Research in Social and

Administrative Pharmacy 8 (2012) 357–359

Editorial

Showing the way: Enhance the value of research findings

Pharmacy’s current evidence base for practice

change is well served by recently published articlesin Research in Social and Administrative Pharmacy(RSAP). Many of the journal’s most frequentlydownloaded articles from 2011 show that phar-

macy researchers appear to study problems undermore typical conditions than restrictive efficacytrials.1–9 According to some, the use of typical

conditions to study effectiveness should makethe translation of research into practice morestraightforward.10 But, is this sufficient?

The overall value of research is diminishedwhen findings are not disseminated and subse-quently implemented. Although researchers can-

not guarantee uptake of research findings whenthey publish, all stakeholders can improve itsreporting. Four of the most recent RSAP articlesin the area of health systems reform warrant a sec-

ond look at how externally valid and amenablethey are to being translated into action.2,5,6,9 Us-ing Green and Glasgow’s criteria11 should help

readers to judge how a study’s findings could begeneralized. Indeed, the 4 articles commented onmay have counted in the top because they had ad-

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-

plication adequately described?); (2) implementa-tion (eg, Is the quality of implementing differentstudy components consistent? Is the level of expe-

rience required to deliver or replicate the programor intervention stated? Can the intervention beadapted for use in other settings?); (3) outcome

(eg, Are outcomes reported in a way that theycan be compared with other findings of similarstudies? Are potential barriers to obtaining the

outcomes reported? Are data on the costs of theintervention reported?); and (4) maintenance, orsustainability (eg, Are data reported for longerterm effects? Are data about attrition reported?).

As a means of demonstrating how a manuscriptmight actually be acceptable for use beyond its

1551-7411/$ - see front matter � 2012 Elsevier Inc. All rights

http://dx.doi.org/10.1016/j.sapharm.2012.05.011

simple publication, 4 articles are reviewed here that

report effectiveness sufficient to generalize theirtopic for application in pharmacy reform. Briefly,one is a critical synthesis on the effectiveness ofmedication reconciliation in the transition between

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-

tive studiesdone describes the implementation ofsupplemental prescribing in theUK,5 and the otherdescribes the exchanges made between pharmacists

and physicians in highly collaborative workingrelationships (CWRs).6

Reach

Chhabra et al9 reviewed in their literature syn-thesis only studies with a good description ofstudy subjects included in various medication rec-

onciliation activities. They also specified whichtransitions of care subjected to medication recon-ciliation would be included. The tabular represen-

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

subjects who participated. Dawoud et al includedall pharmacists (n¼ 26) who had received supple-mentary prescribing rights in Southern England.5

Then, an explanation of why some pharmacistswere excluded from the survey was specified(n¼ 9). The sampling frame for Teinila et al’sstudy2 of primary outpatient care physicians in

Finland was described as was the subsequent re-ceipt of surveys from 29% of the population. Atable shows this representativeness and where

there was over-representation in those physiciansolder than 50 years and those who had a perma-nent position. The practicalities of identifying

a plausible qualitative sample are introduced inthe article by Snyder et al.6 A model of CWRsproposes how individual, context, and exchange

characteristics influence the move toward collabo-ration between pharmacists and physicians. This

reserved.

358 Editorial / Research in Social and Administrative Pharmacy 8 (2012) 357–359

study sought to describe the personal one-to-oneexchanges that occur between pharmacists andphysicians already operating as highly CWRs.

Implementation

Implementation of various study components iswide ranging in this sample of health system reformarticles. However, when considered together, the

articles offer explicit descriptions on how pharma-cists could practice successfully and effectively in thegreater health care environment. Chhabra et al9 is

very specific about what is meant by medicationreconciliation (comparing the pharmacists list ofmedications with the physician’s list at points oftransition). However, medication reconciliation

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-

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

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

to reminder procedures and a description of non-responders is a model to other authors writingmethods sections for surveys (or indeed, developing

protocols for studieswith surveys). In addition, theirthoughtfulness in includingopen-endedquestions toexplain quantitative responses is still relatively inno-

vative on a survey distribution of this size.The 2 qualitative studies reviewed are both

explicit in their approach to capturing the de-

scription of policy implementation and relation-ship building.12 Dawoud et al used frameworkanalysis to capture pharmacists’ views of howa new policy affected their practice.5 Identifying re-

curring themes helps to facilitate cross- and within-case comparison. Snyder et al6 faced a samplingchallenge in their study and use a nonrandom, pur-

poseful sampling technique to identify and recruitpairs of pharmacist-physician participants to de-scribe exchanges between the 2 professions. The ex-

planations of howboth of these studies approachedtheir qualitative analyses are reproducible for otherstudies of pharmacist practice.

