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•What is the influence of a newly
developed product on health and health
economics?
•How is drug distribution carried out in
countries that have different education
and availability of pharmacists?
•How do pharmacists perceive and act
The Concept of upon their expanded roles in health care
delivery?
The other general area of research in
Social Pharmacy addresses user (or patient
Social Pharmacy or customer) perceptions and use of drugs/
medicines. Research questions in this area
are as diverse as the patients and providers
* + ** involved in medication use activities, for
Sørensen EW MSc(Pharm), Mount JK PhD, RPh, Christensen ST PhD(Pharm)
example:
* Associate professor, The Danish University of Pharmaceutical Sciences, •Why is the patient taking (or not
Dept of Social Pharmacy, Copenhagen, Denmark taking) a medicine as it was prescribed?
Email: ews@dfk.dk •What kind(s) of drug information has
+ Associate professor, University of Wisconsin, the best effect on patient understanding
Dept of Social and Administrative Pharmacy, Madison, USA and when should it be provided?
** Assistant research professor, The Danish University of Pharmaceutical Sciences, •How can a pharmacist most effectively
Dept of Social Pharmacy, Copenhagen, Denmark identify a patient’s drug-related
problems/side effects?
The 13th International Social Pharmacy Workshop will be held •How can new pharmaceutical services
for the patient/customer be
in Malta in July 2004. The Social Pharmacy Workshops are implemented in health care?
international conferences for research in social and
behavioural pharmacy. Meetings are held every second year Thus, Social Pharmacy can assist anyone
and participation has grown steadily since the first Workshop who wants to use a scientific approach to
was held in Helsinki, Finland, in 1980. Following the describe, explain, understand, and/or
change practice. As such, it offers benefits
successful 2002 conference in Sydney, Australia, the 2004 to researchers, policy-makers, and
meeting in Malta will be the first one held in the pharmacists as well as other health care
Mediterranean area! providers.
The primary pursuit of Social Pharmacy
research is to investigate questions and
Introduction sciences simply do not provide adequate themes concerning pharmacy practice and
But what is Social Pharmacy? In this tools or perspectives. They need to be medicine use. It is a hybrid field that uses
article, we give a brief overview of this supplemented with knowledge from the theories and methods from numerous
field. We identify key questions addressed humanistic and social scientific disciplines
in Social Pharmacy research and introduce disciplines that deal with people and in order to explore all aspects of pharmacy
its major theories, concepts, and research systems, i.e., the humanistic and social practice. Because of this interdisciplinary
methods. Finally, we discuss the future of sciences. And this is where Social Pharmacy nature, it is necessary to be familiar with
Social Pharmacy and how it relates to the comes into the picture. diverse disciplines and skilled in applying
future of Pharmacy in general. Within Social Pharmacy, the drug/ their methods of inquiry. Social Pharmacy
medicine sector is studied from the social regularly draws upon the disciplines of
What is Social Pharmacy? scientific and humanistic perspectives. sociology, social psychology, psychology,
Traditionally, chemistry, biochemistry, Topics relevant to Social Pharmacy consist political sciences, educational studies,
physics and physiology form Pharmacy’s of all the social factors that influence communications, economics, history, and
core knowledge base. Knowledge of medicine use, such as medicine- and health- anthropology. It leans more heavily on
medications and their effects is the basis of related beliefs, attitudes, rules, psychology, social psychology, sociology,
the pharmacists’ professional expertise. relationships, and processes. One general political science, and economics, especially
Practising pharmacy, however, is carried out area of research focus addresses social as these relate to issues in public health
among human beings, the persons referred aspects of drugs themselves including: drug and social politics.
to as customers or patients or users. They, research and development, drug production, Figure I shows the hierarchy of natural
in turn, are connected with one another in drug distribution, drug prescription, drug systems, the levels of organisation and the
families, organizations and health systems information and drug control. Examples of disciplines in the pharmaceutical education.
in countries and cultures around the world. questions within this area are: a
This is the way that we at the Danish
Thus, when trying to explain, understand or •How do laws influence development and University of Pharmaceutical Sciences
change pharmacy practice, the natural approval of new drug products? explain the relationships between the
8 thechronic✱ill Issue 7 Summer 2003
different pharmaceutical Figure I: Levels of Organisation and the relevant to Social Pharmacy
disciplines. This also illustrates Disciplines involved in Pharmaceutical Education research, a series of articles by
how Clinical Pharmacy serves as Bissell, Traulsen, and Haugbølle13-
15
a bridge that overlaps with and is being published in the
connects the natural sciences International Journal of Pharmacy
and Social Pharmacy. Practice. Each article examines an
Social Pharmacy has strong area of sociological theory and its
connections to Pharmacy relation to pharmacy practice
Practice. In virtually all cases, research. Approaches being
b
books addressing subjects, examined include: functionalism,
theories and methods of Social marxism, symbolic interactionism
Pharmacy associate Social and ethno-methodology,
Pharmacy with the term, feminism, post-modernism and
activities, and/or field of post-structuralism, the work of
Pharmacy Practise. This is Michel Foucault and the
c
illustrated by Wertheimer and developing sociology of the body.
