As we emerge from peak flu season, this year’s challenges highlight the importance of vaccination and pharmacists’ contribution to it. Based on CDC estimates, this season’s flu vaccine reduced the risk of getting sick by about half (48%) for vaccinated individuals.

Although we haven’t had a major flu pandemic in quite some time, the Ebola and Zika outbreaks serve as examples of what can happen when a dangerous pathogen becomes easily transmissible. This is why many epidemiologists are watching out for the next “big one”—on the scale of the 1918 flu pandemic&mdash;that could be brewing right now in a rainforest or a makeshift laboratory. Bill Gates recently sounded an alarm to this effect in a

: “Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year,” wrote Gates, who, through his foundation, is well connected with top epidemiologists. “And they say there is a reasonable probability the world will experience such an outbreak in the next 10 to 15 years.”

Are public health agencies and pharmacies as ready as they should be? The short answer is no: when it comes to pandemics, we can’t be overprepared. In a 2016 interview,

Pandemic: Tracking Contagions from Cholera to Ebola and Beyond

, cited a survey that revealed “the majority of ... pandemic experts of all kinds felt that a pandemic that would

sicken a billion people, kill 165 million people, and cost the global economy about $3 trillion would occur sometime in the next two generations.”

Advances in biotechnology, vaccines, and drugs appear to be our best defenses, and pharmacists are perfectly positioned to employ them. According to the CDC, 1 in 4 Americans is vaccinated in a pharmacy. Because pharmacists are the most widespread and accessible immunizers, public health agencies should be ready to collaborate with them in a pandemic. Pharmacists could immunize patients efficiently, thereby allowing other health care providers the time to treat patients who are ill. However, for pharmacies to be fully leveraged, significant planning and coordination is needed, and more work is needed to ensure pharmacists are incorporated early.

Sam Graitcer, MD, of the CDC Pandemic Influenza Vaccine Task Force, spoke of this collaboration at the 2016 National Adult and Influenza Immunization Summit. In his presentation, “Being Ready for the Next Pandemic: Coordination Between Public Health and Pharmacies for Expanded Access to Pandemic Vaccines,” Graitcer noted how in 2009, pharmacists, although they provided H1N1 vaccinations, were underutilized because the vaccine was not widely available in pharmacies until after the peak of disease. During a severe pandemic, beginning widespread vaccination at the peak of disease would have little impact, according to Graitcer. Expanded use of pharmacists as vaccinators early in a pandemic response is critical.

will continue to do all it can to help educate and prepare pharmacists with content, such as in last month’s Infectious Disease issue. This month’s Central Nervous System issue features carefully prepared articles on headaches, multiple sclerosis, and epilepsy to help you provide the highest quality of care to your affected patients.

Articles

As we emerge from peak flu season, this yearâ€™s challenges highlight the importance of vaccination and pharmacistsâ€™ contribution to it.

The Next Pandemic: Ready or Not?

Thirty-one years ago last month, we lost the Space Shuttle Challenger and its 7 crewmembers. An associate of mine remembers Mission Specialist Col. Ellison Onizuka speaking at his high school months before the Challenger mission. To that gymnasium full of teens in serious need of motivation, Onizuka spoke of dreaming big in his home state of Hawaii, and how that, along with perseverance, led to a distinguished career in the military and the honor of being selected for a shuttle mission.

Tragic events can break our collective heart, unite us, strengthen our resolve, and, ultimately, drive us onward. Strength and persistence are key American attributes, but collaborative effort is critical to success.

I think most Americans would agree that we have experienced an especially politically divisive time for too long, and it has impeded progress. Many at home and around the world are wondering whether Americans will be able to come together to move forward. Do we still have the right stuff? The answer is yes if we can realize our common ground and focus on unifying tasks like the one Abraham Lincoln proposed to a deeply divided nation in his Gettysburg Address:

It is rather for us to be here dedicated to the great task remaining before us ... that government of the people, by the people, for the people, shall not perish from the earth.

—Abraham Lincoln, The Gettysburg Address

I also think most Americans would agree that the following are pillars of our country: freedom, entrepreneurship, and limited government, as designed by our nation’s founders. These principles happen to be good for business, as well.

is celebrating its entrepreneurial spirit by launching a stand-alone immunization supplement series that will be mailed with your regular issue. We recognize the great need for more information on immunization, and we are eager to present this supplement to you. We are also introducing new issue themes, such as last month’s Oncology issue and this month’s first Infectious Diseases issue. As multidrug-resistant organisms become an increasingly important public health threat and CMS begins to require antimicrobial stewardship as an accreditation standard, expert knowledge on infectious diseases is essential for pharmacists. Mainstream media coverage of this topic may not be accurate or up-to-date. Therefore, it is imperative that information such as updates on guidelines and new threats be interpreted properly by experts.

