Int J Clin Pharm (2016) 38:724–730
DOI 10.1007/s11096-016-0300-y
COMMENTARY
Future methods in pharmacy practice research
A. B. Almarsdottir2 • Z. U. D. Babar1,3
Received: 3 August 2015 / Accepted: 11 April 2016 / Published online: 21 May 2016
Springer International Publishing 2016
Abstract This article describes the current and future
practice of pharmacy scenario underpinning and guiding
this research and then suggests future directions and
strategies for such research. First, it sets the scene by discussing the key drivers which could influence the change in
pharmacy practice research. These are demographics,
technology and professional standards. Second, deriving
from this, it seeks to predict and forecast the future shifts in
use of methodologies. Third, new research areas and
availability of data impacting on future methods are discussed. These include the impact of aging information
technology users on healthcare, understanding and
responding to cultural and social disparities, implementing
multidisciplinary initiatives to improve health care,
medicines optimization and predictive risk analysis, and
pharmacy as business and health care institution. Finally,
implications of the trends for pharmacy practice research
methods are discussed.
Keywords Future Pharmacy practice Research methods
& Z. U. D. Babar
z.babar@auckland.ac.nz
1
School of Pharmacy, Faculty of Medical and Health Sciences,
University of Auckland, Building 505, Park Road, Grafton,
Private Bag 92019, Auckland, New Zealand
2
Institute of Public Health, University of Southern Denmark,
Odense, Denmark
3
Lahore Pharmacy College (A project of Lahore Medical and
Dental College), Tulspura Canal Bank, Lahore 53400,
Pakistan
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Impacts of practice
•
•
•
Demographics, technology and professional standards
can influence change in pharmacy practice and it’s
research.
Use of technology and secondary data generation has
also an impact on how pharmacy is being practiced.
Researchers and practitioners need to adapt to these
changes.
Many factors can impact on future pharmacy practice
research. Responding to all factors is vital to improve
patient health outcomes.
Introduction
The practice of pharmacy has rapidly evolved from an
initial focus on extemporaneous compounding and dispensing medications, to now focusing more on patientoriented care [27]. Pharmacists currently play a more
active role in managing a patient’s drug therapy and
medicines related outcomes in both hospitals and community pharmacies than before [1]. This is due mainly to
the change in health care towards more efficiency which
has led to several developments such as the increased use
of information technology, the relatively high accessibility
of pharmacies to patients, and increasing pharmacist prescribing [28]. Information technology is increasingly used
to support the daily work of pharmacists such as creating
medication records, dispensing, managing stock and performing medicines use reviews [2].
Pharmacy practice research has the potential to significantly influence not only pharmacists as a profession but
also patients and therefore it is critical to illuminate new
Int J Clin Pharm (2016) 38:724–730
areas that may require research and the choice of methods.
We have through our work as researchers within this field
observed a number of factors which may drive the change
in use of methods within pharmacy practice research. The
most notable are demographic changes, professional standards, and technology.
In this article, we will first describe the drivers of change
and then delve into pharmacy scenarios underpinning this
research. Lastly, we suggest future directions and strategies
for such research and their effects on the choice of research
methods.
Drivers of change
Demographic changes
Life expectancy is increasing and it is expected that by
2050 there will be approximately 19 million people worldwide who are 65 years and over [3]. Consequently an
increase in chronic conditions can be expected, which will
translate to a growth in prescription orders to manage the
health of this sub-population [4]. Additionally, immigration is leading to an increasingly multicultural environment, whereas in some countries ethnic minorities will be
making up to 50 % of the population by year 2050 [5].
These changes in population will affect the way medicines
are used and there will be changes in disease states and
public policies [6].
Professional standards
Professional standards are becoming increasingly important as patients are more aware and less tolerant of medical
mistakes [7]. Patients expect efficiency such as shorter
waiting times and demand a quality service, with the
spotlight remaining on the dispensing function [16]. Policy
makers are increasingly aware of the patient voice in health
care and pharmacy has been increasingly responding to
demands on lower costs and higher productivity [24, 25].
This pressure stems from the frequent view of pharmacy as
a business rather than health care profession and institution
[8]. Other known challenges to professional autonomy and
standards include the lack of privacy in community pharmacies, no desire on behalf of pharmacy owners to change
from a pure medicines distribution model to health care
services, and lack of collaboration between health professionals [9].
Technology
Technology is one of the driving forces of change in
practice which requires pharmacists to continuously adapt
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and even keep ahead of in order to consistently delivering
against expectations [6]. These changes relate both to rapid
advances in physical processes such as robotics and
information technology. Robots are currently starting to
take over many of the dispensing tasks in both outpatient
and inpatient pharmacies [26] which has a huge impact on
the role of pharmacists.
