Time to redefine pharmacy research

There is no universal definition of pharmacy research, and this may be one of the reasons for poor quality research in the sector.

Pharmacy research in the dictionary

As healthcare rapidly evolves, there is increasing complexity of care and rising costs to healthcare systems. There is also an increasing need for data to inform healthcare decisions made by patients, practitioners and governments. Many organisations have identified this need and tried to address it systematically by defining and refocusing research agendas[1],[2]
. Pharmacists have been identified as an important group of professionals, with unique expertise, to contribute to the creation of research impacting on health outcomes[3],[4],[5]
.

No definition

Research conducted under the umbrella of ‘pharmacy’, or specifically by pharmacists, is often termed ‘pharmacy research’. This term is problematic because it is broad, vague and difficult to define. In 2010, we sought to define pharmacy research as part of a pharmacy residency research project
[6]
. We were unable to find a clear definition in the literature, nor could we get consensus among the project members who were all well versed on the topic. What was striking was that, although used frequently, pharmacy research had, and continues to have, no universal definition. In fact, it is often used interchangeably with the term ‘pharmacy practice research’, a component of health service research, but does not encompass the potential scope of research performed by pharmacists and other topics relating to pharmacotherapy. And although undoubtedly important to the practice of pharmacy, this is not the only form of research pharmacists should engage in. To improve overall care and outcomes, questions regarding the use of medicines will need to be answered outside the direct practice of pharmacists.

The scope of research that pharmacists should be involved in is broad and includes anything from drug discovery to clinical trials. The American College of Clinical Pharmacy (ACCP) outlines a vision for clinical pharmacists in research as part of its 2030 strategic plan, which describes pharmacists as “leaders in biomedical research, serving as principal investigators and co-investigators for cutting edge translational research, pivotal clinical trials, creative health service studies and other pharmacotherapy research”[7]
. The scope in the same document includes all forms of research, from basic science to clinical trials. It also lists the key objectives pertaining to all types of research, including any “direct benefits to patients and society, or indirectly contributing to future pharmacotherapy by understanding the pathophysiology of disease or condition as it related to pharmacologic interventions”.

There are, of course, overlapping areas of research with other disciplines, but some of these topics are well suited to pharmacists based on their training and expertise. For most practising pharmacists, focusing on the clinical application of research seems most logical and may include any topic that addresses optimal drug therapy. As defined by the ACCP, optimal drug therapy “implies the use of drugs to achieve targeted clinical, humanistic and economic outcomes; drug use that is safe, effective, appropriate, affordable, cost effective, efficient and specific to the needs of a given patient”[3]
. These topics are relevant in everyday pharmacy practice.

Pharmacists in research

In the United States, there has been a shift in the national research agenda to focus efforts on clinical and translational research. This encompasses both bench-to-bedside and bedside-to-patient research. Pharmacists are well positioned to add value to bedside-to-patient research, which encompasses health services research, drug effects in large populations and comparative effectiveness research[8]
. As part of this shift, there has been a call to action for pharmacists to contribute to the creation of this much needed knowledge. In turn, there has been identification of a deficit of appropriately trained pharmacists who can fill this void and questions on whether or not pharmacists can be trained fast enough to fill this societal need[8],[9]
. Furthermore, conversations about the most appropriate training to prepare pharmacists to take on the role of clinical scientists are ongoing
[8],

[9],[10]
.

Similar to clinical practice, there are overlapping roles with other disciplines in research, but there is also the unique perspective that pharmacists bring to the research table. Some topics are better suited to pharmacists, given their training and focus, such as medicines adherence, medication safety, pharmacokinetics, pharmacoeconomics and pharmacogenomics, to name a few. Many of these fields are evolving or often overlooked and require better data to make decisions with. This unique perspective is also an asset to bring to a research team. Research rarely happens in isolation and the promotion of team-based research is evolving. Pharmacists have an opportunity to lead and participate on these teams. As healthcare systems become more complex, the complexity of research questions and subsequent answers will also increase, requiring a multidisciplinary approach.

Current engagement 

Perhaps there is no clear definition for pharmacy research because current engagement of pharmacists in research is poor, regardless of practice setting[7],[11]
. There are many reasons for this cited in literature. Across studies, the most commonly cited reasons include lack of time, lack of training and lack of confidence[12],[13]
. But regardless of their participation, most of the literature suggests that pharmacists value research and believe that it does improve patient care[12],[13]
.

A paper that looked at research and hospital pharmacists in the UK identified clinical work taking priority as a barrier to research in their practice[12]
. Another barrier was the added responsibility of training undergraduate students. This evolution in practice needs to be supported by evidence and this shift in practice must also include research.

Moving research forward

We need to change research culture within pharmacy, just as we are changing the culture in direct patient care. The practice of evidence-based medicine in caring for patients has been adopted and now there needs to be a more prominent role in creating the evidence used to care for patients. There must be an expectation that pharmacists participate and lead research, which needs to come from within the profession and from the outside, including governments, the larger healthcare community and patients.

