Student Advocacy and Its Impact on Tobacco Cessation Programs

After I first learned about smoking cessation during the respiratory module of Professor Andrew Straw’s class at the Cedarville University School of Pharmacy, I became more aware of patient interest in nicotine replacements at my retail pharmacy and began identifying prescriptions that were suboptimal. Although I learned a great deal in the class, I still wondered how patients could have better, easier access to this type of care. I never envisioned that soon I would be involved in a project that would have a statewide impact or that my efforts would bear tangible results.

This opportunity has come while pursuing my PharmD degree in Ohio, where I have been working at the Center for Pharmacy Innovation and Outcomes at the Cedarville University School of Pharmacy. A few years ago, The Ohio Pharmacist’s Association (OPA) approached the center about developing a smoking cessation training program for pharmacists, and we jumped at the chance to support them. Led by Myriam Shaw Ojeda, PharmD, administrator of an OPA grant from the Ohio Department of Health, we were tasked with helping the association via research, data collection, advertising, and the creation of educational materials.

Like many other states, any patients in Ohio can approach a pharmacist for counseling about medication to stop smoking. The only FDA-approved OTC drug in the United States is nicotine replacement therapy, which is available as a patch, a lozenge, and gum. Because pharmacists are one of the most accessible health care providers, we are trained in medication selection and in how to counsel patients who wish to stop smoking.^1,2 Often, this service is provided without incentive for the pharmacist, so it can be difficult for them to advertise, provide, or enhance the service. Our team quickly addressed this challenge by initiating data collection, media production, and educational resources aimed at supporting pharmacists to enhance their provision of care.

With few data on the subject, there were many questions we had to answer: How often do pharmacists offer tobacco cessation services? How well does the profession as a whole do in terms of cessation rates? How have pharmacies used collaborative practice agreements in this area? With these questions as a starting point, a classmate and I began to search the literature and create standardized surveys for distribution to community pharmacists across Ohio.

Soon, the pieces began to fall into place. The surgeon general’s 2020 update on smoking cessation provided excellent guidance. Studies gave us datasets from programs that offered pharmacists payment-based incentives and showed that the impact of pharmacists on cessation rates was similar to that of other professionals. Our survey determined that most Ohio pharmacies sought out patients and provided a full range of care, from product selection to counseling about medication and quitting.

In addition, a portion of our OPA grant was set aside to create educational modules for pharmacists on this topic. The Cedarville pharmacy faculty developed a training program on smoking cessation that is now available on the website of the Ohio Pharmacists’ Association. This 3-part series was aimed specifically at community pharmacists and focuses on the essentials of a cessation plan, a review of pharmacologic cessation agents, and an overview of practical implementation strategies. To build awareness of this resource, the team created informational materials, media content, and various types of advertising.

For the most part, the projects that health care professionals pursue do not exist in isolation. At every step, our efforts are informed and leveraged with a bigger goal in mind: taking better care of patients and advocating for the profession. This project was no different; it went on to impact the role of pharmacists at the state level and was cited as evidence in favor of increasing Ohio’s budget to promote higher smoking cessation rates. Little by little, the road toward state and federal recognition as providers is being paved through the diligent work of pharmacists caring for and seeking to care for patients in new ways. Data are essential to advocacy, but so is providing excellent care, looking to improve, and not accepting arbitrary obstacles that impede our ability to serve patients. What we end up doing may not look like conventional pharmacy work, but every small interaction we have with the community has an even bigger impact on our patients.

The opportunities I have encountered during my time as a graduate student have served as a launchpad to my career. For many, a project like the one with OPA may sound far off, too good to be true, or perhaps even daunting. Maybe you find yourself a victim of imposter syndrome, always worried that you don’t know enough, need more training, or must watch someone else do it first before you feel qualified. What a wonderful challenge to overcome! The work must start somewhere, and assuming you possess basic pharmacy skills, there are conventional and unconventional roles you can pursue if you develop personal skills and talents beyond the clinical ones.

Think of an unanswered question you had from a rotation or ask your faculty about behind-the-scenes efforts going on at your school. Is there something—large or small—you can help with? It just might be the beginning of something that ends up having a great impact.

Matt Merical is a fourth-year pharmacy student at Cedarville University School of Pharmacy.

Andrew Straw, PharmD, BCADM, is an associate professor of pharmacy practice and vice chair at Cedarville University.

References

1. Provider status. National Community Pharmacists Association. Accessed March 15, 2022. https://ncpa.org/ provider-status

2. Valliant SN, Burbage SC, Pathak S, et al. Pharmacists as accessible health care providers: quantifying the opportunity. J Manag Care Spec Pharm. 2022;28(1):85-90. doi:10.18553/jmcp.2022.28.1.85