide decisions, especially in chain or retail pharmacies.
A survey conducted by PBCHD among Walgreens pharmacy managers found that community pharmacists are eager to be involved in all-hazards planning. Half of all pharmacists had interest in working with the LHD to provide prophylaxis in event of an anthrax attack, and 96 percent of pharmacists said they would be comfortable talking to patients about medical countermeasures during a disaster. Pharmacists' skills and daily activities, such as the preparation and dispensing of medications and patient education, lend themselves to being used effectively in natural or man-made disasters. In general, PBCHD has found that pharmacists welcome enhanced use of their skill sets during disasters in activities such as surveillance, distribution of medical supplies, evaluation and triage of symptoms, and community-based planning and relief efforts.