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Chronic Medications in Iraq:
A True Army Lesson Learned

After medical logistics officers found that their plans for supplying soldiers in Iraq with chronic maintenance medications did not work, they developed a process that ensures soldiers will receive their medications without having to order them.

Nearly 2 years ago, our country was faced with a dilemma: Declare war on Iraq immediately, or allow United Nations inspectors to complete their inspections and proceed based on their findings. While this decision was being made, the military forces were busy with operational planning, which had to be conducted with high levels of secrecy. The U.S. military already was supporting combat operations in Afghanistan; however, establishing a logistics support concept—particularly medical logistics support—for Iraq was a completely different matter. Military medical materiel managers had to keep in mind that they might have to deal with the effects of biological or chemical weapons if the United States went to war with Iraq. The planning phase was extremely detailed and labor intensive. Many scenarios were discussed before logistics support concepts were developed.

The focus of medical materiel managers during operational and tactical planning for Operation Iraqi Freedom was combat healthcare operations. They had to ensure that soldiers stayed healthy and protected from diseases and biological weapons and that the combat healthcare system could respond to combat injuries quickly. However, they did not anticipate the duration of the deployment. What initially had been envisioned as a “quick” war similar to Operation Desert Storm in 1991 quickly turned into multiple deployments of 12 months or longer. The extended deployments significantly affected the maturing supply-chain management of medical materiel; specifically, the refilling of prescription medications that the Army identifies as chronic maintenance medications.

Chronic maintenance medications are those medications needed to treat or control chronic health conditions of individual soldiers. Maintenance medications normally are used on a regular, predictable schedule rather than sporadically as needed. Examples include medications used to treat high blood pressure, high cholesterol, thyroid disease, diabetes, ulcers, depression, and chronic pain.

Concept of Medical Logistics Support

The underlying concept for medical logistics support in Operation Iraqi Freedom was to make the maximum use of distribution in order to relieve the forward units of the burden of managing and moving large quantities of supplies. The goal was to have medical units deploy with their required materiel and equipment. However, this proved to be more difficult than expected because combat unit medical supplies, which are generally too expensive to keep on the shelf during peacetime, were not readily available. This placed a significant burden on the medical supply system and commercial partners to manage the surge in requirements.

Based on the assumption that Operation Iraqi Freedom would be similar to Operations Desert Shield and Desert Storm, guidance was issued that each soldier would deploy with a 90-day supply of chronic maintenance medications. However, most of the medications were consumed before the soldiers departed from home station because the medications were issued weeks in advance of deployment. Planners had assumed that soldiers would be able to use the Department of Defense Mail-Order Pharmacy System for refills, but no process was ever developed and put into place to make that a realistic alternative.

By late April 2003, the need to obtain prescription refills was becoming an overwhelming problem in the Southwest Asia theater of operations. Nearly 10 percent of all soldiers had prescription requirements, and it was almost impossible to predict each soldier’s actual drug and dosage requirements because chronic medications were not identified before deployment. With 120,000 soldiers in theater, over 12,000 prescriptions had to be refilled.

As the problem escalated, it was discovered that units did not know what specific chronic medications their soldiers used. Once medications were consumed, the medical materiel system could not handle the volume of requirements and process requisitions in time to get prescription refills to soldiers. As a result, units initially bypassed the system and reached back to home station hospitals to have refills shipped into the theater.

To correct the problem, combat support hospital pharmacies began collecting prescription requirements and stocking chronic medications for soldiers in their area. Units were instructed to provide detailed listings of the chronic maintenance medications their soldiers needed. This requirement led to a major reengineering of the deployment process to ensure that prescription requirements are compiled in a clinical database during predeployment processing. Soldiers now are required to deploy with 8-month supplies of medications, and female soldiers using oral contraceptives must take 14-month supplies.


Data Collection

Data on chronic maintenance medications for deploying soldiers are now captured and managed by a Web-based system called the Predeployment Medication Analysis and Reporting Tool (P–MART). The Department of Defense Pharmacoeconomic Center in San Antonio, Texas, issues a P–MART report to help commanders and medical officers accurately identify the chronic medications being used by their soldiers.

Once a unit has been identified for deployment, its soldiers must pass through medical readiness checks. One such check, called the Soldier Readiness Program, offers soldiers the opportunity to create wills, establish powers of attorney, make financial allotments, get medical assessments that identify immunizations they need, and verify their medical histories. After this process is complete, each unit commander or unit medical officer provides the Pharmacoeconomic Center a
by-name roster of all personnel within the unit designated for deployment. The center generates a P–MART report that lists soldiers’ chronic medications and the approximate dates they will need to be refilled.

The P–MART report goes a step further. Once information is captured in the system, refills are automatically filled and shipped to the medical logistics battalion in Iraq and then distributed to the deployed unit. Using P–MART, the battalion receives bulk shipments of chronic medications and immediately forwards the medications to the appropriate unit for distribution to soldiers. Refills normally are shipped at the 4-month mark for the deployed unit. This ensures that medications are received in a timely manner and neither the soldier nor his unit has to initiate the request.

Deployments to combat operations present soldiers and their units with many challenges. Fortunately, providing chronic medications is no longer one of them. Drawing from lessons learned, the Army now has a system in place that ensures that soldiers have the chronic medications they need and combat hospitals stock the pharmaceuticals required by the soldiers they serve.
ALOG

Major Greta L. Bennett is the V Corps Medical Logistics Officer. She has a bachelor’s degree in business administration from Howard University in Washington, D.C., and a master’s degree in public administration from Troy State University in Alabama. She is a graduate of the Army Medical Department Officer Basic Course, the Combined Logistics Officers Advanced Course, and the Combined Arms and Services Staff School.