The evolution of pharmacy practice research—Part II: Time to join the rest of the world

Pharmacy is a science-based degree, pharmacists are the scientists in the High Street, pharmacists are the experts in medicines. These phrases are ones with which, as pharmacists, we are all familiar and of which we should be proud. Pharmacists are involved in the development of new medicines, making existing medicines better and making sure that the medicines we have are used well. This continuum of the input of pharmacists into the development and use of medicines, the mainstay of maintaining health in today’s 21st century, is well documented in the Royal Pharmaceutical Society of Great Britain’s 2014 publication New Medicines, Better Medicines, Better Use of Medicines¹ and Canada’s Blueprint for Pharmacy.² For unless we continue to use our scientific knowledge to underpin these 3 tenets of health care, then our central role will diminish in the future. One of the important things that these documents has done was to include what we often refer to as “pharmacy practice research” as part of the continuum of science that underpins our practice. But in fact, the pharmacy practice research components could also have been referred to using more universally recognized terms such as clinical sciences, applied health sciences or health services research.

So why have we given ourselves the label of pharmacy practice research? What does it mean and what are the implications? By definition, pharmacy practice is what pharmacists do, and therefore, pharmacy practice research should be about what all pharmacists do, not just those working at the patient-facing end of the continuum described above. So the name is wrong. What are the implications? The implications are that we have given ourselves a label that means nothing to anyone other than pharmacists, and not even all pharmacists understand the term. We have had many a discussion with pharmacy colleagues working at the more basic end of the research continuum as to whether what we do is science or not and, by implication, something about its second-class status as an academic discipline and indeed its intellectual challenges. Pharmacy practice research is not recognized terminology, in contrast to disciplines such as health psychology, health economics, anthropology, statistics, sociology or linguistics, to draw upon just a few of the many disciplines that we embrace when we are undertaking pharmacy practice research. Umbrella terms that could also be used and that are generally recognized and referred to above would be applied health sciences or health services research. Given that we have adopted nonstandard terminology, it is hard sometimes for our research to be accepted as part of the body of work of one of those established research disciplines. Do we want our research to only be meaningful to pharmacists? Surely we strive to influence the health care system on a wider basis. One could argue that the term pharmacy practice research is too inward looking, and as such, to those outside pharmacy, it seems irrelevant to the bigger picture of the health care system. It also means that much of what we do has been focused on demonstrating the role of pharmacists rather than taking a theoretically based approach to understanding what is happening and using recognized state-of-the-art techniques to develop the profession in the interests of better health care for all. Hence, in a previous editorial,³ we questioned the value of the proliferation of multiple small studies that did not generate new knowledge, often surveys justifying the role of the pharmacist. We suggested it was time to reflect on what we know already and implement the good using a theoretically informed implementation science approach or to take stock of the gap in evidence and design a research strategy to take the profession forward again.

In 1994, Nicholas Mays⁴ published a critical personal review of health services research in pharmacy. This ground-breaking piece of work identified many of the same issues we have outlined above. He also concluded that the term pharmacy practice research was unhelpful, yet a quarter of a century on, little has changed. Although there is a slowly increasing pipeline of complex larger studies, these are not the norm. Three years after his earlier study, Mays⁵ chaired and reported on the findings of the UK Pharmacy Practice R and D Task Force, which came to similar conclusions as his earlier personal reflection. A strategy to address the continued shortcomings included a recommendation that all pharmacists should be research aware, 10% should be research active and 1% should be research leaders. As a mechanism to promote this, he made detailed recommendations for academic career pathways in the United Kingdom. However, these recommendations have not come to fruition in the United Kingdom or in Canada. In Canada and the United Kingdom, there are just under 50,000 registered pharmacists each, so 1% of 50,000 would be 500 in each country. There are clearly not 500 pharmacy research leaders in either the United Kingdom or Canada.

The UK Royal Pharmaceutical Society faculty assessment considers the level at which pharmacists are operating within 6 clusters: expert professional practice; collaborative working relationships; leadership; management; education, training and development; and research and evaluation. The highest level that can be awarded is mastery. It is somewhat disheartening to see that those who have achieved mastery in the first 4 struggle to even achieve the lowest level in research and evaluation, and the same is true to a slightly lesser extent for education, training and development. We have a challenge to encourage more of the most able of our profession to contribute to our scientific base, but we also need to lobby for more posts and more supportive infrastructure.

To come back to where we started, and as Nicholas Mays^4,5 recommended, we should begin referring to pharmacy practice research as “health services research in pharmacy,” or alternatively, “applied health sciences in pharmacy.” Pharmacy is the context, not the methodology. This term will be understood by other researchers yet retain the pharmacy link when needed. Please do let us know what you think and join this debate.