Pharmacy practice research: challenges and opportunities

Abstract

It could be argued that pharmacy practice research currently has a lower profile than research undertaken by other professions. This is somewhat surprising at a time when governments are advocating greater integration of pharmacy into mainstream health care delivery, particularly in primary care. Although pharmacy practice research has recently attracted larger grants, and some robust evidence is emerging, there remains a paucity of knowledge on the quality of services delivered by pharmacists and a lack of evidence in terms of patient outcomes and value for money. This lack of evidence on outcomes is highlighted in recent policy documents for pharmacy in England and in the Darzi next stage review which emphasises the importance of quality of services and of integrated partnerships and brings sharply into focus the need for rigorous pharmacy practice research on a larger scale. This presents both an opportunity and a challenge for researchers. Pharmacy faces an uncertain future, with advanced practice of all health care professions, a stronger emphasis on developing and using evidence in practice and competing priorities from all professions for limited research resources, there is now, more than ever, a need for a structured and strategic national programme for research. This will require pharmacists leading the way in identifying key research priorities across the UK that are commensurate with the aspirations of policy. At the same time consideration must be given to both integrating evidence into practice and building research capacity in pharmacy; a fundamental requirement to the development of a professional evidence base and to a long term strategic view of research.

It could be argued that pharmacy practice research does not share the high profile that other research within the primary care environment enjoys. However, the ever-growing focus on increased health provision in the community (Department of Health, 2006), more collaborative working in primary and community care and a move towards integrated pathways (Department of Health, 2008a) plus the contractual framework for community pharmacy (CFCP) in England and Wales (Department of Health, 2005) provide a focus, and a demonstrable need, for such research.

Introduced in 2005 the CFCP opened the door for a range of innovative service developments, which are leading to a demand for pharmacy services to integrate with mainstream health care pathways.

The NHS Next Stage Review final report in its Vision for primary and community care (Department of Health, 2008b) emphasizes the importance of an integrated partnership approach to underpin high-quality care and health improvement. The report also refers to the paucity of knowledge, notably in community health services where little is known about potential variations in quality of services because varied comparable information about services and health outcomes is collected.

This lack of information on outcomes reinforces the need for health services research in pharmacy, highlighted in the recently published White Paper on pharmacy in England (Department of Health, 2008c), which emphasizes future commissioning decisions will need to be based on sound evidence of improved outcomes. However, the paper pointed out that the evidence base demonstrating how pharmacy delivers effective, high quality and value-for-money-services is, at best, patchy. It went on to make a number of proposals to support pharmacy research, including the introduction of an expert panel to inform research priorities and building research capacity within pharmacy.

The White Paper acknowledged the contribution already made to this area of research by the Pharmacy Practice Research Trust (the Trust). The Trust has been building pharmacy practice research capacity since it was established as an independent research charity by the Royal Pharmaceutical Society of GB (RPSGB) in 1999. It has a broad remit to support and develop a research evidence base for pharmacy and to support research capacity. More than £1.25m has been invested in research: 30% supporting capacity building in pharmacy practice research and 70% on commissioned research. Furthermore, the Trust is committed to disseminating the results of its commissioned research to ensure that the knowledge is used to inform evidence-based changes to policy, practices and services.

Through its over-arching research programme, Medicines and People, the Trust is committed to creating knowledge that

ensures that the right person get the right medicine at the right time in a manner that meets the needs and expectations of the individual that will take it.

The Medicines and People Programme addresses five broad themes:

• • The health of the public and the place of medicines.

• • The right medicine for the right patient; preventing medication errors.

• • Pharmacy: a profession fit for purpose (workforce, education and ethics).

• • Medicines and the health of communities.

• • Science, technology and medicines.

Over the last three years the Trust has been overseeing a rolling programme of research funded by a grant from the RPSGB, which focussed on pharmacy, a profession fit for purpose and covered workforce, education and ethics. Examples of two major studies commissioned as part of this programme include the National Evaluation of the Community Pharmacy Contract (Blenkinsopp et al., 2007) led by Professor Alison Blenkinsopp and a five-year longitudinal cohort study into pharmacy careers (Willis and Hassell, 2007) due to be completed in 2009.

2008 has seen the start of a new commissioning programme, funded with a grant from the Pharmaceutical Trust for Educational and Charitable Objects (PTECO), that builds on the findings from earlier research. This will include research into professionalism in pharmacy practice and the introduction of multidisciplinary service development grants that support research in public health or in the care of patients with long-term conditions in terms of patient outcomes and economic evaluation.

To further build research capacity, the development of new partnerships with academia in the field of social science through collaborative Arts and Humanities Research Council Collaborative Doctoral Awards or Economic and Social Research Council CASE Studentships are underway. These new awards reflect the need to imbed pharmacy practice within the wider health and social care research agenda.

Building pharmacy practice research capacity is fundamental and the Trust offers an annual programme of practice research awards and research training bursaries, which is supported in the main with grants from the Leverhulme Trade Charities Trust. The Galen Award and the Sir Hugh Linstead Fellowship are funded grants intended to support practitioners in developing expertise in research and newly qualified researchers to establish research careers. The Bursary Scheme is intended to support community pharmacists who have an interest in developing their skills in conducting research relating to everyday practice from conducting small-scale projects to undertaking Masters-level education.

Exposure to the influence of research on practice, or development of an interest in a specific disease group, or group of patients, all exert external influences on pharmacists during the course of their working lives. For those who wish to change direction in their career, or add new dimensions to an existing career, the ability to do so can only benefit the profession, bringing knowledge from one sector to bear on another. For some, realising the potential of using evidence in practice, increasing knowledge towards specialist and advanced practice status and gaining academic qualifications to move into research and teaching could be a real option, but one that is pursued far too infrequently in pharmacy (Sheldrake and Allen, 2007).

The Trust also provides support for those new to research, recognizing that it is important to maintain momentum and interest, especially in the early stages of planning and development. There can be a feeling of isolation from the research community, and to help strengthen the important link between academia and practice, the Trust has launched a one-to-one mentoring scheme. This will provide the opportunity to help and support pharmacists in building the evidence-base for their practice, encourage the future academic workforce and extend potential collaborations outside academia.

Pharmacy practice research faces a challenging future. The advanced practice of all health professionals, a stronger emphasis on developing an evidence-base and competing priorities for limited research resources all point to the need for a structured national programme for pharmacy research such as Australia’s Community Pharmacy Agreement – Research and Development Program (Pharmacy Guild of Australia, 2008).

Plans to establish an independent regulator and a separate professional body for pharmacy is recognized by Nigel Clarke in his recent inquiry report as a threat to the support for research currently provided (Clarke, 2008). The need for a UK-wide research strategy such as that developed in Australia together with sustainable investment in projects, programmes and capacity building in pharmacy which will contribute to the NHS requirement for evidence-based practice, has never been greater.