Considerations for Retrograding Deployed Army Pharmacy Operations: What about Department of Defense Civilian Contractors? Lessons from Kosovo.

Background: Over the past two decades, changes in mission and expectations of deployed medical assets are requiring adaptations of pharmacy services. Specifically, the Department of Defense (DOD)-deployed contractors in theater are now eligible for varying levels of care from DOD-deployed assets. Pharmacy must now stock and maintain a complex medication footprint. This new requirement makes the attempt to retrograde a long established deployed pharmacy difficult and presents new challenges.

Methods: We review the issues surrounding this quandary from the perspective of the deployed pharmacy in Kosovo, one of the longest standing theaters of deployed medical assets.

Findings: Data from the 20th and 21st medical rotations in this theater demonstrate that DOD contractors consume a significant portion of pharmacy operational support. However, not only do contractors increase the volume but also pharmacy must address the use and monitoring of complex medications such as anticoagulants, antidiabetics, sleep, and psychiatric medications, as well as chronic obstructive pulmonary disease and asthma drugs, which are not typical in the deployed environment.

Discussion/Impact/Recommendations: Contractors are now serving in the Balkan theater at a greater than 1:1 ratio of contractors to soldiers. Contractors are typically older than deployed soldiers and thus their pharmaceutical needs are more complex. This complicates the pharmacy operation, which on the one hand is trying to retrograde as the mission winds down, yet, on the other hand, must expand to more complex operations to support the DOD contractors in theater.