CPHP Certification Review

Certified Public Health Pharmacist (CPHP) Review

A Review Guide for the Certified Public Health Pharmacist (CPHP) Exam

Block 1: Foundations of Public Health

A-C

  • ACIP: Advisory Committee on Immunization Practices.
  • AHRQ: Agency for Healthcare Research and Quality.
  • APHA: American Public Health Association.
  • ASP: Antimicrobial Stewardship Program.
  • BRFSS: Behavioral Risk Factor Surveillance System.
  • CBO: Congressional Budget Office.
  • CDC: Centers for Disease Control and Prevention.
  • CER: Comparative Effectiveness Research.
  • CHNA: Community Health Needs Assessment.
  • CHW: Community Health Worker.

D-H

  • DOH: Department of Health.
  • DOT: Days of Therapy / Directly Observed Therapy.
  • EHR: Electronic Health Record.
  • EOP: Emergency Operations Plan.
  • EPA: Environmental Protection Agency.
  • Epi: Epidemiology.
  • FDA: Food and Drug Administration.
  • FPL: Federal Poverty Level.
  • GIS: Geographic Information System.
  • HHS: Department of Health and Human Services.

I-N

  • ICD-10: International Classification of Diseases, 10th Revision.
  • ICS: Incident Command System.
  • IHI: Institute for Healthcare Improvement.
  • IOM: Institute of Medicine (now NAM).
  • IRB: Institutional Review Board.
  • MCO: Managed Care Organization.
  • Morbidity: The state of being diseased.
  • Mortality: The state of being subject to death.
  • NAM: National Academy of Medicine.
  • NIH: National Institutes of Health.

O-S

  • OSHA: Occupational Safety and Health Administration.
  • PCP: Primary Care Provider.
  • PDMP: Prescription Drug Monitoring Program.
  • PHS: Public Health Service.
  • POD: Point of Dispensing.
  • PrEP: Pre-Exposure Prophylaxis.
  • QALY: Quality-Adjusted Life Year.
  • RWE: Real-World Evidence.
  • SAMHSA: Substance Abuse and Mental Health Services Administration.
  • SDoH: Social Determinants of Health.

S-Z

  • SNS: Strategic National Stockpile.
  • STI: Sexually Transmitted Infection.
  • TB: Tuberculosis.
  • U.S.P.S.T.F.: U.S. Preventive Services Task Force.
  • VAERS: Vaccine Adverse Event Reporting System.
  • VFC: Vaccines for Children Program.
  • WHO: World Health Organization.
  • WIC: Special Supplemental Nutrition Program for Women, Infants, and Children.
  • YLD: Years Lived with Disability.
  • YRBS: Youth Risk Behavior Survey.

Defining Public Health

  • Public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society.
  • It focuses on the health of entire populations, not just individual patients.
  • The key distinction is the focus on prevention rather than treatment.
  • It addresses the underlying social, economic, and environmental factors that influence health.
  • A CPHP applies their pharmacy expertise to achieve these broad public health goals.

The Three Core Functions

  • The Institute of Medicine (IOM) defined three core functions of public health.
  • 1. Assessment: The systematic collection, analysis, and dissemination of information on the health of the community.
  • 2. Policy Development: The use of scientific knowledge to develop comprehensive public health policies.
  • 3. Assurance: Assuring that the services necessary to achieve agreed-upon goals are provided, either by encouraging other entities or by providing services directly.
  • These three functions provide the overall framework for public health practice.

The 10 Essential Public Health Services (Assessment)

  • These services operationalize the three core functions.
  • 1. Assess and monitor population health status, factors that influence health, and community needs and assets. (e.g., analyzing BRFSS data).
  • 2. Investigate, diagnose, and address health problems and hazards affecting the population. (e.g., conducting an outbreak investigation).
  • A CPHP uses data skills to support these assessment functions.

The 10 Essential Public Health Services (Policy Development)

  • 3. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it. (e.g., a public health campaign on naloxone).
  • 4. Strengthen, support, and mobilize communities and partnerships to improve health. (e.g., partnering with community organizations on a diabetes prevention program).
  • 5. Create, champion, and implement policies, plans, and laws that impact health. (e.g., advocating for smoke-free air laws).
  • 6. Utilize legal and regulatory actions designed to improve and protect the public’s health. (e.g., enforcing pharmacy regulations).

The 10 Essential Public Health Services (Assurance)

  • 7. Assure an effective system that enables equitable access to the individual services and care needed to be healthy. (e.g., operating a public health clinic).
  • 8. Build and support a diverse and skilled public health workforce. (e.g., training and credentialing).
  • 9. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement. (e.g., evaluating the effectiveness of a new program).
  • 10. Build and maintain a strong organizational infrastructure for public health.
  • A CPHP can contribute to all of these essential services.

Block 2: Core Public Health Sciences

Defining Epidemiology

  • Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations.
  • It is the basic science of public health.
  • It is often called the "public health detective," as it seeks to find the causes of disease.
  • A CPHP must have a strong foundational understanding of epidemiological principles.
  • Pharmacoepidemiology is a subfield that applies these principles to the study of medication effects in populations.

Measures of Disease Frequency

  • Prevalence: The proportion of a population that has a disease at a specific point in time. It measures the existing burden of disease. (Prevalence = Number of existing cases / Total population).
  • Incidence: The rate at which new cases of a disease occur in a population over a specific period of time. It measures the risk of developing a disease. (Incidence Rate = Number of new cases / Person-time at risk).
  • A CPHP must be able to calculate and interpret these fundamental measures.

Study Designs

  • Descriptive Studies (Case Report, Cross-Sectional): Used to describe the distribution of disease. They cannot determine causality.
  • Analytic Studies (Cohort, Case-Control): Used to test hypotheses about the determinants of disease.
  • Cohort Study: Follows a group of people over time to compare the incidence of disease in those who are exposed versus unexposed to a risk factor.
  • Case-Control Study: Compares the past exposures of people with a disease (cases) to those without the disease (controls).
  • Randomized Controlled Trial (RCT): The "gold standard" experimental design.

Measures of Association

  • These statistics are used to quantify the relationship between an exposure and a disease.
  • Relative Risk (RR): Calculated from a cohort study. It is the ratio of the incidence in the exposed group to the incidence in the unexposed group.
  • Odds Ratio (OR): Calculated from a case-control study. It is the ratio of the odds of exposure in the cases to the odds of exposure in the controls.
  • An RR or OR > 1 suggests a positive association (the exposure is a risk factor).
  • An RR or OR < 1 suggests a negative association (the exposure is protective).

Bias and Confounding

  • A CPHP must be able to critically evaluate a study for potential errors.
  • Bias: A systematic error in a study that results in a mistaken estimate of the exposure-disease relationship. Common types include selection bias and information bias.
  • Confounding: A third factor that is associated with both the exposure and the disease, which can distort the true relationship.
  • For example, smoking is a confounder in a study of alcohol and lung cancer.
  • Statistical methods can be used to control for confounding, but not for bias.