Individuals now have more access to applications
(‘‘apps’’) and devices with which they can monitor various
signs and symptoms related to their health, such as blood
glucose levels and peak airflow monitoring. Patients are
becoming more critical and aware of their health status
[10]. Further developments now allow remote monitoring
of a patient’s health status, allowing early detection of
deterioration (or indeed improvement) of health status [11].
The increased access to information on the internet and
supply of medicines online could has also lead to the
development of online pharmacies providing prescription
medicines, as evidenced now in USA, Germany, Sweden
and the UK [3]. With access to the internet this may also
allow the development of patient consultations at home,
known as telecare, which is a big step to changing the
pharmacy sector [2]. Not only will consumers have
increased access to information, but health professionals
such as doctors, nurses, pharmacists, occupational therapists and others will be able to share and utilize a lot more
information about an individual [12]. This will become an
essential tool to help pharmacists keep up to date with
patient’s health status and aid co-ordination of health services to provide patient oriented care [13]. The integration
of human genome sequencing will also allow for more
personalised drug therapy which pharmacists can become
more involved in, this may help target sub-populations
whilst improving safety and reducing adverse effects [14].
Future practice of pharmacy
With changing demographics, education, professional
standards and technology landscape, the future pharmacy
role has needed to change. The role of pharmacists in the
future is slowly being developed so that they are more
integrated in the healthcare sector both in primary and
secondary care. In primary care they are increasingly
involved in screening services and in monitoring of
patients’ medication and adherence [15]. There is also a
need for further development to ensure that patients are
optimizing their medication use and that patients get a
medicine that best suits the individual [7]. Services such as
medication therapy management are slowing being offered
by some community pharmacies which can later develop to
ambulatory care [15]. Ambulatory care increasingly will
involve the patient seeing the pharmacist first to obtain a
full medication history which can be updated on an
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electronic database. This can then be used to synthesise a
pharmacotherapy plan which can be accessed and altered
by other health professionals [1]. The collaboration
between pharmacists in primary and secondary care will
intensify as it is realised that they play an important role in
patients transferring between the sectors [29].
The rapid technological advances mentioned above such
as robotics highlight that if pharmacies have the technology
but need to take advantage of the cognitive services they
can provide [6]. It is also becoming widely realised that
pharmacists, apart from supplying medicines, are also
responsible for the outcome of the treatment (providing
pharmaceutical care). The aim for the future is for patients
to see their community pharmacists more often to discuss
their health. This will be helpful in order to detect more
sinister illnesses earlier, address the underlying components to health (smoking cessation, weight, sexual health)
as well as checks for long term conditions (diabetes checks,
blood pressure monitoring and flu vaccinations) and for
treating minor illnesses [17].
In order to improve the standard of the profession, and
to focus on patient-centred services, some changes need to
be made in relation to the future practising model [18].
Pharmacy practice research is crucial in identifying areas
where the profession can be further developed to make way
for new ideas and ensure the survival of practice of pharmacy [17, 18].
Evolving pharmacy practice research
The knowledge about and use of qualitative methods was
particularly prominent in pharmacy practice researchers
working within the realm of social pharmacy. Conversely
hospital pharmacists working with patients (clinical pharmacy) have relied more on quantitative methods.
Many researchers who classify themselves as pharmacy
practice researchers also work in departments that define
their work as part of drug utilization research (DUR),
clinical pharmacy, pharmaceutical policy, health services
research, or health economics. In these fields quantitative
methods have dominated. Some pharmacy practice
researchers can even relate to having one or more of these
as areas of expertise. As pressure increases to participate in
large multi-disciplinary research consortia collaboration
between those working in the fields of pharmacy practice
research, DUR, pharmacoepidemiology, economics, social
science theories, and clinical pharmacy will be expected to
intensify. Researchers with a pharmacy background who
possess any of these competencies will therefore need
develop a common front towards the public and ally with
scientists primarily from the medical and social sciences.
The choice of methods within any of these fields goes
hand in hand with the precise research questions.
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Int J Clin Pharm (2016) 38:724–730
Conversely, the availability of new methods to study
practice of pharmacy opens up new avenues of research.
Furthermore, the research questions hinge upon the political climate of practice of pharmacy, and the challenges
and opportunities envisioned.
An important methodologically-relevant development is
the increased availability of ‘‘big data’’ in many countries
around the globe. Big data in healthcare refers to electronic
health data sets so large and complex that they are difficult
(or impossible) to manage with traditional software and/or
hardware; nor can they be easily managed with traditional
or common data management tools and methods [19]. This
development will increase the pressure on pharmacy
practice researchers to be knowledgeable about the use of
extensive data sets in evaluating practice of pharmacy
related health care initiatives. This will also imply that
those involved in qualitative methodologies may have to
become savvier in using big secondary qualitative data that
is generated i.e. by social media discourse.
