A science-based profession?

Abstract

It is generally acknowledged that the profession of pharmacy is built on a sound scientific base, and that the raison d'être of practice -an ever-increasing pharmacopoeia of effective medicines -is one of the key scientific success stories of the last century.However, despite this there is a general belief that most pharmacists do not see the relevance of science to their everyday practice, and are reluctant to engage with researchers in new empirical studies.Research has been conducted from time to time to identify the barriers which restrict participation in research, with time often cited as one of key barriers. [1]An article by Cvijovic in this issue confirms this, with time reported as the main reason why pharmacists did not collect the data expected in their study, despite the fact that the data collection took just a few seconds per patient. [2]Facilitators include interest, a belief that research is important and that it will benefit the customer. [1]lthough our practitioner colleagues, in all healthcare disciplines, are undoubtedly under increasing time pressures as demands of patients, 'form filling' and other administrative tasks increase, it is undeniably a human trait that people do find time for what they want to do, and the reason that time is cited as a barrier to research is probably not the fundamental reason for lack of participation.It is more likely to be lack of interest.How then can we make research relevant?If one of the facilitators, a belief that the research will benefit the customer, is taken as a starting point, this maps directly onto one of the key functions for members of the pharmacy profession: ensuring that patients are prescribed or recommended the most clinically and cost-effective medicine for them, and that it will be supplied and used in such a way that the benefits are maximised and the risks minimised.Simple as the above sounds, it is only too well known that despite the accumulation of evidence-based guidelines, people are not always recommended or prescribed the 'best' medicines for them, and that even when the 'best' medicine is recommended or prescribed, patients do not always take it in a way that gives optimum results.There is much for us as researchers to contribute to finding solutions to both of these.Another area for prioritisation at this time of financial challenge is where to make savings.Where should there be disinvestment and where strategic re-investment?Ideally such savings should be made in such a way that patient care is not compromised.Whereas to many this might seem to be an oxymoron this is not necessarily the case.For example, many drugs dispensed are never taken by the patient, and are returned as medicines waste at times of medicine amnesties, when a patient dies or as routine returns.This represents a big loss of resources which could have been used otherwise for patient care, and indeed understanding more about why people collect but don't necessarily take medicines is a holy grail for researchers involved in studying patient adherence and concordance.Likewise, consideration of skill mix across healthcare teams and re-allocation of duties to different professional groups could mean the scarce resources of more highly paid specialised team members could be focused on areas where their expert knowledge is needed and also provide intellectually exciting and professionally rewarding roles to more 'junior' members of the team.New technologies can be used to deliver routine technical tasks, such as robotic dispensing, and information management systems can support team members with less training, and in depth knowledge to carry out more clinical cognitive roles using online decision support.These are just a few examples of service-redesign developments which are long overdue, but for which there has been little incentive to explore, evaluate and implement.However, managers making decisions to consider these new service models need evidence to allow them to plan and