Defining Health Disparities and Health Equity

  • Health Disparities: Preventable differences in the burden of disease, injury, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.
  • Health Equity: The principle that everyone has a fair and just opportunity to be as healthy as possible.
  • Achieving health equity requires removing obstacles to health such as poverty, discrimination, and their consequences.
  • The reduction of health disparities is a central goal of public health.

Social Determinants of Health (SDoH)

  • SDoH are the conditions in the environments where people are born, live, learn, work, and play that affect health.
  • They are the root causes of many health disparities.
  • The five key domains of SDoH are:
  • 1. Economic Stability.
  • 2. Education Access and Quality.
  • 3. Health Care Access and Quality.
  • 4. Neighborhood and Built Environment.
  • 5. Social and Community Context.
  • A CPHP must understand how these factors impact medication-related outcomes.

The Pharmacist's Role in Addressing SDoH

  • Pharmacists can play a key role in identifying and addressing SDoH-related barriers to medication access.
  • This can include screening for food insecurity, transportation challenges, and low health literacy.
  • They can connect patients with community resources to help address these needs.
  • This requires moving beyond the traditional dispensing role to a more holistic, public health-oriented practice.
  • A CPHP is a leader in integrating SDoH screening into pharmacy workflow.

Cultural Competency

  • Cultural competency is the ability to provide care to patients with diverse values, beliefs, and behaviors.
  • It is a key strategy for reducing health disparities.
  • It involves being aware of one's own cultural worldview and being open to understanding the patient's perspective.
  • It also requires providing care that is linguistically appropriate, such as using qualified medical interpreters.
  • A CPHP must be a culturally competent practitioner.

Analyzing Data for Disparities

  • A key role for a public health analyst is to use data to identify and monitor health disparities.
  • This involves stratifying health outcome data (e.g., medication adherence rates) by race, ethnicity, socioeconomic status, and geography.
  • This analysis makes disparities visible and allows for the targeting of interventions.
  • For example, if the data shows that adherence to diabetes medications is much lower in a specific zip code, resources can be directed to that community.
  • A CPHP must be skilled at this type of equity-focused data analysis.

The Role of Policy in Public Health

  • Policy is one of the most powerful tools for improving the health of a population.
  • Policies can change the environment to make healthy choices the easy choices (e.g., smoke-free air laws).
  • They can also improve access to care (e.g., the Affordable Care Act).
  • A CPHP must understand how policy is made and how it can be used to advance public health goals.
  • This is the "Policy Development" core function of public health.

The Legal Basis for Public Health

  • Public health law is the body of law that gives government the authority to protect the public's health.
  • In the U.S., the primary authority for public health rests with the states (the "police power").
  • This is why state and local health departments have the authority to do things like issue quarantine orders.
  • The federal government's authority comes primarily from its power to regulate interstate commerce.
  • A CPHP should understand this legal framework.

The Legislative Process

  • A CPHP should understand the basic process of how a bill becomes a law.
  • This involves introduction, committee review, floor debate and votes in both chambers of the legislature, and finally, signature by the executive (governor or president).
  • Understanding this process is essential for effective advocacy.
  • It allows an advocate to know the key points in the process where they can have the most influence.

The Regulatory Process (Rulemaking)

  • When a law is passed, it often gives a government agency (like the Department of Health) the authority to write the specific rules to implement it.
  • This is done through a formal "rulemaking" process.
  • The agency must publish a proposed rule and allow for public comment before issuing a final rule.
  • The public comment period is a key opportunity for pharmacists and other stakeholders to provide their expert input.
  • A CPHP can play a key role in analyzing and commenting on proposed rules.

Advocacy

  • Advocacy is the process of influencing public policy.
  • It involves educating policymakers about a problem and proposing a solution.
  • Pharmacists can be powerful advocates for public health policies.
  • This can be done through professional associations like APhA and ASHP.
  • It can also be done at the individual level by building relationships with local elected officials.
  • A CPHP should be an active advocate for policies that improve the public's health.

Block 3: Public Health Pharmacy Practice

Accessibility of Pharmacists

  • Pharmacists are the most accessible healthcare professionals in many communities.
  • Over 90% of Americans live within 5 miles of a community pharmacy.
  • Patients see their pharmacist much more frequently than their primary care provider.
  • This accessibility makes pharmacists an ideal partner for public health initiatives.
  • They are a trusted source of health information in the community.

Screening Services

  • Pharmacists can provide a wide range of public health screening services.
  • This includes screening for chronic diseases like hypertension, diabetes, and dyslipidemia.
  • They can also screen for infectious diseases like HIV and Hepatitis C.
  • Screening for mental health and substance use disorders is another key role.
  • The CPHP is a leader in designing and implementing these screening programs in the pharmacy setting.

Immunizations

  • Pharmacists are now one of the leading providers of immunizations in the United States.
  • They are authorized to administer a wide range of vaccines to adults in all 50 states.
  • Their accessibility makes them a crucial partner in improving vaccination rates for influenza, pneumonia, shingles, and many other diseases.
  • The CPHP is often involved in the public health planning for vaccination campaigns.

Patient Education

  • Patient education is a core function of a pharmacist.
  • In a public health role, this education extends beyond the individual to the entire community.
  • A CPHP may be involved in creating and delivering public health educational campaigns.
  • This can include topics like smoking cessation, naloxone use, and the safe disposal of medications.
  • This is a key part of the "inform and educate" essential service.

Collaborative Practice

  • Pharmacists can work under collaborative practice agreements (CPAs) with physicians to manage the care of patients with chronic diseases.
  • This team-based approach has been shown to improve outcomes for conditions like diabetes and hypertension.
  • From a public health perspective, these models can be a powerful way to improve the management of chronic disease at a population level.
  • A CPHP is an advocate for policies that expand the scope of practice and allow for these innovative models of care.

Levels of Prevention

  • Prevention is the cornerstone of public health. There are three levels of prevention.
  • Primary Prevention: Aims to prevent a disease before it ever occurs (e.g., immunizations, smoking cessation).
  • Secondary Prevention: Aims to reduce the impact of a disease that has already occurred by detecting and treating it early (e.g., screening for hypertension, cancer screening).
  • Tertiary Prevention: Aims to soften the impact of an ongoing illness or injury that has lasting effects (e.g., chronic disease management, rehabilitation).
  • A CPHP is involved in programs at all three levels.

Health Promotion

  • Health promotion is the process of enabling people to increase control over and to improve their health.
  • It is a proactive approach that focuses on building assets and strengths.
  • It addresses the underlying social determinants of health.
  • Pharmacists can be key health promoters in their communities.
  • This can involve partnering with local organizations to promote healthy behaviors.

The U.S. Preventive Services Task Force (USPSTF)

  • The USPSTF is an independent panel of national experts in prevention and evidence-based medicine.
  • They make evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
  • Their recommendations are assigned a letter grade (A, B, C, D, or I).
  • Under the ACA, most health plans are required to cover services with an "A" or "B" rating at no cost to the patient.
  • A CPHP must be an expert on the USPSTF recommendations.

