The latest output from the Pharmacy and Public Health Forum recommends pharmacies to commissioners for some services, but warns of a lack of evidence in others.

THE DIRECTION of travel for the NHS can be summed up in one word: evidence. Whether it’s a question of prevention, diagnosis or treatment, today’s health professionals need to have the proof of concept to back up the services they provide.

It’s no surprise, then, that the Pharmacy and Public Health Forum, set up in 2011 to report on ways to develop and utilise pharmacies in delivering public health services, would have a work stream focused on a review of the evidence base. And the evidence group’s report, published by Public Health England last month, overall paints a positive picture.

Serious option

Commissioners should “seriously consider pharmacy as an effective delivery mechanism for public health services,” the report recommends. Particular areas of praise included smoking cessation services and chronic disease management, with clear evidence for pharmacy services in reducing lipids and screening for diabetes.

“The positives from the report are that community pharmacies are shown to be the right places to provide public health services,” says RPS policy and practice lead (England), Heidi Wright. “It highlights to commissioners that pharmacists and their teams have an important role in improving health.”

And pharmacies are already chomping at the bit to innovate and get involved, says PSNC head of pharmacy practice, Barbara Parsons. “We believe that the profession is ready and willing to increase its roles in this area,” she explains.

In 2012, a PSNC survey found 73 per cent of pharmacy owners were ‘very interested’ in providing more public health services, with a further 23 per cent ‘quite interested’. So is the report good news for pharmacies? Not entirely.

There are many areas where evidence is absent

 

The catch

The paper also holds a few caveats – in particular around areas most pharmacists would consider home turf. Emergency hormonal contraception (EHC), for example, was found to be available in a timely manner through pharmacies and pharmacy services were highly rated by women. Yet the review found a surprising lack of evidence about the impact these services had, such as a drop in teen pregnancy rates.

The report also finds “insufficient evidence currently to support investment in the provision of weight management services through community pharmacy” and “little empirical evidence” of services for alcohol misuse beyond small-scale local initiatives.

Another, perhaps more surprising, blot on the copybook is supervised methadone consumption. While the review found ‘moderate quality evidence’ of high attendance rates and acceptability of the service to patients, the evidence was largely based on descriptive studies.

Ultimately, the report concludes that the evidence for pharmacy is “not universally supportive” and “there are many areas where evidence is absent and further research is needed”.

Balance of evidence

Good evidence

• Smoking cessation
• Cardiovascular disease prevention
• Blood pressure management
• Diabetes
• Asthma
• Heart failure

Lack of evidence

• COPD management
• Infection control
• Substance abuse
• Weight management
• Minor ailments
• EHC </box>

 

The evidence problem

Yet the group makes it clear that the case is far from closed. The report constantly high- lights anecdotal evidence of pharmacies going above and beyond in delivering services. The real problem is that the sector lacks randomised controlled trials, data collection, robust evaluation of services, tracking of outcomes and publication of results.

“Development of the evidence base is vital,” says Heidi Wright. “We are working with research teams applying for Pharmacy Research UK grants to further example the role of community pharmacy in public health.”

Barbara Parsons agrees, highlighting the £1.5m investment pledged by the Department of Health to research pharmacies as a resource likely to bolster pharmacy’s evidence base. “In the meantime, we would encourage pharmacies and LPCs to continue their hard work to secure and provide public health services, wherever they are available, and to gather evidence for those.”

Another factor is the age of the report, as it was originally prepared in February 2013 – making it almost a year old at official release. A year in healthcare is a long time, particularly for programmes still in their infancy, such as the influential healthy living pharmacy roll-out.

Greater integration

The report’s message also warns against leaping to conclusions without looking at pharmacies in context. Unlike GP surgeries or dentists, pharmacies have no registered population and no access to NHS systems – an arrangement that has obvious advantages and disadvantages. It’s important to consider pharmacy “as part of an integrated approach” to public health.

The lack of evidence for the value pharmacies add to the system doesn’t mean it isn’t there, as the review states. “Well-functioning systems are effective; poorly functioning ones are not”. Pharmacies are only one component of a primary care team that requires a holistic, not siloed, approach.

Despite its age, the report’s message appears to be clear. In an evidence-driven NHS, it’s vital pharmacy backs up its words with more than just customer satisfaction. Now, more than ever before, healthcare commissioning is focused on outcomes, rather than outputs.

If pharmacy is going to succeed in its public health role, it’s going to need to come up with some hard evidence.