New research questions and availability of data
impact future methods
As the institution and profession of pharmacy develops
within the realm of rapidly changing health care technology, health care systems, and patient populations it faces
future challenges and has to respond to these.
Table 1 shows five plausible areas that will be increasing in importance within pharmacy practice research, how
the methods foci will change for each one of them due to
availability of data, and relationships to other disciplines
involved in the research.
Area 1. The aging IT users and what they want
from health care
Patients are increasingly culturally diverse and active
analysers and decision makers who use technology to their
advantage. With the ‘baby boomers’ aging there will be a
domineering group of people expecting healthy aging. This
group will employ many approaches to prevention and life
enhancement as they are more health literate, critical and
information-seeking than the generations before them. This
feature lends them a stronger voice in health care politics
and ability to set agendas [20]. This characteristic will
impact all of health care research. On the pharmacy front,
this will go hand in hand with demand for evidence for
practicing in a certain way. Why pharmacists do as they do
will be questioned, just as for other health care professionals. This will mean that interventions need to be
evaluated and founded not only in professional but in
patient rationalities.
Int J Clin Pharm (2016) 38:724–730
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Table 1 New pharmacy practice research areas, methodological focus changes and science disciplines involved
Area
New research area
Use of
quantitative
versus
qualitative
methods
Methods focus changes
Current methods
focus
Future methods focus
Science disciplines
involved in the research
1
The aging IT literate—what do
they want from health care?
Both
quantitative
and
qualitative
methods
Interviewing,
focus groups,
surveys
(primary data
collection)
‘‘Big data’’ on internet usage
frequency and content (secondary
data)
Sociology, education
2
The cultural and social
disparities in pharmacy
services—what are the needs
and how should pharmacy
respond?
Both
quantitative
and
qualitative
methods
Interviewing and
focus groups
Participant observation, descriptive
data analysis of drug utilization
(DUR) and health trends in
geographic areas of diverse
populations
Anthropology, sociology
of culture, social
epidemiology,
geography
3
How to implement multidisciplinary initiatives to
improving health care
Primarily
qualitative
methods
Trials,
intervention
studies
Mixed methods, participatory action
research
Organizational behavior,
political science
4
Medicines optimization and
predictive risk analysis of
local populations of patients
Primarily
quantitative
methods
N/A (as this is a
new area for
pharmacy
practice
research)
Content analysis of patient and
professionally reported outcomes in
integrated electronic health care
records
Pharmacoepidemiology,
clinical pharmacology,
health services
research
5
Pharmacy as business/
information center/health care
institution
Primarily
quantitative
methods
N/A (as this is a
new area for
pharmacy
practice
research)
Various secondary data collected
within the organization re. quality
and finance
Business administration,
sociology, economics
The public will have more (evidence based) information
about health and medicines ready at their fingertips which
they are able to use due to their high level of health literacy
and will show little or no submissiveness to authority,
rather looking at health professionals as partners in their
decisions about health care and life style. This will make
physicians, pharmacists and other health care professionals
into ‘‘guides/ facilitators/ advocates’’ and not all-knowing
experts [21].
Practicing pharmacists and their pharmacy researcher
colleagues will have to adapt to this new reality by studying
how lay persons use the informatics available, and how this
information influences them. In terms of methods this will
mean coupled with the availability of big data – that
increasingly the research on the user perspective will employ
content analysis of secondary data. This can for example be
quantitative data on internet usage and the content analysis of
qualitative data on the information and discussions on social
media. Primary data will still have an important place in
pharmacy practice research due to the myriad of research
questions that will rise from the proliferating research using
the newly available secondary data.
Area 2. Cultural and social disparities—
understanding needs and how to respond
Cultural differences—especially within countries with
significant immigration—make for a burgeoning field of
research within pharmacy. This trend will be escalated as
the baby boomers are primarily a phenomenon of the
inhabitants of post-industrial knowledge economies. There
will also be large minority groups within these countries
who have recently immigrated who have been shown to
need a totally different health care approach [30].
These trends coupled with increased globalization will
also lead to increased social disparities which pharmacy
practice research needs to understand and address. It will
mean that even though methods such as interviews and
focus groups will still be relevant, it will also be important
to observe the social discourse and understand how pharmacy can communicate more effectively with these population segments. Geographic and epidemiological
methods can also be used more to map these social disparities in light of increasing availability of data for secondary analysis.
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Area 3. Implementing multidisciplinary initiatives
to improve health care
The challenges faced by health care systems are forcing
providers and professionals to implement more complex
team based health care services [22]. This is an opportunity
for pharmacists to get involved and/or build on models of
care that have been generated internationally. Smaller
projects started by enthusiastic ‘trail blazers’ within pharmacy have often been successful since these pioneer
pharmacists have high motivation and sound connections
within the community they work in. Making their models
transferrable to a larger scale and different settings is the
challenge facing both practitioners and researchers.
