Innovation, pharmacy and medicines: evolution, not revolution – RPS Conference Chairman’s Address
The presentation by Conference Chair, Dr Margaret Watson, was “Innovation, pharmacy and medicines: Evolution, not revolution”. She described why innovation is needed to meet increasing demand (ageing population, patient choice) as well as restricted or decreasing funding. Without being innovative in the way we work, it will not be possible to deliver the services that need to be delivered whilst ensuring patient safety and quality. She emphasised that innovation does not always mean using a completely new method or technology; it can be “copying” products or processes used in a completely different sector and applying them within healthcare and pharmacy practice. Innovation is commonplace with the pharmacy profession and medicines use, ranging from drug development by the pharmaceutical industry to patient-centred care in community pharmacies.
However, Dr Watson emphasised the need to undertake research to generate evidence of the effectiveness and cost-effectiveness of innovations because it is only with robust reliable evidence that we can demonstrate to funders, commissioning groups and others, that it is worthwhile to invest in new pharmacy services.
Several examples of research were then presented which quantified innovations relevant to pharmacy practice or medicines use. The first described the first randomised controlled trial to be conducted to evaluate the effectiveness and cost-effectiveness of pharmacist prescribing. The pilot study was led by Professor Christine Bond, University of Aberdeen and measured the effect of pharmacist prescribing for patients with chronic pain. The results were promising in terms of the effect of the innovative service on patients’ pain measurement and this now needs to be evaluated on a larger scale to derive definite evidence.
Dr Watson then described a study that the University of Nottingham had led and to which she and other researchers had collaborated, to evaluate the contribution of adverse drug reaction (ADR) reporting by patients to overall pharmacovigilance. Patient reporting of ADRs was an innovative process that was introduced by the MHRA several years ago. The evaluation included over 26,000 ADR reports submitted to the Yellow Card Scheme over a 2-year period. One fifth of all reports came from patients. Nearly 50 new serious ADRs were identified using the addition of patient reports to those from health care professionals (HCPs). Importantly, 49% of patients who had submitted a report and who responded to a survey about their experience, had learned about the scheme form a community pharmacist member of the community pharmacy team, demonstrating the importance of community pharmacy personnel in encouraging public engagement with this pharmacovigilance activity.
The presentation continued with examples of innovations (old and new) which had been developed to increase public access to medicines, including: pharmacist prescribing; medicines reclassification; minor ailment schemes; and, tele-pharmacy/tele-medicine. These were promoted as examples of increasing capacity within healthcare in terms of enabling patients to self-care and avid using higher cost services such as general practice and Accident and Emergency. Examples of innovation were presented which enable pharmacy premises to be used for the provision of novel services, including nurse-led minor injury clinics, online access to cognitive behavioural therapy treatment courses and Vitamin D clinics for sun-impoverished Scots! Many innovative services are developing from the extended role of community pharmacists and their staff in terms of public health services. However, Dr Watson cautioned regarding the need for deriving evidence from research of the effectiveness and cost-effectiveness of new services and used weight management as an example, citing a systematic review that she and colleagues had conducted which failed to show definitive benefits of pharmacy-based weight-management initiatives, often because of poor study design. On a more positive note, she described the results of the first pilot RCT to evaluate screening and alcohol brief interventions delivered in community pharmacies. A full scale study is no w required to derive definitive results of this service in this setting.
The presentation ended with the use of a diagram which categorises people according to their adoption of innovation, with “innovators” representing 2.5% of the total (of any, not just pharmacy) population, and 15% being regarded as “laggards”, ie, individuals who are the slowest to adopt new technologies or innovations. Examples of innovations relevant to pharmacy practice and everyday life were distributed across the diagram and conference delegates were asked where they might position themselves in terms of willingness to innovate. They were then challenged to try to move towards the leading edge of the curve, ie, to become more innovative or willing to adopt innovation in their everyday practice.
