Advocacy in Pharmacy

Mary Choy, PharmD, CGP Associate Professor, Touro College of Pharmacy Clinical Pharmacist, Metropolitan Hospital President, New York City Society of Health-Systems Pharmacists

Objectives
Define advocacy in the traditional sense versus the current definition Link leadership and advocacy Review the consensus statement for advocacy in pharmacy and the core competencies Discuss the current legislation Identify how pharmacists can become involved as advocates of the profession

Traditionally.

Advocacy 101
What is advocacy?
Textbook definition: The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support Current definition: act or process of supporting a cause. Student pharmacists: develop the skills and desire to create positive change in practice Advocacy does NOT always require legislative involvement

Advocacy 101
Who can advocate? Why is advocacy important?

Leadership
If the right leadership is applied to an objective, sometimes the right movement can accelerate when seemingly modest steps are taken Malcolm Gladwell Medication safety and effectiveness
Drug Distribution Systems Processing of Prescriptions

Leadership and Advocacy

Leaders are advocates Vision driven Advocacy
Externally focused activity Messages are crafted and communicated to influence the thinking of others

Reasons for Not Advocating

Difficult to see tangible and immediate results Rare, especially at the federal level, to see advocacy efforts translated into a piece of legislation passed by both House and Senate, and signed into law by President Telephone call, health screening?

Leadership
Internal and external focus Motivate a group to accomplish its goals

Why do we still advocate then?

Shared vision Contribute to shared vision those contributing can consider their work to be effective Initiative should have clear objectives
Effort to mobilize student pharmacists to send email or letters to the state legislature or board of pharmacy

Consensus Statement
Advocacy for the Profession of Pharmacy An ongoing commitment to advancing the awareness of the value that a pharmacist provides to the health and wellbeing of society by actively supporting and communicating that vision concisely to opinion leaders, elected ofcials, decision makers, potential partners and any other audience in order to inuence their perspective and ultimately have them speak and/or act on your behalf

Bzowyckyj AS, Janke KK. A consensus definition and core competencies for being an advocate for pharmacy. Am J Pharm Educ. 2013 Mar 12:77(2); 24.

Core Competencies
1. Engagement & Involvement
Demonstrate the importance of engagement and involvement within the profession. Interact with others

Core Competencies
3. Research & Preparation
Analyze issues and demonstrate comprehension Evaluate the values/perspectives of those with competing ideas to bolster ones argument

2. Communication Skills
Identify and communicate key talking points Engage stakeholders both within and outside of the profession to advocate on ones behalf

4. Experience
Establish credibility from acquired knowledge, prior experience and credentials Be professional at all times and portray a favorable image

Core Competencies
5. Legislative
Describe the overall legislative process Demonstrate how to find your legislator and access their record of voting on past bills

Tips for Advocacy

Know the facts: To gain and maintain credibility, it is critical that you have all of the facts on both sides of any issue. Use the facts: Any position you take should be grounded in the facts. It is often helpful to put your facts into one-pagers that you can distribute. Have clear and concise message: To the point conversations, avoid jargon and acronyms used in the pharmacy field

6. Communication Outlets/Media
Assess and utilize public relations, buzz marketing, and other communications methods Discuss the principles of social marketing

Tips for Advocacy

Nurture relationships and work collaboratively: Advocacy is a joint venture Engage the public: Use the media, social media, petitions, letters, e-mails Make your voice heard! Advocacy is not the place for being shy.
Meetings, press conferences, letters, petitions, rallies, phone calls

Pharmacy Advocacy on the State and National Level

Pharmacists as Immunizers Collaborative Therapy Drug Management (CDTM) Medication Therapy Management (MTM) Tobacco-Free Pharmacies Compounding in Pharmacy Pharmacies Taking Back Controlled Substances

Say thank you: Time is valuable. When your advocacy is a success, always thank everyone who helped you achieve your victory!

