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The Local Pharmacy: An Untapped Resource for Viral Hepatitis Care

Thaddeus PhamLast year, I went to my local drugstore to get my seasonal flu shot. As my pharmacist prepared the materials, she asked about my niece’s recent hula performance.  I asked how her daughter was doing in school. As we chatted it occurred to me: I know my pharmacist better than my doctor. And she knows ME better than my doctor does. My pharmacist is a part of my extended family or ‘ohana as we say in Hawaiian.  I recognized that this was a potential opportunity for collaboration to address viral hepatitis in my community.

Pharmacists play an increasingly important role in our evolving health care system, especially with the increased focus on preventive health.  Pharmacists dispense medications, advise on side effect management, discuss drug-drug interactions, counsel on nutrition, and provide health education and other preventive services. Pharmacies have become a one-stop shop for health information, vaccines, over-the-counter and prescription medications, as well as everyday items such as toiletries, food, and household goods. For many communities, especially rural ones, local pharmacies are important sources of healthcare because of their ease of access, convenience, and familiarity.

Leveraging Opportunities

Despite the burden of viral hepatitis, there are comparatively few resources dedicated to addressing this “silent epidemic.”  To help address community needs, state Viral Hepatitis Prevention Coordinators (VHPCs), have become especially adept at identifying and leveraging opportunities to enhance services along the care continuum for viral hepatitis: from education and awareness, through screening and diagnosis, to linkage to care and treatment. Following the exchange with my local pharmacist, I began to envision a collaboration between Hawaii’s Department of Health (HDOH) and local pharmacies and pharmacy clinics. Such a partnership would be especially valuable given the fact that Hawaii has the highest rate of liver cancer in the nation—believed to be related to chronic viral hepatitis B and C.

We began by identifying opportunities within the existing services of local pharmacies, and we then explored services beyond those usually provided. In February 2014, we began partnering with local pharmacies to increase hepatitis B vaccination rates among contacts of persons living with chronic HBV.  Historically, the HDOH had limited follow-up capacity, referring susceptible HBV contacts to a single monthly, hour-long hepatitis immunization clinic in Honolulu.  In our new initiative, contacts were referred to more accessible pharmacies with longer hours (including 24-hour pharmacies). The project required minimal change to the pharmacies’ current practices as they already provide and bill for hepatitis B immunizations.  The pharmacies received free monovalent hepatitis B vaccines for the uninsured from the HDOH, and agreed to waive the administration fees.  The outcomes of the project are mutually beneficial, with increases in both pharmacy customer base and revenue, and greater HBV vaccination coverage reported through the Hawai‘i Immunization Registry.

For National Hepatitis Testing Day 2014 in Hawaii, we explored the expansion of pharmacy-based viral hepatitis services by launching a pilot screening project. Although the 18 participating pharmacies did not have the capacity to offer hepatitis testing, they agreed to provide hepatitis risk assessment screenings and refer clients to primary care for hepatitis testing, as appropriate, using Testing Referral Forms developed by HDOH. On that day, 34 people were screened and 8 referred for follow-up testing.  Since many persons already go their local pharmacies for health-related inquiries and services, we leveraged the pharmacists’ existing relationship with their local communities to promote a wider array of viral hepatitis services. Partner pharmacies benefited from increased client interaction and community profile, as well as collaborative media opportunities including press releases about the pilot viral hepatitis project.

Local Efforts, National Impacts

The Hawaii Department of Health-pharmacy partnership illustrates the types of collaborations needed to help achieve the goals of the national Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis (2014-2016).  We can utilize relationship capital of non-traditional partners from our ‘ohana to enhance services along the viral hepatitis care continuum, making health services more accessible, and improving the quality of medical care for viral hepatitis.

Read more about the CDC-supported Viral Hepatitis Prevention Coordinators.

Editor’s Note: April is Minority Health Month, bringing a national focus on advancing health equity and ending health disparities. During April we will be sharing several blog posts about responding to viral hepatitis disparities among minority communities.