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Guild of Healthcare Pharmacists (www.ghp.org.uk)

The GHP pharmacy practice research database — a new resource

The Guild of Healthcare Pharmacists recently announced the launch of a hospital pharmacy practice research database that will be freely available to all pharmacists (see PJ, 20 April, p527). The following article,contributed by the guild, provides further information

More than 1,000 research reports concerned with the value, effectiveness or efficiency of hospital pharmacy services have been identified and catalogued in a study commissioned by the Guild of Healthcare Pharmacists. The database containing the results will soon be freely available through the organisation's website (www.ghp.org.uk). "This resource will make it easier for researchers to check out what has already been done and easier for managers to identify reports of best practice,", said guild president Robert McArtney.

Research is essential

Pharmacy practice research is essential to underpin the pharmacy contribution to an evidence-based health service. Much practice research is undertaken to investigate problems in day-to-day practice and the results are used to improve services. The results of many such studies are not widely publicised and, as a consequence, there is a certain amount of "reinventing of the wheel" when similar projects are repeated on several sites. Another problem is that highly respected journals are often not widely read, so that if work is published in a journal of high academic standing, it may be seen by only a few people. On the other hand, material published in some popular journals may not be easy to find using electronic searches, because the journals are not indexed in Medline. Clearly, hospital pharmacy could benefit greatly if there were a means of bringing together all the available information into a searchable database. Several years ago the guild council set about devising a way to do this.

The method chosen was a commissioned research project. An outline brief was prepared and researchers were invited to bid to undertake the project. Funding was obtained from the pharmaceutical industry. A team comprising Professor Judith Cantrill (professor of medicines usage, evaluation and policy, University of Manchester), Damian Child (principal pharmacist, clinical services, South Manchester University Hospitals NHS Trust) and Dr Jonathan Cooke (director of pharmacy and deputy director of research and development, South Manchester University Hospitals NHS Trust) was commissioned to carry out the project.

The database was developed using systematic search methodology that is, the same approach that is used to compile systematic reviews. The objective of this approach is to identify all published material relating to the topic or question under investigation. In this case the purpose of the search was to identify all reports of studies that measured, demonstrated or evaluated the effectiveness of hospital pharmacy practice. Reports of clinical trials in which a pharmacist had been involved do not fit into this category and were excluded.

The research team searched 13 electronic databases. These included Medline, Embase, Pharmline and the Cochrane library and some less well known databases such as Sigle (System on Grey Literature in Europe and e-PIC (Royal Pharmaceutical Society Electronic Pharmacy Information Coverage). Different databases use different keywords and so simple searches using only keywords could have missed some reports. The team devised a search strategy that involved using the broad terms "pharmacy", "pharmacist", "pharmaceutical care", "clinical" and "hospital" to search MESH terms, keywords and text. This high sensitivity, low precision strategy yielded more than 10,000 citations in the first instance, but many turned out to be duplicates. Where the database permitted, searches were limited to identify publications originating in the United Kingdom that were written in English and published after 1980.

Items hand-searched

Hand-searching of conference proceedings was an important step in the search process. This was the only way that the team was able to identify many reports. The proceedings of guild weekend schools and day conferences were searched in this way as were the proceedings of UK Clinical Pharmacy Association conferences. In addition, letters were sent to senior pharmacists requesting details of locally published material.

A total of 824 reports of UK studies were included in the final list together with 324 reports of non-UK studies. To make it easier to search the database, the reports have been classified by subject. The categories reflect what has been published rather than a formal classification system, explains Mr Child. For example, there are categories for "anticoagulation services", "pharmacist prescribing" and "extended hours, residency or on-call services".

Many of the studies identified are descriptive rather than evaluative and therefore provide only limited evidence. In the database, each entry includes the authors, the title, the reference and the abstract or a brief summary of the report. An attempt was made to classify the level of evidence in each report but, so far, there has been no synthesis of the data.

Gaps

Mr Child says that the project has uncovered some notable gaps. The areas where there are large numbers of studies do not necessarily reflect the areas of greatest importance. On the other hand, in some important areas, such as paediatric pharmacy practice, the team found little published material. Dr Cooke says that further work is now needed to turn this work into a useful everyday tool for pharmacy managers.

Helen Remington, immediate past president of the guild, comments: "This project has, for the first time, given us a clear picture of the extent, depth and quality of publications in hospital pharmacy practice research in the UK. It is a landmark in itself, but the critical thing will be to keep the database up to date and easily accessible. We believe that in the current circumstances this is one of the best ways to support members who are striving to develop high quality pharmacy services".

Mr McArtney says: "The guild is committed to progressing this excellent piece of work. However, this is only a snapshot in time. The real value will be in maintaining a database which is kept up to date with new research as it appears. This work also can identify areas of practice which are under-researched or require more robust data to support their development and promulgation."

The guild will be seeking partners to help support taking this valuable work forward.