Abstract
Objective. To assess the current practices of US schools and colleges of pharmacy pertaining to teaching legislative advocacy; the engagement of staff, faculty, postgraduates, students, and administrators in legislative advocacy partnerships and activities; and their future goals for legislative advocacy involvement by academic pharmacy institutions.
Methods. An electronic survey was distributed to deans of schools and colleges of pharmacy across the United States. Respondents were asked to complete 53 items about their school’s involvement in, barriers to involvement in, and relative importance of involvement in legislative advocacy. Responses were evaluated using descriptive statistics.
Results. The survey accrued responses from 48 of 143 (33%) schools and colleges of pharmacy. Sixteen percent of responding schools required a course on advocacy and approximately 50% offered an advocacy elective. A majority (58.8%) of responding institutions ranked their institution’s involvement in legislative advocacy high (≥7 on a scale of 1-10), and 75.8% ranked the importance of legislative advocacy in external collaboration high. A majority of institutions (60%) ranked the importance of faculty, staff, and postgraduate roles in advocacy high; however, 42.3% did not rank involvement as strongly. Fifty percent of institutions plan to expand involvement in legislative advocacy.
Conclusion. Respondents highly ranked the importance of legislative advocacy. Many perceived their institution’s involvement as strong and having plans to expand. Moving forward, curricula and resource allocation should be reviewed to diminish the dissonance between an institution’s perception of the importance of legislative advocacy and actual implementation of legislative advocacy components.
INTRODUCTION
Pharmacists are required to learn laws that govern practice and to stay updated on evidence that influences the delivery of high-quality patient care. However, their level of professional engagement varies when it comes to legislative advocacy, which influences changes in laws and regulations that shift and advance pharmacy practice. The Joint Commission of Pharmacy Practitioners (JCPP) Vision Statement asserts that “Pharmacists will be accountable for health, medication-related, and patient and population-specific needs.” 1 Unfortunately, laws governing pharmacist scope of practice and reimbursement for services present barriers to achieving this vision. Policy change is necessary to achieve JCPP’s vision as well as address the multifaceted social issues that affect patient health and access to care. 2 A way to influence policy change is through legislative advocacy, which is defined along with other terms in Table 1. Research has shown that citizens, professionals, and organizations can influence congressional decisions, indicating that advocacy can be a key component in changing legislation. 3 Legislative change is essential to advance patient care; accordingly, skill development in legislative advocacy may need to be included in Doctor of Pharmacy (PharmD) training.
Key Terms Used in a Survey of Legislative Advocacy Within US Schools and Colleges of Pharmacy8
According to the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, which guides institutions regarding PharmD curricular outcomes, pharmacists should be trained as educators. The CAPE states that being an educator “involves conducting a learning needs assessment of constituents who would benefit from pharmacist delivered education (eg, patients/caregivers, technicians, pharmacy students, fellow pharmacists, other health care providers, and legislators).” 4 To align with the CAPE outcomes, assessing the educational needs of legislators on current issues in pharmacy should be included within PharmD training. Despite this expectation around legislative advocacy in pharmacy education, no reports or literature exist that describe the integration of legislative advocacy in schools and colleges of pharmacy in the United States.
Few studies, including one conducted by Blake and Powell, have evaluated individual components of advocacy teaching and learning activities such as an elective. 5 This and similar articles have found that implementation of advocacy into the PharmD curriculum increases competence and confidence in participating in legislative advocacy. 6 Still, there is a gap in the literature related to how schools and colleges of pharmacy across the country integrate legislative advocacy teaching and learning activities through required courses, electives, experiential curriculum, and co-curricular opportunities. Additionally, literature does not currently address partnerships with stakeholders, such as state boards of pharmacy and professional organizations that influence policy change. By evaluating the legislative advocacy activities of schools and colleges of pharmacy across the country via an electronic survey to institution leadership, the roles academic institutions play in the practice and teaching of legislative advocacy could be quantified and goals for the future of pharmacy advocacy could be informed. The objectives of this survey project were to assess the current practices of schools and colleges of pharmacy pertaining to teaching legislative advocacy; assess the engagement of staff, faculty, fellows, residents, and administrators in legislative advocacy activities; and consider future goals for legislative advocacy in academic pharmacy institutions.
