U.S. community pharmacies recognized for contributions to public health during pandemic

A recent JAMA Health Forum article paid tribute to the vital role that community pharmacies in the United States played in the public health response to the COVID-19 pandemic.1 Through a federal program, more than 6,000 pharmacies in all 50 states provided millions of COVID-19 tests. In addition, US community pharmacies provided more than 300 million doses of COVID-19 vaccines, representing more than two of every five doses administered in the United States. In 2006, the American Public Health Association made a resolution, declaring “There are many functions of public health that can benefit from pharmacists’ unique expertise that may include pharmacotherapy, access to care, and prevention services.” However, five years later, pharmacists were found to be “remarkably underutilized in the US health care delivery system given their level of education, training, and access to the community.” As the special authority to provide COVID-19 testing and vaccination is scheduled to end in the United States in December 2024, the role of US community pharmacists and pharmacies is uncertain in the postpandemic world.1 The JAMA Health Forum article notes that there are more than 67,000 pharmacies in the United States and 88.9% of individuals live within five miles of at least one pharmacy. The authors believe that the pharmacy network could greatly contribute to the health, equity and well-being of US individuals, particularly in the following four clinical domains:1 1. HIV. In 2020, only one-quarter of the 1.2 million US residents who could benefit from preexposure prophylaxis (PrEP) for HIV had obtained a PrEP prescription. Availability of PrEP in community pharmacies could accelerate efforts to end the HIV epidemic. A Washington State pilot program allows pharmacists to assess patients and prescribe PrEP. Since 2020, California has permitted pharmacists to provide up to a 60-day supply of PrEP without a prescription. Ten states allow pharmacists to provide postexposure prophylaxis for HIV under a standing order. 2. Hypertension. Only one-fourth of US individuals with hypertension have their blood pressure under control. Pharmacists can diagnose and treat hypertension based on treatment guidelines and with support from specialists. Pharmacy-based models of care are supported by randomized controlled trials, such as the Alberta Vascular Risk Reduction Community Pharmacy Project, which showed that pharmacists’ interventions can reduce systolic blood pressure and overall cardiovascular risk. 3. Overdose. More than 100, 000 US individuals die from overdoses each year; however, many US counties do not have a single buprenorphine prescriber or harm reduction service. Evidence supports pharmacies providing naloxone, clean syringes and buprenorphine treatment through a collaborative agreement with physicians. 4. Reproductive Health Care. US pharmacy organizations have created a maternal health tool kit for pharmacists, developed because of high maternal mortality and major inequities in maternal and birth outcomes. The tool kit supports pharmacists in offering preventive services and folic acid supplementation, providing support during pregnancy, and providing postpartum services. A US Food and Drug Administration advisory committee recently voted in support of making oral hormonal contraception available over the counter and 20 states now allow pharmacists to prescribe hormonal contraception. Past surveys have indicated that as many as two-thirds of women would use pharmacies to obtain contraception. At a recent meeting at the University of Maryland School of Pharmacy, experts discussed four key ways to enable pharmacy contributions to health in the United States: Provide pharmacists with access to healthcare data, to enable them to better understand their patients and share their work with medical colleagues. Urge public and private payers to increase reimbursement for public health services at pharmacies. Strengthen training at pharmacy schools to address issues of stigma and better prepare pharmacists to provide counselling on sensitive topics. Advise state legislatures to reassess what activities pharmacists can do alone or in partnership with physicians and other health professionals.1 The article points out that in some areas of the United States and in federally run programs, pharmacists’ scope of practice has expanded, enabling them to help control HIV, reduce smoking and manage diabetes. In other areas of the country, however, physicians and other health professionals are firmly opposed to any effort to increase pharmacists’ scope of practice, even those related to public health activities.1 The article authors (a pharmacist and a physician) encourage the medical profession to recognize the substantial evidence that pharmacists can perform key clinical tasks, consistent with their training, and in collaboration with physicians when needed, to address major unmet public health needs. The fundamental goal of saving lives justifies expanding what pharmacists are permitted to do through innovative and adequately reimbursed models of pharmacy care.1 The authors conclude that “It would be profoundly unfortunate for pharmacists to recede from the public health landscape. With increasing numbers of U.S. individuals dying of preventable causes in recent years, the US cannot afford to leave critical, lifesaving resources in every community hidden in plain sight.”1 Reference 1. Layson-Wolf C, Sharfstein JM. US community pharmacies and public health—building on the COVID-19 response. JAMA Health Forum 2023;4(6):e232583. (accessed July 4, 2023).

U.S. community pharmacies recognized for contributions to public health during pandemic

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