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					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
Public Health
___________________________________________________




                       Prescription


                           Patient


                      Public Health
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
Definition of Public Health
___________________________________________________




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


 Public Health                    Medicine

 ■ Focus   on Population          ■ Focus   on Individual

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


 Public Health                    Medicine

 ■ Multiple  professional         ■ Well established
   identities with diffused         professional with sharp
   public image                     public image

 ■ Emphasis  on prevention,       ■ Emphasis  on diagnosis/
   health promotion for the         treatment/care for the
   whole community                  whole patient
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
Recent Statistics
___________________________________________________




              The Health of King
                 County 2006


                  Jim Krieger, MD, MPH
                  Epidemiology, Planning
                     & Evaluation Unit
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
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
Determinants of Health
___________________________________________________



                         Public Health
     Social
  Environment

                          Behaviors &
    Physical
                            Biologic
                                                      Health &
  Environment                                         Disease
                           Response

    Genetic
  Endowment
                          Health Care
Chronic Disease Risk Factors
(Common and Increasing)
___________________________________________________
#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
#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
Diabetes
___________________________________________________




 ■ Prevalence among adults
   has doubled in the last
   decade

 ■ Hospitalizations, which
  can often be avoided with
  good diabetes management,
  are increasing
Chronic Disease: Diabetes
___________________________________________________
Show Me the Money:
Who is going to Pay You
___________________________________________________




   ■ Insurance Companies
   ■ The State- Medicaid

   ■ Self-Insured Companies

   ■ Your Patients
Access to care decreasing
___________________________________________________




 ■ Highest rate of
   uninsured populations
   since data collection
   began in King County
Access to care
___________________________________________________
Health of King County Report link
___________________________________________________




    http://www.kingcounty.gov/healthservices/
    health/data/hokc.aspx
Pharmacy Involvement
___________________________________________________



      Pharmacy Related Public Health Initiatives

       ■ Tobacco            ■ Emergency   Prescription
       ■ Immunizations       Assistance Program
       ■ Safe Disposal      ■ TB
       ■ Naloxone           ■ Biosurveillance
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
Tobacco
___________________________________________________




 “Reducing access to tobacco: Supporting
 100% smoke-free housing, parks, and school
 and college campuses; and ending tobacco
 sales at pharmacies.”
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.
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
Immunizations- Potential Next Steps
___________________________________________________



 ■ How    are Immunizations being tracked?
          Child Profile- Can Pharmacies utilize it more
                          effectively?

 ■ Are   Pharmacy efforts limited to adults?

 ■ CanPharmacists play a role in advocating for
   immunizations in their communities?
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.
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
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.”
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?
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
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
TB: Direct Observed Therapy
___________________________________________________




 Non-contagious TB patients would come to a
 pharmacy to take their daily dose(s).
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…
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
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
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
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
The Time is Now
___________________________________________________




      Is this finally the time to move from the
             Prescription to the Patient?

				
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