FOCUS ON THE FUTURE: COLLEGE HEALTH

THE FUTURISTS AT DISNEY WORLD have conjured up a compelling vision of health care for the ?community of the future? in their Celebration Health exhibit. A futuristic pharmacy is ideally placed, literally, at the center of the facility. Pharmacists are showcased providing drug monitoring, patient education, health screening, and vital linkages to other health care professionals. While Celebration Health gives us a glimpse of the pharmacy of the future, some pharmacists are in a position to shape the health care consumers of the future as they serve their young patients at college health centers. College health is a unique, interesting, and challenging practice environment in which pharmacists work with young people just as they are beginning to shoulder responsibility for their own health care and wellness.

College health clinics vary widely in size and services. Models range from first aid stations employing a single nurse, to large multispecialty clinics with hundreds of employees. Some serve only students, as is the case at the University of Wisconsin?Milwaukee; others serve faculty and the community as well. Some take insurance, others do not, but all strive to keep costs as low as possible to make their services accessible to students. All share the opportunity to reach their patients at a very ?teachable moment? in a setting where they have the opportunity to work with other health care providers and educators.

Much of the focus in the college health setting is on acute care (eg, upper respiratory infections, urinary tract infections, etc) and on women?s health (eg, annual OB/GYN visits and birth control). Sexually transmitted diseases also are an important issue. Although chronic diseases are less prevalent than in other practice settings, college health professionals are in the enviable position of being able to deal with chronic disease at the front end. For instance, diet, behavioral changes, and drugs may be introduced that can stem the tide of metabolic syndrome (eg, diabetes, hyperlipidemia, and hypertension). The ability to partner with many other health care professionals puts pharmacists in the fortunate position of being part of a multidisciplinary team focused on prevention and treating the whole person.

In a speech focused on the future of health care, Steven Schroeder, MD, former president and chief executive officer of the Robert Wood Johnson Foundation, predicted that, thanks to improved sanitation, antibiotics, and vaccines, infectious disease will no longer be the ?scourge of humanity.? With a lengthening human life span, chronic illnesses like heart disease, stroke, cancer, emphysema, and diabetes will be the challenge in the future. According to studies of the determinants of premature death, behavior will be the most influential (50%), distantly trailed by genetics (20%), environment/ social circumstance (20%), and health care (10%). Behavior is now a factor in each of the 9 most common causes of loss of potential years of life. Changing negative health behaviors will become increasingly important. College health pharmacists are situated in an environment where they are players in the arena of what matters most.

Immunizations and vaccines are a larger area of focus in college health than they are in many other areas of pharmacy practice. The protection provided by some early childhood vaccines can wear off, making college students a target for booster vaccinations. Pertussis, for instance, is a disease on the rise among adolescents and young adults, which is why the Centers for Disease Control and Prevention is recommending a booster dose of tetanus-diptheria-pertussis vaccine. Last year?s mumps outbreak put renewed focus on the importance of getting the entire recommended series of measles, mumps, and rubella vaccine. Meningococcal vaccine is recommended for previously unvaccinated college freshmen living in dormitories. The new human papillomavirus vaccine is recommended for sexually active women as a way to prevent cervical cancer.

Changes are afoot on the nation?s campuses. In national discussions about the role of universities in the 21st century, a consensus has developed around the value of universities going beyond outreach and service to active engagement. In its report, The Engaged Institution, the Kellogg Commission charged universities to ?redesign their teaching, research, extension, and service functions to become more sympathetically and productively involved in their communities.? Colleges are looking outward to their communities. What has existed as a unique pharmacy practice setting is becoming even more exciting. Give college health a closer look.