Showing the way: Enhance the value of research findings

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<ul><li><p>itor</p><p>th</p><p>sustainability (eg, Are data reported for longerterm eects? Are data about attrition reported?).</p><p>As a means of demonstrating how a manuscriptmight actually be acceptable for use beyond its</p><p>onciliation activities. They also specied which</p><p>the article by Snyder et al.6 A model of CWRsproposes how individual, context, and exchange</p><p>characteristics inuence the move toward collabo-ration between pharmacists and physicians. This</p><p>in So</p><p>rmacadapted for use in other settings?); (3) outcome</p><p>(eg, Are outcomes reported in a way that theycan be compared with other ndings of similarstudies? Are potential barriers to obtaining the</p><p>outcomes reported? Are data on the costs of theintervention reported?); and (4) maintenance, or</p><p>ceipt of surveys from 29% of the population. Atable shows this representativeness and where</p><p>there was over-representation in those physiciansolder than 50 years and those who had a perma-nent position. The practicalities of identifying</p><p>a plausible qualitative sample are introduced inEd</p><p>Showing the way: Enhance</p><p>Pharmacys current evidence base for practice</p><p>change is well served by recently published articlesin Research in Social and Administrative Pharmacy(RSAP). Many of the journals most frequentlydownloaded articles from 2011 show that phar-</p><p>macy researchers appear to study problems undermore typical conditions than restrictive ecacytrials.19 According to some, the use of typical</p><p>conditions to study eectiveness should makethe translation of research into practice morestraightforward.10 But, is this sucient?</p><p>The overall value of research is diminishedwhen ndings are not disseminated and subse-quently implemented. Although researchers can-</p><p>not guarantee uptake of research ndings whenthey publish, all stakeholders can improve itsreporting. Four of the most recent RSAP articlesin the area of health systems reform warrant a sec-</p><p>ond look at how externally valid and amenablethey are to being translated into action.2,5,6,9 Us-ing Green and Glasgows criteria11 should help</p><p>readers to judge how a studys ndings could begeneralized. Indeed, the 4 articles commented onmay have counted in the top because they had ad-</p><p>equate descriptions of the following: (1) reach andrepresentativeness (eg, Are participation rates ofsettings, pharmacists, physicians, patients stated?Is the intended target audience for adoption or ap-</p><p>plication adequately described?); (2) implementa-tion (eg, Is the quality of implementing dierentstudy components consistent? Is the level of expe-</p><p>rience required to deliver or replicate the programor intervention stated? Can the intervention be</p><p>Research</p><p>Administrative Pha1551-7411/$ - see front matter 2012 Elsevier Inc. All rightshttp://dx.doi.org/10.1016/j.sapharm.2012.05.011transitions of care subjected to medication recon-ciliation would be included. The tabular represen-</p><p>tation of the 7 studies used in the synthesis (froma sample of over 1700 abstracts and articles re-viewed) gives one a clear picture of the kinds of</p><p>subjects who participated. Dawoud et al includedall pharmacists (n 26) who had received supple-mentary prescribing rights in Southern England.5</p><p>Then, an explanation of why some pharmacistswere excluded from the survey was specied(n 9). The sampling frame for Teinila et alsstudy2 of primary outpatient care physicians in</p><p>Finland was described as was the subsequent re-ial</p><p>e value of research ndings</p><p>simple publication, 4 articles are reviewed here that</p><p>report eectiveness sucient to generalize theirtopic for application in pharmacy reform. Briey,one is a critical synthesis on the eectiveness ofmedication reconciliation in the transition between</p><p>long-term care and acute care9 and another reportson a physician survey about the potential causes ofmedication errors.2 Further, 2 of the 4 are qualita-</p><p>tive studiesdone describes the implementation ofsupplemental prescribing in theUK,5 and the otherdescribes the exchanges made between pharmacists</p><p>and physicians in highly collaborative workingrelationships (CWRs).6</p><p>Reach</p><p>Chhabra et al9 reviewed in their literature syn-thesis only studies with a good description ofstudy subjects included in various medication rec-</p><p>cial and</p><p>y 8 (2012) 357359reserved.