The researchers can play an important role, with their
knowledge of pharmaceutical policy analysis and implementation research. Pharmacy sometimes gets forgotten in
collaborative schemes to improve quality in health care and
researchers and pharmacy professional organizations need
to monitor closely developments within the wider framework of health care [23]. This leads to further pressure
when undertaking program evaluation and implementation
research and making it known what pharmacists can contribute to patient care within the cross-disciplinary
framework.
According to a recent report from the National Health
Service in Britain there has been enough research carried
out into effects and outcomes [17]. Although still important
to an extent, less emphasis will be on trials of pharmacy
specific interventions. The emphasis within health services
research is shifting to implementation research and for
pharmacy this will mean that studying how decision
makers can be influenced to incorporate pharmacy in large
scale health services planning will be essential. Future
pharmacy practice research will have to shift towards
studying collaborative models; identifying problem areas,
and reaching consensus on systematized approaches. It will
be even more important to listen to professions that pharmacists will collaborate with social and organizational
scientists in order to avoid the programs’ failing due to
unobserved negative attitudes [24].
Methodologically this will require a solid foundation in
participatory action research and the use of mixed methods.
The researchers will need to increasingly be knowledgeable about organizational behavior and political sciences in
order to better work in the cross-disciplinary research
groups.
Area 4. Medicines optimization and predictive risk
analysis
Future research could focus on medicines optimisation and
on improving safety and effectiveness of medicines. With
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Int J Clin Pharm (2016) 38:724–730
active engagement of pharmacists in local primary care
networks and their access to integrated patient records, they
will be in a better position to conduct this type of research.
Other uses of integrated patient records data could include
pharmacists’ undertaking predictive risk analysis of local
populations of patients. This could also help to identify and
target patients considered at risk of developing complications in conditions like asthma or when taking high risk
medicines.
Area 5. Pharmacy as business and health care
institution
This area is rather undeveloped, but is related to Area 3.
However, it is more about how pharmacy is practiced and
focused within pharmacy (either in the community or
hospitals). Although we have stated that pharmacy cannot
practice in a vacuum, the institution/business of pharmacy
still needs to understand its functions and on this foundation be able to optimize the quality and effectiveness of its
work.
In order to fulfil this promise, pharmacy practice
researchers will increasingly use the data that is being
collected as part of running the organization to understand
how processes can be optimized and services improved.
This may mean using data such as queries sent by email or
on chat functions, documented medicines review results,
monitoring the use of pharmacýs home page, waiting
times, sales data, patient satisfaction, and financial information. The researchers will be leaning towards a multitude of other science disciplines, but mostly focused on
business and management as subject areas.
Implications of the trends for pharmacy practice
research methods
As the institution and profession of pharmacy develops
within the realm of rapidly changing healthcare technology, it faces future challenges and has to respond to these.
Due to the expansion of techniques available and challenges faced, researchers will have to be able to use a larger
palette of methods and be ready to combine methods in
novel ways (i.e. using mixed methods). They will have to
be even more knowledgeable about various designs,
methods, and theories when working in teams of
researchers who do not have the same science background.
Pharmacy practice researchers need to be clearer about
who they are, where they sit on the epistemological spectrum and what special competences they bring to complex
inter-professional projects. They need to keep an open
mind of which data sources are (uniquely) available to
them and utilize these in innovative ways.
Int J Clin Pharm (2016) 38:724–730
Funders of research have views of what they want to
achieve and how this should be evaluated. As key stakeholders they are likely to require a broad health care services focus and be less likely to fund pharmacy focused
research. These projects are then often lead and administered by social science trained persons who make crucial
decisions on funding. Therefore pharmacy practice
researchers will have to follow closely, developments in
methods and theories within the social sciences.
729
6.
7.
8.
9.
Conclusion
10.
The current and future scenarios in pharmacy suggest that
pharmacy practice researchers will have to adapt to
changing population demographics and changing expectations from health care. Technology adds another layer of
complexity with impact on how pharmacy is practiced and
the availability of data that is generated in the interactions
between people and between patients and health care. We
the authors do not possess a crystal ball, but we envision
that this field is increasingly forced to step out of isolation
in order to deal with the challenges of funding research and
implementation research where collaborative models will
be in the foreground. One important aspect in meeting
these challenges is knowing about a broad palette of
methods. The most valuable is to realize the potential of the
secondary data material that is being generated through
information technology, but also to harness the potential of
primary data collection especially to understand the complexity of implementation projects involving pharmacy.
11.
12.
13.
14.
15.
16.
17.
Funding None.
18.
Conflicts of interest None of the authors have any competing
interests in the manuscript.
19.
20.
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