Advocacy Leader in Pharmacy Katrina Azer: ‘From my early career years, I decided to be the change I wished to see’

SnapshotEducation: Bachelor of Pharmacy, Postgraduate Clinical Pharmacy - University of Otago, New ZealandRole/Title:Clinical Consulting PharmacistPharmacy Council of New Zealand BoardFounder - Australasian Precision Medicine AcademyDescribe your journey into the field of pharmacy and what inspired you to take on a leadership role in advocacy.What was a summer job over two summers eventually sparked my interest in the combination of healthcare and medicines and so I pursued a BPharm. A couple of years into pharmacy practice, I started feeling a bit frustrated with the disconnect between the ideal state of what a pharmacist should do and what happens on the frontlines. To put it bluntly, I was over bureaucracy, just like we all are, but some of us don't take ‘this is just the way it is’ for an answer. From my early career years, I decided to be the change I wished to see and to take the lead in advocacy, which eventually led to my current board role. In addition to this, I had a particularly rough time with workplace bullying as an early-career pharmacist, and I decided that since no one else was doing anything about it, I started speaking up about this issue. Eventually, I rallied a group of early-career pharmacists who became an advocacy group and developed the Early Career Pharmacist White Paper with recommendations for society here in New Zealand to make early-career pharmacist wellbeing and career progress a priority.What are some of the most significant challenges you have faced in your advocacy efforts, and how have you overcome them?The fragmentation within the profession itself is probably the most challenging barrier. There is a degree of intraprofessional rivalry between pharmacists such as the one between pharmacy proprietors and employee pharmacists and this is hampering our progress. We need to unite before we can tackle the external forces fighting us.Another challenge stems from a lack of understanding of the role of the pharmacist itself, from the healthcare industry and patients alike, who still see the pharmacist as a shopkeeper or pill counter. We are our best advocates, and the onus is on every pharmacist to preach their role in their community because we must challenge the misconceptions out there to thrive as a profession. I can’t say the above are issues that I have overcome yet, nor do I think I ever will. They require a concerted effort from the whole profession globally, but those who know me will know I am very vocal about these issues, and I think leveraging social media for advocacy is a great way to gain exposure to these challenges and develop professional unity to overcome them.How do you envision the future of pharmacy practice, and what role do you see advocacy playing in shaping that future?As many have said before me, pharmacy is on the cusp of revolution in practice if we leverage the opportunity we have in front of us. With demands on healthcare rising, chronic diseases on the rise and inflation, health systems need health professionals to collaborate for the wellbeing of the patient and aid in reducing healthcare spend while delivering value. Delivering value when it comes to medicine optimization is our realm, and the biggest healthcare dollars are spent on medicines. Now is the time to leverage our medicines expertise combined with precision medicine technologies, AI and telepharmacy to deliver value and cut down on healthcare spend, especially in areas of chronic disease management, which is arguably the biggest cost in healthcare. Advocacy must focus on value-based, outcome-focused healthcare models within the profession, not on the product, because that is not only delivering poor outcomes but is causing immense dissatisfaction in the profession and driving pharmacists away from pharmacy. Pharmacies should become clinical healthcare hubs, especially in rural areas where there is often little medical care. Strong advocacy at a political level is essential to driving this change and increasing awareness of the role pharmacists can play in alleviating healthcare pressures through medication optimization and interprofessional collaboration. Advocacy bodies must tirelessly fight not just for better reimbursements of existing models, but for new models of care that drive collaboration between health professionals and focus on delivering better outcomes, not on the value derived from dispensing medicines.Can you share a success story where your advocacy efforts led to a tangible improvement in pharmacy practice?Between 2018-2020 I had a vision for collaborative practice that enhanced patient outcomes in my local community. I was a community pharmacist back then and I worked next door to some physiotherapists. I saw that we had a large proportion of patients with osteoarthritis, and typically, these patients are on large doses of pain medications, which is contrary to existing research evidence that proves that patients with OA get better outcomes from manual stretch therapy and exercise. I saw an opportunity to prove to healthcare that collaboration between physio and pharmacy improved outcomes for those patients. We initiated a collaborative program delivering medication therapy management and exercise interventions and monitored patients over a 12-month. The program was a success and proved that interdisciplinary collaboration enhanced outcomes and through strong advocacy for the value pharmacists can deliver with a program like this, it was eventually reimbursed by healthcare. It highlighted the impact pharmacists