William G. Lang

Report of the 2010-2011 Standing Committee on Advocacy: Leveraging faculty engagement to improve public policy.

According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Advocacy Committee: “will advise the Board of Directors on the formation of positions on matters of public policy and on strategies to advance those positions to the public and private sectors on behalf of academic pharmacy.” COMMITTEE CHARGE President Rodney Carter charged the 2010-2011 Advocacy Committee to: “examine the question how can AACP and its members most effectively leverage faculty scholarship/research to impact on public policy at the state and federal level?” The Committee met in-person in October in Arlington, VA to discuss the charge and determine the approach to meeting the charge. After a wide-ranging discussion guided by the Chair the Committee agreed that a case study approach would meet the intent of the charge and serve the broader Academy by providing examples of evidence-based advocacy. Committee members agreed that the case studies could include completed, ongoing, or developing examples of how faculty scholarship and research did or failed to impact public policy. A framework for case study submission was developed and agreed to by the Committee. Case Study Framework: Each advocacy committee member will present one initiative that supports the integration of the pharmacist or recognizes academic pharmacy as a resource for evidence-based public policy development as a case study that provides a “roadmap for implementation” for AACP members. Each case study will be included as a section in the report. Each section will use the following format: State the healthcare reform/advocacy issue and the opportunity or expectation for the integration of the pharmacist; Describe the development of the partnership with the academic or community-based partner and their understanding and expectation of the integration of the pharmacist into issue activities or how pharmacy faculty can contribute to furthering public policy development; Describe through examples of teaching, research, or service, current activity at the college or school level to address the issue; List the AACP/other resources that provide evidence of academic activity that support the selected issue; and Recommendations regarding additional resources or evidence needed to advance the role of the pharmacist into the activities supporting the healthcare reform/advocacy initiative. BACKGROUND Leveraging public policy development to your advantage requires strong evidence that supports or opposes the policy. Public policy is advanced by science-based contributions.1,2 It is helpful to keep in mind that there is no guarantee that evidence improves the final policy since politics can be a dominant influence. However the strength of the evidence can contribute to its consideration in public policy.3 How and to whom the evidence is presented remains an essential element of influencing public policy. The creation of new knowledge and evaluation of existing knowledge are responsibilities of every faculty member of a college or school of pharmacy. Therefore, leveraging public policy development requires 1) identification of public policy of personal or professional interest and those supporting or opposing the policy, 2) assessing the policy for personal or collective contribution opportunities, and 3) determining the best approach for contributing the evidence. For instance, a significant piece of public policy, the Patient Protection and Affordable Care Act, includes provisions that seek to increase access to medication therapy management. The specific public concern being poor medication management is costly in terms of health and economic outcomes. This public concern was leveraged by evidence generated, translated and provided by pharmacy faculty. This evidence included examples of research, some of it supported by federal grants,4 demonstrating improved health outcomes associated with the provision of MTM services. Influencing public policy through evidence-sharing will continue to be an important goal of academic and professional organizations. The Patient Protection and Affordable Care Act creates many opportunities for academic pharmacy to leverage its implementation through the creation of new knowledge or evaluate current knowledge and translating both new and current knowledge into programs and services that meet the intent of the law.5 Members of the Academy are already providing significant contributions to the literature supporting the integration of the pharmacist across the continuum of care competent to provide patient-centered, team-based care.6,7 Likewise, daily activities such as interactions with state-based organizations, community partners, health insurance payers and even accrediting organizations provide opportunities for your position to be articulated and supported through evidence-sharing. The ability to leverage policy development requires an understanding and appreciation of other individuals and groups that will be engaged in the creation of new policy and its eventual implementation. Understanding and appreciation, regardless of whether you agree or disagree, requires the development of relationships with individuals, institutions and organizations involved in influencing public policy you deem important or relevant to your personal or professional goals. Understanding the advocacy or public policy goals of others is the first step in determining how what information you will provide to leverage their goals to your advantage. Through discussions with other individuals and groups you begin the second step, to assess the relevance of their goals to yours. Identification of goal alignment is an important step toward influencing public policy. Shared goals strengthen advocacy. The recognition of this strength regularly results in the establishment of coalitions and task forces that combine individual or organizational goals into a larger presence to influence public policy development, implementation and evaluation. Coalitions and other groups built upon mutual advocacy goals are sustained and strengthened through the evidence they are able to share with those developing or implementing the policy. Toward this end, pharmacy faculty are able to leverage public policy by working with others that share their goals, creating and communicating evidence that supports those goals.

Making “Health in All Policies” a Reality Requires You!