The Pharmacist's Role in Prevention

  • Pharmacists contribute to all three levels of prevention.
  • Primary: Providing immunizations and tobacco cessation services.
  • Secondary: Conducting screenings for blood pressure and diabetes.
  • Tertiary: Providing MTM and chronic disease management to prevent complications.
  • A CPHP works to integrate these preventive services into routine pharmacy practice.

Behavior Change Theories

  • To be effective at health promotion, a CPHP should be familiar with theories of health behavior change.
  • The Transtheoretical Model (Stages of Change): Views change as a process through stages (Precontemplation, Contemplation, Preparation, Action, Maintenance). Interventions should be matched to the patient's stage.
  • Health Belief Model: Suggests that a person's belief in a personal threat of an illness, together with their belief in the effectiveness of the recommended behavior, will predict the likelihood of the behavior.
  • Motivational Interviewing: A counseling style that helps patients to explore and resolve their own ambivalence about change.

Defining Health Literacy

  • Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions.
  • It is not just about the ability to read; it also includes numeracy and communication skills.
  • Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available.
  • Low health literacy is associated with poor health outcomes.
  • A CPHP must be a champion for health literacy.

The Universal Precautions Approach

  • It is not possible to tell a person's health literacy level by looking at them.
  • Therefore, the "Universal Precautions" approach should be used.
  • This means assuming that all patients may have difficulty understanding health information.
  • All communication, both verbal and written, should be made as clear and simple as possible for everyone.
  • This is a key strategy for patient safety.

Plain Language and Clear Communication

  • Plain language is communication that your audience can understand the first time they read or hear it.
  • This involves avoiding medical jargon and using simple words and short sentences.
  • The "teach-back" method is a key tool for clear verbal communication. This involves asking the patient to explain in their own words what they need to know or do.
  • A CPHP must be an expert at using these clear communication techniques.

Cultural Competency

  • Cultural competency is the ability to provide care to patients with diverse values, beliefs, and behaviors.
  • It is a key strategy for reducing health disparities.
  • It involves being aware of one's own cultural worldview and being open to understanding the patient's perspective.
  • It requires providing care that is respectful of and responsive to the patient's cultural background.

Linguistic Competency

  • This is the ability to provide care to patients with limited English proficiency.
  • It is a key part of cultural competency.
  • It requires providing access to qualified medical interpreters. Using family members as interpreters is not appropriate.
  • Written materials, such as prescription labels and patient education, should be available in the primary languages of the community being served.
  • A CPHP advocates for these resources to be available in their practice setting.

The Role of Communication in Public Health

  • Effective communication is one of the 10 Essential Public Health Services.
  • It is the process of informing, educating, and empowering people about health issues.
  • It is a key tool for health promotion and disease prevention.
  • A CPHP is often a key messenger in public health communication campaigns.

Health Communication Campaigns

  • A health communication campaign is an organized effort to communicate a specific health message to a target audience.
  • The campaign should be based on a clear understanding of the audience's knowledge, attitudes, and behaviors.
  • It should use a variety of communication channels to reach the audience.
  • The message should be clear, simple, and consistent.
  • A CPHP may be involved in the design and implementation of these campaigns at the local level.

Risk Communication

  • Risk communication is a specific type of health communication used in emergencies and outbreaks.
  • The goal is to provide the public with the information they need to make the best possible decisions about their health in a time of uncertainty.
  • Key principles of risk communication include being first, being right, and being credible.
  • It requires communicating with transparency, empathy, and respect.
  • A CPHP may be a key spokesperson during a public health emergency.

Working with the Media

  • The media is a powerful partner for disseminating public health messages.
  • A CPHP may be asked to serve as a subject matter expert for interviews with journalists.
  • It is essential to have a clear and consistent message.
  • The pharmacist should be prepared to answer difficult questions.
  • Building relationships with local health reporters can be a valuable strategy.

Social Media and Digital Communication

  • Social media is now a key channel for public health communication.
  • It allows for the rapid dissemination of information to a wide audience.
  • However, it is also a major source of health misinformation.
  • A key role for a CPHP is to be a credible and evidence-based voice on social media.
  • They can use these platforms to share accurate health information and to counter misinformation.
  • This is a new and important part of modern public health practice.

Purpose of a CHNA

  • A CHNA is a systematic process for identifying the key health needs and assets of a community.
  • It is the foundation for all community health improvement planning.
  • It is a key part of the "Assessment" core function of public health.
  • Under the ACA, all non-profit hospitals are required to conduct a CHNA every three years.
  • The CPHP is a key stakeholder who can provide valuable input to this process.

The CHNA Process

  • The process involves collecting and analyzing data from a variety of sources.
  • It must include input from the community, especially from medically underserved, low-income, and minority populations.
  • The process culminates in a formal report that identifies the community's significant health needs.
  • The hospital must then develop an implementation strategy that describes how it will address these needs.

Quantitative Data Sources

  • The CHNA uses quantitative data to describe the health of the community.
  • This includes data on leading causes of death and disease prevalence.
  • It also includes data on health behaviors from surveys like the BRFSS.
  • Data on SDoH, such as poverty and education levels, is also analyzed.
  • A CPHP can help to analyze and interpret the data related to medication use and access.

Qualitative Data Sources

  • Qualitative data is essential for understanding the community's perspective.
  • This is gathered through methods like community forums, focus groups, and key informant interviews.
  • This process allows community members to share their own stories and to identify the health issues that are most important to them.
  • The CPHP can be a key participant in these community engagement activities.

The Pharmacist's Role in the CHNA

  • As a highly accessible provider, the pharmacist has a unique understanding of the community's health needs.
  • They can provide valuable input on medication-related issues, such as affordability and access.
  • They can be a key informant in the data collection process.
  • After the CHNA is completed, the CPHP can be a leader in developing and implementing pharmacy-based programs to address the identified needs.
  • This is a key opportunity for the pharmacy to demonstrate its value to the community.

Block 4: Infectious Disease & Emergency Preparedness

The Pharmacist's Role as an Immunizer

  • Pharmacists are a key part of the nation's immunization infrastructure.
  • All 50 states now authorize pharmacists to administer a wide range of vaccines to adults.
  • The accessibility of pharmacies makes them a crucial partner for improving vaccination rates.
  • A CPHP is a leader in the design and implementation of pharmacy-based immunization programs.
  • They are experts on vaccine storage, handling, and administration.

The Advisory Committee on Immunization Practices (ACIP)

  • The ACIP is a committee of medical and public health experts that provides recommendations to the CDC on the use of vaccines in the U.S.
  • They develop the official, evidence-based adult and childhood immunization schedules.
  • A CPHP must be an expert on the current ACIP recommendations.
  • These recommendations are the foundation of all immunization practice.

Vaccine Hesitancy

  • Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is a major public health threat.
  • It is fueled by misinformation and disinformation, especially on social media.
  • Pharmacists are a trusted source of information and are in a key position to address vaccine hesitancy.
  • This requires using empathetic communication and motivational interviewing techniques.
  • The goal is to have a respectful conversation, not an argument.
  • A CPHP should be skilled in these communication strategies.

