Quiz 9: SBAS

What is the focus of population health?

improving health and well-being of a group, community, or population; not just individual patients.

What does population health require an understanding of?

social, cultural, environmental, and behavioral determinants of health

What is an example each of social, environmental, and behavioral determinants of health?

social: income/education

environmental: pharmacy/food deserts

behavioral: smoking or alcohol use

What are the three major pharmacist responsibilities in CKD/CKM population management?

screening (eGFR, UACR), GDMT initiation/optimization, and patient education/adherence support

What is GDMT?

Guideline-Directed Medication Therapy

GDMT for CKD/CKM

ACEi/ARB, ARNI, SGLT2i, GLP-1 RA, MRA

What two lab tests should pharmacists ensure for CKD screening in diabetes/hypertension patients?

serum creatinine/eGFR and urine albumin-to-creatinine ratio (UACR)

What is the importance of pharmacy-led patient education in CKD/CKM?

educates patients on why they need medication, improves adherence, and reduces disease progression

What are 3 data sources used in population health research?

EHRs, pharmacy dispensing data, and claims databases

What key information does EHR data provide in CKD/CKM management?

lab values (eGFR, UACR), demographics, diagnoses, medication timing, and hospitalization data

What defines quantitative data?

numeric, measurable, statistically analyzed

ex. eGFR values, percent of patients on SGLT2 inhibitors

What defines qualitative data?

descriptive, experience-based, theme-analyzed

ex. patient beliefs about medications

What trend was seen in glucose-lowering medication use (Medicare claims, 2007-2016)?

sulfonylurea use declined, while GLP-1 RA and SGLT2i use rose slowly but remained very low

How can pharmacists impact these "dismal" CKD medication use rates?

by screening, initiating GDMT early, optimizing doses, educating, and reducing inequalities

What research method captures patient experiences, such as barriers in CKD care?

qualitative data through focus groups, interviews, and open-ended surveys

What are 4 four key quantitative population health metrics used in CKD/CKM?

screening rates, GDMT use rates, HbA1c/BP/LDL control, and hospitalization or readmission rates

What qualitative insights are essential for transforming CKD practice toward pharmacoequity?

patient perceptions, resource needs of practitioners, and insights to reduce CKD disparities

What is an ethical dilemma?

a situation where one must choose between two morally acceptable options - "good vs. good," with no clear right or wrong

What is the first step in the Ethics Problem-Solving Framework?

Determine if an ethical dilemma exists

What is the purpose of Step 1: assessing ethical dilemma using yes/no questions?

to decide if the situation involves unfairness, harm, breached rights, or threatened relationships

Autonomy

the right of a competent person to make informed decisions about their own health

What is Paternalism, and when is it ethically allowed?

overriding autonomy to protect the patient or others when treatment refusal could cause harm or is futile

Beneficence

to do good

Non-maleficence

to do no harm

What ethical principle supports telling parents about measles risks and consequences?

Veracity - truth-telling to support informed decisions

How does Material Risk apply in a vaccine discussion?

the parent must be informed about significant risks, even if rare (e.g., SSPE, hospitalization)

What ethical principle is violated when parents refuse vaccines, risking other children's safety?

non-maleficence (causing preventable harm to others)

Justice (in resource protection for schools)

fair protection of community health, requiring high vaccination rates for herd immunity

What type of justice prioritizes "doing the greatest good for the greatest number"?

utilitarian justice

How is Libertarian justice reflected in parental objections to vaccine mandates?

parents value individual liberty and believe health decisions should be personally controlled

What is Egalitarian justice in vaccination access?

everyone is entitled to basic protection (herd immunity), especially vulnerable individuals

What is the type of value conflict present in vaccine refusal?

personal autonomy vs. societal beneficence and justice

Who are the stakeholders affected in this vaccine ethical dilemma?

unvaccinated children, medically exempt children, parents, school board, and community

What is Step 2 in the Ethics Problem-Solving Framework?

identify relevant facts - technical, legal, and contextual

hat are two technical facts relevant to measles vaccination requirements?

herd immunity threshold is 95%; MN vaccination rate is under 88%

What law regulates school immunization in MN?

students must provide proof of vaccination unless medical or personal exemption is approved

What is Step 3 of the framework?

Values Analysis - assessing personal, professional, institutional, and societal values

What professional values must the pharmacist consider as a School Board member?

protecting public health, upholding ethical standards, and advocating for students' well-being

What societal values apply in the measles case?

protecting children from preventable disease and representing community values

What is Step 4?

Identify your goals - should be specific, measurable, and time-bound

What is Step 5 in the framework?

generate reasonable alternative solutions; brainstorm without judging feasibility

What are 2 example alternatives presented in Step 5 (for the measles scenario)?

1. allow unvaccinated children to attend school

2. require vaccination per law

What is Step 6?

analyze pros and cons of each alternative using ethics concepts and principles

Which alternative supports Aristotelian "middle ground"?

directing parents to file for personal exemption to balance autonomy and public safety

What is Step 7?

select an ethically justified alternative and support your decision with reasoning

What matters most when you choose an ethical action?

not which decision you pick, but how well you justify it using ethical frameworks and values