METHODS
An electronic survey was distributed via email through Qualtrics to 143 deans of schools and colleges of pharmacy across the United States. The dean could delegate staff, faculty, fellows, residents, and/or administrators to complete the survey. The survey was developed by two student pharmacists, a postgraduate fellow, and a senior faculty member at the Ohio State University College of Pharmacy. Prior to distribution, the survey was pilot tested with pharmacy educators and the Associate Dean for Academic Affairs at the author’s institution based on their survey development experience and involvement in the PharmD curriculum. The 53-question survey instrument included multiple-choice, open-ended, and scale (rated from 1-10) questions evaluating schools and colleges of pharmacy on stated objectives. Respondents were not required to answer every question. The survey was broken up into six domains: didactic curriculum; experiential curriculum; co-curriculum; faculty, staff, and postgraduate roles; external collaborations; and overall institutional engagement. Within each domain, participants were asked to answer questions that assessed the activities of pharmacy institutions. Participants also completed an assessment of their institution’s perceived level of involvement in advocacy and the importance of such involvement. Researchers used the following scale to describe a response as a high ranking: involvement rating of ≥7 on a scale of 1-10, with one being not well and 10 being extremely well; importance rating of ≥7 on a scale of 1-10, with one being not important and 10 being extremely important. The study was not designed to evaluate any associations or compare between rankings of involvement and importance. Demographic data gathered from respondents included whether their institution was public or private, whether it was established before or after the year 2000, whether a recent curriculum restructuring had occurred, how many pharmacy schools and colleges and/or satellite campuses existed in their state, their location in relation to their state capital, and in which US census region their institution was located.
Email addresses for pharmacy schools were obtained through the American Association of Colleges of Pharmacy (AACP) Deans email list. Survey data was collected using Qualtrics online survey software, and all identifiable information was stored on Qualtrics’ secure online database. The survey was distributed on August 1, 2020, with email reminders sent on September 1, 2020, to signal four weeks left to complete the survey, and on September 15, 2020, to signal two weeks left to complete the survey. The survey was closed on September 30, 2020.
Consent was attained by selecting the option to complete the survey and all survey responses were de-identified for aggregate analysis. Participants were entered in a drawing to receive a $100 Amazon gift card at the conclusion of the survey. Ethical approval to conduct the study was obtained from the Institutional Review Board of The Ohio State University.
RESULTS
Forty-eight of 143 (33.6%) schools and colleges of pharmacy responded to the survey. Demographic information for the responding institutions is included in Table 2. A majority of responding institutions had between two and seven pharmacy schools and colleges in their state, and there was an equal split of institutions located near their state capital (within an hour’s drive) and institutions located further away.
Demographic Information of Schools and Colleges of Pharmacy That Participated in a Survey of Legislative Advocacy Within US Schools and Colleges of Pharmacy8-9
Results related to institutional involvement in and perceived importance of the six domains covered in the survey are included in Table 3. A majority of institutions highly ranked (≥7 out of a scale of 10) their institution’s involvement in and the importance of integration of advocacy into the following domains: didactic curriculum (involvement, 58.5%; importance, 63.9%), co-curriculum (involvement, 90.9%; importance, 90.5%), external collaboration (involvement, 58.8%; importance, 75.8%), and overall institutional engagement (involvement, 66.7%; importance, 75.9%). Most respondents highly ranked (≥7 out of a scale of 10) their institution’s perceived importance of integration of legislative advocacy into the experiential curriculum (importance, 51.4%) and faculty, staff, and postgraduate roles (importance, 60%). Involvement was not ranked as highly in these categories (involvement 40% and involvement 42.3%, respectively). Results of questions within the six domains of the survey are summarized below.
Schools and Colleges of Pharmacy Rating of Institution Integration Into and Importance of Legislative Advocacy
With regard to the didactic curriculum, an overwhelming majority of respondents (82.9%) indicated their PharmD program did not require a course in legislative advocacy; however, a comparable majority (85.4%) had legislative advocacy topics embedded in required courses in their curricula. Many pharmacy schools (40%) offered an elective in legislative advocacy, with most courses conducted on an annual basis (76.5%) with an average enrollment of 5-25 students (70.6%).
Experiential curriculum with a focus on legislative advocacy were more prominent during advanced pharmacy practice experiences (APPEs), with 63.4% of pharmacy schools offering at least one APPE. In comparison, only 5% of pharmacy schools offered at least one introductory pharmacy practice experience (IPPE) with a focus on legislative advocacy. A majority (80.8%) of IPPEs and APPEs with a focus on legislative advocacy were offered in partnership with state or national pharmacy associations.