Vaccine Storage and Handling

  • Vaccines are fragile biological products that must be stored at the correct temperatures to remain effective.
  • This is known as the "cold chain."
  • The CDC has a detailed "Vaccine Storage and Handling Toolkit" that provides the standards for this.
  • This includes requirements for the use of pharmaceutical-grade refrigerators and continuous temperature monitoring.
  • A CPHP is responsible for ensuring their program is fully compliant with these standards.

Vaccine Adverse Event Reporting System (VAERS)

  • VAERS is a national early warning system to detect possible safety problems in U.S.-licensed vaccines.
  • It is co-managed by the CDC and FDA.
  • Healthcare providers are required to report certain adverse events after vaccination.
  • Anyone can submit a report to VAERS.
  • It is important to understand that VAERS reports are not proof that a vaccine caused an event, only that the event occurred after vaccination.
  • A CPHP must know when and how to report to VAERS.

The Pharmacist's Role in STI Prevention

  • Pharmacists are in a key position to provide education and services for STI prevention.
  • This includes counseling on safe sex practices and the correct use of condoms.
  • They are also key providers of vaccinations for preventable STIs, such as HPV and Hepatitis B.
  • In some states, pharmacists can now prescribe and dispense pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV.
  • A CPHP is a leader in these public health initiatives.

Expedited Partner Therapy (EPT)

  • EPT is the clinical practice of treating the sex partners of patients diagnosed with an STI without the partner first being examined.
  • This is a key public health strategy to reduce reinfection and curb the spread of STIs like chlamydia and gonorrhea.
  • This is legal in most states.
  • It typically involves the provider giving the patient a prescription or medications to give to their partner.
  • A CPHP should be an advocate for and an expert on the local laws and procedures for EPT.

HIV Pre-Exposure Prophylaxis (PrEP)

  • PrEP is the use of antiretroviral drugs by HIV-negative individuals to prevent HIV infection.
  • It is a highly effective prevention tool for individuals at high risk.
  • The most common regimen is a once-daily oral pill containing tenofovir and emtricitabine.
  • A long-acting injectable formulation is also now available.
  • A CPHP is a key provider of PrEP services, from identifying candidates to managing the therapy.

HIV Post-Exposure Prophylaxis (PEP)

  • PEP is the use of antiretroviral drugs after a single high-risk event to prevent HIV infection.
  • It must be started as soon as possible after the exposure, and always within 72 hours.
  • It involves taking a 28-day course of antiretroviral medications.
  • A CPHP should be an expert on the guidelines for both occupational and non-occupational PEP.

CDC Treatment Guidelines

  • The CDC publishes comprehensive, evidence-based guidelines for the treatment of STIs.
  • These guidelines are the standard of care.
  • They are updated regularly to reflect new evidence and changing resistance patterns.
  • A CPHP must be an expert on the latest version of these guidelines.
  • They are the primary resource for all aspects of STI management.

The Role of the Epidemiologist

  • An outbreak investigation is the core work of a field epidemiologist, or "disease detective."
  • The investigation is a systematic process to confirm that an outbreak is occurring, identify the cause, and implement control measures.
  • A CPHP may be a key member of the outbreak investigation team, especially if it involves a foodborne or waterborne illness where medications may be needed.

Steps of an Outbreak Investigation

  • There is a standard, multi-step process for an investigation.
  • 1. Prepare for fieldwork.
  • 2. Establish the existence of an outbreak.
  • 3. Verify the diagnosis.
  • 4. Construct a case definition.
  • 5. Find cases systematically and record information.
  • 6. Perform descriptive epidemiology (person, place, time).
  • 7. Develop hypotheses.
  • 8. Evaluate hypotheses epidemiologically.
  • 9. Implement control and prevention measures.
  • 10. Communicate findings.

Descriptive Epidemiology (Person, Place, Time)

  • This is the process of characterizing the outbreak.
  • Person: Who is getting sick? (Age, sex, etc.)
  • Place: Where are they getting sick? (Geographic location)
  • Time: When are they getting sick? (The "epi curve").
  • An epidemic curve, or epi curve, is a graph that plots the number of cases over time. The shape of the curve can provide clues about the type of outbreak.
  • A CPHP should be able to interpret an epi curve.

The Pharmacist's Role in an Outbreak

  • Pharmacists can be an early warning system for an outbreak.
  • An unusual increase in the dispensing of certain medications (e.g., anti-diarrheals) can be the first sign of a community outbreak. This is known as syndromic surveillance.
  • The pharmacist is also a key player in the response.
  • This includes ensuring an adequate supply of the necessary medications (e.g., antibiotics for a bacterial outbreak).
  • They also serve as a key source of information for the public.

Point-of-Dispensing (POD) Sites

  • In a large-scale outbreak or a bioterrorism event, a key response strategy is to set up Points of Dispensing (PODs).
  • These are temporary sites, often in community locations like schools, where medications or vaccines can be dispensed to a large number of people quickly.
  • Pharmacists are the clinical leaders of these PODs.
  • A CPHP is often involved in the public health planning and drills for these POD operations.

The Threat of Antimicrobial Resistance

  • Antimicrobial resistance is one of the biggest public health challenges of our time.
  • Bacteria and other microbes are evolving to become resistant to the drugs we use to treat them.
  • This can make common infections difficult or impossible to treat.
  • The primary driver of resistance is the overuse and misuse of antibiotics.
  • A CPHP must be a leader in the fight against antimicrobial resistance.

Core Elements of Antimicrobial Stewardship Programs (ASPs)

  • The CDC has outlined Core Elements for both hospital and outpatient ASPs.
  • Key elements include leadership commitment, accountability, drug expertise (pharmacist leadership), and action.
  • Other elements are tracking and reporting of antibiotic use and resistance patterns.
  • Education of clinicians and patients is also a critical component.
  • A CPHP can help to design and implement these programs in various practice settings.

Key Stewardship Interventions

  • Prospective Audit and Feedback: A pharmacist prospectively reviews antibiotic orders and provides real-time recommendations to the prescriber.
  • Formulary Restriction: Certain broad-spectrum antibiotics require pre-approval from the stewardship team.
  • Education: Providing education to prescribers on appropriate antibiotic use.
  • Development of Clinical Guidelines: Creating local, evidence-based guidelines for the treatment of common infections.
  • A CPHP can be involved in all of these interventions.

The Role of the Antibiogram

  • An antibiogram is an annual summary of the susceptibility patterns of local bacterial isolates.
  • It is a critical tool for guiding empiric antibiotic selection.
  • It helps clinicians to choose an antibiotic that is likely to be effective against the local pathogens.
  • The CPHP is involved in the creation and dissemination of the antibiogram.
  • They can also use it to track changes in resistance patterns over time.

The "One Health" Approach

  • "One Health" is a collaborative, multisectoral approach to health that recognizes the interconnection between people, animals, plants, and their shared environment.
  • In the context of antimicrobial resistance, this is a critical concept.
  • A large percentage of all antibiotics are used in agriculture.
  • This use contributes to the development of resistant bacteria that can then spread to humans.
  • A comprehensive public health approach to stewardship must address antibiotic use in both humans and animals.
  • A CPHP should be an advocate for this "One Health" perspective.

