The community pharmacy profession is changing and moving towards a more patient-centred role. In a recently published article, we find that the evidence in support of this transformation is mixed, often inconclusive and suffers from important methodological flaws. Given the limitations of the available evidence on the effectiveness of pharmacists’ broader role, should policy makers devise and implement policies to expand their part within the health care system? We take the view that evidence alone is not sufficient and that social and economic factors are equally important.
A new role for community pharmacists
A number of countries are introducing policies to formally expand the role played by community pharmacists. Many countries have already moved beyond retailing activities. In Canada for instance, the scope of practice of community pharmacists has greatly expanded with pharmacists now assuming a crucial role in optimizing drug therapy and reducing drug-related morbidity (Jones et al. 2005). Danish community pharmacists advise patients about the use and dosage of medicines and generic substitutions, as well as provide blood glucose, blood pressure and cholesterol measurement services in addition to asthma counselling (Herborg et al. 2007).
Common sense dictates that pharmacists should do more. Pharmacists are well-suited to assume responsibilities beyond retailing of medicines: they are the third largest healthcare professional in the world after physicians and nurses and are at times patients’ first and only contact with the health care system. Additional patient-centred responsibilities for community pharmacists have the potential to improve patients’ outcomes and reduce costs of care by promoting health, preventing illness and avoiding adverse events (Smith et al. 2011).
A limited evidence base for policy making
Yet, we find that the systematic review literature evaluating the effectiveness of community pharmacist interventions in patient-centred roles (effective, safe, and appropriate use of medicines, and promotion, prevention, and disease management) has numerous methodological drawbacks, which limits the generalizability of its findings and its applicability for evidence-based policy making. For instance, evidence of effectiveness varied considerably both within and between countries. While there was strong support in the US, much of the evidence stemming from the UK was negative. Another limitation is that most of the studies in the literature are academically-focused and do not focus on evaluations of actual policy interventions. In sum, the existing evidence is not adequate to forecast the likely effect of expanding the role of community pharmacists.
The way forward
What are the implications of our findings for the community pharmacist profession? Should the pharmacy profession only undertake tasks for which there is strong policy relevance with evidence of economic and public health benefits? Despite the limitations of the existing evidence base, reconfiguring the role of community pharmacists to tap better into their potential is becoming inevitable, given the current pressing health challenges linked to population ageing and the rising prevalence of chronic conditions. A good example is the much-touted, and indeed worsening, “polypharmacy” issue (Fulton et al. 2005). The use of multiple medications is becoming common among older patients and represents a risk factor for morbidity and mortality. Medication-related adverse events resulting in complications and hospitalizations are common and costly. These changes have prompted greater attention to pharmaceutical regulation, and consideration is justifiably given to the part different health care providers, such as community pharmacists, could play.
Overall, our findings indicate that more rigorous research is needed to document adequately the effects of community pharmacists’ interventions. We also find that despite the tension between the necessity to formulate new policies during a period of economic constraints and the level of corresponding evidence, several countries like the Netherlands, Denmark, Sweden, and Canada have begun entertaining policies to equip community pharmacists with patient-centred responsibilities. As implementing these roles requires significant changes in the wider health care system, further research is needed to evaluate country-level policy developments.
For the full article, see Mossialos E, Naci H, Courtin E (2013) Expanding the role of community pharmacists: Policymaking in the absence of policy-relevant evidence? Health Policy, 111, 2, 135-148.
Fulton MM, Allen ER (2005) Polypharmacy in the elderly: A literature review, Journal of the American Academy of Nurse Practitioners, 17, 4, 123-132.
Herborg H, Sørensen EW, Frøkjær B (2007) Pharmaceutical care in community pharmacies: practice and research in Denmark, The Annals of Pharmacotherapy, 41, 4, 681-689.
Jones EJ, MacKinnon NJ, Tsuyuki RT (2005) Pharmaceutical care in community pharmacies: practice and research in Canada, The Annals of Pharmacotherapy, 39, 9, 1527-1533.
Smith M, Giuliano MR, Starkowski MP (2011) In Connecticut: Improving Patient Medication Management In Primary Care, Health Affairs, 30, 4, 646-654.
About the authors
Elias Mossialos is Brian Abel-Smith Professor of Health Policy at the Department of Social Policy at the London School of Economics and Political Science, and Director of LSE Health.
Huseyin Naci is a doctoral candidate in Pharmaceutical Policy and Economics within LSE Health, and Thomas O. Pyle Fellow in Population Medicine at Harvard University.
Emilie Courtin is a doctoral candidate in Social Policy within the Personal Social Services Research Unit (LSE) and a research officer at LSE Health.