The evolution of pharmacy practice research—Part I: Time to implement the evidence

In this editorial, we bring together two leading pharmacy research journals, the International Journal of Pharmacy Practice and the Canadian Pharmacists Journal, to take stock of the current evidence on the effectiveness of pharmacists’ contribution to patient care and make recommendations for future areas of research. The role of pharmacists has been changing globally over the past 30 years, moving away from a technical dispensing role to a more holistic cognitive role that begins to optimize the use of the full range of pharmacist competencies acquired during basic and advanced training. The drivers for this change are multifactorial but include the increasing needs and demands of an ageing population, sustainability of the traditional physician–nurse led health care workforce, increasing use of pharmacological approaches as the mainstay of disease management and need to increase the efficient and effective use of health care budgets. Underlining the direction of the change has been evidence derived from research studies confirming that the care provided by pharmacists is generally equivalent to and sometimes better than usual care. A recently published Cochrane review concluded that “some services provided by pharmacists can have positive effects on patient health, including improved management of blood pressure and physical function,” while emphasizing the challenges from the heterogeneity of the identified studies and risk of bias in some. Similarly, another Cochrane review focusing solely on hypertension concluded that “pharmacist-led care may be a promising way of improving control in patients with hypertension, with the majority of RCTs being associated with improved blood pressure control, improved systolic blood pressure and more modestly improved diastolic blood pressure, but these interventions require further evaluation.” Likewise, Santschi et al. showed an average reduction of 7.6/3.9 mmHg over 39 trials of pharmacist care vs usual care. Finally, a third Cochrane review, on prescribing by other health care professionals, concluded that “with appropriate training and support, nurses and pharmacists are able to prescribe medicines as part of managing a range of conditions to achieve comparable health management outcomes to doctors.” The body of research exploring the expanded scope of pharmacy practice is large, but as the Cochrane reviews and others have highlighted, many reports are small-scale nonrandomized studies or, when a randomized controlled trial is reported, there is insufficient detail of the intervention or Figure 1 Components of a full scope of pharmacy practice