PSAP Topic 5: Pharmacy-Based Sociological Knowledge  How is drug distribution carried out in countries

Generation that have different education and availability of

pharmacists?
Social Pharmacy  How do pharmacists perceive and act upon their
- Traditionally, chemistry, biochemistry, physics and expanded roles in health care delivery?
physiology form Pharmacy’s core knowledge base.
Knowledge of medications and their effects is the The other general area of research in Social Pharmacy
basis of the pharmacists’ professional expertise. addresses user (or patient or customer) perceptions and
- Practicing pharmacy, however, is carried out among use of drugs/ medicines. Research questions in this area
human beings, the persons referred to as customers are as diverse as the patients and providers involved in
or patients or users. They, in turn, are connected medication use activities, for example:
with one another in families, organizations and  Why is the patient taking (or not taking) a medicine
health systems in countries and cultures around the as it was prescribed?
world.  What kind(s) of drug information has the best effect
- Thus, when trying to explain, understand or change on patient understanding and when should it be
pharmacy practice, the natural sciences simply do provided?
not provide adequate tools or perspectives. They  How can a pharmacist most effectively identify a
need to be supplemented with knowledge from the patient’s drug-related problems/side effects?
disciplines that deal with people and systems, i.e.,  How can new pharmaceutical services for the
the humanistic and social sciences. And this is patient/customer be implemented in health care?
where Social Pharmacy comes into the picture.
- Within Social Pharmacy, the drug/ medicine sector Research In Social Pharmacy
is studied from the social scientific and humanistic - Social Pharmacy/Pharmacy Practice Research is
perspectives. Topics relevant to Social Pharmacy linked to the broad field known as health services
consist of all the social factors that influence research. This linkage emphasizes that this is an
medicine use, such as medicine- and health-related applied field of research, concerned with both
beliefs, attitudes, rules, relationships, and understanding and improving pharmacy practice
processes. and medication use.
- One general area of research focus addresses social - What topics require investigation? The Pharmacy
aspects of drugs themselves including: drug Practice and Research Group recommended eight
research and development, drug production, drug themes and topics for pharmacy practice research:
distribution, drug prescription, drug information 1) Supply, distribution and availability of services
and drug control. 2) Demand of services
- Thus, Social Pharmacy can assist anyone who wants 3) Organization and process of service delivery
to use a scientific approach to describe, explain, 4) Effectiveness and outcomes of services
understand, and/or change practice. As such, it 5) Improving quality of services and quality
offers benefits to researchers, policy-makers, and assurance
pharmacists as well as other health care providers. 6) Evaluations of policy and practice experiments
- The primary pursuit of Social Pharmacy research is and innovations
to investigate questions and themes concerning 7) Interface between pharmaceutical and other
pharmacy practice and medicine use. It is a hybrid health services
field that uses theories and methods from 8) Payment and remuneration for services and
numerous humanistic and social scientific pharmaceuticals
disciplines in order to explore all aspects of
pharmacy practice. Quantitative Research Designs In Pharmacy Practice
- Because of this interdisciplinary nature, it is  A wide range of quantitative methods are
necessary to be familiar with diverse disciplines and commonly applied in pharmacy practice research.
skilled in applying their methods of inquiry. These methods are widely used in published
- Social Pharmacy regularly draws upon the pharmacy practice literature to explore
disciplines of sociology, social psychology, appropriateness of medicines use, appropriateness
psychology, political sciences, educational studies, and quality of prescribing, and medication safety,
communications, economics, history, and through analyzing existing datasets, direct
anthropology. It leans more heavily on psychology, observation, or self-report.
social psychology, sociology, political science, and  Pharmacy practice research questions also seek to
economics, especially as these relate to issues in determine the knowledge, behaviors, attitudes, and
public health and social politics. practices of pharmacists, other healthcare
providers, patients, policy-makers, regulators, and
Examples of questions within this area are: the general public.
 How do laws influence development and approval  Quantitative methods are also used in evaluating
of new drug products? the effect of new pharmacy services and
 What is the influence of a newly developed product interventions to improve medicines use. These
on health and health economics? practice research projects provide valuable insights
about how medicines are used, and how to
maximize their benefits and minimize their harmful
 effects. In the context of this chapter, quantitative a) Experimental design — In experimental design (also
study designs will be broadly classified into three: known as interventional design), the investigator
(1) observational, (2) experimental and quasi performs an intervention and evaluates cause and
experimental, and (3) other designs. effect relationships.
b) Quasi-experimental design — The quasi-
Qualitative Research Desigs In Pharmacy Practice experimental design is very similar to the true
 Qualitative research methodology is applied to experimental design described above and it involves
investigate a problem that has unmeasurable an intervention. The design has been employed
variables, to get a comprehensive understanding of when randomization is inappropriate or impossible,
