Military Pharmacy Confronts Present, Future Issues

http://www.ashp.org/news/ShowArticle.cfm?id=15137

BETHESDA, MD, 01 May 2006 — Pharmacy and other health care issues that affect one branch of the military affect all of the armed services, said Captain David E. Price, specialty leader and pharmacy consultant to the U.S. Navy Surgeon General. So, he said, pharmacy leaders at the Department of Defense work jointly to solve problems and plan strategies.

"Teamwork is not just a word with us," he said. "It's a way of life."

In addition to monthly meetings with his counterparts at the Air Force, Army, and Coast Guard, Price said he is in constant telephone and e-mail contact with the pharmacy chiefs at the other three armed services and Tricare Management Activity, the health benefits provider for members of the U.S. uniformed services.

"We believe in solving issues together," he said.

All but one of the four armed services pharmacy chiefs were appointed to their positions in the past year.

Captain Mary Fong, a commissioned officer in the U.S. Public Health Service (PHS), assumed the pharmacy program consultant and coordinator position for the U.S. Coast Guard in August 2003.

Military pharmacy, said Lieutenant Colonel Everett B. McAllister, pharmacy consultant to the U.S. Air Force Surgeon General, is currently facing two demanding missions: (1) providing patient services to active-duty military members and retirees and their families and (2) ensuring that servicemen deployed for wartime and contingency operations have access to needed medications.

"We tend to focus a lot on taking care of those patients stateside," he said. "But that mission is meant to prepare us so that when we deploy to places like Iraq that we have the skills necessary to operate in that type of environment."

Combating the pharmacist shortage. The biggest challenge in trying to balance both missions, McAllister said, is retaining sufficient personnel and recruiting new pharmacy officers to stay fully staffed.

"You never have enough people," he declared.

The military, the Navy's Price said, has not been immune to the pharmacist shortage that has plagued the nation.

"We are having trouble recruiting and retaining personnel, which makes it difficult for us to run our operation," he said.

"Ditto," McAllister remarked.

The Navy, Price said, started the fiscal year with 142 pharmacists. But, he said, he plans to lose 31 of those pharmacists because of retirements or people leaving the armed services.

The military is vexed by the high salaries offered by community pharmacies, Price said, making it difficult to compete for pharmacists in a tight employee market.

"The salary difference is huge," he said, adding that the military is working on increasing salaries for pharmacists.

Management opportunities. While Price said he counts on enticements like sign-on bonuses, educational opportunities, and student-loan repayment programs to attract pharmacists to the Navy, he said he emphasizes management and leadership opportunities when speaking to pharmacy students or new practitioners as the more valuable incentives to join the military.

"We put a lot of responsibility on new pharmacists," said Price, who said he enlisted in the Navy in 1973 as a pharmacy technician and worked his way up "from the trenches."

"Not only are you responsible for the pharmacy operation, but as an officer, you're responsible for the area you are assigned and the personnel that are assigned to you," he said.

Because the Coast Guard has only 16 active-duty pharmacy officers, pharmacists in that branch of the armed services wear multiple hats, said Fong, who has been with the Coast Guard since 1991.

Three of the Coast Guard's pharmacy officers, including Fong, serve in upper-level management positions, she noted. The other 13 pharmacists oversee pharmacy operations at 37 ambulatory health care facilities.

In addition to being responsible for more than two pharmacies each, Fong said, the cadre of Coast Guard pharmacists oversees pharmacy operations at more than 150 independent duty stations, including sea vessels called cutters.

"Because they are the lone person in the pharmacy," she said, "they're involved in everything," including dispensing, procuring medications and other supplies, facilitating the site's pharmacy and therapeutics committee, and coordinating quality improvement.

PHS in the military. The Coast Guard's 16 active-duty pharmacists differ from pharmacy officers in the other armed services because they are all PHS commissioned officers detailed to serve in the Coast Guard, Fong noted.

However, she said, PHS officers in the Coast Guard are subject to the uniform code of military justice, which PHS commissioned officers detailed to other agencies, such as the Bureau of Prisons, Immigration and Customs Enforcement, and FDA, are not.

PHS officers in the Coast Guard wear the Coast Guard's uniform, Fong said.

However, she noted, their uniforms bear the PHS insignia.

PHS officers in the Coast Guard can, if approved by Coast Guard chain of command, be deployed for PHS missions, which last up to two weeks, Fong said.

Several Coast Guard pharmacists this past fall deployed to the Gulf Coast to aid victims of Hurricane Katrina, she said, adding that pharmacy officers have continued to seek approval to deploy to hurricane-affected areas as needs arise.

However, Fong noted, Coast Guard pharmacists are first obligated to ensure that their own facilities' operational needs are met before they are permitted to deploy for PHS missions.

Coast Guard pharmacists are sometimes called on to fill in for other pharmacy officers or augment the pharmacy staff at Coast Guard health facilities during times of need, she said.

When Hurricane Katrina struck the Gulf Coast in August 2005, Fong said, the Coast Guard sent pharmacy officers to augment the pharmacy at the aviation training center in Mobile, Alabama. The pharmacist there was overwhelmed when beneficiaries, unable to get medications at military installations affected by the storm, converged on the small facility.

Fong said she and the other two management-level pharmacy officers also fill in for Coast Guard pharmacy staff members when needed.

Be all that you can be. Pharmacists in the military, said Colonel Isiah M. Harper Jr., pharmacy consultant to the U.S. Army Surgeon General, are expected to do more than dispensing and providing clinical services.

"I'm looking for people who will be able to train and lead others," he said. "We want to make sure we sustain the fighting force. So sometimes it's going to require you to do other things besides just be a pharmacist."

Military pharmacists more than ever before are playing a major role in medication logistics and inventory activities, said Harper, who has served in the Army for 26 years.

Pharmacists, he said, know information about drugs that logisticians do not, such as at what temperature a certain drug should be stored or that many drugs have various brand names.

For example, Harper said, a logistician would not know that Bactrim and Septra are brand names for the same drug combination.

Since pharmacists know the recommended dosage of a drug to treat a particular disease, they are essential personnel during inventory auditing and ordering, he added.

Wartime advances. For the first time during a war, Harper noted, the Army has a pharmacy consultant in "the field" in Iraq.

Lieutenant Colonel Brett Kelly of the 44th Medical Command from Fort Bragg, North Carolina, Harper said, provides critical information to him and other military medical personnel about pharmacy-related issues affecting soldiers in Iraq.

The current wars in Iraq and Afghanistan are also the first time the military has been able to use its pharmacy mail-order program to ship medications directly to soldiers serving in combat, he said.

When soldiers are transferred to another location, they can easily notify the mail-order program by sending an e-mail from the military's Web site, Harper noted.

Although the program needs some "tweaking," he declared, "it's going very well."

Leading the way. Military medicine, said the Air Force's McAllister, "tends to lead or usher in new changes and new paradigms" that directly affect patient safety issues.

For example, he said, the military's electronic medical records system gives military clinicians the ability to access any beneficiary's medication profile from any military health care institution.

"That enhances patient safety," said McAllister, who has served in the Air Force for 22 years.

Many drugs and vaccines on the U.S. market today, Harper maintained, are available to citizens because of treatments first tested and used by the military.

He noted that the Strategic National Stockpile—a national cache of antiinfectives, chemical antidotes, vaccines, and medical supplies that can be deployed within 12 hours to anywhere in the United States or its territories—was based on a concept developed by the United States Army Medical Material Agency.

Harper predicted that military pharmacy will play other vital roles in homeland defense readiness.

"I see it coming," he said. "And we are going to be ready."

—Donna Young