The American Public Health Association (APHA) held its annual meeting in Washington, DC, during the first week of November 2011. The APHA meeting is a policy wonks heaven as the meeting presentations span the spectrum from those related to a specific research question to those who implore the basic public health law tenet of personal responsibility. I moderated a panel that discussed health services research and its contributions to improving health care quality. Thousands of individuals attended the meeting where the key phrase, repeated in many sessions, was “health in all policies.” I attended a session where the concept of “health in all policies” was described by policy staff members from the US Department of Health and Human Services and policy experts participating in advisory panels for Healthy People 2020 and the National Prevention Strategy. In the few sessions I was able to attend, the opportunities for individual engagement in community activities aimed at changing the way our lives are lived was simply amazing! The idea behind “health in all policies” is that all federal, state, and local policy should be required to answer the question “How will this improve the health of the community in which it will be implemented?” This applies to economic, transportation, education, and any other policy you want to list. What is exciting in this is that more and more communities and their leaders are recognizing the connection between economic development, education, and health! But wait, there is more! Community leaders are strengthening the public commitment to some of our most needy citizens, those most likely to written off as laggards, incorrigible, and not worth our time. Ignoring the most needy has been an approach our society has endorsed for too long, yet we continue to struggle to lower infant mortality rates, decrease joblessness, and increase graduation rates. A new way of thinking that addresses the needs of the most needy through focused resource allocation appears to be taking hold among policymakers and community leaders. Consider the approach of Common Cause, an organization with a mission to end homelessness by providing not just a home but all the services necessary to help a homeless individual succeed in this significant transition. Common Cause sold the concept of “supportive housing” to leaders in New York City by focusing their attention on the fact that long-term homelessness costs the city much more in terms of uncompensated care, jail time, and criminal action. By finding them a place to live and providing them with health care, mental health, and job skills, the negative costs associated with the “care” of a homeless individual are significantly less than the cost of supportive housing. Similarly, the city of Baltimore used a focused approach to reduce infant mortality in Maryland by focusing on Baltimore neighborhoods with the highest infant mortality rates. The programs implemented by the citys health department have reduced the infant mortality rate for these neighborhoods which, in turn, reduces the citys overall infant mortality rate. This targeted approach has improved neighborhood statistics more dramatically than a general, state-wide approach had been able to accomplish. Another example of focusing on the most-in-need came to my attention while visiting one of our member institutions. We heard about a focused approach aimed at improving the economic situation of a states most economically depressed counties. Along with their school of pharmacy, partner community leaders focused their resources in ways that have improved the health outcomes for some of the states neediest citizens. This focused approach means increasing their access to care including access to medications and the management of those medications. This has improved individual patient health outcomes, reduced unscheduled time off from work, increased family commitment to education, and led to increased business interest in these once isolated, depressed communities. The inspiration of public health advocates and these examples of successful community engagement hopefully provide members of the American Association of Colleges of Pharmacy with ideas to improve the health of their communities. Work toward “health in all policies.” The continued escalation of health care costs crowds out the importance of and opportunity to address other social issues. The Robert Wood Johnson Foundation published supporting evidence of this “crowd out” effect in a 2008 report. Faculty members know the value of pharmacy education to students and in turn to the communities they serve. This value improves the quality of care, increases access to medically necessary care, and helps reduce overall costs of care. Share with your community the link between pharmacy education and improving health, improving healthcare services, and reducing costs. Help your community value pharmacy education by making this link for them. Doing so can strengthen your communitys support for pharmacy education. Work to reduce health disparities. Public appreciation of the impact of health disparities has increased a mere 4% over the past decade even though colleges and schools have spent millions of dollars to help students provide patient-centered, culturally competent care. Academic pharmacy is a strong champion of care delivery that meets the needs of individual patients. The education of a culturally competent health professional is an important component of meeting the needs of individual patients. Strengthen your students’ commitment to cultural competence by creating experiential education opportunities that place them in culturally diverse communities. Work to improve the literacy of your community. The United States lags many developed nations in its educational attainment. The Organization for Economic Cooperation and Development, along with the Program for the International Student Assessment, provides statistics about national educational attainment that can help focus local community approaches to improving the education of our youngest citizens. Education is an important driver of individual health literacy. Poor health literacy has a significant impact on our health system. Work with your local partners to improve health literacy so that our health system benefits from patients with a greater understanding of the personal responsibilities associated with their care. Join your community in community needs assessments. You can use your knowledge of research methodologies to assist communities with developing evidence-based approaches to public health issues. Collecting the correct evidence is essential for increasing the success rate of grant applications even for the most respected community-based organizations. Data collection and expression is increasingly a Web-based activity. Health data “apps” (software), like the program created by Catholic Health West, make the expression of community-based data easier to manage and demonstrate trends and “what ifs” to any stakeholder. The US Department of Health and Human Services has opened its data files to researchers, making national data available to support community needs assessments. Join or present at community-based organizations. Rotary clubs, chambers of commerce, local and state health department, school boards, and professional societies all need and are looking for solutions that will lead to healthier communities. Sharing your knowledge with others can lead to significant social change. Build energizing presentations by pulling your research together and showing data in interesting, easy-to-understand data formats focused on a community-identified need or set of needs. Educational, economic, and health improvements can best be addressed at the local level. National scalability is a laudable endeavor, but the political and policy alignment required for such is often insurmountable. You know your community and what it needs to create greater opportunity for all those living within it. The opportunities are greater than ever and the rewards can far exceed your expectations. To make health an integral part of all public policy offers pharmacy faculty members real opportunities to share their knowledge with any number of community partners, policy makers, and other concerned citizens. There is plenty to do!