the topic, through discussing it with the involved especially when implementing complex
individuals, and to recognize the natural context in interventions.
which the investigated issue takes place. c) Observational design — It involves only observation
 The use of qualitative research methodology is of natural phenomena and does not involve
becoming increasingly common across diverse investigator intervention. Typically, this study
health-related disciplines, including pharmacy design investigates associations and not causation.
practice. This is because of its ability to describe Examples include cohort study and case–control
social processes and behaviors associated with study. These studies can explore an association
patients or healthcare professionals, which between a pharmacologic agent and a disease of
strengthen the research impact. Therefore, interest.
pharmacy researchers and practitioners need to be
better oriented to qualitative research methods. 4. Classification based on question orientation:
Quantitative vs. qualitative vs. mixed method designs
Classification Of Research Methodologies Used In a) Quantitative design — This is based on
Pharmacy Practice measurement of quantity and it is applicable to
Various classifications for research designs and methods phenomenon that can be quantified (i.e., expressed
used in pharmacy practice have been used in the in terms of numbers).
literature. The following are some of the approaches for b) Qualitative design — Qualitative research is
the classification of research designs: concerned with qualitative phenomenon (i.e., a
phenomenon relating to or involving quality).
1. Classification based on time orientation: c) Mixed method designs — Mixed method design
Retrospective vs. prospective designs brings together qualitative and quantitative
a) Retrospective design — A retrospective study methodologies within a single study to answer or
design observes what has happened in the past. It understand a research problem.
begins and ends in the present. This design involves
a major limitation as it looks to collect information 5. Classification of pharmacoepidemiologic study
about events that occurred in the past. An example designs
of this design is retrospective case-control study. a) Case–control studies — In this design, patients
b) Prospective design — A prospective study design (those who develop the disease or outcome of
begins in the present and progresses forward, interest) are identified and control patients (those
collecting data from subjects whose outcomes lie in who do not develop the disease or outcome of
the future. An example of this design is prospective interest) are sampled at random from the original
cohort study. cohort that gives rise to the cases. The distribution
of exposure to certain risk factors between the
2. Classification based on study purpose: Descriptive cases and the controls is then explored, and an odds
vs. analytical designs ratio (OR) is calculated.
a) Descriptive design — A descriptive study describes b) Cohort studies—This can be described as a study in
a population/sample in terms of distribution of the which a group of exposed subjects and a group of
variables, and frequency of outcomes of interest. unexposed subjects are followed over time and the
Unlike analytical studies that include control incidence of the disease or outcome of interest in
(comparison) group, descriptive studies do not the exposed group is compared with that in the
include a comparison group. Descriptive studies unexposed group.
include case reports, case series reports, cross- c) Case-crossover studies—The case-crossover may be
sectional studies, surveillance studies, and considered comparable to a crossover randomized
ecological studies. controlled trial in which the patients act as their
b) Analytical design — An analytical study identifies own control. Pattern of exposure among the cases
risk factors, associated factors, mediating factors, is compared between event time and control time.
etc. Analytical studies are either experimental or The between-patient confounding that occurs in a
observational. Case–control and cohort studies are classic case-control study is circumvented in this
types of observational studies. design. Tubiana et al. evaluated the role of
antibiotic prophylaxis and assessed the relation
3. Classification based on investigator orientation: between invasive dental procedures and oral
Experimental vs. quasi-experimental vs. observational streptococcal infective endocarditis, using a
designs nationwide population-based cohort and a case-
crossover study design.
d) Case–time control studies — This design is an
extension of the case-crossover design, but includes
a control group. A group of researchers assessed
medication-related hospitalization. They used the
case–time control study design to investigate the
associations between 12 high risk medication
categories (e.g., antidiabetic agents, diuretics,
benzodiazepine hypnotics) and unplanned
hospitalizations.
e) Nested case–control studies — In this design, a
cohort of individuals is followed during certain time
periods until a certain outcome is reached and the
analysis is conducted as a case–control study in
which cases are matched to only a sample of
control subjects.
f) Cross-sectional studies — In this type of study, the
investigator measures the outcome of interest and
the exposures among the study participants at the
same time. It provides a snapshot of a situation for
a particular period.

Classification Of Research Methodologies Used In

Pharmacy Practice
 There is a great demand for innovation and quality
in pharmacy practice. These can be achieved partly
through robust and well-designed pharmacy
practice research. Pharmacy students, practitioners,
educators, and policy-makers are exposed to a
variety of research designs and methods.
 We need to have the best evidence (e.g., in policy,
regulation, practice) for making decisions about the
optimal research design that ensures delivering an
ultimate pharmacy practice and a quality patient
care.