How can community pharmacists become involved in practice research?
Hazel Gilbert, Elizabeth Mills and Elaine Ward, pharmacy practiceresearchers and research support manager from London
Further information is availablefrom Elizabeth Mills
Last year, in this column, John Wilson asked why there are so few contributions to original research from community pharmacists (PJ, 28 May 2005, p644). Since one of us (HG) had recently taken on a research development role for the North Central London Research Consortium (NoCLoR — a primary and community health care research organisation) teaching and mentoring community pharmacists new to research, this question was of great interest.
The remit of this role was to consolidate previous work to broaden a local portfolio of pharmacy research, already in its infancy, by facilitating the development of the community pharmacy research culture. Aims included the provision of an environment conducive to conducting research, through a dedicated community pharmacy research centre and consultancy service, and to identify and promote opportunities for local sector pharmacists to develop research knowledge and skills. As a psychologist, HG’s role was to offer mentorship and methodological advice, to support the development of proposals and projects. Health care research involving human participants uses the same methodology, and is subject to the same ethical obligations as research in psychology. In addition, EM, an academic pharmacist working part-time in practice, was able to supply specialist knowledge when needed. These activities were hosted by the research centre, Green Light Pharmacy.
Almost 10 years ago, the National Primary Care Working Group recommended that research networks should address issues of low research capacity in primary care (the Mant report). At the same time, the Pharmacy Practice Research and Development Task Force (1997) recommended that all pharmacists should use research to inform practice and improve health care, and a small proportion (10 per cent) should also be actively involved in research by helping to collect data, and participate in interventions. An even smaller proportion of these will be independent researchers.
One of the aims of NoCLoR, in accord with other UK primary care networks established since the Mant report, is to increase the involvement in research of a range of primary care professionals, including community pharmacists. To fulfil this aim, NoCLoR incorporates both top-down (academic-led) and bottom-up (practitioner-led) models, encouraging practitioners to develop their own ideas into fully fledged research projects by offering both funding — in a series of awards providing protected time, and mentorship — by linking new researchers with experienced academic researchers. This capacity building has been a central theme in NoCLoR’s activities. Encouragement is offered to pharmacists in the form of inclusion in the award schemes, and training workshops in a dedicated pharmacy research centre.
To return to the original question, it became evident to us that the major reason for the lack of contribution to research from community pharmacy is the lack of time. There are several issues around this “relentless pressure of work”, cited by Mr Wilson as a possible cause.
First, many community pharmacists are self-employed. Keeping their heads above water, ensuring their livelihood through the business, is understandably their first concern. Secondly, the new community pharmacy contract implemented in 2005 has increased the pressure on their time due to the provision of new services, and the training and paperwork these services involve. Thirdly, Mr Wilson suggests a possible lack of opportunity to develop ideas. However, as can be seen from NoCLoR’s portfolio of activities, there are many opportunities on offer. A series of research workshops over the past two years were relatively well attended by pharmacists in north central London, given the demands on their time. Enthusiasm was high and ideas were in abundance. However attendance fell, ideas remained ideas and, in spite of encouragement and support to apply for research capacity building awards available from NoCLoR, it was apparent that most community pharmacists are unable to find the time to complete the short application form to apply for funding to continue.
This brings us to a vital question: is there sufficient interest and desire among community pharmacists to create the time needed to carry through a research project? Research does not just happen. If a community pharmacist is fortunate enough to receive funding from the local primary care trust (as has been the case in Camden and Islington) to attend workshops and training in research, any ideas resulting from those will not flourish unless the pharmacist is sufficiently committed to give up some leisure time to read, think, plan and write, in order to obtain more funding and to carry out a research project from start (an idea) to finish (publication of the results). Given that full-time academic researchers do not work a nine-to-five day, but often find themselves burning the midnight oil, are we asking too much to expect pharmacists to become active, independent researchers in addition to their full-time commitment to their patients?
It is essential to continue to evaluate standards of practice, prescribing methods and services in order to improve health care. The development of an evidence base for community pharmacy practice is essential, as is the understanding of the outcomes of research, for interpretation and translation into practice. Although most pharmacists do not have the drive and commitment to become researchers in addition to their role as pharmacists, many do have sufficient interest to want to be involved in relevant research at a basic level through recruiting and collecting data. Academic researchers can fail to appreciate the realities of day-to-day practice when designing studies. More user involvement, and more discussion between practitioners and academics, can serve to make research more relevant and appealing and results more usable. Actively involving pharmacists in the planning and designing of studies can help to dispel this notion of the “ivory tower syndrome”.
Local networks, grouping to form a national network, could provide a research base to facilitate robust, generaliseable research in community pharmacy, as well as an opportunity for training practitioners in research methods through active involvement. Community pharmacists would also like their involvement recognised, and such a network could provide the opportunity for practitioners to get involved in the design and piloting of studies, overcoming some of the difficulties of combining research in a busy practice. To this end, NoCLoR is in the process of setting up a community pharmacy research network in north central London, where pharmacists will have be able to get more or less involved according to their interest and commitment.
So, although interested community pharmacists should be encouraged to do good and innovative research in practice, it is perhaps better to direct efforts towards engaging them initially in recruitment and implementation of interventions, thereby allowing them to be gradually involved in research without the expectation of becoming full-time researchers, unless that is their aim.
Citation: The Pharmaceutical Journal URI: 10020798
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