Policymakers may interpret evidence differently

I read with interest the article by Stephen Robinson published in
The Pharmaceutical Journal
(2015;294:638) in which it is advocated that the next generation of pharmacists “must embed research into practice”.

I agree with the sentiments expressed by Ash Soni, President of the Royal Pharmaceutical Society, that “research into pharmacy practice will become absolutely key to pharmacists in the coming years with the increasing importance of evidence-based interventions”. Further, that pharmacists need to evolve and “show the evidence to support what we do in practice. And if we are going to continue to evolve, more and more of that needs to happen”.

However, we must be mindful that decision-making processes that are based on research will inevitably be required to take into consideration the significance of outside influences such as professional and commercial interests. That the development of policy should be based on evidence gleaned from the results of appropriately conducted research seems a reasonable postulation, but this is not always the case, and money and power may cloud policymakers’ judgement.

The relationship between evidence-based research and policymaking is not simply defining a problem, the solution to which will result from scientific research. Those who make policies interpret evidence in different ways, with each individual reflecting the variations in their values and background[1]
. Thus, for optimum results, researchers and policymakers should gain an understanding of each other’s perceptions and tenets. For the findings to be meaningful in the political and decision-making arenas, there needs to be an effective system for transferring the findings of research into policy, bearing in mind ill-designed and untested policies may have disastrous outcomes[2]
. Consequently, the results of research should be translated into evidence-based health policymaking and projects piloted and evaluated before adoption and implementation.

Pharmacists who conduct research will be aware that there are evidence-based research findings available from, for example, the UK Cochrane Centre, to inform the knowledge base on which policymakers can make decisions. However, the indications are that much of this goes unheeded and that the relationship between policymaking and research, especially in healthcare, is tenuous.

Politicians may steer clear of commissioning research in case the outcomes will prove to be inconvenient[2]
. According to Black[3]
, research has little influence on service policies for reasons including:

  • Policymakers have goals other than clinical effectiveness (social, cultural, financial, strategic development of service, terms and conditions of employees, electoral);
  • Lack of consensus about research evidence, scientific controversy, different interpretations;
  • Competing evidence (personal experience, local information, eminent colleagues’ opinions, medico legal reports);
  • Social and cultural environment not conducive to policy change;
  • Poor quality of knowledge purveyors.

The briefing papers produced by Chris Ham in 2007[4]
, 2009[5]
and 2010[6]
for the Nuffield Trust focused on the requirement for a close collaboration between organisations involved in developing and consistently improving health services. Importantly, he recognised that “what works in one area may not work in another because of variations in context and in relationships between stakeholders”[4],[7]
. Policymakers should state any reasons for either organisational change or the delivery of services subsequent to having gained the support of professional bodies and patient groups[6]
.

The above factors, when integrated with the other tensions involved in constructing pharmaceutical policy, impact on every aspect of the negotiations both at national and local level.

When conducting research with a strong focus on factors relating specifically to patients, researchers must be cognisant that findings restricted to one aspect of a broad subject matter may not hold sway in the policymakers’ decision[8]
.

Notwithstanding the above arguments, pharmacy students should indeed be encouraged to conduct evidence-based research in all aspects of pharmacy as stated by Caroline Parkhurst, teacher practitioner at the University of Reading School of Pharmacy, in Robinson’s piece.

Elmarie Brache

Guernsey

References

[1] Burstein P. Policy domains: organization, culture, and policy outcomes. Annual Review of Sociology. 1991;17:327–350.

[2] Ham C, Hunter DJ & Robinson R. Evidence based policymaking. BMJ 1995;310:71–72.

[3] Black N. Evidence based policy: proceed with care/commentary: research must be taken seriously. BMJ 2001;323:275–279.

[4] Ham C. Clinically integrated systems: the next step in English health reform? Nuffield Trust for Research and Policy Studies in Health Services 2007.

[5] Ham C. Policy options for integrating health and social care. London: Nuffield Trust. 2009.

[6] Ham C & Smith J. Removing the policy barriers to integrated care in England. The Nuffield Trust. 2010.

[7] Ham C. Policy options for integrating health and social care. London: Nuffield Trust. 2009.

[8] Brache E. A Study of medicines use reviews in The Bailiwick of Guernsey. 2013.

Last updated
Citation
The Pharmaceutical Journal, PJ, 5 September 2015, Vol 295, No 7878;295(7878):DOI:10.1211/PJ.2015.20068816