The Pharmacist's Role in Disasters

  • Pharmacists are critical members of the emergency response team.
  • They are medication experts who are essential for managing the pharmaceutical supply chain during a disaster.
  • They also serve as a key source of information for the public.
  • A CPHP is often a leader in the public health planning for emergencies.

The Emergency Operations Plan (EOP)

  • Every public health agency and healthcare organization must have a formal EOP.
  • This plan details how the organization will respond to a wide range of potential disasters.
  • The CPHP is a key author of the pharmacy-specific annex of this plan.
  • The plan must be practiced through regular drills and exercises.
  • This is part of the "Assurance" core function of public health.

The Strategic National Stockpile (SNS)

  • The SNS is the nation's largest supply of life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.
  • The SNS is a federal asset, but it is distributed and dispensed at the state and local level.
  • A CPHP is a key leader in the local planning for how to receive, secure, and dispense these SNS assets.

Points of Dispensing (PODs)

  • In a large-scale emergency, a key strategy is to set up Points of Dispensing (PODs).
  • These are temporary sites, often in community locations like schools, where medications or vaccines can be dispensed to a large number of people quickly.
  • Pharmacists are the clinical leaders of these PODs.
  • A CPHP is often involved in the public health planning and drills for these POD operations.
  • They are experts on the operational logistics of a mass dispensing campaign.

The Incident Command System (ICS)

  • The ICS is a standardized management system designed to enable effective and efficient incident management.
  • It is used by all levels of government to manage emergencies.
  • A CPHP should be trained in the basic principles of ICS.
  • This allows them to effectively integrate into the broader emergency response structure.
  • In the ICS structure, the pharmacy would typically fall under the Logistics Section.

Block 5: Chronic Disease & Substance Use

The Burden of CVD

  • CVD is the leading cause of death in the United States.
  • It is a major driver of healthcare costs.
  • Many of the major risk factors for CVD are modifiable.
  • Therefore, prevention is the cornerstone of a public health approach to CVD.
  • A CPHP is a key player in community-based CVD prevention programs.

The Million Hearts® Initiative

  • Million Hearts® is a national initiative, co-led by the CDC and CMS, with the goal of preventing one million heart attacks and strokes.
  • It focuses on a small set of evidence-based priorities, the "ABCS":
  • Aspirin use when appropriate.
  • Blood pressure control.
  • Cholesterol management.
  • Smoking cessation.
  • Pharmacists are recognized as key partners in this initiative.

Blood Pressure Control

  • Hypertension is a major risk factor for heart attack, stroke, and kidney disease.
  • Unfortunately, only about half of all people with hypertension have their blood pressure under control.
  • A key public health strategy is to improve blood pressure control rates.
  • Pharmacist-led interventions, including medication management and patient education, have been shown to be highly effective.
  • A CPHP can design and evaluate these types of programs.

Cholesterol Management

  • High LDL cholesterol is another major risk factor.
  • Statin therapy is a highly effective primary and secondary prevention strategy.
  • However, many high-risk patients who would benefit from a statin are not on one.
  • A key public health role for the pharmacist is to identify these gaps in care and to work with providers to get patients on appropriate therapy.
  • Improving adherence to statins is also a major focus.

Team-Based Care

  • The most effective approach to CVD prevention is a team-based care model.
  • This involves physicians, pharmacists, nurses, and other professionals working together.
  • The pharmacist is the medication expert on this team.
  • They can work under collaborative practice agreements to manage medication therapy for hypertension and dyslipidemia.
  • This model has been shown to be more effective than usual care.
  • A CPHP is an advocate for policies that support this model of care.

The Diabetes Epidemic

  • Type 2 diabetes is a major public health epidemic in the U.S. and around the world.
  • It is a leading cause of kidney failure, blindness, and amputations.
  • It is also a major risk factor for cardiovascular disease.
  • A large percentage of the population has prediabetes and is at high risk of developing the full disease.
  • A public health approach is essential for tackling this epidemic.

The National Diabetes Prevention Program (DPP)

  • The DPP is a national, evidence-based lifestyle change program for people with prediabetes.
  • It is based on the landmark DPP clinical trial, which showed that an intensive lifestyle intervention was more effective than metformin at preventing the progression to diabetes.
  • The program is a year-long, structured curriculum that focuses on healthy eating, physical activity, and behavior change.
  • Some pharmacies are now offering the National DPP to their patients.
  • A CPHP may be involved in the implementation of this program.

Diabetes Self-Management Education and Support (DSMES)

  • DSMES is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care.
  • It is a critical component of high-quality diabetes care.
  • Pharmacists are in a key position to provide DSMES.
  • Many pharmacies have accredited DSMES programs.
  • A CPHP may be a certified diabetes care and education specialist (CDCES) who leads one of these programs.

The Public Health Impact of Newer Agents

  • The newer classes of diabetes medications (GLP-1 agonists and SGLT2 inhibitors) have been shown to have significant cardiovascular and renal benefits.
  • This has transformed the diabetes treatment paradigm.
  • From a public health perspective, ensuring that high-risk patients have access to these evidence-based therapies is a key goal.
  • However, their high cost is a major barrier.
  • A CPHP would be involved in analyzing the population-level cost-effectiveness of these agents.

Adherence and Glycemic Control

  • From a population health perspective, two key metrics for diabetes care are medication adherence and glycemic control (A1c).
  • A CPHP is the data analyst who tracks these metrics for a health plan or health system.
  • They analyze the data to identify populations with poor control or low adherence.
  • This data is then used to target pharmacist-led interventions, such as MTM or case management.

The Pharmacist's Role in Prevention

  • Pharmacists can play a key role in primary and secondary cancer prevention.
  • Primary Prevention: Counseling on lifestyle factors that reduce cancer risk (e.g., smoking cessation, sun safety) and providing the HPV vaccine.
  • Secondary Prevention: Encouraging and providing access to recommended cancer screenings.
  • A CPHP can lead the development of these prevention programs in the pharmacy setting.

HPV Vaccination

  • The HPV vaccine is a cancer prevention vaccine.
  • It prevents the infections that cause the vast majority of cervical cancers, as well as many other types of cancer.
  • Vaccination rates in the U.S. are still below the national public health goals.
  • Pharmacists are a key partner in the effort to improve these rates.
  • A CPHP is an advocate for policies that expand the pharmacist's ability to administer this life-saving vaccine.

Tobacco Cessation

  • Smoking is the leading preventable cause of cancer.
  • Pharmacists are highly effective at providing tobacco cessation counseling and pharmacotherapy.
  • A CPHP may be involved in designing and implementing a large-scale, pharmacy-based tobacco cessation program for a community or health plan.

Cancer Screening Recommendations

  • A CPHP must be an expert on the USPSTF recommendations for cancer screening.
  • Breast Cancer: Mammography.
  • Cervical Cancer: Pap test and/or HPV test.
  • Colorectal Cancer: Colonoscopy or stool-based tests.
  • Lung Cancer: Low-dose CT for high-risk smokers.
  • The pharmacist's role is to educate patients about these screenings and provide referrals.

