Available online at www.sciencedirect.com

Research in Social and

Administrative Pharmacy 5 (2009) 195–196

Editorial

Challenges facing social pharmacy

In this issue, Puspitasari et al1 present a reviewof research on counseling given to people purchas-ing prescription medicines in community pharma-

cies. Their results point to some challenges forsocial pharmacy research, such as the nature of re-searchers’ relationships with the profession, how

to improve community pharmacy practice, the im-portance of learning from other disciplines, andthe need to internationalize our discipline.

Since the 1970s pharmacists have argued for an

increasing role in patient caredpatient counselingis one of the cornerstones of this new role.2-5 Thevery wide variation in counseling rates found by

Puspitasari et al (from 8% to 80% of patients re-ceived verbal counseling) suggests that this newrole is carried out more in some settings than

others. Social pharmacy research has played andcontinues to play an important role in document-ing this practice variation.

The more difficult question is how to improvethe practice of those settings and practitioners whoare currently lagging behind. Social pharmacy/pharmacy practice researchers tread a delicate

line. Relationships with practitioners must be closeand positive so that research results are takenseriously, and researchers must listen to and

engage practitioners so that they respond to newevidence by improving practice. At the same time,researchers need to be distant and independent

enough so that they can identify the need forimprovement, and advocate for the interests andhealth of the public rather than the short-sighted

professional interests of those who want to keepthings as they are and not draw attention toproblems. Those social pharmacy researchers whoare not pharmacists face an additional set of

challenges and pressures; that is, of establishinga valid role within social pharmacy, but not withinpharmacy; working out whether (and under which

circumstances) they are insiders or outsiders6 in thepharmacy profession, while maintaining their posi-tion within their home disciplines (whichmay often

be skeptical about professional interests).7

1551-7411/08/$ - see front matter � 2009 Elsevier Inc. All righ

doi:10.1016/j.sapharm.2009.03.001

Improvements in community pharmacy prac-tice are clearly needed, as Puspitasari’s reviewclearly shows. Studies demonstrating that moti-

vated, innovative pharmacists can provide effectivenew services are undoubtedly important8,9; how-ever, we also need intervention studies that explore

how to improve the performance of the ‘‘average’’pharmacist or pharmacy assistant. If only themoti-vated, innovative pharmacists improve their ser-vices, practice variation will increase, rather than

decrease. Negative consequences include greaterdisparities in the public’s access to good pharmacyservices (this would be particularly unfortunate if

the innovative pharmacists tended to practice inwealthy areas of town). There are also considerablepolitical risks of allowing somepractitioners to pro-

vide poor servicedpoor performers tend to attractmore public and political attention, and are likelyto have a negative impact on funding negotiations.

There is a considerable body of work now inother professions about how to improve practice,and social pharmacy shouldbuild on this rather thanattempting to reinvent the wheel. In particular, the

Cochrane Effective Practice and Organization ofCare Review Group have done a lot of work in thisarea.10,11Muchof thisworkhasestablished thatpas-

sive dissemination of information, such as writtenmaterials and lectures is not effective in changingpractice. Consistently effective strategies include re-

minders, interactive educational meetings that en-courage discussion, and educational outreach.Multifaceted interventions tend to be more effective

than single interventions. Reviews of evidence onspecific issues, such as interventions to improve anti-microbial use have produced similar findings.12

Strategies for improving practice are a key

concern in most health professions, but are dealtwith separately in each profession. This is one ofmany areas where the division of practice research

into separate professions (ie, pharmacy, medicine,nursing, and so forth) can limit progress.Although there might be differences between

professions and between countries, practice

ts reserved.

196 Editorial/Research in Social and Administrative Pharmacy 5 (2009) 195–196

researchers in each discipline can learn consider-ably from each other.

Puspitasari et al’s review also illustrate that

social pharmacy research is carried out in a verysmall number of (almost exclusively) developedcountries. Puspitasari’s search of English languagepublications on counseling on prescription medi-

cines in community pharmacies found studies fromthe United States, the United Kingdom, the Neth-erlands, Finland, Australia, and Canada. This

closelymirrors the development of social pharmacyexpertise. Ryan et al found social pharmacy beingtaught in 17 countriesdthose above (although so-

cial pharmacy is taught in Finland, Finland wasnot included) plus 4 more Scandinavian countries,3 more European countries, New Zealand, and 4countries in the developing world.13

There are significant problems in the purchase,distribution, and use of medicines all around theworld, particularly in developing countries, and

social pharmacy researchers should be seizingopportunities to use their expertise to addressthese. This would involve making strategic alli-

ances with those already working in these areasdin the case of developing countries there is a strongcommunity of ‘‘rational use of drugs’’ experts,14

the World Health Organization (www.who.int),Management Sciences for Health (www.msh.org),and other organizations with expertise, experi-ence, and commitment to improving access to

and use of medicines in developing countries.There are also opportunities to work with col-leagues and build capacity in social pharmacy re-

search in Eastern Europe.Reviews like that done by Puspitasari et al1

provide an opportunity for a stock-take for our

discipline, encouraging us to reflect on where weare and to discuss ways forward to maximizeour contribution to public health.

Pauline T. Norris, B.A., M.A., Ph.D.*

School of PharmacyUniversity of Otago

Box 56Dunedin 9054New Zealand

*Corresponding author. Tel.: +64 3 479 7359;

fax: +64 3 479 7034.

E-mail address: pauline.norris@otago.ac.nz

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