What actions are you taking to promote unity—and to reap its rewards&mdash;in your community and your organization? We will be asking for your teambuilding ideas on social media. The stories of American pioneers such as astronaut Ellison Onizuka remind us of what’s possible when we are personally motivated and corporately united.

Strength and persistence are key American attributes, but collaborative effort is critical to success.

What's Good for the Country

The increasing incidence of diabetes is outpacing the number of health care providers skilled in caring for affected patients. According to the CDC, an estimated 29.1 million individuals have diabetes in the United States, and another 86 million adults have prediabetes. If the trends continue, as many as 1 in 3 US adults could have diabetes within about 30 years.

The good news is that nurse practitioners (NPs) and physician assistants (PAs) are well positioned for the challenging and satisfying work required to control our national diabetes crisis. According to the results of a study reported in

, “Inclusion of physician assistants/nurse practitioners in a variety of roles on primary care teams within a single organization resulted in encouraging outcomes more often than not.”

In addition, “Older patients with diabetes on panels with physician assistant/nurse practitioners in any role did the same or better for most outcomes than those with physician-only care.” For another example of how NPs are making a difference, see “Nurse Practitioners Prevent Hospital Admissions Among Diabetics” at contemporaryclinic.com.

It’s good to have supportive data, but I’m sure you don’t need studies to tell you that you’re making a difference in the health of your patients with diabetes. You see positive outcomes all the time by educating and treating these patients and communicating with their other health care providers.

To continue to be an influential player on the health care team, exercise your freedom to learn new skills and obtain continuing education, especially in regard to managing diabetes. To assist NPs and PAs in becoming go-to patient educators, we offer this Diabetes issue with articles on hypo- and hyperglycemia, mental health counseling, peripheral neuropathy, and foot exams. In addition, go to contemporaryclinic.com and search for “diabetes.” For continuing education, click the dropdown menu on the top navigation bar.

is here to be your best resource for practical clinical information. Ultimately, it’s all about preparing to provide your patients with optimal care. And you might be surprised by how many of them notice your extra effort and express their appreciation.

Autumn is the perfect time for recognizing your contributions. National PA Week was October 6 through 12, and National NP Week will be held November 13 through 19. So, please join

and your peers in celebrating dedicated retail clinic staff at #ThankaPA and #NPWeek. We appreciate and value your work in preventing and treating diseases such as diabetes and setting our nation on a path toward better health.

Diabetes. CDC website. cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm. Accessed September 8, 2016.

Preidt R. Shortage of doctors who treat diabetes looming. US News website. health.usnews.com/health-news/articles/2014/06/20/shortage-of-doctors-who-treat-diabetes-looming. Published June 20, 2014. Accessed September 8, 2016.

Everett CM, Thorpe CT, Palta M, Carayon P, Bartels C, Smith MA. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes. Health Aff (Millwood). 2013;32(11):1942-1948. doi: 10.1377/hlthaff.2013.0506.

The increasing incidence of diabetes is outpacing the number of health care providers skilled in caring for affected patients.

Be a Key Player on the Diabetes Care Team

The convenient, cost-effective care provided by a growing number of retail clinics is churning out remarkable revenue for the retail health industry.

First, a November 2015 report from Accenture forecasted that the retail clinic footprint will expand to 2800 clinics by 2017, a remarkable increase from about 2150 clinics in 2015. Now, an analysis from Frost & Sullivan projects that this growth will translate to $4 billion in revenue for the global retail health market in 2022, significantly up from the $1.35 billion in revenue that the market earned in 2015.

Clearly, the retail health industry is not only here to stay, but also gaining popularity among consumers seeking fast, affordable health care. As the authors of Frost & Sullivan’s “Future of Retail Healthcare Delivery” report explained it, “The convenience and cost advantages for patients, along with lucrative opportunities to capture new revenue streams for care providers, ensure the rapid uptake of the retail care model.”

Another factor paving the way for the future growth of retail clinics is the current shortage of primary care physicians, which, according to Frost & Sullivan’s report, is resulting in longer wait times. As a “cure for the common wait” on the retail clinic front, MinuteClinic recently launched a new digital tool that allows patients to view estimated wait times at most MinuteClinic locations and hold a place in line through their mobile device. Currently, the tool is only available to patients visiting MinuteClinic locations inside CVS pharmacy stores and Longs Drugs in Hawaii, but it’s set to be expanded to Target-based clinics later this year.