can make in the management of chronic conditions when working alongside other healthcare providers. The interesting thing here is that often when we think about collaborating with other healthcare providers, we think of MDs and not other health professionals in healthcare such as physiotherapists, dietitians, etc. It is important that we identify these patient cohorts in our communities and deliver valuable services to them. Often, we wait until services are reimbursed before we provide them, and I think this is one of our pitfalls. Healthcare policymakers want to see the value of provided and numbers before providing reimbursement, ‘show me the value, I’ll show you the money,’ and this is how we managed to get a new service like this reimbursed and mainstream.What strategies do you find most effective in engaging government and policymakers in discussions about pharmacy-related issues?● Achieving common ground is key–you will find that there is more you agree than disagree on, and highlighting that early on in the conversation achieves mutualunderstanding and a sense of alignment of agendas.● Going forth to speak to them by knowing what their agenda and priorities are beforehand and aligning with their priorities, rather than going in with your own agenda, which does not achieve tangible outcomes.● Understanding what their biggest pain points are, where healthcare is straining them and where pharmacists can add value, similar to how we assisted during the COVID pandemic with vaccinations.What advice would you give to young pharmacy professionals who are passionate about advocacy and want to make a difference in the field?You are the future of this profession. Be the change you wish to see in pharmacy; don't wait for someone else to be your voice. The reality is that it is up to each one of us to own our future and not wait for anyone else to change the paradigm for us.Can you highlight any current or upcoming initiatives that you are particularly excited about in your advocacy work?Advocating for mainstream uptake and implementation of pharmacogenomic testing across the medical discipline. So far, through concerted efforts, there is a single gene panel that is reimbursed, and we are now working with psychiatrists to get mental health reimbursed hopefully in the not-too-distant future. I’m taking a back-to-front approach by equipping pharmacists with the knowledge and tools and increasing awareness that I'm hoping will drive adoption and put pressure on healthcare systems to reimburse testing rather than waiting for reimbursement before implementation, as that not only harms the patient but puts us 10 years behind in terms of evolving practice and meeting changing patient demands.There are two dimensions to this initiative in terms of advocacy. On one hand, I need to advocate for uptake within the pharmacy profession itself because PGx education and adoption in pharmacy are lacking. On the other hand, I need to advocate for healthcare systems to see the value of this for the patient and reimburse it. It is a long haul, but I am excited about it, and even if I die before seeing this change manifest, I will have at least planted the seed of change, so I’ll die happy!What personal qualities or experiences do you believe have been most instrumental in your success as an advocacy leader?● Persistence and patience in negotiation.● Learning to hold on to your vision but knowing when to compromise and reach middle ground.● Knowing that you can't win in healthcare, you can't have what you want all the time orat all sometimes, but more to give and take and find that win-win for all parties involved.● Coming to the table with an open mind-set and listening, being the last to speak after you've heard all sides of an argument—one of my favourite quotes is by Stephen Covey: “Seek first to understand, then be understood.” It’s from his book, The 7 Habits of Highly Effective People, which I can’t recommend enough.Looking back on your career, is there anything you would do differently, or any key lessons you have learned along the way?My career has been tumultuous and challenging. In my first year as an intern pharmacist, I was made to feel like a total failure of a pharmacist and my preceptor didn't want to approve me to attend the final assessment to register as a pharmacist. It turns out the experience was there to shape me for what's to come and make me who I am today. So, I absolutely wouldn't change a thing about my journey; otherwise, I wouldn't land where I am. I appreciate it with all its ups and downs because it led me to my calling. What doesn't kill you truly makes you stronger.What advice would you give to colleagues who want to participate in advocacy efforts or initiatives?To unite in our efforts. Often, there are multiple organizations with the same agenda and it seems a waste of resources to not leverage a united voice to drive change. We need strong voices to drive change and if you feel you have it in you to advocate, then please don’t let anything hold you back. We need strong, resilient leaders in pharmacy, more now than ever before, because pharmacy is at a crossroads. We either leverage the weaknesses of the health system to our advantage or forever stay in our existing frustrating paradigm of practice and miss the opportunity to transform our profession and attract people into it. The choice is ours to make, and the time to act is now.Sherif Guorgui - FIP-Community Pharmacy Section | LinkedIn

Advocacy Leader in Pharmacy Katrina Azer: ‘From my early career years, I decided to be the change I wished to see’

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