The centre for evidence-based pharmacotherapy, now in the school of life and health sciences, Aston University, was set up in July, 1995, and carries out research in the methodology of medicines assessment, pharmaco-epidemiology and pharmacoeconomics. Pamela Mason went to Aston to find out about the work of the centre
Evidence-based pharmacotherapy is the "systematic, explicit and judicious use of best evidence in making decisions about drug treatments for patients both at individual and population (policy) levels." This is the definition of Professor Alain Li Wan Po (director of the centre for evidence-based pharmacotherapy at Aston). Including economic evaluation of drugs in addition to risk-benefit considerations, evidence-based pharmacotherapy aims to ensure that patients receive the most cost-effective therapy using the best available evidence.
The emphasis on pharmaceutical agents, without including other aspects of health care delivery such as surgery and diagnosis, means that evidence-based pharmacotherapy is essentially a subdivision of evidence-based medicine. But both concepts, if adopted properly, demand exactly the same approach - one that is systematic and rigorous in appraising the evidence and, most importantly, applying the evidence to individual patients.
One of the concerns about evidence-based medicine - and by extension, evidence-based pharmacotherapy, too - has been that it relies entirely on evidence from clinical trials and population studies, without taking into account either the clinical expertise of the practitioner or factors relating to individual patients. However, Professor Li Wan Po insists that the practice of both means integrating individual clinical expertise with the best available external clinical evidence from systematic research, and applying all of that at the individual patient level.
Neither clinical expertise nor best available external evidence alone is enough. Without clinical expertise, care of patients can easily become tyrannised by evidence, but without current best evidence, practice risks becoming out of date. Moreover, the importance of taking into account patients' preferences, co-morbidities and risk factors should not be underestimated, Professor Li Wan Po says.
The centre for evidence-based pharmacotherapy was set up in July, 1995. Core funding is obtained from the university, with research money coming from the Department of Health and a number of pharmaceutical companies. The work of the centre is to undertake research in the methodology of medicines assessment, pharmacoepidemiology and pharmacoeconomics. Primary reasearch is conducted, too. Current research projects are in the areas of pain relief, glaucoma, dermatology, herbal remedies, psychotropic agents and methodology in evidence-based pharmacotherapy.
The centre works closely with a number of clinical teams and health technology assessment centres, and is keen to establish more research links with other organisations, including hospitals. It has collaborative projects in dermatology, ophthalmology, cardiology, gastroenterology, pain relief, psychiatry, rheumatology and risk assessment.
Active within the Cochrane collaboration, the centre has membership of the editorial team of the dermatology review group and membership of the statistical methods working group and is involved in co-ordination of the pharmaceuticals field. Most recently, the centre has established links with the British National Formulary and Martindale to explore the application of evidence-based pharmacotherapy in those publications, and to set up a new studentship in evidence-based pharmacotherapy methodology at Aston.
The centre leads several projects in risk assessments of drugs with various members of drug regulatory agencies. This is important because, to obtain a product licence, manufacturers have to provide evidence of efficacy - evidence that can only usually be obtained from well designed randomised controlled trials. Such trials are expensive to conduct and it is important to optimise them to ensure that the maximum amount of high quality data is generated. Safety profiles for drugs also have to be provided by the industry and pharmacoepidemiological studies can be used to estimate risk benefit ratios.
The centre is aiming to collaborate with a number of centres specialising in drug adverse reaction monitoring to optimise the quality of the evidence obtained in all these areas.
Teaching and training
Evidence-based pharmacotherapy is now included in the pharmacy undergraduate curriculum and will, within a short period, form one module of the undergraduate programme.
|
Dr Darrin Baines (senior lecturer in health economics, Birmingham University and research associate at the centre for evidence-based pharmacotherapy) running a workshop at the centre |
Although research is the centre's main focus, dissemination of information and promoting the importance of evidence-based pharmacotherapy in practice - both within pharmacy and medicine - is a crucial part of its remit.
Dr Darren Ashcroft (see Panel) is using expertise gained at the centre to tackle clinical problems on the hospital ward. Within the context of current secondary care structures, he thinks that the main area of opportunity for hospital pharmacists in evidence-based pharmacotherapy is at the policy level, for example, in medicines management committees and drug and therapeutics committees.
Professor Li Wan Po recognises that primary care practitioners cannot always find answers to many of the questions that are frequently asked by patients. He is therefore proposing to work with 15 local general practitioners to identify common issues they face on a day-to-day basis. As he also acknowledges, there may be little trial evidence in these areas, and he therefore plans to set up relevant clinical studies to try to find evidence-based answers.
The centre has recently obtained funding to set up a joint Primary Care Research Network in collaboration with Warwick University.
With quality and cost effectiveness in the NHS and the move to clinical governance being high priorities for the government, the agenda for evidence-based pharmacotherapy is set, says Professor Li Wan Po. This is creating enormous opportunities for pharmacists - opportunities that are being reinforced by the knowledge that it is difficult for clinicians to keep up to date and interpret the literature relevant to their practice. "But we need more pharmacists working in this area. If pharmacy embraces this initiative seriously and can demonstrate value for money and improved patient outcomes, even more opportunities will open up for us as a profession. As a centre, we hope to become recognised for the quality of our research and dissemination of information. But above all, what we want is to provide a service to all those practitioners at the sharp end and, ultimately, to the patients for whom they care."
Dr Mason is a pharmacist and freelance writer from Sydenham, South East London
Staff at the centre for evidence-based pharmacotherapy
Dr Darren Ashcroft has a joint post as lecturer and researcher at the centre and as senior pharmacist at Derbyshire Royal infirmary. At the hospital, his job is to implement the clinical governance agenda in pharmacy services and is he using this opportunity to encourage the application of evidence-based pharmacotherapy in everyday hospital practice.
|
