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“Without a measureless and perpetual uncertainty, the drama of human life would be destroyed.”
– Winston Churchill

It wasn’t long ago, back in the pandemic, when pharmacies were heroes. And, boy, were they:  315 million Covid vaccinations given during the main Federal effort (FRPP), nearly half of all the U.S. Covid vaxxing… all while keeping up their usual pharmacy duties.  Definitely heroic.

And yet, back from the battle, what’s happened to those heroes? Rite-Aid filed for bankruptcy. Walgreen’s announced mass store closures. And John Beckner of the National Community Pharmacists Association (NCPA) told us last year that among independent pharmacies there’s an average of one closure per day. Some way to treat a hero.

Photo by Nathan Dumlao

Meanwhile, other heroes of the pandemic aren’t having it much better: I’m thinking here of the folks of public health. And they, too, are, facing a fresh set of uncertainties.

So, here’s our question: Could pharmacies and public health come together again in a way that makes both stronger? We asked Jason Briscoe that question and he not only gave us an emphatic YES, but added, “Why wait for the next pandemic?”

Jason is a pharmacist who headed operations for a regional drug chain before joining STChealth as Vice President, working to bring technology efficiencies to healthcare. We visited with him to ask about the future of pharmacies and of public health. He began with an interested distinction:

“Let’s begin with defining ‘public health.’ There’s Public Health, with a capital P and capital H that would be the system of government agencies and organizations, while lowercase public health is the objective of community health and well-being that includes the private sector. Those in Public Health agencies and organizations measure outcomes and sometimes they also deploy their own tactics in delivering health care at the local level, but that’s also what the private sector does.  Healthcare is personal and local, taking place between a trusted healthcare provider and an individual person or a patient, so leveraging the trusted relationships of those health care providers in concert with Public Health is the opportunity.”

Jason Briscoe

An opportunity to do what, specifically?

“During Covid, when the lights were bright and the stakes were high, pharmacies executed.  So, do we need to wait for the next pandemic?  Right now, there are problems to solve for patients, whether it’s chronic disease – obesity, diabetes, smoking cessation, you name it — there are problems to solve and patients who need help in getting them solved. That’s where the light bulb continues to stay lit.”

That makes sense, but let’s dig deeper into that first dot you’re connecting, the one about pharmacies needing more opportunities. We started by talking about all the pharmacy closures, so perhaps Public Health should be nervous about partnering with a struggling industry.  What’s your take on what’s gone wrong?

There’s the matter of payment reform, and there are plenty of people talking about that. But what else is needed is striking the right balance of the proportion of total revenue that comes from clinical services in relation to dispensing prescriptions. I’m not advocating for community pharmacy to be decoupled from the dispensing function — that’s something that’s really important because in many ways it’s what creates the opportunity for patients all across this country to have direct, face to face, frequent access to highly trained, highly skilled, trusted health care providers in community pharmacists. Oftentimes the dispensing function in a pharmacy is unheralded because a mail order pharmacy or an Amazon pharmacy can put pills in a bottle and ship them to your house – potentially even in a drone. But I don’t want to see the dispensing function ripped out of the community pharmacy because there is value in your pharmacist who you deal with knowing the full view of you as a patient and much, much more than a name and a prescription number.

“At the same time, community pharmacies cannot only hang their hat on putting pills in a bottle; they must continue to find ways to diversify revenue streams, not only for profitable growth but for maintaining relevancy. Why do I not want to get my prescriptions delivered to my front door by a drone? It’s because the relationships that I create with my pharmacist and that team, and the fact that I could go there for an immunization or a point of care test or diabetes education or whatever else it may be.  Again – healthcare is local; healthcare is personal.

“In sum, it’s that that shift of diversifying relevancy and diversifying revenue streams. And that’s where I see the big opportunity to partner with Public Health.”

But you have a problem: pharmacies are cutting costs by cutting back on the hours they are open and by cutting staff. How are they going to be doing education if there’s a line of people waiting for their prescriptions?