Chemoprevention

  • Chemoprevention is the use of medications to reduce the risk of cancer.
  • Breast Cancer: For high-risk women, medications like tamoxifen or raloxifene can reduce the risk.
  • Colorectal Cancer: Low-dose aspirin may reduce the risk in certain individuals.
  • A CPHP should be familiar with the evidence for these interventions and the concept of shared decision-making for their use.

The Public Health Burden of Tobacco

  • Tobacco use is the leading cause of preventable disease, disability, and death in the United States.
  • It is a major driver of cancer, cardiovascular disease, and chronic respiratory disease.
  • A comprehensive public health approach is needed to combat the tobacco epidemic.
  • Pharmacists are a key part of this approach.

The 5 A's Model for Counseling

  • The 5 A's is an evidence-based framework for brief tobacco cessation counseling.
  • Ask: Ask every patient about their tobacco use status.
  • Advise: Advise every tobacco user to quit in a clear and personalized manner.
  • Assess: Assess the patient's willingness to make a quit attempt.
  • Assist: For patients willing to quit, provide counseling and pharmacotherapy.
  • Arrange: Arrange for follow-up contact.
  • A CPHP can train other pharmacists on how to effectively use this model.

Nicotine Replacement Therapy (NRT)

  • NRT is a first-line pharmacotherapy for cessation.
  • It works by reducing the withdrawal symptoms associated with quitting.
  • It is available in many OTC and prescription forms (patch, gum, lozenge, inhaler, nasal spray).
  • Combination therapy (e.g., the patch plus the gum) is more effective than monotherapy.
  • A CPHP is an expert on the proper use of all forms of NRT.

Non-Nicotine Pharmacotherapy

  • There are two main non-nicotine prescription medications.
  • Bupropion SR: An antidepressant that also reduces cravings and withdrawal symptoms.
  • Varenicline: A partial nicotinic receptor agonist that both reduces cravings and makes smoking less pleasurable. It is the most effective single agent.
  • A CPHP must be an expert on the use, side effects, and contraindications of these medications.

Population-Level Policies

  • In addition to individual counseling, a CPHP is also an advocate for population-level tobacco control policies.
  • These are the most effective interventions for reducing smoking rates.
  • Examples include significant increases in tobacco taxes.
  • Comprehensive smoke-free air laws.
  • Well-funded media campaigns.
  • Providing comprehensive insurance coverage for cessation treatments.

The Opioid Crisis as a Public Health Emergency

  • The opioid crisis is one of the most pressing public health emergencies of our time.
  • It is driven by a complex interplay of factors, including the over-prescribing of prescription opioids and the rise of illicit fentanyl.
  • A comprehensive public health approach is needed, focusing on prevention, treatment, and harm reduction.
  • Pharmacists are on the front lines of this crisis.

The Role of PDMPs

  • Prescription Drug Monitoring Programs (PDMPs) are state-level databases that track the dispensing of controlled substances.
  • They are a key tool for preventing the diversion and misuse of prescription opioids.
  • Pharmacists must check the PDMP before dispensing an opioid to identify any red flags, such as a patient receiving opioids from multiple prescribers.
  • A CPHP is an advocate for policies that make PDMPs more user-friendly and allow for interstate data sharing.

Medications for Opioid Use Disorder (MOUD)

  • MOUD is the evidence-based standard of care for treating opioid use disorder.
  • Methadone: A long-acting opioid agonist. Can only be dispensed by a federally-regulated Opioid Treatment Program (OTP).
  • Buprenorphine: A partial opioid agonist. Can be prescribed by any provider with a waiver and dispensed by a community pharmacy.
  • Naltrexone: An opioid antagonist, available as a long-acting injection.
  • A CPHP works to expand access to these life-saving medications.

Harm Reduction

  • Harm reduction is a pragmatic public health approach that aims to reduce the negative consequences of substance use.
  • It is a key part of a comprehensive strategy.
  • Key harm reduction services include:
  • Naloxone Access: Dispensing the opioid overdose reversal drug, often under a statewide standing order.
  • Syringe Service Programs (SSPs): Providing sterile syringes to people who inject drugs to prevent the spread of HIV and Hepatitis C.
  • A CPHP is a strong advocate for removing barriers to these services.

Stigma and Patient-Centered Care

  • Substance use disorder is a chronic medical condition, not a moral failing.
  • Stigma is a major barrier that prevents people from seeking care.
  • A CPHP must be a champion for providing non-judgmental, compassionate, and patient-centered care to people who use drugs.
  • This includes using person-first language (e.g., "a person with a substance use disorder" instead of "an addict").
  • This cultural shift is a key part of addressing the overdose crisis.

Block 6: Advanced Topics & Final Review

Principles of Environmental Health

  • Environmental health is the branch of public health concerned with all aspects of the natural and built environment that may affect human health.
  • It focuses on preventing disease and creating health-supportive environments.
  • Pharmacists have a role in addressing environmental exposures that impact health.
  • This includes issues like air and water quality, hazardous waste, and exposure to toxic substances.
  • A CPHP should understand these fundamental principles.

Pharmacists and Environmental Exposures

  • Pharmacists can be a key resource for patients with concerns about environmental exposures.
  • This can include counseling on how to reduce exposure to lead in the home.
  • It can also involve providing information on the health effects of air pollution, especially for patients with asthma or COPD.
  • They can also be a source of information during a chemical spill or other environmental emergency.

Pharmaceuticals in the Environment

  • A major environmental health issue is the presence of pharmaceuticals in the water supply.
  • This is primarily due to the excretion of drugs by humans and the improper disposal of unused medications.
  • While the levels are very low, there are concerns about the long-term ecological effects.
  • A CPHP is a key advocate for and organizer of drug take-back programs.
  • These programs are the best way to prevent the improper disposal of medications.

Principles of Toxicology

  • Toxicology is the study of the adverse effects of chemical, physical, or biological agents on living organisms.
  • A key principle is "the dose makes the poison."
  • Pharmacists, with their deep knowledge of pharmacology, have a strong foundation in toxicology.
  • A CPHP can apply these principles to environmental toxicology.
  • They can be a key resource for the local health department or poison control center during an exposure event.

Climate Change and Health

  • Climate change is a major public health threat.
  • It can impact health through a variety of pathways.
  • This includes more frequent and severe heat waves, worsening air quality, and changes in the patterns of infectious diseases.
  • Pharmacists have a role in helping patients to prepare for and adapt to these health threats.
  • For example, they can counsel patients with respiratory disease on how to manage their condition during a wildfire smoke event.
  • A CPHP should be an advocate for policies that address the health impacts of climate change.

The Importance of MCH

  • The health of mothers and children is a key indicator of the health of a nation.
  • Public health programs focused on MCH aim to improve the health and well-being of women, infants, children, and families.
  • This is a core focus of public health practice.
  • A CPHP can play a significant role in MCH programs.