</p></li><li><p>Implementation</p><p>358 Editorial / Research in Social and Administrative Pharmacy 8 (2012) 357359Outcome</p><p>Chhabra et als review9 describes no fewer than27 dierent outcome measures of undertakingImplementation of various study components iswide ranging in this sample of health system reformarticles. However, when considered together, the</p><p>articles oer explicit descriptions on how pharma-cists could practice successfully and eectively in thegreater health care environment. Chhabra et al9 is</p><p>very specic about what is meant by medicationreconciliation (comparing the pharmacists list ofmedications with the physicians list at points oftransition). However, medication reconciliation</p><p>alonewas not the only intervention studied in the ar-ticles reviewed. Medication care was bundled inmany of the studies to include, at a minimum, a re-</p><p>view of the appropriateness of the medicines recon-ciled. The authors were explicit in describing whatthe pharmacist did for the patient at the point of</p><p>transition in each of the articles included in the re-view. Teinila et al2 surveyed primary care physiciansin Finland. Their complete methods section fromchoice of population to random sample derivation</p><p>to reminder procedures and a description of non-responders is a model to other authors writingmethods sections for surveys (or indeed, developing</p><p>protocols for studieswith surveys). In addition, theirthoughtfulness in includingopen-endedquestions toexplain quantitative responses is still relatively inno-</p><p>vative on a survey distribution of this size.The 2 qualitative studies reviewed are both</p><p>explicit in their approach to capturing the de-</p><p>scription of policy implementation and relation-ship building.12 Dawoud et al used frameworkanalysis to capture pharmacists views of howa new policy aected their practice.5 Identifying re-</p><p>curring themes helps to facilitate cross- and within-case comparison. Snyder et al6 faced a samplingchallenge in their study and use a nonrandom, pur-</p><p>poseful sampling technique to identify and recruitpairs of pharmacist-physician participants to de-scribe exchanges between the 2 professions. The ex-</p><p>planations of howboth of these studies approachedtheir qualitative analyses are reproducible for otherstudies of pharmacist practice.study sought to describe the personal one-to-oneexchanges that occur between pharmacists andphysicians already operating as highly CWRs.medication reconciliation and review; includedare 12 categories of potential drug-related prob-lems, which arise from both discrepancies and</p><p>pharmacist review. Most are well-dened in thearticle without having to reference the original ar-ticle. To facilitate better understanding of theirndings, Teinila et al2 rst make the point that</p><p>pharmacists relationships with primary care phy-sicians are not so dierent from those in NorthAmerica consisting mainly of communication in</p><p>prescription renewals and technical problemswith prescriptions. This context helps the readerto understand the factors, from physicians per-</p><p>spectives, that the major cause of medicationerrors is the physicians unawareness of patientscomedication use. An interesting outcome ofTeinila et als study was the measurement of ex-</p><p>pectations versus actual contacts with pharma-cists. Physicians expect more contacts fromcommunity pharmacists than actually occurs par-</p><p>ticularly in the cases of potential drug abuse andproblems in drug use.</p><p>Dawoud et al5 use 3 dimensions to query phar-</p><p>macists experiences in implementing supple-mentary prescribing practices: ability to startprescribing within 6 months, the frequency of pre-</p><p>scribing, and self-perceived achievement of out-comes of prescribing. Pharmacist experiences aredescribed using 3 descriptive titles: a blind alley(noticeable barriers and delays in prescribing),</p><p>a stepping stone (in frequent prescribing underlimited conditions), and a good t (implementedprescribing promptly with greater frequency over</p><p>time). Pharmacists faced with permissive legislationaround prescribing would be well served to under-stand how theymight nd themselves in oneof these</p><p>situations. On reection, the article itemizes prereq-uisites for successful implementation of these pre-scribing powers. In an interesting twist, the articleby Snyder et al6 could help pharmacists faced with</p><p>blind alley and stepping stone overcome someof the limitations imposed by physicians. Pharma-cists should probably be the profession to initiate re-</p><p>lationships with physicians through face-to-facevisits. Having done so, it appears that physiciansare able to recognize a commitment by pharmacists</p><p>for improved patient care.When pharmacists makeconsistent contribution to care that improve patientoutcomes over time, then physician trustworthiness</p><p>is established. Snyder et al6 observed that opendiscussions regarding professional roles through ac-knowledgmentof professional norms (ie, physiciansas decision makers) were essential.