Public health is well-embedded into the fabric of pharmacy practice

The Association Report column in JAPhA reports on activities of APhA’s 3 academies and topics interest to members those groups.The APhA Academy Pharmacy Practice Management (APhA--APPM) is dedicated assisting enhancing the profession pharmacy, improving medication use, advancing patient care. Through APhA--APPM Special Interest Groups (SIGs), provides a mechanism network support profession, by addressing emerging issues. To learn more about APhA–APPM access listing APhA—APPM SIGs, visit https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management.The mission Research Science (APhA--APRS) stimulate discovery, dissemination, application research improve health. are source authoritative information key scientific issues work advance pharmaceutical sciences quality pharmacy practice. APhA--APRS Sections (Clinical Sciences; Basic Pharmaceutical Economic, Social, Administrative Sciences), for experts all areas influence policymaking process. APhA--APRS, https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science.The Student Pharmacists (APhA–ASP) be collective voice student pharmacists, provide opportunities professional growth, care, envision future pharmacy.The written Officers respective coordinated staff. Suggestions content may sent Margaret Tomecki, Director, Academies ( [email protected] ). groups. https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management. https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science. pharmacy. There has been growing recognition role pharmacists public health, which only accelerated during coronavirus disease pandemic. As begin play vital roles testing for,1Balick R. watch: can test COVID-19 regardless state regulations, HHS says. American Association.https://www.pharmacist.com/article/apha-coronavirus-watch-pharmacists-can-test-covid-19-regardless-state-regulations-hhs-saysDate accessed: October 31, 2020Google Scholar vaccinating against,2Fortin F. hails announcement authorizing administer vaccines. Association.https://www.pharmacist.com/press-release/apha-hails-hhs-announcement-authorizing-pharmacists-administer-covid-19-vaccinesDate severe acute respiratory syndrome 2, it would beneficial review how we systematically measure demonstrate our impact not this health crisis, but also other concerns. Public so well embedded into fabric practice that often do recognize own contributions nation’s Although there several tangible examples involvement such as providing vaccinations, screenings (e.g., blood pressure checks, diabetes testing, on), smoking cessation services, hormonal contraceptive antimicrobial stewardship, naloxone trainings, critical promoting subtle ways counseling safe appropriate use medications, therapy management (MTM) answering questions over-the-counter products. most accessible professionals—and sometimes ones, case rural communities—our value care framework unquestionable. Yet, overlooked underused within formal initiatives reimbursement models.3AMERICAN PUBLIC HEALTH ASSOCIATIONThe pharmacist Health Association.https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/13/05/the-role-of-the-pharmacist-in-public-healthDate Scholar,4CDCHow Centers Disease Control Prevention.https://www.cdc.gov/grand-rounds/pp/2014/20141021-pharmacist-role.htmlDate This part due dearth strong scientifically rigorous evidence proves pharmacists’ outcomes. For instance, systematic meta-analysis published Journal Medical Internal Medicine found although MTM services reduce frequency medication-related problems nonadherence, insufficient at time their outcomes.5Viswanathan M. Kahwati L.C. Golin C.E. et al.Medication interventions outpatient settings: meta-analysis.JAMA Intern Med. 2015; 175: 76-87Crossref PubMed Scopus (203) Google Viswanathan al.5Viswanathan concluded “The degree identifying resolving drug translates consistent, detectable improvements biomarkers morbidity, experience, costs cannot determined from body evidence.” Other policy researchers have gone identify similar limitations studies related example, Majumdar al.6Majumdar S.R. Soumerai S.B. unhealthy research.Health Aff. 2009; 28 (Suppl 1): w900-w908Crossref (33) point out 1 they reviewed marked glycemic control, was limited lack control arm considerable loss follow-up. such, opportunity better design conduct evaluates unequivocally demonstrates pharmacist-provided interventions. Most date aim determine various outcomes, using 1-group preintervention postintervention quasi-experimental study design. Quasi-experiments establish causality between intervention outcome without random assignment intervention.7Harris A.D. McGregor J.C. Perencevich E.N. al.The interpretation medical informatics.J Am Med Inform Assoc. 