Preconception and Prenatal Care

  • A key public health strategy is to ensure all women have access to preconception and prenatal care.
  • The pharmacist's role in this includes counseling on the importance of folic acid supplementation to prevent neural tube defects.
  • It also includes conducting a preconception medication review to ensure that a woman is on the safest possible medications before she becomes pregnant.
  • This is a critical primary prevention activity.

Medication Safety in Pregnancy and Lactation

  • A CPHP is an expert on the resources used to determine the safety of medications in pregnancy and lactation.
  • They can be a key resource for both patients and providers on this topic.
  • They can also be involved in public health surveillance programs that monitor for the potential teratogenic effects of new drugs.

Childhood Immunizations

  • Childhood immunization is one of the greatest public health achievements in history.
  • Pharmacists are playing an increasingly important role in administering these vaccines.
  • A CPHP is an advocate for policies that expand the pharmacist's scope of practice to include the full range of childhood immunizations.
  • They are also a key voice in combating vaccine misinformation and hesitancy.

WIC and Other Nutrition Programs

  • The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a key public health program.
  • It provides nutritious foods, nutrition education, and healthcare referrals to low-income pregnant women and young children.
  • A CPHP should be familiar with this and other key MCH programs in their community.
  • They can provide referrals to these programs for their patients.

Defining Global Health

  • Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.
  • It emphasizes transnational health issues, determinants, and solutions.
  • In our interconnected world, a health threat anywhere can become a health threat everywhere.
  • A CPHP should have a basic understanding of the key principles and players in global health.

The World Health Organization (WHO)

  • The WHO is the directing and coordinating authority for health within the United Nations system.
  • They are responsible for providing leadership on global health matters.
  • They shape the health research agenda and set norms and standards.
  • They also provide technical support to countries and monitor and assess health trends.
  • The WHO's Model List of Essential Medicines is a key global health document.

Major Global Health Issues

  • The burden of disease varies significantly between high-income and low-income countries.
  • Key issues in global health include infectious diseases like HIV, malaria, and tuberculosis.
  • Maternal and child mortality are also major challenges in many parts of the world.
  • There is also a growing "double burden" of disease, as low- and middle-income countries are now facing a rise in chronic, non-communicable diseases as well.

The Pharmacist's Role in Global Health

  • Pharmacists play a key role in addressing global health challenges.
  • This includes managing the complex supply chains for essential medicines in resource-limited settings.
  • It also involves providing direct patient care and medication management for both infectious and chronic diseases.
  • Pharmacists are key leaders in building pharmacy capacity and training the pharmacy workforce in other countries.
  • A CPHP may be involved in global health work through NGOs or academic institutions.

Travel Medicine

  • Travel medicine is a key area where a CPHP can have a direct impact on global health.
  • This involves providing pre-travel consultations to international travelers.
  • Key services include providing all recommended and required immunizations.
  • It also involves prescribing prophylactic medications, such as for malaria.
  • Counseling on food and water safety and other travel-related health risks is also essential.
  • Many pharmacies now offer specialized travel health clinics.

Defining Public Health Informatics

  • Public health informatics is the systematic application of information, computer science, and technology to public health practice, research, and learning.
  • It is about using data to improve the health of populations.
  • A CPHP is a type of public health informatician who specializes in pharmacy data.

Key Data Sources

  • Public health informatics uses data from a wide variety of sources.
  • This includes clinical data from EHRs, administrative data from insurance claims, and surveillance data from public health departments.
  • Pharmacy data, especially from PDMPs, is a key source.
  • New sources of data, such as from social media and wearable devices, are also being explored.

Geographic Information Systems (GIS)

  • GIS is a powerful tool used in public health informatics.
  • It is a system for capturing, storing, analyzing, and displaying data related to positions on the Earth's surface.
  • It allows for the creation of maps that can visualize health data geographically.
  • For example, a CPHP could use GIS to map the locations of opioid overdoses in a community.
  • This can help to identify "hot spots" and to target interventions more effectively.

Health Information Exchanges (HIEs)

  • An HIE is a system that allows healthcare providers and patients to appropriately access and securely share a patient's medical information electronically.
  • They are a key piece of infrastructure for population health management.
  • They allow for a more complete, longitudinal view of a patient's care across different health systems.
  • A CPHP should be an advocate for the integration of pharmacy data into HIEs.

The Role of the CPHPA

  • The Certified Population Health Pharmacy Analyst is the person with the skills to do this work.
  • They are the ones who can manage and analyze these large, complex datasets.
  • They are the ones who can turn the raw data into the actionable intelligence that is needed to drive public health improvement.
  • This is a highly specialized and in-demand skill set at the intersection of pharmacy, public health, and data science.

Behavioral Risk Factor Surveillance System (BRFSS)

  • The nation’s premier system of health-related telephone surveys that collect state-level data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services.
  • A key data source for a CHNA and for tracking population health trends.

Youth Risk Behavior Survey (YRBS)

  • A CDC-led national survey that monitors health behaviors that contribute to the leading causes of death and disability among youth and young adults.
  • Provides key data on issues like substance use, sexual behaviors, and mental health in adolescents.
  • A CPHP would use this data to inform prevention programs for young people.

Health-Related Quality of Life (HRQOL) Scales

  • Standardized, validated questionnaires used to measure a person's perception of their own health.
  • A common example is the SF-36 or SF-12.
  • These tools are used in program evaluation to measure the impact of an intervention on a patient's quality of life.
  • This is a key patient-centered outcome.

Health Literacy Assessment Tools

  • Tools used to assess an individual's health literacy.
  • REALM (Rapid Estimate of Adult Literacy in Medicine): A word recognition test.
  • TOFHLA (Test of Functional Health Literacy in Adults): A reading comprehension test.
  • Newest Vital Sign: A quick test that uses a nutrition label.
  • These tools are used in research and can be adapted for clinical screening.

Community Health Needs Assessment (CHNA) Tools

  • There are a variety of frameworks and toolkits available to guide the CHNA process.
  • The CDC and the Catholic Health Association are key sources for these tools.
  • They provide guidance on how to collect and analyze data, and how to engage the community.
  • A CPHP participating in a CHNA would use these standardized tools.

Prevalence

  • A fundamental measure of disease frequency. It represents the proportion of a population that has a disease at a specific point in time.

\( \text{Prevalence} = \frac{\text{Number of Existing Cases}}{\text{Total Population}} \)

Incidence Rate

  • Another fundamental measure of disease frequency. It measures the rate at which new cases of a disease develop in a population over a period of time. It is a measure of risk.

\( \text{Incidence Rate} = \frac{\text{Number of New Cases}}{\text{Person-Time at Risk}} \)

Relative Risk (RR)

  • A key measure of association from a cohort study. It compares the incidence of disease in an exposed group to the incidence in an unexposed group.

\( \text{RR} = \frac{\text{Incidence in the Exposed}}{\text{Incidence in the Unexposed}} \)

Odds Ratio (OR)

  • A key measure of association from a case-control study. It compares the odds of exposure in the cases to the odds of exposure in the controls. For rare diseases, the OR approximates the RR.

