Our literature review found few empirical studies that directly investigated the relationship between college/school of pharmacy affiliation and pharmacy innovations and practice change. For example, in an exploratory study of 6 independent community pharmacies, regular interaction with practice change advocates such as colleges/schools of pharmacy was a key factor to support practice change.19
While this study was useful in identifying key facilitators to practice change, their findings had limited generalizability as the data were collected from 6 selected independent community pharmacies.19
The second study examined factors associated with the provision of pharmaceutical care services by surveying 2,048 pharmacies.20
Pharmaceutical care services were more frequently offered by university-affiliated pharmacies than non-affiliated pharmacies.20
Since both studies were exploratory in nature, they provided limited explanations as to why and how school affiliation was associated with practice innovations.
Building on these studies, we used Social Network Theory to provide a possible explanation for why, when controlling for general pharmacy characteristics, pharmacies affiliated with college/schools of pharmacy were more involved in public health activities than their non-affiliated counterparts. This theory suggests that social connections with pharmacy colleges/schools allow affiliated community pharmacies to gain new knowledge and exposure to new opportunities. Learning about new opportunities may prompt these pharmacies to obtain competencies that contribute to their practice advancement in the area of public health activities. This, in turn, leads us to argue that pharmacy colleges/schools should serve as change agents by facilitating the diffusion of public health activities among community pharmacies.21
To accomplish this, colleges and schools should introduce innovative ideas in community pharmacies, assist practitioners in developing a need for change, help practitioners translate intent to change into action, and stabilize the adoption of new practices.21
Relationships developed through network connections between community pharmacies and pharmacy colleges/schools are mutually beneficial. For example, community pharmacies that serve as experiential education sites may learn new ideas from preceptor training programs offered by colleges/schools and subsequently develop their competencies to build competitive advantage. Benefits for the college/school of pharmacy result when students gain experiences during their experiential education and ultimately are able to achieve the outcomes at the level specified by CAPE.3
Public health-related variables were added to the model; The effects of college/school affiliation diminished. This was true for all selected public health activities except vaccine distribution. These findings do not contradict our previous explanations of the relationship between college/school and pharmacy involvement in public health activities; instead, they provide additional insights into the importance of social networks. First, the findings emphasized the importance of having at least 1 staff pharmacist who was trained in immunization delivery or emergency preparedness and response. Through connections with a college/school of pharmacy, staff pharmacists may have been exposed to new opportunities and thus sought formal training to advance their practice sites. We recommend that to facilitate pharmacy involvement in public health activities colleges/school of pharmacy offer training programs in immunization delivery and emergency preparedness and response for community pharmacies on a regular basis. Second, another significant factor included in the analysis was the degree of perceived support for public health activities; community pharmacies were more likely to participate in public health activities if they perceived a greater degree of support from various groups, including physicians and clinics, health departments, employing organizations, and the state board of pharmacy. Similar to the explanation given above for affiliation with a college/school of pharmacy, network connections between community pharmacies and these groups may help facilitate the implementation of public health activities. For example, for pharmacies to provide in-house immunization services, state boards of pharmacy need to grant or recognize authority for pharmacists in their states to administer vaccines, employing organizations and supervisors need to provide support for immunization activities, and physicians need to provide support by referring patients to and/or entering into collaborative practice agreements with community pharmacies. Without such supports, community pharmacies cannot engage in successful public health activities. For this reason, we also recommend that colleges/schools of pharmacy communicate with these groups regarding how pharmacists and pharmacies can help to promote public health.
Our study uses Social Network Theory to offer one explanation for the relationships between affiliation with a college/school of pharmacy and pharmacies involvement in public health activities. Since a key limitation of this study is its use of cross-sectional data, causal effects cannot be established and at least 2 alternative explanations for these findings should be noted. First, pharmacy involvement in public health could facilitate affiliation with a college/school of pharmacy. That is, pharmacies that are involved in public health may be attractive to colleges/schools of pharmacy, prompting the colleges/schools to seek out these pharmacies and ask to collaborate with them, for example, by serving as experiential education sites or participating in a practice-based research network. A second alternative explanation for our results is that the significant relationship between affiliation with a pharmacy college/school and pharmacy involvement in public health activities was a result of a spurious effect. That is, affiliation may have had no causal connection with public health involvement; instead both variables could have been caused by a third factor, such as being an innovative practitioner. For example, an innovative practitioner might both affiliate with a pharmacy college/school and provide public health-related services. Since our study could not establish causal effect, future research should examine processes that could further explain the relationship between college/school of pharmacy affiliation and pharmacy involvement in public health or other innovations. A study of the processes in which pharmacy schools attract and collaborate with experiential education sites could provide important insights into research questions such as: How did connection between the pharmacy and the college/school originate? What characteristics attracted the college/school to the pharmacy and/or the pharmacy to the college/school? What types of assistance do experiential education sites receive from colleges/schools of pharmacy and what effects do these have? And what are mechanisms used by the college/school of pharmacy to advance experiential education sites?
Our study shows that affiliation with colleges/schools was positively associated with community pharmacies' involvement in public health activities. We recognize that the nature of college/school affiliation may differ across participating pharmacies; for example, some affiliated pharmacies serve as experiential education sites while others serve as practice-based research sites. Therefore, future research should address the following questions: What is the nature and strength of college/school affiliation(s) in relation to pharmacy involvement in public health activities or other innovative practices? How do different types of college/school affiliation influence pharmacy involvement in public health activities or innovative practices? How might the influence of affiliation be enhanced?
Experiential education sites that engage in public health activities are needed to provide adequate opportunities for students to actively participate in pharmacy-based public health activities and acquire in-depth experiences in public health activities. College/school of pharmacy goals are to ensure that student learning achieves the CAPE outcomes and prepare them for expanded public health roles. Because little is known about how best to improve student learning outcomes related to public health, colleges and schools of pharmacy should reexamine their curricula to ensure that competencies in public health are adequately achieved to prepare future pharmacists.22
Future research should explore the following possible research questions: To what extent do students engage in public health activities during pharmacy practice experiences? What mechanisms used in experiential education sites improve student learning outcomes? And what methods can best prepare students to carry out key public health activities?
Beyond reliance on cross-sectional data, certain limitations need to be considered when interpreting and generalizing the results presented here. First, key informants may have been subject to recall errors. We did not believe this was a problem, as key informants were able to access pharmacy records while being interviewed. Second, this study investigated the effects of only particular factors; it did not evaluate all factors that may be associated with pharmacy involvement in public health activities. Lastly, the study may have limited generalizability to nonrespondents, other states beyond the 17 study states, other public health activities, and pharmacy practice innovations.