2006; 13: 16-23Crossref (406) well-known example Asheville Project: Long-Term Clinical Economic Outcomes Community Diabetes Care Program.8Cranor C.W. Bunting B.A. Christensen D.B. long-term clinical economic outcomes community program.J Pharm Assoc (Wash). 2003; 43: 173-184Abstract Full Text PDF (555) addition randomization comparator group allowed an draw meaningful conclusions results. However, important note always preferred owing concerns around generalizability benefits “real world” settings participants. In addition, feasible ethical considerations, small sample sizes, logistical difficulties randomizing participants, especially location clinic). Quasi-experimental therefore inevitable, because investigators them consider address make causal inferences. First, quasi-experiments subject threats internal validity. validity observed changes reliably attributed Borrowing principles epidemiology, see 9 major validity, described Table 1. Similarly, Bradford Hill criteria enables interpretations, rather than association- correlation-based seen 2. encouraged carefully each these outcomes.Table 1Threats validity9Shadish W.R. Cook T.D. Campbell D.T. Experimental quasi-Experimental Designs Generalized Causal Inference. Houghton Mifflin, Boston, MA2002Google ScholarThreatDescriptionAmbiguous temporal precedenceUnclear whether occurred before outcome.Selection biasOccurs when participants who enrolled different were excluded, resulting effect.HistoryEvents occurring concurrently with could cause effect.MaturationNaturally over confused treatment effect.RegressionWhen units selected extreme scores, will less-extreme subsequent occurrence effect.AttritionLoss respondents produce artificial effects if correlated intervention.TestingHaving tested previously affect scores tests, effect intervention.InstrumentationThe nature change or conditions way effect.Interactive effectsThe depend level another intervention. Open table new tab 2Bradford inference10Fedak K.M. Bernal A. Capshaw Z.A. Gross S. Applying 21st century: data integration changed inference molecular epidemiology.Emerg Themes Epidemiol. 12: 14Crossref (223) ScholarCriterionDescriptionStrength (effect size)The stronger association/correlation outcome, likely attributable uncontrolled residual confounders.Consistency (reproducibility)Consistent findings across multiple points populations increase confidence less just chance.SpecificityThe specific its posited effect, alternative explanations why (and publish) well-defined outcomes.TemporalityThe must precede expected delay then occur after delay).Biological gradientThere observable linear (or nonlinear) relationship dose-response curve.PlausibilityIdeally, should preexisting knowledge supporting biological plausibility administered intervention.CoherenceSimilar plausibility, criterion requires fits known facts natural history context disease/condition.ExperimentIf shown (ideally under experimental conditions) consistently produces greater rates nonintervention sample, clear compelling causation.AnalogyFinding reporting theories interest. Next, randomized trial preferred, fortified design, includes pretests post-tests uses comparison group, interrupted series study.7Harris type study, implemented compared second group. 2 groups equivalent (assignment randomization); therefore, confounding exist need statistically adjusted for. main advantage having pre- time-varying effects. They easier assess for, address, regression mean statistical analytic capability through robust data.7Harris best practices graphically display trends implementation.6Majumdar visually displaying patients’ glycosylated hemoglobin (A1C) levels year A1C patients help create narrative add reliability effects.6Majumdar Finally, symbiotic partnerships practice-based potential high-quality clearly illustrates A recent collaboration APhA–APRS. partnership, residents able consult with, tap into, resources ensure residency projects result publications. building supportive base gain credibility ultimately widen scope even well-being Americans. Meena N. Murugappan, PharmD, MPH, PhD Student, University Minnesota College Fellow; Oncology Center Excellence, U.S. Food Drug Administration, Minneapolis, MN; Incoming 2021–23 APhA–APRS Postgraduate Officer. E-mail: