Speaking at a symposium on evidence-based pharmacy on September 9, Dr SUE AMBLER (head of practice research and development, Royal Pharmaceutical Society) emphasised the importance of practice research in informing service delivery and the development of practical policy in pharmacy.
The Society had been active in this area with the work of the Getting Research into Pharmacy Practice (GRIPP) group, and had recently published a report (PJ, September 4, p342). Key considerations of GRIPP's work had included the problems of busy professionals in reading and accessing relevant scientific journals which could supply the evidence on which to base practice, and the group had suggested that summaries of relevant papers be made available on the Society's web page and in key pharmacy journals, she said. Connection to the NHSnet and the national electronic library for health would also be important.
Another issue for pharmacy was the sale of non-prescription medicines and alternative therapies, for which efficacy in the traditional biomedical model remained unproven. However, these products occupied a specific niche in self care, and the role of the pharmacist in encouraging their appropriate use and acting as a facilitator of decision making among the lay public was an important consideration, rather than the efficacy of the product per se.
Professor PETER NOYCE (professor of pharmacy practice, school of pharmacy and pharmaceutical sciences, University of Manchester) discussed the development of evidence for evidence-based practice. In assembling evidence there was a tendency in pharmacy to rush into data collection before evaluating the existing literature, and critical review of studies was vital.
Describing research at the school of pharmacy in Manchester on consumer behaviour in pharmacies, Professor Noyce said that a preliminary study in 18 pharmacies had shown different patterns of presentation for different conditions (eg, hay fever, vaginal thrush, red eye, cystitis and acne) throughout the week. This was not surprising, he said, but such studies could identify issues such as who were the consumers and why they used pharmacies.
Further studies had looked at the advice accompanying the sale of recently deregulated products and the staff involved in providing advice in pharmacies. Again, both showed substantial variation. Advice given with specific products varied with the pharmacist's perceived risk of using that product. Thus 73 per cent of pharmacists in the study gave dosage instructions on sodium cromoglycate but only 4 per cent gave dosage advice on ibuprofen.
Despite these differences in practice, the important question to ask was: "Is the practice appropriate?" and a generic instrument had been developed at Manchester for determining the appropriateness of advice giving in community pharmacy. Comprising issues such as general communication skills, information gathered, rational content of advice, rational product choice and referral, the instrument had been tested for validity (by 500 pharmacists) and reliability (by a further 345 pharmacists). Validity was generally rated as good, but the reliability of the instrument was open to question,suggesting that pharmacists might not be consistent in what they believed to be appropriate advice.
In another study, the feasibility of transferring management of self-limiting acute illness from GPs to community pharmacists was explored. Twelve conditions (including coughs, colds, constipation, diarrhoea and hay fever) were explored for transfer, and as part of this process, the study had demonstrated that there were differences in the patterns of people's usage of GPs and community pharmacists for treatment of these conditions. In community pharmacy, cough, hay fever and headache represented the most common presentations and while cough and hay fever were also in the top three presentations in general practice, headache was replaced by sore throat.
Moreover, in community pharmacy, the "top three" represented a smaller proportion of the total presentations than was the case in general practice, indicating that community pharmacists were presented with a much wider range of acute self limiting conditions than GPs. GPs had 6.3 contacts per 1,000 people (with acute, self-limiting illness) per week and community pharmacies had 8.0 per 1,000. This gave an indication of both the potential size of the transfer of this work and the potential impact of the transfer on both general practice and community pharmacy.