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CPHP Interactive Case Studies
Certified Public Health Pharmacist (CPHP)
The Scenario: Responding to a Measles Outbreak
You are a Public Health Pharmacist for a county health department. Your county has seen a sudden increase in measles cases. The health director has tasked you with leading the pharmacy response. You must analyze available data to understand the problem's scope and causes to inform a public health intervention.
Data Sets
County Surveillance Data
| Metric | County Data | State Average |
|---|---|---|
| MMR Vaccination Rate (Kindergarten) | 85% | 95% |
| Measles Cases (Last 30 Days) | 25 | 1-2 |
Community Survey Themes
- Concern about a link between MMR vaccine and autism.
- Belief that measles is a mild childhood illness.
- Difficulty accessing pediatric appointments.
Your Task
Task 1: What is the primary public health problem identified by the surveillance data?
Answer:
The county is experiencing a measles outbreak driven by suboptimal vaccination coverage. The county's vaccination rate of 85% is well below the 95% threshold required for herd immunity against a highly contagious disease like measles, creating a large pool of susceptible individuals and allowing the virus to spread.
Task 2: Based on the survey, what are the two distinct types of barriers to vaccination in this community?
Answer:
The two distinct barriers are: 1) Vaccine hesitancy (an attitudinal barrier driven by misinformation and risk perception) and 2) Access barriers (a structural problem related to the difficulty of securing appointments).
Task 3: What is the concept of "herd immunity," and why is the county's 85% vaccination rate insufficient?
Answer:
Herd immunity is the indirect protection from a disease that occurs when a large percentage of a population is immune, making it difficult for the disease to spread. For measles, this threshold is about 95%. An 85% rate is insufficient because it leaves a large enough susceptible population (15%) for the virus to sustain transmission and cause an outbreak.
Task 4: Propose a multi-component public health intervention to control the outbreak.
Answer:
- Public Education Campaign: Launch a targeted campaign using local media and community leaders to counter misinformation about vaccine safety and emphasize the real dangers of measles.
- Provider Education: Host a webinar for local providers and pharmacists on empathetic communication strategies, like motivational interviewing, to address parental concerns effectively.
- Increase Access via Pharmacies: Establish pharmacist-led, walk-in MMR vaccination clinics at community pharmacies, especially during evenings and weekends, to directly overcome the barrier of appointment availability.
The Scenario: Analyzing a Proposed Naloxone Law
A state legislature is considering a bill that would reclassify naloxone as a Schedule V controlled substance, available only by a patient-specific prescription from a physician. Proponents claim this is for safety; opponents fear it will reduce access. The State Board of Pharmacy asks you, a CPHP, to provide an expert analysis of the bill's potential public health impact.
State Data & Policy Information
State Opioid Overdose Data (Annual)
- Fatal Opioid Overdoses: 850
- EMS-Responded Overdoses: 4,200
- Naloxone Administrations by Laypersons: 1,200
Policy Details
Current Law: Pharmacists may dispense naloxone to any person at risk or in a position to assist, pursuant to a statewide standing order.
Proposed Bill: Reclassifies naloxone to Schedule V and repeals the standing order, requiring a patient-specific MD prescription.
Your Task
Task 1: What is the primary public health argument against the proposed bill?
Answer:
The bill would create a catastrophic barrier to access for a life-saving medication. Requiring a physician visit and a patient-specific prescription will prevent laypersons—the people most likely to witness an overdose—from obtaining naloxone. This will inevitably lead to an increase in preventable overdose deaths.
Task 2: How would you use the state's own data to demonstrate the negative impact of this bill?
Answer:
The data shows that laypersons administered naloxone 1,200 times last year. Each of those events was a potential life saved by the current standing order policy. The proposed bill would effectively eliminate those 1,200 rescues. Given the state's 850 fatal overdoses, removing the most effective community-level prevention tool would be a devastating step backward.
Task 3: The bill's sponsor argues that requiring a prescription is a necessary safety measure. How do you counter this argument?
Answer:
This argument is not supported by evidence. Naloxone is an opioid antagonist with no potential for abuse or misuse; it has no effect in the absence of opioids. Decades of data and recommendations from every major public health body (CDC, WHO, SAMHSA) confirm that broad, non-prescription community access to naloxone is overwhelmingly safe and effective.
Task 4: What is your final policy recommendation to the legislature?
Answer:
"My unequivocal recommendation is to vote against this bill. The evidence clearly shows it will cause harm by reducing access to a life-saving medication. Instead, the legislature should strengthen the existing, successful standing order policy by allocating state funds for naloxone purchasing and distribution through community organizations and pharmacies, ensuring this critical tool reaches every person who might need it."
The Scenario: Designing a Pharmacist-Led Hypertension Program
You are a CPHP at a clinic in a low-income, predominantly African American community. Your clinic's data reveals a significant health disparity: your patients with hypertension have far poorer blood pressure control than the city average. You have been tasked with designing a new, pharmacist-led community health program to address this disparity head-on.
Community Health & Focus Group Data
Health Disparity Data
| Metric | Your Clinic | City Average |
|---|---|---|
| % of HTN Patients at Goal | 45% | 65% |
| Medication Adherence (PDC > 80%) | 55% | 75% |
Patient Focus Group Themes
- "I don't trust a lot of doctors."
- "It's hard to get time off work for appointments."
- "The pharmacy is the place I trust and go to most often."
Your Task
Task 1: Based on the data, identify the three main drivers of poor blood pressure control in this community.
Answer:
The three main drivers are: 1) Medication non-adherence (only 55% are adherent); 2) Access barriers (difficulty getting to appointments); and 3) Lack of trust in the traditional medical system.
Task 2: What is the core concept of a "Collaborative Practice Agreement" (CPA), and why is it essential for this program?
Answer:
A CPA is a formal agreement between a pharmacist and a provider that grants the pharmacist authority to perform specific patient care functions, such as initiating and adjusting medication dosages. It is essential here because it empowers the pharmacist to act on high blood pressure readings immediately, overcoming clinical inertia and the access barrier of requiring a separate physician visit for every medication change.
Task 3: Design a culturally competent, pharmacist-led hypertension management program. Name the program and describe its key components.
Answer:
Program Name: The Healthy Heart Barbershop & Salon Program.
Key Components:
- Community-Based MTM: Embed a clinical pharmacist in trusted, accessible community locations like barbershops, salons, and churches. The pharmacist will conduct BP checks and medication management sessions in these familiar environments to build trust and overcome access barriers.
- Collaborative Practice Agreement: The pharmacist will operate under a CPA with the clinic's physicians, allowing them to adjust and intensify antihypertensive medications on the spot based on the BP readings and a pre-approved protocol.
Task 4: What is one key process measure and one key outcome measure you would use to evaluate the program's success after one year?
Answer:
- Process Measure: Medication Adherence. You would track the Proportion of Days Covered (PDC) for antihypertensive medications among enrolled patients. An increase from the baseline of 55% towards a goal of >80% would demonstrate the program is successfully improving medication-taking behavior.
- Outcome Measure: Blood Pressure Control Rate. You would track the percentage of enrolled patients who achieve a blood pressure of < 130/80 mmHg. An increase from the baseline of 45% would demonstrate that the program is having a direct, positive impact on health outcomes.