There were diverse co-curricular experiences offered that focused on legislative advocacy, with most institutions reporting between one to five co-curricular experiences per year (85.7%). The most reported experiences included legislative advocacy workshops (n=31), panel sessions involving individuals connected to legislative advocacy (n=31), legislator visits to campus (n=28), and legislator visits with students, the institution, or at pharmacy events (n=22). Experiences highly available to institutions included statewide pharmacy and/or student pharmacist legislative advocacy days. Of the institutions reporting, 92.9% reported their states held pharmacist legislative advocacy days at least annually, and 86.4% reported their states held student pharmacist legislative advocacy days.
Many institutions employed individuals focused on legislative advocacy. The most reported categories were faculty members (n=33) and administrators (n=28). These individuals participated in a variety of experiences that supported legislative advocacy efforts at their schools; the most frequently reported efforts included coordinating student visits to their state’s capitol building, state house, and/or legislator’s office (n=32), and/or student participation in legislative advocacy events (n=27). Specific to legislative days, 23 institutions reported that their faculty and students participated.
Postgraduate involvement in legislative advocacy was limited. Of all role designations (staff, faculty, postgraduate, administrator, or other) that could be involved in legislative advocacy, only 5.5% of respondents indicated postgraduate involvement at their school. Respondents reported that within the postgraduate programs at their institution, 10.9% of residencies, 5% of fellowships, and 2% of research (PhD, MS) programs had trainees who were involved in some way in advocacy. However, only 1% of residencies and 2% of fellowship trainees had significant involvement in advocacy. When evaluating programs individually, residencies had the greatest reported percentage involvement in any amount of advocacy efforts with 44.4% of residency programs reporting involvement in comparison to 26.9% of fellowship programs, 8.3% of research (Doctor of Philosophy [PhD], Master of Science [MS]) programs, and zero postdoctoral researcher programs.
There were a variety of external collaborators that pharmacy schools indicated partnering with on legislative advocacy efforts. The majority of institutions reported either a strong or very strong level of collaboration (rated on a five-point Likert scale ranging from very weak to very strong), including 97.5% with state pharmacy associations, 82.1% with national pharmacy associations, 80.6% with other pharmacy schools in the state, 77.5% with state boards of pharmacy, and 69.7% with local pharmacy associations.
A majority (64.1%) of the institutions that responded reported that legislative advocacy was included in their pharmacy school’s strategic plan. Although there was perceived importance of legislative advocacy indicated by pharmacy schools, numerous barriers were described. The most common barriers included 31.3% of institutions reporting lack of dedicated resources and 20.3% of institutions reporting lack of faculty or staff interest. In addition, 14.1% institutions reported restrictions with university policy. The survey did not inquire about the type of policy restrictions, but participants’ open-ended comments and the authors’ experience suggest limitations, including public universities having restrictions on government relations, and restrictions from institutional government affairs offices to engage on issues that may be in contradiction to other stakeholders, such as other health care professions in the institution.
In addition to receiving information from institutions regarding their efforts in legislative advocacy at the time of the study, institutions had the opportunity to share future plans to promote legislative advocacy in their institution’s curriculum, co-curriculum, experiential curriculum, and/or partnerships, and to provide any additional comments regarding the role pharmacy schools should play in legislative advocacy. Regarding future plans in legislative advocacy, a near even split of institutions planned to continue their efforts (47.6%) or planned to do more (52.4%), with no respondents indicating decreasing efforts. Within the responses of those who plan to do more in the future, the most common goal (40%) was expanding or enhancing partnerships with external partners that prioritized legislative advocacy. Following this, institutions planned to increase student legislative day participation (20%) and enhance legislative advocacy involvement in the experiential curriculum (20%). Most respondents (70%) agreed that schools and colleges of pharmacy should be involved with legislative advocacy.
DISCUSSION
The goal of this study was to describe the landscape of legislative advocacy curricula and involvement at US schools and colleges of pharmacy. The results of this study describe current practices, the perceived importance of legislative advocacy, potential areas for growth of legislative advocacy in didactic, experiential curriculum, and co-curricular experiences, as well as involvement of faculty, staff, postgraduate students, and external partners. In reporting survey results, authors referred to the number of responses to individual questions as respondents were not required to answer every question. Participants in this study were located at schools and colleges of pharmacy across the country, with respondents representing 20% of all private institutions and about 31% of all public institutions. The results of this study can help to understand how pharmacy schools perceive they are performing in the area of legislative advocacy, how important legislative advocacy is to their institution, and their perspectives about strategies to improve pharmacist involvement in legislative advocacy.