The Report of the 2016-2017 Advocacy Standing Committee

EXECUTIVE SUMMARY Based on the growing importance of community engagement and the recognition of its importance by the American Association of Colleges of Pharmacy (AACP), the committee offers several examples of community engagement activities for consideration and replication by our academy and beyond. These activities, including those of winning institutions of the Lawrence J. Weaver Transformational Community Engagement Award, can be mapped to the core components of community engagement presented in Table 1. The committee, using an implementation readiness framework, provides the reader with insight into the challenges that may impact successful community engagement and encourages our academy to continue its work to support faculty capacity in this area. Toward that end, the committee offers a policy statement that encourages schools and colleges of pharmacy to have an office or designate a faculty member whose focus is specifically on community engagement. The committee also offers a recommendation that the core components be included in the criteria for the Weaver Award.

Report of the 2011-2012 Standing Committee On Advocacy: the relevance of excellent research: strategies for impacting public policy.

According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Advocacy Committee: “will advise the Board of Directors on the formation of positions on matters of public policy and on strategies to advance those positions to the public and private sectors on behalf of academic pharmacy.” COMMITTEE CHARGE President Brian Crabtree charged the 2011-2012 Advocacy Committee to: 1. Examine what AACP should do to balance the advocacy portfolio with respect to education and science scholarship. 2. Recommend strategies for demonstrating the value of education and science scholarship to address the mission of the Academy in communities served by member institutions. 3. Recommend specific approaches and advocacy strategies for consideration by AACP and member institutions for implementing interprofessional education. The Committee met in-person in October in Arlington, VA to discuss the charge and determine the approach to meeting the charge. This face-to-face meeting allowed for a very wide ranging discussion that brought into clear focus: 1. the imbalance/disconnect in the number of AACP policy statements relevant to science (biomedical and translational) research compared to those relevant to education research. AACP has many more policy statements relevant to science scholarship than it does policy statements relevant to education scholarship. 2. that AACP organizational activity related to educational research in terms of programmatic and student assessment, student progress, publication of educational research in AJPE, is extensive and yet there is little organizational policy supporting this activity. 3. Possible answers to questions such as: Who is interested in the quality of our education? Who cares about the good education processes we engage in? What is the value to the public of the way we educate and the outcomes of our education? How long does “we are teaching you for the future” remain relevant? 4. The fact that many communities and stakeholders do not fully understand or appreciate the importance of either science or education scholarship and their contributions to individual and public health. 5. AACP members engagement in science and education scholarship is worthy of recognition of its social impact. 6. The importance of moving from identifying barriers to effective interprofessional education toward overcoming and eliminating these barriers. Continuing reflection by the committee resulted in an approach that would increase the public’s appreciation of the benefits of pharmacy education to health. Public appreciation would be increased by rearticulating the connection between both education and science scholarship as the foundations for continuous quality improvement of pharmacy education. An organizational policy agenda, broad in its application to our Academy, and focused in its application to public policy, was developed. This policy agenda is framed within the teaching, research and service expectations of pharmacy faculty. It establishes the importance of: 1. teaching as the primary contribution of the Academy to the public’s health through the education of a pharmacist competent to work collaboratively and interprofessionally with patients, caregivers and other health professionals; 2. the creation, integration and application of education and science scholarship as essential contributors to the continuous improvement of pharmacy education; and 3. the importance of the educational and science scholarship and interprofessional education as a key opportunity for addressing the public policy question of how best to reorganize our healthcare system. BACKGROUND The benefit of academic pharmacy to the health of our nation and the world is a direct result of the teaching, research and service of its faculty. These three components, reflecting the mission of higher education, are relevant and important to improving individual and population health, improving health care processes and delivery, and preventing further escalation of associated costs. Teaching is the Foundation of the Academy’s Commitment to the Public The primary purpose of pharmacy education is to improve the public health through the education of a health professional, the pharmacist, competent to meet or exceed the public expectations of the pharmacist as expressed in state practice acts. Pharmacy education meets that competency expectation through a progressive series of educational experiences guided by educational outcomes, accreditation standards and individual institution priorities. The mission of AACP is to improve the quality of pharmacy education so that our public contract is met. As stated by AACP policy passed by the House of Delegates and proposed by the Academic Affairs Committee in 2007 “The mission of pharmacy education is to prepare graduates who provide patient-centered care that ensures optimal medication therapy outcomes and provides a foundation for specialization in specific areas of pharmacy practice; participation in the education of patients, other healthcare providers, and future pharmacists; conduct of research and other scholarly activity; and provision of service and leadership to the community.” The continual assessment and use of that assessment for the improvement of individual faculty, courses, programs and entire curricula is essential. Support for these activities is stated in the AACP policy “AACP supports and encourages the implementation of on-going program assessment processes at member institutions for the purpose of enhancing the quality of educational programs and student services approved by our House of Delegates in 2004. This assessment process also addresses a significant public policy discussion regarding the value of higher education in light of continually increasing tuition and education costs. Scholarly teaching and the study of effective education approaches are both important contributions of our faculty to the assurance of public health.