“OK, here’s where the technology comes in. You’re a pharmacist and I know you only have so many hours in the day and my goal is to do 20 clinical activities a day or, for sake of an example, let’s just say it’s 20 immunizations a day.  Where do you start? It’s not by having a conversation with every patient that comes in, only to have some say, ‘you gave me my shingles shot last week, you knucklehead.’ No, you use the information that’s in their system, plus what’s in the in the registry, to create programs that would say, ‘all right today I’m going to talk to 20 patients about a the importance of being protected against shingles and I can have confidence that I’m not going to have my staff take wasted steps because this forecast put at my fingertips at the right time for the right patients to have those conversations.’ This creates clinical efficiency to focus in on the conversations I should be having.

“Now, will those 20 conversations lead to 20 immunizations? Maybe or maybe not. But, you then you have the ability to say if Store One is executing 10 out of 20 times in the 20 conversations, and Store Two it’s 2 out of 20, you just identified an opportunity for improvement with Store 2. Nobody has the time to take wasted steps and nobody really has the time to do a research project prior to every encounter. But we can automate that, allowing you to see who you should talk to about clinical service XYZ and who needs to have a conversation about what vaccine. Thus, you’re creating time as you create public health opportunities.”

Okay, that’s the pharmacy piece. Now how would you sum up your thinking on pharmacies and Public Health working together?

“One, if pharmacies are in need of more opportunities; and, two, they proven the ability to deliver on the things Public Health cares about, then let’s connect those dots. And let’s do it in non-pandemic times to start covering more ground and doing right by patients. Whether it’s immunizations or clinical services, that’s the intersection — community pharmacy can be an extension of, and a driver for Public Health (and public health) all day, every day. Let’s just connect the dots.”

Photo by Anton Darius

STATS OF THE MONTH

Public Health Stress Testing:

How resilient are your communities?

By Bill Davenhall, Geospatial Advocate

“Community resilience” is a popular phrase these days. The American Psychological Association says this about resilience:

“Resilience is like a muscle that can be strengthened over time. It involves a combination of internal qualities, such as optimism, self-awareness, and problem-solving skills, as well as external supports, such as strong relationships and access to resources.”

They add that “community resilience” is, “The capacity of individuals and households to absorb, endure, and recover from the health, social, and economic impacts of a disaster such as a hurricane or pandemic.”

These ideas are quantified by the U.S. Census Bureau as Community Resilience Estimates, which track how socially vulnerable every neighborhood in the United States is to the impacts of a disaster. The Community Resilience Estimates use American Community Survey microdata and Population Estimates Program data to measure the capacity of individuals and households to absorb the external stresses of the impacts of a disaster. The Census Bureau conducts these experimental surveys to study the impact of “natural disasters” on the resident population of every neighborhood across America. (You can read more about the Resilience experimental surveys here. )

The U.S. Census Bureau fielded a large experimental survey of households to learn more about such things.  Here are a few things we learned:

  • People living in about 458 counties would likely struggle with in encountering an unexpected /wide-area disaster event in their community.
  • States with the most people that would likely be considered seriously “vulnerable” include CA, TX, NY, FL, IL, AZ, NV, WA,MI, and PA.

Go here to learn of the estimated size of the populations in any county’s “social resilience.” At this site you will find data that can be searched by any neighborhood in the U.S. (Census data on each State, County, and Census Tract).

Why is this important to know? you ask:

Most unexpected events cause major disruptions to the flow of community activities and preparedness efforts that various agencies, volunteers, and public health entities would face in the wake of the “mad scramble” that usually takes place in providing immediate  assistance and support for a geographic population. A fast-spreading infectious disease in these “high” social vulnerability “risk geographies” can seriously diminish the ability of any community institution to respond. Knowing one of your geographies is more vulnerable will likely contribute to the ultimate capacity to bounce back or leverage the resilience that may already exist.

Below is a table of the counties with over a half million persons that would likely be seriously vulnerable in such a wide area disaster. Check on some areas you may be familiar with — you might be surprised.

Maya Angelou, an American poet laurate, is credited in saying, “Do the best you can until you know better. Then when you know better, do better.” Not a bad way to view and use this interesting experimental data from the Census Bureau’s American Community Survey to know where you might need to strengthen a community’s social resilience.