Most participants rated their institution’s involvement in legislative advocacy as high (≥7 out of a scale of 10) in all domains except two: integration of legislative advocacy into the experiential curriculum and in faculty, staff, and postgraduate roles. When evaluating the importance of advocacy, most institutions rated their institution high (≥7 out of a scale of 10) in all six domains. Co-curriculum ranked highest in involvement in legislative advocacy and institutional ranked importance. Overall, a majority of schools and colleges of pharmacy assessed their involvement in legislative advocacy in the didactic curriculum, co-curriculum, external collaboration, and overall engagement positively and ranked all six domains as important. Only two domains, experiential curriculum and faculty, staff, and postgraduate roles, received a moderate involvement ranking, which did not align with the high importance ranking. This identifies a dissonance between the perceived importance of advocacy engagement in the experiential curriculum and in faculty, staff, and postgraduate roles and the level of involvement in these areas, and presents an opportunity for growth.
All respondents reported that their institutions planned to either continue or increase current involvement in legislative advocacy. This may mean continued growth of advocacy efforts across the six domains, highlighting the larger roles that academic institutions could play in advocacy efforts. The intent to increase involvement can also be observed by the proportion of institutions (n=27, 65.9%) donning legislative advocacy efforts in their strategic plans. One of the primary methods by which institutions hope to increase their advocacy efforts is by expanding external relationships. The expansion of external relationships could include involvement with professional pharmacy associations, state boards of pharmacy, healthcare systems, companies involved in policy change, or other community or professional organizations. Many of the planned expansions in the future align with institutions’ lowest ranked domain in the self-assessment portion of the survey: integration of advocacy in experiential curriculum.
Despite interest in further participation in legislative advocacy, several barriers were identified that may limit pharmacy school’s involvement. Primary barriers include lack of resources and staff and faculty interest in participation. This contrast with institutional ranked importance of advocacy efforts and decreased involvement across the six domains may be explained by these identified barriers. Notably, the number of trainees, such as residents, fellows, and graduate students, involved in legislative advocacy is low at academic pharmacy institutions. There may be an opportunity to address this resource gap by designating trainee resources for this area while also encouraging involvement of staff and faculty. Additional barriers that exist, such as university policies that prohibit involvement in legislative advocacy, should be clarified to determine what activities are permitted for students and employees, including determining if acting on behalf of themselves as citizens is allowable instead of on behalf of the organization.
Limitations of the study include the low survey response rate as well as response to the survey by faculty and administrators of varying roles and titles at schools and colleges of pharmacy. While the survey was sent to the dean of each school, many responses were submitted from faculty and administrators designated by the dean to complete the survey. The respondents of this survey do represent a cross-section of US pharmacy academic institutions with demographics that align with those of the Academy. 7 With one representative from each institution completing the survey, there may be unknown activities that may not have been captured or reported. Additionally, respondents indicated their perceptions of the importance of the domains and their responses may not represent the views of other leaders at their school or college of pharmacy. This study provides a useful summary and description on the largest scale to date but does not provide a complete report of legislative advocacy within all US schools and colleges of pharmacy.
The results of the study represent the most comprehensive data available on legislative advocacy activities within US schools and colleges of pharmacy. Overall, respondents indicated that involvement in legislative advocacy is important and should be expanded. This study forms a foundation for further research into the specific topics and strategies for teaching legislative advocacy as well as a platform to launch further development of legislative advocacy integration across the aforementioned six domains. The knowledge and skills of student pharmacists in legislative advocacy, the influence of the Academy on policy change to advance health care and pharmacy practice, and examination of opportunities for experiential curriculum and postgraduate training programs are areas for future investigation.
CONCLUSION
Survey respondents ranked the importance of legislative advocacy by their academic institution as high and many felt their institution’s involvement was strong, especially in the co-curriculum. Opportunities exist to showcase and enhance involvement in legislative advocacy in experiential curriculum and postgraduate training. Moving forward, curricula and resource allocation should be reviewed to diminish the dissonance between importance and implementation of legislative advocacy components.
- Received March 29, 2021.
- Accepted September 8, 2021.
- © 2022 American Association of Colleges of Pharmacy
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