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NABP Resolutions and Actions Support HHS 'Healthy People' Project Goals
Every 10 years, the United States Department of Health and Human Services (HHS) establishes overarching health goals for the country’s population, reassessing the previous decade’s targets and reporting progress made. Called the Healthy People initiative, this blueprint of the nation’s health priorities is intended to “meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity,” as noted by the Centers for Disease Control and Prevention.
Both the Healthy People 2010 and 2020 projects include objectives related to the practice of pharmacy and specifically to patient safety. Over the past decade, NABP has worked to achieve many of the same objectives for patient safety and public health through the Association’s resolutions, task forces, continuing education programs, and information dissemination.
Healthy People shapes the public health debate by offering a blueprint that can help interested parties, such as state agencies, community organizations, professional organizations, and individuals, to develop programs to improve the public health, but it does not provide specific program funding. HHS is in the process of reviewing the most recent decade’s work – Healthy People 2010 – and finalizing the overarching goals and more specific objectives that will shape Healthy People 2020. Preliminary results for Healthy People 2010 indicate mixed success; while some goals (increased vaccination rates, for example) show progress, others (such as reduced obesity rates) have noticeably failed.
Healthy People 2010
Two main goals – increasing the years and quality of healthy life, and eliminating health disparities among different ethnic and racial groups – formed the backbone of Healthy People 2010. The endeavor was broken down into 28 focus areas (such as “Access to Quality Health Services,” “Cancer,” or “Family Planning”), which were further divided into specific objectives. The program specified 10 Leading Health Indicators – physical activity, weight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care – that would serve to measure the nation’s health.
A number of objectives are expected to be carried over from Healthy People 2010 to the 2020 project, though not all. Two objectives not included in the 2020 proposal – for reasons pertaining to data, target, or policy, according to the project’s Web site – have been significant areas of concern and action for NABP and the boards of pharmacy.
First, Healthy People 2010 aimed to increase the proportion of patients receiving information that meets guidelines for usefulness when their new prescriptions are dispensed. In 1996, NABP participated in a steering committee that developed the Action Plan for the Provision of Useful Prescription Medicine Information to meet the federally mandated goals of useful written consumer medication information (CMI) to be provided to every patient when obtaining a new prescription. Subsequently, NABP, through a contract with Food and Drug Administration (FDA), coordinated a pilot study to evaluate the usefulness of CMI, and findings were presented to stakeholders at a public meeting convened by FDA on March 1, 2000. NABP coordinated a follow up study on behalf of FDA in 2007. Results were improved, but still below the target goal. NABP will continue to follow the issue.
Second, Healthy People 2010 aimed to increase the proportion of patients who receive verbal counseling from prescribers and pharmacists on the appropriate use and potential risks of medications. Language in the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act) specifies pharmacist counseling with every prescription dispensed, and boards frequently remind pharmacist licensees about counseling requirements in official communications such as newsletters. At the NABP 105th Annual Meeting, the continuing education session “Patient Counseling – Catch the Wave” allowed participants to examine barriers to counseling and explore new models and techniques to encourage the practice, as well as to hear views on counseling expressed by members of the pharmacy-related regulatory, academic, and corporate sectors. In addition, the NABP community pharmacy accreditation program will emphasize patient care including appropriate counseling to reduce medication errors.
Healthy People 2020
Healthy People 2020 at press time was awaiting finalization following the initial development of a framework and objectives, and a public comment period that ran through the end of 2009. HHS has striven to make the process both inclusive and transparent, encouraging input and comments from stakeholders and the general public, just as it relies on the general public and interested entities to achieve its goals. The program is expected to launch during 2010.
Two proposed objectives included in Healthy People 2020 – increasing the safe and effective treatment of pain, and reducing the number of antibiotic courses prescribed for the common cold (the latter a carry-over from the 2010 project) – have been addressed by NABP communications efforts. For example, the February 2008 NABP Newsletter included an article on pain medication policies and the legitimate treatment of pain. And the article “Reducing Overuse of Prescription Medications to Minimize Drug Resistance, Abuse, and Diversion” was published in the November-December 2009 NABP Newsletter. The Association also educates its members and readers by covering this topic periodically in the bi-weekly NABP e-News.