Outcome

Chhabra et al’s review9 describes no fewer than27 different outcome measures of undertaking

medication reconciliation and review; includedare 12 categories of potential drug-related prob-lems, which arise from both discrepancies and

pharmacist review. Most are well-defined in thearticle without having to reference the original ar-ticle. To facilitate better understanding of theirfindings, Teinila et al2 first make the point that

pharmacists’ relationships with primary care phy-sicians are not so different from those in NorthAmerica consisting mainly of communication in

prescription renewals and technical problemswith prescriptions. This context helps the readerto understand the factors, from physicians’ per-

spectives, that the major cause of medicationerrors is the physician’s unawareness of patients’comedication use. An interesting outcome ofTeinila et al’s study was the measurement of ex-

pectations versus actual contacts with pharma-cists. Physicians expect more contacts fromcommunity pharmacists than actually occurs par-

ticularly in the cases of potential drug abuse andproblems in drug use.

Dawoud et al5 use 3 dimensions to query phar-

macists’ experiences in implementing supple-mentary prescribing practices: ability to startprescribing within 6 months, the frequency of pre-

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),

“a stepping stone” (in frequent prescribing underlimited conditions), and “a good fit” (implementedprescribing promptly with greater frequency over

time). Pharmacists faced with permissive legislationaround prescribing would be well served to under-stand how theymight find themselves in oneof these

situations. On reflection, 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

“blind alley” and “stepping stone” overcome someof the limitations imposed by physicians. Pharma-cists should probably be the profession to initiate re-

lationships with physicians through face-to-facevisits. Having done so, it appears that physiciansare able to recognize a commitment by pharmacists

for improved patient care.When pharmacists makeconsistent contribution to care that improve patientoutcomes over time, then physician trustworthiness

is established. Snyder et al6 observed that opendiscussions regarding professional roles through ac-knowledgmentof professional norms (ie, physiciansas decision makers) were essential.

359Editorial / Research in Social and Administrative Pharmacy 8 (2012) 357–359

Maintenance

Chhabra et al9 describe several natural experi-ments in their 7-study review of the role of medica-tion reconciliation processes during transitions in

care from nursing homes. Data were collected un-der real-world conditions and, in at least 3 studies,for 6 months or more. Keeping interventions

sustained for 6 or more months may indicate theability of one to sustain the interventions studiedespecially when positive differences in outcomes

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

regarding implementation of their findings overtime.2,5,6 Regardless, future experimentation usingtheir findings would contribute to the developmentof health pharmacist policy. For example, the

qualitative exploration of the exchanges made be-tween pharmacists and physicians should lead tosustained efforts by pharmacists to initiate profes-

sional relationships with physicians to establishtrust in the care provided by pharmacist involve-ment in patient care.6 Likewise, using these princi-

ples to initiate discussions with primary carephysicians (in Finland) may help to improve theoccurrence of medication errors.2

At the beginning of this commentary, Imade thesupposition that undertaking and reporting onresearch undertaken in the “real-world” may notbe sufficient to have it implemented into day-to-day

practice. Four of RSAP’s leading articles in healthsystems reform have demonstrated, to the extentpossible, that good reporting practices may lead

not only to improved reporting but to enhanceduse. Showing theway to reporting research findingsmore completely can only help to enhance the value

of the research endeavor in pharmacy practiceresearch.

Colleen J. Metge, Ph.D.Research & Evaluation Unit

Winnipeg Regional Health AuthorityFaculty of Pharmacy

University of Manitoba

Manitoba, CanadaCorresponding author. Tel.: þ1 204 926 7127;

fax: þ1 204 474 7617

E-mail address: c_metge@umanitoba.ca

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