The Pharmaceutical Journal Vol 265 No 7127 p893
December 16, 2000 Broad Spectrum

Broad Spectrum

Evidence-based medicine -is pharmacy keeping up?

Evidence-based medicine (EBM) has been described as the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients.¹ Over the past few years, the National Health Service has been driving for the reduction of health inequalities, an improvement in professional standards and the standardisation and optimisation of care.² However, given the huge amount of research information available, standardisation of research findings is not a mean achievement. It is therefore increasingly important that health care professionals know how to access, interpret and apply the principals of evidence-based medicine.
The reference to "health care professionals" above does not in any way exclude pharmacists. Over the years, pharmacy, as a profession, has expanded from packaging and dispensing medicines to working with other health care professionals in the direct provision of care. The concept of pharmaceutical care has placed pharmacists into a patient-centred practice that identifies, resolves, and prevents drug-related problems. After accepting this role, pharmacists must keep up with the ever accelerating changes in health care provision. One such evolution is the concept of evidence-based medicine. Pharmacists must keep up to date with the available evidence and learn the skills necessary to participate in evidence-based medicine (or evidence-based pharmacy). The profession must be able to demonstrate that all pharmacists are providing the best possible care for patients and support for their professional colleagues.
In 1999, the Working Group on Getting Research into Pharmacy Practice³ recommended that pharmacists be aware of current evidence and how to apply it to their practice. Despite these recommendations, there is a growing body of evidence to suggest that pharmacists are often not making full use of the available research evidence when making decisions about individual patients and their medicines.⁴ A quick browse at the Cochrane Library, for example, would quickly give an answer as to how much pharmacists are keeping up with the synthesis of evidence or are being targeted as recipients of such evidence. An important message to come out of this analysis is that if pharmacists do not do it for themselves then no one is going to do it for them.
As the first, and sometimes the only, health care professional to be consulted, as well as the last to be seen by patients before taking their medicines, pharmacists are strategically positioned in relation to illness prevention and the safe, effective and appropriate use of medicines. In these areas, and in certain areas such as therapeutics and patient counselling, pharmacists are ideally best placed to spearhead the process of gathering evidence. In a review to evaluate the concepts of evidence-based medicine in pharmacotherapy, Etminan⁵ failed to pick up any article intended for pharmacists although clinical pharmacists may need to use evidence-based concepts more than any other professional when making pharmacotherapeutic decisions.
Historically it can be argued that there is much about the "culture" of pharmacy which is supportive of evidence-based practice. For example, the profession strongly supports the value of "keeping abreast of pharmaceutical knowledge", as evidenced by continuing professional development. It is hardly surprising, therefore, that the vast majority of individual pharmacists have no difficulty in recognising the importance of research evidence to their work.⁴ If pharmacists accept the concept of evidence-based medicine, then the task of getting the momentum should not be a major issue. To start with, leaders in the area are needed, such as the evidence-based medicine group at Aston University, to continue promoting the concept and to make the benefits clear. Other strategies that could be used might include:
•The teaching of evidence-based medicine in pharmacy training and in continuing education
•The involvement of more pharmacists in such groups as the Cochrane Collaboration (At a recently held Cochrane Collaboration Colloquium, the number of pharmacy-initiated or pharmacy-
directed projects was disappointingly low.)
•More collaborative work with other health care groups involved in evidence gathering (eg, forums such as the Health Service Research and Pharmacy Practice groups can be useful)

Among some of the concerns about evidence-based medicine 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. Ideally, however, the practice of both means integrating individual clinical expertise with the best available external clinical evidence, and applying all of that at the individual patient level.
To conclude, the onus is on pharmacists themselves to realise the importance of the role they have, not only in using evidence but also in producing it. Pharmacy as a profession has been moving on and it is its ability to manoeuvre itself into new roles that has seen its survival as an integral part of the health care system. Undoubtedly it is this ability to manoeuvre that will determine the future of pharmacy.

Lloyd Matowe works on evidence-based medicine issues in the health service research unit at Aberdeen university.