Pharmacists as Immunizers
Effective February 12, 2013, Governor Cuomo issued Executive Order No. 93 which permits pharmacists who are already authorized to administer vaccinations against seasonal influenza to individuals 18 years of age and older also to administer vaccinations against seasonal influenza to individuals between six months and 18 years of age.

Pharmacists as Immunizers
Pharmacists wishing to administer immunizing agents must obtain a separate certification to administer influenza, pneumococcal and acute herpes zoster vaccinations to adults 18 years of age and older. To become certified, a pharmacist must:
be currently licensed and registered in NY provide evidence that an approved immunization course has been completed within the past three years provide evidence they are currently certified in Cardio Pulmonary Resuscitation (CPR) or Basic Life Support (BLS)

Collaborative Therapy Drug Management (CDTM)

On May 17, 2011 Governor Andrew Cuomo signed into law a bill authorizing certain pharmacists to engage in CDTM within New Yorks teaching hospitals and affiliated clinics. The new law, and required regulations, took effect on Thursday, September 14, 2011.
Result of 20 years of lobbying

CDTM
In accordance with the required written agreement or protocol, a pharmacist may adjust or manage a drug regimen of a patient who is being treated by the participating physician for a specific disease or disease state. Such adjustment or management shall be done only pursuant to a patient specific written order or protocol made by the patients physician, and may include adjusting:
a. drug strength; b. frequency of administration; or c. route of administration.

CDTM Impact
Asthma Lipids Anticoagulation Immunizations Smoking Cessation Heart Failure Hypertension Pain Nutrition Support

A Day in CDTM
Review lab values Review medication profile Participate in daily rounds Adjust doses of medications, order labs Counsel patients Develop order sets

Technician Licensing
Emilys Story: March 1, 2006
Technician did not use a standard prepared bag of sodium chloride solution (with less than 1% of sodium chloride solution). Compounded a concentrated sodium chloride solution of 23.4% Outcome: ?

Outcomes of Advocacy
Engaging pharmacists more deeply in improving patient outcomes and continuity of care Fostering pharmacist participation on patientcare teams Building pharmacist accountability for medication therapy outcomes Documenting how the pharmacy dept. contributes to achieving institutional priorities Pharmacy involvement in programs to improve the health of the community served by the hospital

NYS Status

Question
Advocacy initiatives have led to the following outcomes in NYS: A. Pharmacists as Immunizers B. CDTM C. Tobacco-Free Pharmacies D. A and B only E. All of the above

Student Pharmacists
Student organizations Numerous channels for outreach, service, and leadership development
Volunteering for a committee Coordinating an event Seeking an elected position

Freeloading

American Society of HealthSystem Pharmacists

Advocate for changes in laws, regulations, and standards that will improve patient care Pharmacy technician licensure in all states Leverage key provisions in the Affordable Care Act and educate members on the implementation of pharmacy-related provisions, including accountable-care organizations, medical homes

ASHP Advocacy Goals

Payment - Paying pharmacists for patient care services Quality & Safety - Preventing harm, applying evidence, improving outcomes Residencies - Expanding funding for pharmacy residency training Technicians - Achieving standardized education, training, certification, and registration Workforce - Solving the challenges of staffing, credentialing, and leadership

New York State Council of Health-System Pharmacists (NYSCHP)

CDTM became law on May 18, 2011 Supports legislation that expands the role of pharmacists as immunizers Registration and certification of technicians For more information, www.nyschp.org

NYSCHP
How can you help?
Talk among your peers about the need to pass pharmacy legislation (student organization meetings, etc.) Meet with local assembly member or senator Come to Albany for Pharmacy Day and NYSCHP Lobby Day Make a personal donation to the NYSCHP Political Action Committee (PAC) Fund Organize a fundraiser for PAC

Year-round Advocacy Efforts

October: American Pharmacists Month Write a letter or email Make a phone call Visit a legislator

Advocacy is the responsibility of ALL pharmacists to improve the profession.