Impact of a Five-Part, Student Pharmacist-Led Advocacy Certificate Program

By: Dr. Anita Yang, Dr. Kevin Rhash, Dr. Andrew Cartwright, and Dr. Adam Persky

Abstract

Objectives: Evaluate the impact of a five-part, student pharmacist-led “Student Pharmacist Advocate Certificate’’ program on students’ pharmacy legislation interest, knowledge, and comfortability speaking with legislators compared to baseline prior to the advocacy program.

Methods: Retrospective review of pre- and post-surveys of students who completed the “Student Pharmacist Advocate Certificate” program in the spring of 2021. Surveys were based on a Likert scale to assess impact through paired t-tests.

Results: After completing the advocacy program, student pharmacists’ legislation interest, knowledge, and comfortability speaking with legislators significantly increased, while there was no significant change in perceptions of the importance of understanding pharmacy legislation. Students’ knowledge and comfortability speaking to legislators on all four core topics significantly improved: PBMs, CPAs, prescriptive authority, and pay parity.

Conclusion: With proper instruction, knowledge, and experience, student pharmacists can effectively advocate for advancing the pharmacy profession. Thus, pharmacy schools should consider implementing more robust opportunities into curricula to better prepare student pharmacists as life-long advocates.

comes more prominent and essential in patient care.1-3 Pharmacists are well-positioned to be accessible clinicians as they can offload physician burden in inpatient and outpatient clinics.4,5 Despite apparent benefits, pharmacists must be more utilized due to federal and state laws and regulations and the inability to reimburse compensation for direct patient care services.3 Concerted and effective advocacy efforts from other healthcare professions, such as physician assistants, nurse practitioners, and optometrists, have successfully advanced their scope and field of practice.6-8 Therefore, legislative pharmacy advocacy from students and practicing pharmacists is essential to proactively engage with legislation, legislators, and the bill-making process to see positive changes in pharmacy practice ultimately. However, there is currently a lack of integration of legislative advocacy into didactic, experiential, and co-curricular experiences in colleges and schools of pharmacy.9,10 Thus, pharmacy schools may be missing the opportunity to stress the impact and importance of self-advocacy early in students’ pharmacy careers, which is crucial to ensure patients receive optimal and quality healthcare.

Introduction

As healthcare evolves, the pharmacist’s role be-

Developing effective advocacy knowledge and skills as a student pharmacist provides foundational skills that can extend into becoming a pharmacy practitioner and leader. Current literature displays positive outcomes in advocacy-based classroom simulations for pharmacy students and that structured advocacy events tailored towards pharmacy students can increase comfortability.11-13 Since many pharmacy schools still need to incorporate advocacy into their curricula formally, there continues to be an increased demand for investigating effective hands- on approaches to engage students in pharmacy advocacy outside the classroom setting through state and national pharmacy associations.9

Currently, an ongoing objective of the North Carolina Association of Pharmacists (NCAP) is to immerse students in advocacy efforts through active participation in state legislation. Student leaders of the NCAP Student Pharmacists Forum (NCAP SPF) created a large-scale, five-part advocacy series and a “Student Pharmacist Advocate Certificate” to offer students from all four pharmacy schools in North Carolina. This study aims to assess the impact of the student-led, five-part advocacy series for student pharmacists in North Carolina to facilitate best practices in integrating advocacy efforts within and beyond the pharmacy school curriculum. The study hypothesis is that students who complete the “Student Pharmacist Advocate Certificate’’ program will experience increased levels of pharmacy legislation interest, knowledge, comfortability speaking with state legislators, and the importance of understanding compared to their baseline.

Methods

This study was a retrospective review of pre- and post-surveys from students who successfully participated in the five-part advocacy series and completed the “Student Pharmacist Advocate Certificate” in the spring of 2021. NCAP SPF representatives coordinated this student-led, five-part student advocacy series from four pharmacy schools within North Carolina: Campbell University, Wingate University, High Point University, and the University of North Carolina. First-year through fourth-year pharmacy students enrolled in a North Carolina pharmacy school were eligible to participate in the advocacy series.

Due to the SARS-CoV-2 (COVID-19) pandemic, all events occurred via a virtual platform. This five-part series included the following events: 1) Why Advocate as a Student Pharmacist, 2) State Pharmacy Legislation Information Session, 3) State Pharmacy Legislation - Hot Topics Discussion, 4) Legislation Meetings Preparatory Session, and 5) Virtual Meetings with State Legislators. The final event allowed students to engage in meaningful conversations with state legislators and discuss pertinent issues regarding pharmacy practice and its effect on pa- tient care.

A “Student Pharmacist Advocate Certificate” was offered through NCAP for students who attended required events and completed pre- and post-advocacy series surveys. The series examined four pertinent pharmacy legislation topics identified by NCAP in greater detail: pharmacy benefit managers (PBMs), collaborative practice agreements (CPAs), prescriptive authority, and pay parity.