</p></li><li><p>Maintenance</p><p>Chhabra et al9 describe several natural experi-ments in their 7-study review of the role of medica-tion reconciliation processes during transitions in</p><p>References</p><p>1. Bush J, Langley CA, Wilson KA. The corporatiza-</p><p>tion of community pharmacy: implications for ser-</p><p>vice provision, the public health function, and</p><p>359Editorial / Research in Social and Administrative Pharmacy 8 (2012) 357359care from nursing homes. Data were collected un-der real-world conditions and, in at least 3 studies,for 6 months or more. Keeping interventions</p><p>sustained for 6 or more months may indicate theability of one to sustain the interventions studiedespecially when positive dierences in outcomes</p><p>such as death are reported and despite study designissues. The remaining 3 studies were cross-sectionalin nature so no comment can be made from them</p><p>regarding implementation of their ndings overtime.2,5,6 Regardless, future experimentation usingtheir ndings would contribute to the developmentof health pharmacist policy. For example, the</p><p>qualitative exploration of the exchanges made be-tween pharmacists and physicians should lead tosustained eorts by pharmacists to initiate profes-</p><p>sional relationships with physicians to establishtrust in the care provided by pharmacist involve-ment in patient care.6 Likewise, using these princi-</p><p>ples to initiate discussions with primary carephysicians (in Finland) may help to improve theoccurrence of medication errors.2</p><p>At the beginning of this commentary, Imade thesupposition that undertaking and reporting onresearch undertaken in the real-world may notbe sucient to have it implemented into day-to-day</p><p>practice. Four of RSAPs leading articles in healthsystems reform have demonstrated, to the extentpossible, that good reporting practices may lead</p><p>not only to improved reporting but to enhanceduse. Showing theway to reporting research ndingsmore completely can only help to enhance the value</p><p>of the research endeavor in pharmacy practiceresearch.</p><p>Colleen J. Metge, Ph.D.Research &amp; Evaluation Unit</p><p>Winnipeg Regional Health AuthorityFaculty of Pharmacy</p><p>University of Manitoba</p><p>Manitoba, CanadaCorresponding author. Tel.: 1 204 926 7127;</p><p>fax: 1 204 474 7617E-mail address: c_metge@umanitoba.capharmacys claims to professional status in the</p><p>United Kingdom. Res Social Adm Pharm 2009;5(4):</p><p>305318.</p><p>2. Teinila T, Kaunisvesi K, AiraksinenM. Primary care</p><p>physicians perceptions of medication errors and er-</p><p>ror prevention in cooperation with community phar-</p><p>macists. Res Social Adm Pharm 2011;7(2):162179.</p><p>3. Bryant LJ, Coster G, Gamble GD, McCormick RN.</p><p>General practitioners and pharmacists perceptions</p><p>of the role of community pharmacists in delivering</p><p>clinical services. Res Social Adm Pharm 2009;5(4):</p><p>347362.</p><p>4. Worley MM, Schommer JC, Brown LM, et al. Phar-</p><p>macists and patients roles in the pharmacist-patient</p><p>relationship: are pharmacists and patients reading</p><p>from the same relationship script? Res Social Adm</p><p>Pharm 2007;3(1):4769.</p><p>5. Dawoud D, Griths P, Maben J, Goodyer L,</p><p>Greene R. Pharmacist supplementary prescribing:</p><p>a step toward more independence? Res Social Adm</p><p>Pharm 2011;7(3):246256.</p><p>6. Snyder ME, Zillich AJ, Primack BA, et al. Exploring</p><p>successful community pharmacist-physician collabo-</p><p>rative working relationships using mixed methods.</p><p>Res Social Adm Pharm 2010;6(4):307323.</p><p>7. Roberts AS, Benrimoj SI, Chen TF, Williams KA,</p><p>Hopp TR, Aslani P. Understanding practice change</p><p>in community pharmacy: a qualitative study in Aus-</p><p>tralia. Res Social Adm Pharm 2005;1(4):546564.</p><p>8. Guirguis LM, Chewning BA. Role theory: literature</p><p>review and implications for patient-pharmacist</p><p>interactions. Res Social Adm Pharm 2005;1(4):</p><p>483507.</p><p>9. Chhabra PT, Rattinger GB, Dutcher SK, Hare ME,</p><p>Parsons KL, Zuckerman IH. Medication reconcilia-</p><p>tion during the transition to and from long-term</p><p>care settings: a systematic review. Res Social Adm</p><p>Pharm 2012;8(1):6075.</p><p>10. GlasgowRE, Lichtenstein E,Marcus AC.Why dont</p><p>we see more translation of health promotion research</p><p>to practice? Rethinking the ecacy-to-eectiveness</p><p>transition.AmJPublicHealth 2003;93(8):12611267.</p><p>11. Green LW, Glasgow RE. Evaluating the relevance,</p><p>generalization, and applicability of research: issues</p><p>in external validation and translation methodology.</p><p>Eval Health Prof 2006;29(1):126153.</p><p>12. Ritchie J, Lewis J. Qualitative Research Practice:</p><p>A Guide for Social Science Students and Researchers.</p><p>London, UK: Sage; 2003.</p><p>Showing the way: Enhance the value of research findingsReachImplementationOutcomeMaintenanceReferences</p></li></ul>

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