1 5
Smith, and Taylor and Harding.
In fact, in some countries, Methods
Social Pharmacy actually is In Social Pharmacy, as in the
incorporated under the more social and humanistic sciences,
general term “pharmacy there is no one single method of
practice”.4 research but several, because the
types of question that need to be
Research in Social Pharmacy 5. Improving quality of services and answered differ. Research is classified into
Social Pharmacy/Pharmacy Practice quality assurance four types in relation to the core questions
Research is linked to the broad field known 6. Evaluations of policy and practise they can answer, the typical design and
as health services research. This linkage experiments and innovations research method(s) used, and the different
16
emphasises that this is an applied field of 7. Interface between pharmaceutical and quality criteria for each type. This is shown
research, concerned with both other health services in Table I.
understanding and improving pharmacy 8. Payment and remuneration for services Research methodology in Social
practice and medication use. Why is and pharmaceuticals Pharmacy/pharmacy practice is described in
5 17
research of this type so important? Addressing all these topics obviously is by Taylor et al and Smith.
Increasingly, we recognise that pharmacy a major challenge, one that leads Further information about research in
practice must be evidence-based and must researchers into many different areas of Social Pharmacy, may be sought from the
make use of best practices. Thus, it is investigation and application. How can following sources:
important that pharmacy practices be such diverse studies be united with one
evaluated and that findings of such research another? By using theories developed in International journals:
be implemented. Much work is still needed the humanistic and social sciences to guide •Journal of Social and Administrative
in this area. Reviews such as those by De Social Pharmacy investigations, we are able Pharmacy
6 7 8
Young, Schumock and Singhal et al, to develop a more general understanding of •International Journal of Pharmacy
conclude that pharmacist consultation and social factors that influence pharmacy Practice
pharmacy-based interventions have positive practice and medicine use.
effects. Applying the strict criteria used to As a relatively new discipline, though, Books about Social Pharmacy/Pharmacy
conduct a systematic review, however, the theoretical bases of research in the area Practice:
9
Beney, Bero and Bond concluded that more of Social Pharmacy and Pharmacy Practice •Taylor K, Harding G (2001) Pharmacy
rigorous research is needed to document the 11
effects of pharmacist interventions. Thus, it still are in the process development. The Practice. London: Taylor and Francis.
is important that pharmacist practitioners number and range of theories useful for
research, however, are enormous and National or international conferences:
participate in collaborative Social Pharmacy 12
research or undertake their own research varied. In the Social Pharmacy research
community and at the Social Pharmacy •International Social Pharmacy Workshop
and professional audits. Workshops, we recognize and try to improve • Pharmaceutical Care Network Europe
What topics require investigation? upon this; theories are discussed, critiqued, (PCNE)
The Pharmacy Practice and Research and further integrated into current research. • European Society of Clinical pharmacy
Reflecting the wide array of theories (ESCP)
Group10 recommended eight themes and
topics for pharmacy practice research:
1
1. Supply, distribution and availability of a) A similar model is described by Mount in Wertheimer and Smith (1989).
2 1
services b) This section is based on the following sources: Lilja, 1988; Wertheimer and Smith, 1989; Harding,
3 4 5
2. Demand of services Nettleton and Taylor 1990; Harding, Nettleton and Taylor, 1994; Taylor and Harding 2001.
3. Organisation and process of service c) Language usage reflects social changes. For example, in their 1996 revised edition, Wertheimer and
delivery Smith revised the title to Social and Behavioral Aspects of Pharmaceutical Care and Harding and
colleagues used the terms Sociology and Social Pharmacy in their earlier textbooks (Harding et al
4. Effectiveness and outcomes of services 1990; Harding et al 1994).3,4
10 thechronic✱ill Issue 7 Summer 2003
•Health Services and Pharmacy Practice References
Research conferences
•FIP: The International Pharmaceutical 1. Wertheimer AI, Smith MC. Pharmacy Practice: 10. Mays N. Health Services Research in
Federation Social and Behavioral Aspects. Philadelphia: Pharmacy: A Critical Personal Review.