\( \text{OR} = \frac{\text{Odds of Exposure in Cases}}{\text{Odds of Exposure in Controls}} = \frac{ad}{bc} \)

Sensitivity and Specificity

  • These are measures of the validity of a screening test. Sensitivity is the ability of a test to correctly identify those with the disease. Specificity is the ability to correctly identify those without the disease.

\( \text{Sensitivity} = \frac{\text{True Positives}}{\text{All Diseased}} \) ; \( \text{Specificity} = \frac{\text{True Negatives}}{\text{All Non-Diseased}} \)

The Importance of MCH

  • The health of mothers and children is a key indicator of the health of a nation.
  • Public health programs focused on MCH aim to improve the health and well-being of women, infants, children, and families.
  • This is a core focus of public health practice.
  • A CPHP can play a significant role in MCH programs.

Preconception and Prenatal Care

  • A key public health strategy is to ensure all women have access to preconception and prenatal care.
  • The pharmacist's role in this includes counseling on the importance of folic acid supplementation to prevent neural tube defects.
  • It also includes conducting a preconception medication review to ensure that a woman is on the safest possible medications before she becomes pregnant.
  • This is a critical primary prevention activity.

Medication Safety in Pregnancy and Lactation

  • A CPHP is an expert on the resources used to determine the safety of medications in pregnancy and lactation.
  • They can be a key resource for both patients and providers on this topic.
  • They can also be involved in public health surveillance programs that monitor for the potential teratogenic effects of new drugs.

Childhood Immunizations

  • Childhood immunization is one of the greatest public health achievements in history.
  • Pharmacists are playing an increasingly important role in administering these vaccines.
  • A CPHP is an advocate for policies that expand the pharmacist's scope of practice to include the full range of childhood immunizations.
  • They are also a key voice in combating vaccine misinformation and hesitancy.

WIC and Other Nutrition Programs

  • The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a key public health program.
  • It provides nutritious foods, nutrition education, and healthcare referrals to low-income pregnant women and young children.
  • A CPHP should be familiar with this and other key MCH programs in their community.
  • They can provide referrals to these programs for their patients.

Defining Global Health

  • Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.
  • It emphasizes transnational health issues, determinants, and solutions.
  • In our interconnected world, a health threat anywhere can become a health threat everywhere.
  • A CPHP should have a basic understanding of the key principles and players in global health.

The World Health Organization (WHO)

  • The WHO is the directing and coordinating authority for health within the United Nations system.
  • They are responsible for providing leadership on global health matters.
  • They shape the health research agenda and set norms and standards.
  • They also provide technical support to countries and monitor and assess health trends.
  • The WHO's Model List of Essential Medicines is a key global health document.

Major Global Health Issues

  • The burden of disease varies significantly between high-income and low-income countries.
  • Key issues in global health include infectious diseases like HIV, malaria, and tuberculosis.
  • Maternal and child mortality are also major challenges in many parts of the world.
  • There is also a growing "double burden" of disease, as low- and middle-income countries are now facing a rise in chronic, non-communicable diseases as well.

The Pharmacist's Role in Global Health

  • Pharmacists play a key role in addressing global health challenges.
  • This includes managing the complex supply chains for essential medicines in resource-limited settings.
  • It also involves providing direct patient care and medication management for both infectious and chronic diseases.
  • Pharmacists are key leaders in building pharmacy capacity and training the pharmacy workforce in other countries.
  • A CPHP may be involved in global health work through NGOs or academic institutions.

Travel Medicine

  • Travel medicine is a key area where a CPHP can have a direct impact on global health.
  • This involves providing pre-travel consultations to international travelers.
  • Key services include providing all recommended and required immunizations.
  • It also involves prescribing prophylactic medications, such as for malaria.
  • Counseling on food and water safety and other travel-related health risks is also essential.
  • Many pharmacies now offer specialized travel health clinics.

Defining Public Health Informatics

  • Public health informatics is the systematic application of information, computer science, and technology to public health practice, research, and learning.
  • It is about using data to improve the health of populations.
  • A CPHP is a type of public health informatician who specializes in pharmacy data.

Key Data Sources

  • Public health informatics uses data from a wide variety of sources.
  • This includes clinical data from EHRs, administrative data from insurance claims, and surveillance data from public health departments.
  • Pharmacy data, especially from PDMPs, is a key source.
  • New sources of data, such as from social media and wearable devices, are also being explored.

Geographic Information Systems (GIS)

  • GIS is a powerful tool used in public health informatics.
  • It is a system for capturing, storing, analyzing, and displaying data related to positions on the Earth's surface.
  • It allows for the creation of maps that can visualize health data geographically.
  • For example, a CPHP could use GIS to map the locations of opioid overdoses in a community.
  • This can help to identify "hot spots" and to target interventions more effectively.

Health Information Exchanges (HIEs)

  • An HIE is a system that allows healthcare providers and patients to appropriately access and securely share a patient's medical information electronically.
  • They are a key piece of infrastructure for population health management.
  • They allow for a more complete, longitudinal view of a patient's care across different health systems.
  • A CPHP should be an advocate for the integration of pharmacy data into HIEs.

The Role of the CPHPA

  • The Certified Population Health Pharmacy Analyst is the person with the skills to do this work.
  • They are the ones who can manage and analyze these large, complex datasets.
  • They are the ones who can turn the raw data into the actionable intelligence that is needed to drive public health improvement.
  • This is a highly specialized and in-demand skill set at the intersection of pharmacy, public health, and data science.

Prevention is the Primary Goal

  • The core focus of public health is to prevent disease before it happens.
  • This requires an "upstream" approach that addresses the root causes of poor health.
  • While treatment is important, a public health perspective always prioritizes primary prevention.
  • A CPHP is a leader in preventive health, from immunizations to smoking cessation.

Focus on Populations, Not Just Individuals

  • While all healthcare is delivered to individuals, public health thinks in terms of populations.
  • The goal is to improve the health of the entire community, not just the patients who walk through the door.
  • This requires a different set of skills, including epidemiology and data analysis.
  • A CPHP must be able to move between the individual patient level and the broader population health level.

Health Equity is a Core Value

  • Public health has a fundamental commitment to social justice.
  • A core goal is to eliminate health disparities and achieve health equity.
  • This requires a focus on the Social Determinants of Health and the needs of the most vulnerable populations.
  • A CPHP must be a champion for health equity in all of their work.

Evidence is the Foundation

  • Public health is a scientific discipline.
  • All programs and policies must be based on the best available scientific evidence.
  • This requires a rigorous, data-driven approach to practice.
  • A CPHP is an expert in finding, appraising, and applying this evidence.
  • This commitment to science is what makes public health effective.

Collaboration is Essential

  • Public health is a team sport.
  • The complex problems we face cannot be solved by any one person or profession alone.
  • Success requires collaboration between a wide range of partners, including government agencies, healthcare providers, and community organizations.
  • A CPHP must be a skilled collaborator and relationship-builder.
  • They are a key bridge between the world of pharmacy and the broader public health community.
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