The impact of this advocacy initiative was assessed through pre- and post-initiative surveys on a 1 (lowest) to 5 (highest) point Likert scale. Post-initiative surveys had to be completed within one week of certificate completion. The pre-and post-initiative surveys assessed the impact of the initiative’s effect on students’ pharmacy legislation interest, knowledge, and comfortability speaking with state legislators (Appendix 1). The surveys also assessed the importance of understanding pharmacy legislation as a student pharmacist and if pharmacy advocacy is only beneficial in certain areas of pharmacy. Additionally, students could note topics discussed with their state legislators within the post-advocacy initiative survey.

Baseline characteristics included pharmacy school, class year, and North Carolina House and Senate District. Student characteristics are presented as percentages of categorical variables and mean ± standard deviation (SD). The impact of pre- and post-advocacy series surveys was analyzed through paired t-tests. Statistical significance was set at p<.05. The University of North Carolina Institutional Review Board exempted this study.

Results

From January 2021 to April 2021, 87 student pharmacists in North Carolina expressed initial interest in attaining further information regarding the fivepart advocacy series. Ultimately, by May 2021, 50 pharmacy students completed the requirements to earn NCAP’s “Student Pharmacist Advocate Certificate.” All four North Carolina pharmacy schools had student representation, with the majority (98%; n=49) of students within the first three years of their respective four-year programs (Table 1).

uled virtual meetings with fourteen state legislators through the advocacy program. Student pharmacists had virtual meetings with eleven state legislators: six from the House of Representatives and five senators. Three representatives were “no-shows” due to scheduling conflicts. The eleven state legislators represented districts across North Carolina (Figure 1). During student-led meetings with state legislators, most students expressed their passion for the pharmacy field and the importance of advocating, personal patient care stories, PBMs, CPAs, prescriptive authority, and the evolving pharmacist’s role considering COVID-19 (Figure 2).

This program significantly increased students’ pharmacy legislation, knowledge, and comfortability speaking with state legislators (Table 2). Additionally, students’ knowledge and comfortability speaking with state legislators significantly increased on all four focused topics: PBMs, CPAs, prescriptive authority, and pay parity (Table 3) Students’ perceptions of the importance of understanding pharmacy legislation as a student pharmacist were well-received before the advocacy series. While insignificant, these perceptions still increased favorably upon completing the advocacy series.

Discussion

Due to the need for consistent advocacy instruction in the didactic coursework of pharmacy schools, students in North Carolina initiated an advocacy certificate through the state pharmacy association. This retrospective analysis of pre-and post-advocacy initiative surveys highlights the impact of educational and hands-on experience speaking directly with state legislators regarding pertinent pharmacy legislation. Additionally, pharmacy students were shown to successfully execute an impactful advocacy initiative by increasing their knowledge and comfortability on relevant pieces of pharmacy legislation.

The four relevant pieces of pharmacy legislation identified by NCAP aligned with specific bills NCAP was actively lobbying at the state level. While North Carolina does not have the legislation to provide pharmacists with prescriptive authority, legislation has been enacted to increase patient care access and advance pharmacy practice to improve public health needs. Thus, House Bill 96, “Allow Pharmacists to

Administer Injectable Drugs,” which also tied provisions from Senate Bill 575, “Pharmacists Improving Public Health Needs,” was discussed to provide insight into the breadth of pharmacy expertise. House Bill 96 was passed following this advocacy initiative in August 2021. Similarly, PBMs align with Senate Bill 257, “Medication Transparency Act,” and were also recently passed following this advocacy initiative in September 2021. Currently, in progress, CPAs align with House Bill 862, “Improving Access to Patient Care,” and “Fair and Equitable Reimbursement for Pharmacists,” regarding pay parity. Student pharmacists were integral in advancing pertinent pharmacy legislation by speaking directly with state legislators.

Despite the COVID-19 pandemic, student leaders were able to leverage a virtual platform between the four pharmacy schools to provide an informative and impactful advocacy series. Because meetings with state legislators took place virtually rather than in-person at the state capitol, physical and transportation barriers were eliminated. This increased student accessibility to participate in live meetings with state legislators without compromising the quality or effectiveness of those meetings. Similarly, Yu and colleagues successfully utilized a virtual platform for a COVID-19-focused state advocacy day for medical students and residents.14 Their study found that medical trainees understand the importance of effectively attaining the skills and knowledge to advocate for health policy with proper education and guidance.14

Dr. Elizabeth Griffiths indicates that “our patients’ access to care as well as their health and wellbeing depend on our willingness to become advocates on their behalf,” thus, successful legislative advocacy is imperative across all healthcare professions.15 The positive results of this retrospective study strengthen the current literature on the significant benefits of didactic and experiential advocacy efforts in healthcare professional students.11-13, 16, 17 The education students receive while attending pharmacy school should ideally help them become advocates through specific coursework with real-life experiences and participation in professional organizations.12,13,18

As pharmacy practice continues to expand and advance, it is crucial to involve student pharmacists in advocacy early on to understand its value and gain knowledge and tools to be successful advocates for the field. Adequate legislation is necessary to allow pharmacists to practice at the top of their licenses to overcome reimbursement and scope of practice barriers impeding patient care.19

Limitations of this study include a retrospective analysis of self-reported data utilizing a numerical Likert scale with small sample size. Strengths of this study include evaluating the impact of a student-led initiative through the state pharmacy association, the viability of leveraging a virtual platform, and the real-world implications of state legislator meetings on pharmacy practice. With sessions being transitioned to a virtual platform, accessing legislators was more convenient than having students commute in person from across the state to the General Assembly in Raleigh, North Carolina.