Other proposed objectives coincide more directly with areas the Association has targeted frequently. Healthy People 2020 hopes to increase the proportion of health care organizations that are monitoring and analyzing adverse events associated with medical therapies within their systems. NABP has long advocated continuous quality improvement (CQI) programs, and includes CQI language in the Model Act. CQI has also been the subject of several continuing education programs at fall and annual meetings. The Association has also periodically disseminated information on state CQI programs and efforts to prevent medication errors through the NABP Newsletter.
Related to this objective, the Healthy People project aims to reduce emergency department visits for common, preventable adverse events from medications. NABP has addressed, and will continue to address, numerous aspects of reducing preventable, adverse medication events. These aspects include developing useful CMI guidelines and encouraging patient counseling, as well as improving prescription labeling. General progress toward preventing adverse events has been discussed in continuing education sessions such as 2005’s “Realizing a Safer Health Care System: The Progress of Patient Safety Since 1999.” A 2008-2009 Task Force on Uniform Prescription Labeling Requirements was established via a resolution passed at the Association’s 2008 Annual Meeting, with the mandate “[t]o assess and recommend revisions, if necessary, to the prescription labeling provisions of the [Model Act] to standardize labeling and information provided to the patient, increase the readability and comprehension of and decrease confusion caused by prescription labels, and promote patient safety and avoid medication errors.” This task force subsequently recommended that Model Act language addressing prescription drug labeling be amended to set requirements for font type and size, including and highlighting critical data, incorporating additional data elements, and removing some information. In addition, the task force supported NABP working with relevant agencies and organizations to encourage implementation of the label guidelines, and also recommended that NABP work with relevant associations and agencies to require that medication indications be included on written and electronic prescription drug orders.
Healthy People 2020 also aims to reduce the non-medical use of prescription drugs. Many of NABP’s most public actions have taken aim at the inappropriate use of prescription drugs. The NABP Newsletter has devoted much space over the years to the problem, from discussing the dangers and prevalence of teen prescription and over-the-counter drug abuse and NABP’s recommendations regarding legitimate patient-prescriber relationships, to providing updates on state and federal legislation and regulations. On its Web site, the Association provides information and guidance about Recommended Internet pharmacy sites and drug outlets that are Not Recommended – the latter often providing a source for acquiring drugs without a legitimate medical need – and provides links to recent news articles on the topic. And, through news releases, NABP provides updates to members, stakeholders, and the public on the Verified Internet Pharmacy Practice Sites program, which accredits Internet pharmacies that have successfully completed a thorough NABP accreditation process, and on related Internet pharmacy safety issues. NABP representatives also have provided testimony before Congress and have acted as expert witnesses in criminal trials involving Internet drug outlets that have allegedly provided medications without verifying a legitimate medical reason, or demonstrating a legitimate patient-practitioner relationship.
The appropriate use of medications has been a frequent topic of NABP resolutions. A 2008 resolution, Teen Medication Abuse, for example, tasked the Association with using “its newsletter programs to inform constituents of the critical nature of the issue surrounding abuse of medications by teens and the important role of the state boards of pharmacy and practicing pharmacists.”
A 2009 resolution, Overprescribing and Excessive Use of Controlled Substances and Other Prescription Medications, directed NABP to “continue its efforts through task forces and consumer awareness programs to address related issues such as medication disposal and consumer education concerning prescription drugs and abuse; and . . . [to] enlist the assistance of interested stakeholders to communicate the seriousness of this public health concern to patients and health care practitioners, urge prescribers to reduce the incidences of over-prescribing, and urge pharmacists to assist in reducing the excessive use of prescription medications.”
Another 2009 resolution, Valid Patient-Practitioner Relationships, in part told NABP to “urge its member jurisdictions to aggressively pursue pharmacists and pharmacies engaged in the distribution of prescription drugs without a valid patient practitioner relationship in order to further protect the public health.”
And as a final recent example, another 2009 resolution, Develop a Task Force to Research Various PMP Programs and Recommend Standards or Model Rules, recognized the role prescription monitoring programs (PMPs) play in identifying and stopping people attempting to illegally obtain controlled substances. It directed NABP to “commission a task force of interested stakeholders to review existing PMPs in light of the current language on PMPs found in the [Model Act], identify for member boards where variations among programs exist, and encourage states to adopt language and standards to provide uniformity in the various PMP programs across the nation.”
Healthy People 2020 provides an important framework for putting policy decisions into their most important context – their impact on public health. NABP, in keeping with its mission, will continue to take actions aimed to promote patient safety and the protection of the public health. More information about Healthy People is available on the project’s Web site at www.healthypeople.gov.