•American Pharmacists Association Williams and Wilkins; 1989. Manchester: University of Manchester,
2. Lilja J. Theoretical Social Pharmacy: The Drug Pharmacy Practice Research Resource Centre
•American Society of Health-System Sector From a Social Science Perspective. 1994.
Pharmacists Kuopio: University of Kuopio, Department for 11. Nørgaard LS, Morgall JM, Bissell P.
Social Pharmacy; 1988. Arguments for theory-based pharmacy
Conclusion: The Future 3. Harding G, Nettleton S, Taylor K. Sociology for practice research. Int J Pharm Pract 2000:77-
Social Pharmacy has come to stay, and Pharmacists: An Introduction. London: 81.
there are reasons to believe that Social Macmillan; 1990. 12. Bissell P, Traulsen MJ, Haugbølle LS. (1) An
Pharmacy will play an even more crucial role 4. Harding G, Nettleton S, Taylor K. Social introduction to sociology - and what it can
Pharmacy: Innovation and Development. do for pharmacy practice research. Int J
in future pharmacy, i.e. drug engineering London: The Pharmaceutical Press; 1994. Pharm Pract 2001:9:289-95.
based on gene technology and 5. Taylor K, Harding G. Pharmacy Practice. 13. Bissell P, Traulsen MJ, Haugbølle LS. (2) An
nanotechnology and the increasing reliance London: Taylor and Francis; 2001. introduction to functionalist sociology:
on drugs in dealing with human ailments 6. De Young M. Research on the effects of Talcott Parsons’ concept of the “sick role”,
will pose and empower new challenges for pharmacist-patient communication in Int J Pharm Pract 2002:10:60-8.
pharmacists. The nature of modern and institutions and ambulatory care sites, 1969- 14. Bissell P, Traulsen MJ, Haugbølle LS. (3) How
future drugs calls for interdisciplinary 1994, American Journal of Health-System relevant is Marxist sociology for pharmacy
approaches in both research and practice in Pharmacy 1996:53 (June 1):1277-91. practice research? Int J Pharm Pract
7. Schumock GT, Butler MG, Meek PD, et al. 2002:10:127-40.
order to fully understand the associated Evidence of the economic benefit of clinical 15. Bissell P, Traulsen MJ, Haugbølle LS. (4) The
complexity. In the future, health care pharmacy services: 1996-2000, contribution of interactionist sociology to
systems will be stretched far as the Pharmacotherapy 2003:23(1):113-32. understand experience of health and illness.
“invading nature” of future drugs will have 8. Singhal PK, Raisch DW, Gupchup GV. The Int J Pharm Pract 2002:10:213-24.
substantial impact on pharmacists’ impact of pharmaceutical services in 16. Launsø L, Rieper O. Forskning om og med
performance, health care policies and community and ambulatory care settings: mennesker. Nyt Nordisk Forlag Arnold Busck,
expenditures, as well as on the individual Evidence and recommendations for future 2000.
user whose life might be altered radically. research, Annals of Pharmacotherapy 17. Smith FJ. Pharmacy practice research
Social Pharmacy is the interdisciplinary 1999:33(Dec):1136-1355. methods. London: Pharmaceutical Press.,
discipline that enables the pharmacy 9. Beney, J. Bero, LA. Bond, C. Expanding the 2002.
profession to act, take part and take roles of outpatient pharmacists. [Systematic
responsibility in drug matters at a societal Review] Cochrane Effective Practice and
Organisation of Care Group Cochrane
level. Being a discipline developing very Database of Systematic Reviews 2003:1.
fast due to social demand, Social Pharmacy
is likely to have a central position in the
future curricula in Pharmacy Schools.
Table I: The Main Types of Research14
Research Type Descriptive Explanatory Understanding Action-oriented
Core Question How is X What X What is X? How do people
distributed? causes Y? involved develop
the action on basis
What Y results of the knowledge
from X? gained and
communicated during
the research process?
Typical Design Survey Experimental Case study • Action research
• Formative evaluation
Dominating Method Quantitative Quantitative Quantitative Qualitative and
quantitative
Quality Criteria • Reliability • Reliability • Validity • Validity
• Validity • Validity • Wholeness • Does learning occur?
• Precision • Precision • Looking-glass • What direction does
• Generalisation • Generalisation • Provocation change take?
• Prediction • Enlargement • What does change
of meaning mean?
Issue 7 Summer 2003 thechronic✱ill 11
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