Research on the quality, outcomes and cost of pharmacy services is essential for pharmacy practice to evolve in response to changing healthcare needs and marketplace competition, says the Royal Pharmaceutical Society. The organisation urges community pharmacists not to be daunted by the thought of research. ‘All pharmacists are scientists and, as such, already possess a rigorous and structured approach to research which can be used in everyday practice,’ it says in the wealth of research support material on its website. ‘It is important to remember that research is not the preserve of academics – it’s a necessary part of all pharmacists’ professional role.’
The importance of research to the profession was highlighted in a 2008 pharmacy white paper, which says: ‘In order for pharmacy to become an established voice in primary care and to be recognised as a key and essential element in the delivery of clinical services, a sound evidence base that demonstrates how pharmacy delivers effective, high-quality and value-for-money services is needed.’
Pharmacy practice research is about everyday issues that affect pharmacists, their patients and the public. Research topics and questions can arise from straightforward observations made by pharmacists about current service provision or patient populations. As a result of their daily practice, pharmacists may consider that the health needs of a patient group are not being adequately met or that some aspect of work could be carried out more effectively.
Local or national policy developments can urge pharmacists to review certain topics or address new ones. Alternatively, a story in the media might lead a pharmacist to question something in their practice.
Designing and leading your own research is not the only way to get involved, and supporting research can have a range of benefits for both the pharmacy and patients, says Beth Allen, head of research at Pharmacy Research UK.
‘By supporting research locally, in your pharmacy, you can offer your patients better access to research and, ultimately, better care. In doing so, you and your team will develop transferrable skills, develop new professional relationships and create further opportunities to develop your practice for public benefit.’
Pharmacy Research UK is the principal research charity supporting pharmacists and pharmacy to improve healthcare for the benefit of patients and the public. Chairman Professor Anthony Smith says: ‘Our research funding offers an opportunity for the profession to come together to generate new knowledge for the benefit of patients and the public.’
Typically, Pharmacy Research UK has the following grants for pharmacy research and training each year:
New this year will be a ‘Clinical Pharmacy Research Grant’ of £50k, joint-funded between Pharmacy Research UK and the United Kingdom Clinical Pharmacy Association (UKCPA). Other funding streams support research while offering research training at the same time (see panel). RPS members can also join the RPS Science and Research network to receive funding alerts.
Every research funder has different priorities. For example, some cancer charities focus on finding a cure and others on treatment or end-of- life care. It can be important that pharmacists make sure that what they want to explore aligns with what the research funder is interested in.
For Pharmacy Research UK’s training bursaries and personal awards, applicants’ chosen topics do not have to align with its research priorities in the same way the project grants do. Research training funding (such as that available through the National Institute for Health Research Clinical Academic Training scheme) will often not dictate the subject areas they are interested in, as they want the healthcare professionals to determine the topics that they believe are relevant to their practice,’ says Ms Allen.
Pharmacy Research UK’s current priorities are:
Is it cost-effective to be involved in research? ‘If pharmacists were looking to take forward their own research ideas through research training funding, salary costs would normally be covered. Where they are participating in other people’s research, such as promoting and/or recruiting to a local study, delivering a public health intervention as part of a study and so forth, their time would normally be reimbursed.
Studies on the NIHR’s portfolio will reimburse pharmacists at a standard hourly rate. Studies that come directly from academia or industry will have different rates for research involvement. These reimbursement rates may be higher than the actual costs to the pharmacist/pharmacy. Incentives for participating in research (questionnaire completion, interviews and focus groups) vary from study to study.
While it is important that pharmacies’ costs are covered, it is also important that pharmacists consider the ethics around payments for research participation and their responsibilities to their patients, says Ms Allen. For example, relationships could be damaged if patients felt that their recruitment to a trial triggered a large payment to their pharmacy.
Research Ready is an online self-accreditation tool covering the basic requirements for undertaking primary care research in the UK. Once a pharmacy is accredited as Research Ready, local research networks will be informed of its interest in research. The RPS uses the database of Research Ready pharmacies to advise research councils, medical research charities and universities about interested sites. Pharmacies are invited, but not obliged, to take part in studies.
Pharmacies should consider whether they want to participate in health research or clinical trial studies, or both. Health research includes audit, service evaluation and other clinical or service research projects. They do not usually, but may include the administration of a treatment to patients. In contrast, clinical trials are usually set up to test the effectiveness of a medicine. Pharmacies have to meet more requirements to participate in trials, for example the relevant team members would need to have good clinical practice (GCP) training.
There are currently only a limited number of opportunities for community pharmacists to get involved in clinical trials, says Ms Allen. ‘Community pharmacy has to develop a track record in research delivery and, in doing so, more studies will be designed with community pharmacy as a delivery site in mind.’ The Salford Lung Study is a high-profile example, and the learnings from this will be important in further developing this role in the community.
Hull-based community pharmacist Karebor Ngwerume’s interest in research was sparked by media attention on the effectiveness of cough medicine. This led her and her team to question the evidence base for a number of recommendations they routinely made.
The pharmacy team used resources provided by the Hull and East Riding Pharmacy Research Network to develop literature and evidence-searching skills to evaluate the published evidence on a number of non-prescription medicines (NPMs). This information formed an evidence-based portfolio. ‘It was the logical next step to explore whether creating evidence-based portfolios, using elements of the above process, could be replicated with other pharmacy teams,’ says Ms Ngwerume.
With support from the Pharmacy Practice Research Trust, Ms Ngwerume enrolled on a master’s course provided by the School of General Practice and Primary Care at Aberdeen University. She was awarded a bursary to evaluate a training intervention in which pharmacy teams of MCAs, dispensers and pharmacists created evidence-based portfolios on the treatment of four conditions.
The benefits of her research experience were both professional and personal, says Ms Ngwerume. ‘The study provided an opportunity for MCAs to reflect on their practice, and some participants reported an increase in personal confidence as a result of attending the training intervention, developed as part of the study. I have also personally developed new skills that I can subsequently use in my role as a pharmacist, such as critical appraisal skills.’
Alison Astles, a community pharmacist in Cheshire is currently doing a PhD on the topic of professional engagement among locum community pharmacists. She initially had plenty of research ideas but little idea about how to engage with academia. ‘After 20-odd years as a pharmacist, universities felt like very distant organisations,’ she says. ‘At the back of my mind, I think I always wanted to do a PhD, but with a family and work it felt like too big a mountain to climb. The financial support I received is the only thing that enabled me to work towards my PhD, part time. In terms of career development, it has prompted a significant shift as I’m now working in academia, though I’ll never leave my community pharmacy background.’
Ramesh Sadav, a community pharmacist in Worcestershire, is investigating community pharmacists’ role in preventing drug-related deaths. He is undertaking qualitative research using semi-structured interviews to explore the experience of community pharmacists in providing substance misuse services. His research questions are:
A core role of Local Practice Forums (LPFs) is to support practice research. Their role is to bring people together to develop, deliver and disseminate findings, because engagement and networks are so important in research. This includes collective design of the study, engaging communities in the delivery of the research and ensuring stakeholders are involved and engaged so that the research has the best chances of making an impact.
How LPFs take their research support forward varies according to local interests and includes organising events to encourage participation and showcasing completed research.