The Pharmaceutical Journal
Vol 268 No 7196 p624-625
4 May 2002

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Health Services Research and Pharmacy Practice summary

Debate centres on whether pharmacy practice research has enough legs

A motion that research has little influence on the development of pharmacy practice was the contentious topic debated at this year's Health Services Research and Pharmacy Practice conference.

Proposing the motion, Rob Pocock (MEL Research, Aston) argued that at present, practice research was wobbling about on one leg. It would continue to have limited influence unless it started to grow two more. "Pharmacy practice research is limited. It would be stronger with three legs. Adding research into policy, and the commercial imperative would make it much more effective."

He set out three factors that would influence getting research into practice. They were: Will the Government let it happen? Do pharmacists want to do it? Does it actually work?

To date, pharmacy practice research had taken the third factor as the most important one. But in fact the first two had much more influence on events.

"The real truth is that public service decisions are not rational and positivist. I think we practice researchers have a little influence, but not much. To have more influence, we need to understand political and commercial decision-making," said Mr Pocock.

The third research leg was really important because there was much more to understand about the commercial side of pharmacy practice and how this influenced the uptake of new services, or ways of working.

"Do practising pharmacists want to do it? We often forget that one," said Mr Pocock. "We have to get clearer insight into what motivates practising community pharmacists, their attitudes and their aspirations. The question of whether patients are healthier as a result of what we do is increasingly our focus. But the reality is that policy, and what pharmacists in business do, are both more dominant influences."

Speaking against the motion, Professor Clare Mackie (Robert Gordon University, Aberdeen) said: "To influence means to serve, to make change, to modify. The motion is dismissive. It is saying that we have no role. I am not saying research has had a major influence. Maybe one day it will. But we must recognise the contribution it has made to pharmacy practice."

As a student 20 years ago, she had been highly motivated by Gerry Shulman's work on patient medication records. Starting her preregistration training, she had been surprised to find that they did not exist in her pharmacy. She wrote to Mr Schulman and, with his advice, she set up a system and subsequently visited a large number of housebound patients. Some time later, one of the local GPs retired. His replacement found himself in the same situation as she had been: no written patient records. But his patients told him not to worry because "Clare's got my records". So he came to see her and asked if they could share them.

Leading edge practitioners were important catalysts for change. Researchers then provided the evaluation needed to sustain practice.

Seconding the motion Dr Jill Jesson (Aston university, Birmingham) reminded the audience that pharmacy practice research was based in the real world, which was complicated.

"Medicines management development depends on the commercial environment, or on Department of Health funding. In other words it fits into a political and a commercial timeframe," she said.

In Northern Ireland they had found that it was difficult to motivate pharmacists to deliver medicines management, partly because there was a 33 per cent additional cost.

Sometimes there could be good research evidence, but it had no effect.

In 1990 she had done some work with the Birmingham drug action team on needle exchange pharmacies. She had shown that distribution of services was based on pharmacist willingness, not client need. However, the research had not changed anything because the community drug teams had not really wanted pharmacists involved.

On the other hand, change could happen anyway, no matter what the research found. Her example here was the Department of Health-funded repeat dispensing pilot in Birmingham. This feasibility study had been difficult to manage, with seven pharmacies, five different PMR systems and two GP practices, each with different computer system.

"It was awfully muddled and we could not produce real evidence that the pilot scheme would make cost savings. But repeat dispensing is planned to happen, irrespective of the evidence," said Dr Jesson.

She was sceptical about the delusory rigor of randomised controlled trials in the pharmacy environment. Most practice research was naturalistic and uncontrollable. She believed that research does have a little influence. But change in practice would only happen if policy, commerce, and technical conditions all came together.

Seconding Professor Mackie, Dr Catherine Duggan (Barts and the London NHS Trust) said that national service frameworks promoted pharmacists' roles based on evidence. It was not always the best evidence but it was informing policy, which would ultimately affect practice.

It was not the role of research to control practice. Researchers were there to serve the profession. The motion represented "pharmacy in the dark ages".

After some debate, the motion was lost.