Pharmacy practice research has an impact on each and every pharmacist

In this first in a series of three articles on research, Rachel Roberts and Erika Kennington, research strategy co-ordinators for the Royal Pharmaceutical Society, explains that research is not just for academics but is about real issues that affect patients and pharmacists

As part of its 100-day commitments, the new professional body for pharmacy has made a commitment to advance the science and practice research base for pharmacy and healthcare. Most readers may believe that this commitment does not apply to them specifically; that research is something done by academics whose findings may or may not eventually reach pharmacists working in the “real world”.

Although the value of academic research cannot be understated, it is important to realise that a great deal of research is conducted at grass roots level and the findings of such research can often impact on pharmacy practitioners in all settings.

This is the first in a series of three articles intended to illustrate how research is already part of everyday pharmacy practice. We want to show how individual practitioners can engage more fully in research so that they can:

• Strengthen the services they provide
• Build the evidence base for developing and commissioning new services
• Improve patient care
• Contribute to the knowledge base within health service research more widely
• Gain both professionally and personally in the process

Through these articles we wish to engender a culture change by which all pharmacists will identify research as a core part of their normal daily practice. Research is about real issues that affect pharmacists and the patients they see every day.

Secondly, we wish to emphasise the need for increased pharmacy practice research in order to meet the policy aspirations for pharmacy throughout Britain and to lead pharmacy practice in the direction pharmacists wish to take it.

Thirdly, we recognise that many pharmacists who want to become involved in research do not know where to start, what to expect, or where to find the sources of support and expertise they need.

The Royal Pharmaceutical Society science and research team is developing research support and guidance material designed specifically for pharmacy practitioners. These are due to be launched in May (2010) and will be freely available to all members online and as hard copies via local practice forums and the new professional body’s information and advisory service.

There is often a great deal of debate about what research is and what it is not. These debates can include discussion around the ways in which audit differs from research or on the differences between research and service evaluation. Our intention here is not to focus on these debates but instead to provide a broad definition of research that pharmacists can recognise as being applicable to their daily practice and can begin engaging with.

This does not mean that we wish to provide a “dumbed down” version of research or that we want to encourage pharmacists to engage in research that will not stand up to scrutiny. Research must always be systematic, objective and, ideally, free of biases.

However, there is overlap between audit, service evaluation and research and we want to highlight these links, for example, by showing how audit can be viewed as a stepping stone to research and how data collected as part of a local service evaluation can be further developed to inform a more robust and generalisable study.

A useful definition of pharmacy practice research has been provided by the King’s Fund (1997), which describes it as “research which attempts to inform and understand pharmacy and the way in which it is practised, in order to support the objectives of pharmacy practice and to ensure that pharmacists’ knowledge and skills are used to best effect in solving the problems of the health service and meeting the health needs of the population”.¹

This broad definition allows us to view pharmacy practice research as something that can encompass both large-scale, multi-site projects and small-scale projects undertaken to improve understanding of local or practice-specific issues. Indeed, research is not something that only happens in universities.

Research methods are increasingly being used to measure and understand local health needs and to assess the effectiveness of services in meeting those needs. A good understanding of these issues can give focus to local campaigns for change and can act as the driver behind commissioning new services, in terms of justifying both the need for, and the effectiveness and value of these services.

Research within normal practice

Patients are at the heart of pharmacy and all pharmacy professionals strive to improve the quality of their existing services and to develop new ones that benefit their patients. Often this is hampered by a lack of easily accessible evidence both locally — within primary care trusts, local health boards and strategic health authorities — and nationally in the form of published evidence that informs national guidelines around best practice.

Collecting and sharing this evidence is one of the roles that pharmacists need to adopt in the interests of their patients, their practice and their profession. Often what is needed is local evidence that illustrates there is a need for new services or for services to be delivered in a different way.

Pharmacists in all settings can engage more fully in research in order to improve patient outcomes and further develop the profession. Research is needed in order to inform workforce development, education, practice and commissioning decisions.

The accessibility of community pharmacists to large sectors of the population, including those typically defined as “hard to reach”, is one of pharmacy’s strengths. As the largest sector within pharmacy,² community pharmacists can make a significant contribution to future research initiatives. These initiatives can take the form of small scale local projects that seek to identify patient need or to evaluate the effectiveness of new services.

Not only can this benefit the health of the local population but, if shared appropriately, the data and findings generated could be used to inform a larger study, ultimately influencing wider service development and the development of pharmacy.

