When you hear ‘primary healthcare’ it’s natural to think of GP practices but primary healthcare actually encompasses many other aspects of care, including pharmacies, care homes, prisons, telemedicine and more. On 2 February, the RSS Primary Healthcare Special Interest Group started a series of sessions focusing on ‘Out of Practice’ primary healthcare research to consider some these wider areas of primary healthcare research.
This first session, at Errol Street, focused on community pharmacy research, with three engaging presentations discussing recent experiences of pharmacy based research. Debi Bhattacharya, of the School of Pharmacy at the University of East Anglia, introduced some of the common issues in this developing research area. Next, Mark Hann from the Biostatistics Group at University of Manchester, and Sally Jacobs of the Centre for Pharmacy Workforce Studies, Manchester Pharmacy School, recalled the process involved to gain pharmacy agreement for participation in an NIHR research project to investigate variation in clinical productivity within community pharmacies before reporting some of their results. Finally, Dyfrig Hughes from the Centre for Health Economics & Medicines Evaluation at Bangor University, reported on the challenges experienced in recruiting patients via community pharmacies for a multi-national study of self-reported adherence to antihypertensive medicines. The speakers were followed by an open discussion of some key questions arising from the presentations:
- In community pharmacy research, what clinical outcomes can be used?
- Accessing data from private providers for NHS commissioned services – how does commercial sensitivity sit against the transparency agenda?
- How should we account for missing data? And is it ‘Missing at Random’?
The presentations and discussion highlighted a number of common issues for pharmacy research to address:
- Disengagement of pharmacists: Research adds to the demanding workload for pharmacists, but with few incentives for them to participate, especially without recognition of research as part of their role. Furthermore, as many community pharmacies are part of much larger chains, cost reimbursement etc for research projects does not always reach the individual participating pharmacies.
- Patient recruitment: A major difficulty for recruitment is a reluctance of patients to participate in research without approval or recommendation from their GP. With the limited medical details available, it can also be difficult for pharmacies to identify a relevant research cohort, or to check exclusion criteria.
- Organisation of community pharmacy: Many pharmacies are parts of larger chains, particularly a number of well-known highstreet 'multiples'. Recruitment of pharmacies can therefore involve discussions with and agreement from more centralised organisations that are distanced from the pharmacies. As the pharmacies are private sector businesses, there can be pressures to maximise profits, reluctance to weaken brand identity through use of non-branded materials, and concerns about the recording and publishing of commercially sensitive data.
- Outcome measures: Data on standard medical outcomes are difficult to obtain since pharmacies do not have routine access to medical records. Additionally, as patients are not registered at individual pharmacies, they may attend other pharmacies where activity cannot be monitored in the same way. Some suggested measures were medication possession ratio (MPR), change in dispensing volumes, QALY, EQ5D, and change in intervention rates (for example, rate of smoking cessation).
In summary, there is a clear need to encourage more research in community pharmacy. This may involve developing systems to make research easier, improving the professional recognition of research activity and highlighting the benefits for patients, pharmacists and businesses of participating in research.