Personal View International Journal of
Pharmacy Practice International Journal of Pharmacy Practice 2014, 22, pp. 433–436
Pharmacy practice-based research networks: do pharmacists need them? Samuel Koshy Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
Keywords pharmacist; pharmacy; practice-based research networks; research Correspondence Mr Samuel Koshy, Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait. E-mail: [email protected]
Abstract Objectives The aim of this article is to highlight the need for the development of pharmacy practice-based research networks (PBRNs). Key findings Large multicenter research projects that provide evidence for the provision of patient care services by pharmacists are required, which can be facilitated by pharmacy PBRNs. Conclusions There is a growing need for pharmacy PBRNs, and the time is appropriate for pharmacists around the world to engage in the development of pharmacy PBRNs.
Received May 6, 2013 Accepted January 8, 2014 doi: 10.1111/ijpp.12098
Introduction A primary care research network is ‘an organization that aims to increase the involvement of primary care professionals in research’. According to the Agency for Healthcare Research and Quality (AHRQ), a primary care practice-based research network (PBRN) is defined as ‘a group of ambulatory practices devoted principally to the primary care of patients and affiliated in their mission to investigate questions related to community-based practice and to improve the quality of primary care’. One can understand from this definition that there is an organizational structure that is broader than a single research project and there is a continuous commitment to network activities. There are no steadfast rules with regard to what constitutes a PBRN. A PBRN consists of either academic or professional organizations or both, devoted mainly to the care of patients. As a funding agency for primary care PBRNs, AHRQ has put forward guidelines for PBRNs seeking grant support. It recognizes the organizational structure of a primary care PBRN only if it includes a core of at least 15 practices and/or 15 clinicians committed to primary care. PBRNs have been in existence for more than 30 years. They were formed from local, regional and national primary care practices.[4,5] Some PBRNs are discipline specific (e.g. dental, family practice), while others are geographically centred or serve different populations (e.g. underserved populations). Each PBRN has a unique purpose and yet, all are related to ‘real-world’ research in ‘real-world’ settings.[3,6] The USA © 2014 Royal Pharmaceutical Society
alone has more than 200 PBRNs and the numbers are growing. A list of the registry for primary care PBRNs can be found at http://pbrn.ahrq.gov/portal/server.pt. Although the term primary care PBRN is usually assumed to refer to a network of general practices, networks outside this sphere, such as community pharmacy, have developed. In the USA, there are several regional and local pharmacy PBRNs. The aim of this article is to highlight the need for pharmacists to develop pharmacy PBRNs across the globe.
Benefits of PBRNs Although many pharmacy-based services are promising and efficacious for those who participate, such as in community pharmacy, family medicine, primary and managed care clinics and anticoagulation services, these services are bound to remain limited in number and scope unless they can be delivered reliably to a large population at reasonable cost in the pharmacy settings. There is an urgent need for large multicenter research projects that demonstrate the relevance of these services. Practice-based research networks help to implement such multicenter studies. These networks also help to identify questions relevant to research in practice settings and to use the results to improve practice. Therefore, the scope of research goes beyond academic centres and into the community, and the results are International Journal of Pharmacy Practice 2014, 22, pp. 433–436
more generalizable to daily practice than traditional clinical trials.[5,9] The PBRNs have served as the research laboratory for the evaluation and improvement of patient outcomes from primary care physician services. Similarly, a pharmacist PBRN can utilize scientific methods to evaluate and improve patient outcomes from pharmacist interventions. Collaboration in a pharmacist–physician PBRN would strengthen evidence related to patient care outcomes and improve understanding of this relationship in primary care. Pharmacist involvement in primary care has expanded its focus from educational to the provision of collaborative patient care services, which may be due to ‘maturing’ relationships between pharmacists and physicians, the expansion of pharmacists’ role and the need for alternative methods of delivery of patient services for chronic diseases in primary care. The American Academy of Family Physicians stated that they recognize the important role pharmacists play in the delivery of health care and that pharmacists and physicians should work collaboratively to optimize patient care. Collaborations between pharmacy faculty members of academic institutions and practice site-based pharmacy practitioners are mutually beneficial, whereby the faculty is able to connect with practice, helping to resolve problems and share results with the pharmacy practitioners in the community and on the other hand, the practitioners can improve their practice and expand their professional roles. The network model can supply the resources needed to undertake a project and help in engaging and training practitioners in research methodologies.[13,14]