How pharmacists are trained to do research must also be addressed. Exposure to research needs to start early as part of undergraduate training, and graduate and postgraduate training needs to be further developed. Alternative methods of training, such as residencies and fellowships, should also be adapted to help pharmacists establish a research presence as a profession. In addition to formal training, research requires mentorship. Mentorship capacity should be built to support the future of pharmacists in research.

Several pharmacy organisations, including the ACCP and the Royal Pharmaceutical Society in the UK, have identified the need to push the research agenda. We need their leadership, advocacy and support in terms of continuing education and opportunities for funding. Employers must also make research a priority for pharmacists and provide both the time and infrastructure to support research. They should understand how their investment in research for their employee pharmacists now will benefit their business and operation in the future.

Finally, we also must identify that research rarely happens in isolation and that, as a profession, we need to engage each other in research. The creation of practice-based research networks has proven to be a step in the right direction[14],[15]
.

Perhaps the definition of pharmacy research should be any research done by pharmacists that involves science and use of medicines. But it’s not just what we call it, it’s about what we do. Let’s make research a core part of pharmacy practice.

Sheri L Koshman is associate professor of medicine at the University of Alberta, Canada.

References

[1] The Canadian Institutes of Health Research. Health Research Roadmap II: Capturing Innovation to Produce Better Health and Health Care for Canadians. Strategic Plan 2014/15-2018/19. Available at: http://www.cihr-irsc.gc.ca/e/48964.html (accessed September 2016)

[2] The National Institute for Health Research. Available at: http://www.nihr.ac.uk/documents/about-NIHR/Briefing-Documents/2016/1.01-The-National-Institute-for-Health-Research.pdf (accessed September 2016)

[3] American College of Clinical Pharmacy. The research agenda of the American College of Clinical Pharmacy. Pharmacother 2007;27:312–24. Available at: https://www.accp.com/docs/positions/positionStatements/pos32_200608.pdf (accessed September 2016)

[4] Division of Program Coordination, Planning, and Strategic Initiatives, National Institutes of Health, United States Department of Health and Human Resources. The National Institutes of Health Common Fund Office of Strategic Planning Coordination Common Fund Strategic Planning Report, 2011. Available at: https://commonfund.nih.gov/sites/default/files/CF_Strat_Plng_Rept_2011_Final_0.pdf (accessed September 2016)

[5] Secretary of State and Health. Pharmacy in England — building on strengths; delivering the future. Cm 7341. London Department of Health, 2008. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/228858/7341.pdf (accessed September 2016)

[6] Koshman SL & Blais J. What is Pharmacy Research? Can J Hosp Pharm 2011;64:154–155. PMCID: PMC3093426 

[7] Fagan SC, Toucette D & Smith JA. The state of science and research in clinical pharmacy. Pharmacother 2006:26:1027. doi: 10.1592/phco.26.7.1027 

[8] Parker RB, Ellingrod V, DiPiro JT et al. Preparing clinical pharmacy scientists for careers in clinical/translational research: Can we meet the challenge? ACCP Research Affairs Committee Commentary. Pharmacother 2013; 33:e337-e346. doi: 10.1002/phar.1348

[9] Carter BL, Blouin RA, Chewning BA et al. Report of the AACP Educating Clinical Scientists. Am J Pharm Ed 2008;72: article S10. PMCID: PMC2626483

[10] Mueller EW, Bishop JR, Kanaan AO et al. Research fellowship programs as a pathway for training independent clinical pharmacy scientists. Pharmacother 2015;35:e13–e19. doi: 10.1002/phar.1562

[11] Tourcette DR, Bearden DT & Ottum SA. Research publication by pharmacist authors in major medical journals: changes over 10-year interval. Pharmacother 2008;28:584–590. doi: 10.1592/phco.28.5.584

[12] Lowrie R, Morrison G, Lees R et al. Research is a ‘step into the unknown’: an exploration of pharmacists’ perceptions of factors impacting on research participation in the NHS. BMJ Open 2015;5:e009180. doi: 10.1136/bmjopen-2015-009180

[13] Attitudes of Australian pharmacists towards practice-based research. J Clin Pharm Ther 2009;34:397–405. doi: 10.1111/j.1365-2710.2008.01020.x

[14] Koshy S. Pharmacy practice-based research networks: do pharmacists need them? Int J Pharm Pract 2014;22:433-436. doi: 10.1111/ijpp.12098

[15] Koster ES, Blom L, Philbert D et al. The Utrecht Pharmacy Practice network for education and research: a network of community and hospital pharmacies in the Netherlands. Int J Clin Pharm 2014;36:669-674. doi: 10.1007/s11096-014-9954-5

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Citation
The Pharmaceutical Journal, PJ, September 2016, Vol 297, No 7893;297(7893):DOI:10.1211/PJ.2016.20201705