Pharmacy research should not be restricted only to community settings. As a group, hospital pharmacists are becoming more engaged with research as part of their career development — keeping up to date with, and contributing to, research and developments, often in collaboration with medical staff and colleagues in the pharmaceutical industry. In addition, portfolio working is most prevalent among pharmacists working in primary care organisations.²

Coupled with their involvement in primary care interventions, pharmaceutical needs assessment and the broader research and development agenda locally, primary care pharmacists represent a key group within pharmacy that could make a large impact on both building the evidence base and local capacity building.

In this series, we aim to show that pharmacists can build on the activities they already carry out by:

• Conducting research that explores issues identified through regular audit
• Using research methods to identify local needs that incorporate and build on pharmaceutical needs assessments
• Developing services and evaluating them in terms of clinical outcomes, patient satisfaction and value for money

Within pharmacy, the potential areas of research are wide and varied: surveying patients, weight management, patients’ owed medicines and targeted medicines use reviews. It is striking just how closely the purpose of many research projects matches the needs of pharmacy businesses.³

Developing the pharmacy profession

The Department of Health’s 2008 pharmacy White Paper states that “in order for pharmacy to become an established voice in primary care and to be recognised as a key and essential element in the delivery of clinical services, a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed”.⁴

Improving public health and reducing health inequalities is a key aim for each of the home countries, and against this policy of the UK agenda it is important that we know where pharmacy can contribute to improving public health. Indeed, the UK strategies for pharmacy all indicate that research underpinning both clinical and commissioning decisions needs to be strengthened.

In order to meet these policy aspirations and to develop pharmacy practice in the direction most pharmacists wish it to take, there is an acute need to demonstrate the quality and outcomes of pharmacy service provision through research, and to ensure that findings are disseminated through publication in academic and professional journals, through conference presentations and through professional networks.

A report reviewing the literature on the contribution of community pharmacy to improving public health describes “the dearth of UK studies in many key areas” as “a matter for concern”.⁵ It contrasts the situation in the UK with that in Canada and Australia, where there is “a substantial evidence base to underpin proposed new community pharmacy services”⁵

What is needed is more research in order to provide “a greater understanding of the unique characteristics of pharmacy-based interventions”.⁶

Evaluation of the new community pharmacy contractual framework for England and Wales highlighted that many PCOs wanted evidence of the benefit of new services such as MURs.⁷

Christine Bond, external sponsor for the science and practice research stream of the Royal Pharmaceutical Society, said: “The recent changes in the professional role of pharmacy, which have added a clinical cognitive perspective to the traditional dispensing and supply role, make appropriate use of pharmacists’ detailed knowledge of medicines and their expertise in interacting with patients.

“These new roles have built on both small and large scale projects demonstrating the contribution of pharmacy to better patient care and have evolved in line with service need. To maintain this momentum and ensure pharmacy continues to take its place in a constantly changing health care environment, research is necessary to identify areas of sub optimal health care and to demonstrate how pharmacy can provide solutions.”

In order to build the evidence base needed to develop the pharmacy profession, collaborative working is needed between governments, contract negotiators, universities and the professional body.⁵ In essence, a combination of a bottom-up and top-down approach is required.

Catherine Duggan, director of professional support and development at the Society, said: “Research is central to the profession and its development. Pharmacists’ play a key role in delivering high quality, patient-centred care and we need to evidence these interventions so that patients and the public benefit further from our unique skills and expertise. For this to happen, engagement in research across all sectors, in a variety of ways, is required.

“I hope that these articles, and the research support and guidance materials being developed by the science and research team, will encourage more pharmacists to increase their involvement.”

References

1.    Mays N. A new age for pharmacy practice research: promoting evidence-based practice in pharmacy. London: Royal Pharmaceutical Society, 1997.

2.    Seston L, Hassell K. Pharmacy workforce census 2008: main findings (PDF 880K) (accessed 8 March 2010).

3.    Atkin G. The rewards of pharmacy-based research (accessed 8 March 2010).

4.    Department of Health. Pharmacy in England: building on strengths, delivering the future. London: The Department, 2008.

5.    Anderson C, Blenkinsopp A, Armstrong M. The contribution of community pharmacy to improving the public’s health: literature review update 2004–07. London: PHLink, 2008.

6.    Anderson C, Blenkinsopp A, Armstrong M. Summary report of the literature review 1990–2007. London: PHLink, 2008.

7.    Blenkinsopp A, Bond C, Celino G, Inch J, Gray N. National evaluation of the new community pharmacy contract. London: Royal Pharmaceutical Society, 2007.