Examples of published studies involving pharmacy PBRNs A study was published describing the experiences of establishing and maintaining a community pharmacy research network in the UK. More than half of the sample felt that the quality of the advice provided to customers and the relationships between them and the staff had improved by participating in research. The authors state that the network has achieved its aim of involving more community pharmacists in research. Another study described the recruitment of consumers of ibuprofen bought from a research network of community pharmacies in Grampian, Scotland. This study confirmed that it was feasible to recruit users of non-prescription medicines and follow them up over prolonged periods. The study recommended the need for pharmacovigilance studies of ibuprofen. The American College of Clinical Pharmacy PBRN is the first national clinical pharmacy PBRN of the USA. Their PBRN study, titled ‘The American College of Clinical Phar© 2014 Royal Pharmaceutical Society
Pharmacy practice-based research networks
macy (ACCP) Activities Characterizing Clinical Pharmacists (ACCP) Study (ACCP2 Study)’, was motivated by the observation that in clinical trials assessing pharmacist practices, it is often unsure whether the protocols describing clinical care are strictly followed. Furthermore, it is often difficult to demonstrate which aspects of an intervention produced the benefits observed in a trial evaluating a clinical pharmacy service. A very brief summary of the establishment of the University of Tennessee Pharmacist Practice-Based Research Network will illustrate the development of a pharmacy PBRN involving physicians. The network is supported and funded by the University of Tennessee Health Science Center College Of Pharmacy. An evidence-based approach was taken by the network to identify a research topic. Initially, it focused on specific patient populations or disease states for which consultation had already been made with pharmacy practitioners. Priority was placed on topics where it was possible to have collaborative research between pharmacists and physicians and identify diseases in which physicians would feel confident in supporting collaboration and those in which pharmacy services were already received by patients. Physicians were considered as key participants in all projects requiring patient enrolment, although physicians were not members of the network. This arrangement allowed the network to utilize physician’s expertise and provide suitable compensation. Physicians at the member practice sites were satisfied with this arrangement as it did not need a huge commitment of their time beyond daily patient care, but still allowed them to be engaged in research activities. A grant from the Tennessee Department of Health was awarded to the network, shortly after its establishment, to assess the patient outcomes in relation to type 2 diabetes mellitus in an ‘interdisciplinary care environment’. The results of the study published by the network showed that pharmacist–physician collaboration at multiple practice sites and setting types had a positive impact on glycemic control and diabetes-related health maintenance, which was accomplished without increasing antihyperglycemic agents prescribed and without an increase in rate of episodes of hypoglycemia reported by patients. The network also published results which indicated that pharmacist–physician collaboration had a positive impact on cardiovascular risk and assisted patients with type 2 diabetes in attaining national goals for blood pressure and cholesterol. This was attained without increasing total number of antihypertensive and antihyperlipidemic medications prescribed.
Challenges and strategies Some of the challenges that will be faced by emerging PBRNs are securing funds for research, designing innovative methods of research, obtaining resources for network International Journal of Pharmacy Practice 2014, 22, pp. 433–436
infrastructure, establishing by-laws and authorship agreements,facilitation of multiple institutional review board approvals, efficient management of research projects and dissemination of research findings to the practice for improvement of patient outcomes. A conference consensus states four important strategies, as listed below, on how to empower and educate pharmacists to participate in PBRN. • Develop a resource centre for PBRN by developing an Internet-based tool kit, providing access to clinical guidelines and research potential funding avenues, and developing policies and procedures for PBRNs. • Develop tools to facilitate networking by developing a listserv, hosting an annual conference, developing a monitoring system and instituting a visiting practitioner/ scientist programme. • Identify and disseminate practitioners’ best practice models by publishing examples of best practice and developing a list of experts as a resource. • Develop education and training by developing human participant training, training on disease management/clinical skills, training on research methods, training on grant writing, involving students in training programmes and developing advocacy information to support funding requests.
participate in translational studies to improve medication use and clinical outcomes. Pharmacists need to participate in the development of PBRNs for advancement of their practice and to improve patient outcomes. This article can be aptly concluded by quoting Lipowski: ‘The time is right to adopt the PBRN model and blur the distinction between practice and research by bringing practice into research and translating research into practice’.
Declarations Conflict of interest The Author(s) declare(s) that they have no conflicts of interest to disclose.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Authors’ contributions The Author states that he had complete access to the study data that support the publication.
Conclusion The future goal of pharmacists involved in the PBRN and working in collaboration with primary care physicians is to
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