Pharmacy schools have a considerable opportunity to integrate pharmacy advocacy into their curriculum as critical actions and conversations with state legislators can directly impact their future practice and patients in their community. Since students have diverse experiential, extracurricular, and work experiences, they are well-positioned to educate others on pharmacists’ different roles and the impact of student pharmacists. Students also have the knowledge and skills to communicate unique patient-care stories effectively to the public and state legislators. Advocacy for the pharmacy field is not solely limited to speaking directly with state legislators; it is a skill that requires continuous practice in various settings to master advocating for the services, resources, versatility, and knowledge pharmacists bring to healthcare teams.

By creating this advocacy certificate program and showing positive outcomes, we hope other pharmacy schools and state and national pharmacy organizations will increase their role in developing strong student advocates. Whether that be through advocacy training, certificates, or workshops – it is evident that students are more comfortable and knowledgeable regarding pharmacy legislation after increased engagement. Furthermore, because clinical pharmacy services improve patient outcomes, advocating for pharmacy expansion may positively impact patient care. Several of the topics discussed during legislative meetings revolved around expanding pharmacy services, with the end goal of these dis- cussions always focused on improving patient outcomes.

Conclusion

Implementing and completing a “Student Pharmacist Advocate Certificate” increased student pharmacists’ pharmacy legislation interest, knowledge, and comfortability speaking with legislators. Advocating for advancing pharmacy practice can effectively begin as a student pharmacist. With adequate instruction and training, student pharmacists can execute meaningful conversations with state legislators regarding pertinent pieces of pharmacy legislation.

Authors: Anita Yang, PharmD, is a PGY2 Ambulatory Care Pharmacy Resident in the Department of Pharmacy Services at UNC Health Care, anita. yang2@unchealth.unc.edu. Kevin Rhash, PharmD, is a PGY1 Acute Care Pharmacy Resident in the Department of Pharmacy Services at Duke University Health. Andrew Cartwright, PharmD, is a Staff Pharmacist at Atrium Health Wake Forest Baptist Medical Center and High Point Medical Center. Adam Persky, Ph.D., is an Associate Dean of Professional Education at the University of North Carolina Eshelman School of Pharmacy.

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Impact of the Five-Part Advocacy: Pharmacy Legislation

Impact of the Five-Part Advocacy: Pharmacy Legislation Topic Knowledge and Speaking Comfortability

PBM=pharmacy benefit managers; CPAs=collaborative practice agreements

Highlighted North Carolina Districts of Completed Student-Led Legislative Meetings

Highlighted districts of the following 11 virtual student-led legislative meetings in North Carolina: Representative Cecil Brockman (District 60), Senator Chuck Edwards (District 48), Representative Cynthia Ball (District 49), Representative Erin Pare’s Assistant (District 37), Senator Jim Burgin (District 12), Senator Natalie Murdock (District 20), Representative Verla Insko (District 56), Representative Wesley Harris (District 105), Representative Zack Hawkins (District 31), Senator Valerie Foushee (District 23), and Senator Wiley Nickel (District 16).

Topics Discussed During State Legislator Meetings

Appendix 1

Pre- and Post-Advocacy Initiative Survey

Pre-Advocacy Initiative Survey

Student Information

Name, E-mail, Pharmacy School, Class Year

Likert Scale – Pharmacy Legislation

(

1-No interest; 3-Some interest, 5 – Very High interest)

Baseline interest

Baseline knowledge

Baseline speaking comfortability

Baseline speaking comfortability to state legislators on: Pharmacy Benefit Managers, Collaborative Practice Agreements, Prescriptive Authority, Pay Parity

Likert Scale – Pharmacy Legislation

(1-Not important; 3-Somewhat important; 5 – Very important)

Importance of understanding pharmacy legislation as a student pharmacist

Post-Advocacy Initiative Survey

Student Information

Name, E-mail, Pharmacy School, Class Year

Likert Scale – Pharmacy Legislation

(1-No interest; 3-Some interest, 5 – Very High interest)

Current interest

Current knowledge

Current speaking comfortability

Current speaking comfortability to state legislators on: Pharmacy Benefit Managers, Collaborative Practice Agreements, Prescriptive Authority, Pay Parity

Likert Scale – Pharmacy Legislation

(1-Not important; 3-Somewhat important; 5 – Very important)

Importance of understanding pharmacy legislation as a student pharmacist

Legislator Meeting Information

Legislator’s name

Select all the following topics discussed

Passion for the pharmacy profession

Personal pharmacy/patient story

Importance of advocating for the pharmacy profession

County-specific related issues

Pharmacy Benefit Managers

Collaborative Practice Agreements

Pay Parity

Prescriptive Authority

Pharmacist Role in Light of COVID-19

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