U.S. Army Reserve (Medical) Soldier Prescription Challenges during Operation Iraqi Freedom

Military Medicine, Dec 2004 by Savitala, Murty, Dydek, George J

The continuous requirement to mobilize and deploy reserve soldiers presents numerous challenges for the Army Medical Department. One of the challenges in the preparation for deployment of reserve soldiers is the assessment of chronic prescription medication requirements and the eventual filling of these requirements during deployment. The assigned unit pharmacy officer can provide a value-added service through the identification and coordination of the pharmaceutical needs of an activated deploying unit. A unit pharmacy officer conducted a prescription medication use analysis on an activated Army Reserve Medical Unit before deployment in support of Operation Iraqi Freedom. The study population consisted of 181 soldiers identified through a volunteer survey administered by the assigned pharmacy officer. The prescription medication requirements for the unit were identified in a predeployment status and an evaluation was conducted to determine the ability to sustain the medication requirements once the unit was to be deployed. Gaps in the availability of prescription medication requirements in a predeployed status were identified indicating potential deficiencies in the capability to replenish prescription medication requirements during deployment.

Introduction

The cost and use of medications in the United States across all population groups has continuously increased over the last decade.1 This increase in use is expected to continue, since the prescribing of medications is a major component in the health care armamentarium for the prevention and treatment of diseases.

The Department of Defense (DoD) addresses the increase in prescription (Rx) use through a variety of pharmacy benefit activities. One of those activities involves the listing of certain medications on a "formulary" that allows the most cost-effective medications to be available for beneficiaries. Even among military treatment facilities, there is variation in the types of medications stocked based on the population served by the treatment facility. Some of this variation is addressed by standardization across the DoD through the Basic Core Formulary. The practice of limiting medications to a specific list is widely practiced in civilian health care community and varies to the extent of the number of different health care plans available in the country.

During deployments, the Army Medical Department (AMEDD) lists specific medications to be stocked through unit deployment packages (UDP). The UDP is tailored to potential type of hostilities faced by the type of troops supported in the field and the type of conditions they are going to face. The potential shortfall in the UDP being based on mission requirements and the need to address the multiple medications available in medical practice has led the way to the recent development of the joint deployment formulary (JDF).

The Reserve component of the AMEDD is made of citizen soldiers that are called to active duty in time of national requirements (emergencies). These citizen soldiers come from all areas of the country under different civilian health care plans with different pharmacy benefits, requirements, and different formulary medications. Activated U.S. Army Reserve (USAR) soldiers on chronic medications must now fit into the DoD pharmacy benefit options in garrison and when deployed to the area of operations (AO).

Previous publications on the subject of medications related to deployments have focused on the active duty component and in a deployed status.2-5 There have been no publications related to the identification of medication requirements for units composed of primarily USAR personnel in a predeployment status. The objective of this article was to identify the Rx requirements for USAR soldiers preparing for deployment in support of Operation Iraqi Freedom (OIF).

Background Information

The 396th Combat Support Hospital (CSH) was mobilized in January 2003 in support of OIF. The unit was staged at Fort Lewis, Washington, for predeployment training and preparation for further deployment to the AO. The unit was composed of 566 USAR (medical) soldiers of different ranks and age groups. Unit personnel represented varied regions of the United States (Arizona, California, Connecticut, Florida, Georgia, Idaho, Massachusetts, Minnesota, Montana, Oregon, Texas, Utah, and Washington) and some active duty medical personnel from other units.

Pharmacy support for the unit consisted of two pharmacy officers and nine enlisted pharmacy technicians. The assigned pharmacy officers for the unit has the responsibility to identify the need to not only ensure that the appropriate medication supplies are available to fulfill mission requirements of the unit upon deployment, but to also identify the personal medication requirements of unit personnel. Table I indicates the tasks of the unit pharmacy officer to appropriately ensure medication requirements have been addressed for unit personnel.

The plan for pharmacy benefits support at the mobilization site assumed that activated Unit Soldiers had been directed to bring a 90-day supply of their maintenance medications with them. The soldiers were assured that they would be issued more medications after being processed at the soldier readiness process site where a physician would input the Rx requirements into the supporting military treatment facility hospital computer system (Composite Health Care System). All prescriptions were entered under a specific tracking code for expenditures capture. A 90-day supply of medications was entered with three additional refills to last for 1 year. After the prescriptions were entered into the Composite Health Care System, the pharmacy personnel filled the Rx at the supporting military treatment facility. Before dispensing, the unit pharmacist checked the Rx for accuracy. The Rx were then picked up by unit pharmacy personnel and taken back to the Company area for distribution. At the unit pharmacy assembly area, a schedule was established to have soldiers come and pick up their medications. A pharmacist consulted the soldiers as needed and answered any questions about their Rx.