Chapter 4: Prevention & Wellness:  Featuring the Illustrated Case Studies “Screen,” “Change Talk,” & “Mobilized”

INTRODUCTION

Illustrations by George Folz, © 2019 Board of Regents of the University of Wisconsin System

BACKGROUND

Prevention and wellness efforts are frequently associated with public health initiatives. As a concept, public health has been defined as “what we as a society do to assure the conditions in which people can be healthy.”¹ Pharmacists, like other health professionals, regularly contribute their skills and expertise to keep people healthy and to prevent diseases; examples include providing education to patients, policy makers, and communities. Oftentimes, the community pharmacy is a patient’s first access point within the healthcare system, and it is frequently here where prevention and wellness efforts are initiated.

The American Public Health Association has outlined the role of the pharmacist in public health in an updated policy that identifies several areas where the pharmacist is uniquely positioned to promote prevention and wellness.² The policy highlights the value pharmacists have as an accessible source of health and medication information due to their physical location in the community and high degree of clinical training. Pharmacists can serve as educators for other health professionals, patients, and the community. Pharmacists are in an ideal position to promote prevention and wellness initiatives such as health screenings and immunizations, as well as lifestyle modifications linked to diet and the use of alcohol, tobacco, and other substances.²

Public health initiatives that pharmacists engage in emphasize three levels of prevention: primary, secondary, and tertiary.³ Primary prevention focuses on reducing the incidence of disease and injury through direct interventions. Well-known examples of pharmacists contributing to primary prevention efforts include vaccination administration programs and assistance with health behavior change, such as tobacco cessation and improving nutritional status via healthier eating habits.⁴ Secondary prevention focuses on decreasing the progression and severity of disease by screening to identify diseases before the symptoms become severe; examples include assessing patients for heart disease and conducting screenings for high blood pressure and blood glucose. Tertiary prevention involves managing disease and injury after diagnosis in order to slow or stop progression through interventions like rehabilitation and promoting medication adherence.⁴ Readers interested in a more in-depth discussion of medication adherence are encouraged to explore the illustrated cases “Breathe” and “Opportunities” in Chapter 2 Community Pharmacy and Chapter 15 Administration, respectively. Those who would like more information on rehabilitation efforts should read the illustrated case “Educator” in Chapter 5 Cardiology.

One of the challenges identified within the profession as it relates to pharmacists providing public health-focused services, however, is that pharmacists are often not compensated for their prevention and wellness activities. This limits how often pharmacists can provide these services in lieu of reimbursable activities, such as dispensing medications.⁵ New opportunities that can promote pharmacist-delivered wellness services include a shift toward rewarding quality care and increasing use of technology-supported services.⁵ The World ...