Let’s remember to mention the expanding scope of health care services offered at retail clinics, such as treatment and referrals for the acute and chronic skin conditions that are detailed in this Dermatology theme issue of Contemporary Clinic. We’re confident that the key clinical information presented in the articles “Assessment and Treatment of Acne in the Retail Clinic Setting,” “Summer Bites, Stings, Hives, and Rashes: Counseling Points for Retail Clinicians,” and “Best Strategies for Blisters and Sores” will allow our readers to help their patients look and feel their best for the upcoming school year.

Retail Health Market to Reach $4 Billion in Revenue

MinuteClinic recently sealed a deal to allow patients in Ohio to virtually visit Cleveland Clinic clinicians through American Well’s telehealth platform. This partnership is significant because it’s the first time Cleveland Clinic providers will be available to MinuteClinic customers via telemedicine.

To echo the words of American Well Chairman and CEO Ido Schoenberg, MD, “This is the future of telemedicine—or simply, medicine.”

Telemedicine is a perfect union between technology and health care. It has been praised as a cost-effective method for clinicians to examine, diagnose, and manage patients’ medical conditions in a way that transcends time and distance.

As practical evidence that telemedicine isn’t a passing phase but here to stay, MinuteClinic already boasts 1000 locations offering telehealth services in 32 states, and by next year, that number of sites is expected to grow to 1500. Moreover, in a recent

online poll, the majority of our readers believed that more retail clinics should provide telehealth referrals to other clinicians.

Using MinuteClinic’s new partnership with the Cleveland Clinic as an example, here’s how telehealth referrals work in the retail clinic setting. When a MinuteClinic practitioner is seeing a patient and deems it necessary for the patient to consult a primary care clinician at Cleveland Clinic for nonemergency urgent care needs, a virtual visit for this purpose can be arranged in about 5 to 10 minutes during working hours, although the health system is also looking to set up around-the-clock access. Patients can expect to pay about $50 for a mobile consultation, on top of the cost of seeing a MinuteClinic practitioner.

The results of a recent Oliver Wyman survey indicate that the use of telehealth visits has increased from 35% in 2013 to 45% in 2015, while retail clinic use has risen from 15% to 26% in the same 2-year period. Between their flexible scheduling and typically lower costs, telemedicine and retail clinics both have an enormous amount of potential to deliver care to hard-to-reach patient populations and boost patient engagement. Continued efforts to combine these 2 care models could only certify a bright future for the field of medicine.

MinuteClinic recently sealed a deal to allow patients in Ohio to virtually visit Cleveland Clinic clinicians through American Wellâ€™s telehealth platform. 

Telehealth in Retail Clinics Is the Future of Medicine

Because most treatments have been designed with a one-size-fits-all approach, clinicians may see a medication work very well for some patients but not for others. What if there was a better way to identify the best anticoagulant for each atrial fibrillation patient, for instance? Or, as the President pondered in his 2015 State of the Union address, “What if figuring out the right dose of medicine was as simple as taking our temperature?”

Fortunately, data-driven research is accelerating advances in precision medicine to make this a reality. According to the National Institutes of Health (NIH), precision medicine is an innovative approach that takes into account individual differences in a patient’s genes, environment, and lifestyle, thus supplying health care professionals with the tools they need to better predict which treatments will be most effective.

Although some advances in precision medicine have already been made—most notably in the form of routine molecular testing that is guiding cancer treatment&mdash;the practice is not currently used for most diseases, including those commonly treated in retail clinics. That’s where the Precision Medicine Initiative comes into play.

Launched with a more than $200-million earmark in the President’s fiscal year 2016 budget, the Precision Medicine Initiative supports ongoing efforts to build a national cohort of at least 1 million research participants, scale up strategies to identify genomic drivers in cancer, and develop curated databases to support the regulatory structure needed to advance innovation in precision medicine.

Recently, NIH granted the first award under this initiative to Vanderbilt University, in collaboration with Verily, formerly Google Life Sciences, to begin building the largescale research cohort. Simultaneously, NIH is collaborating with the Health Resources and Services Administration to create partnerships with community health centers and expand the initiative’s reach in underserved populations. On the private- sector side, more than 40 health-focused organizations are making commitments that will accelerate precision medicine.

It is only a matter of time before clinicians can provide the right treatment to the right patient at the right time.

Because most treatments have been designed with a one-size-fits-all approach, clinicians may see a medication work very well for some patients but not for others.