Pharmacy Practice Research Methods

Preface
Contents
About the Editor
Chapter 1: Pharmacy Practice Research: Evidence, Impact and Synthesis
	1.1	 Evidence and Evidence-Based Healthcare and Service Redesign
		1.1.1	 Multiplicity of Research
		1.1.2	 Quality of Research
		1.1.3	 The Evidence-Based Medicines Movement
			1.1.3.1	 Systematic Reviewing and Critical Appraisal
			1.1.3.2	 Grades of Evidence
		1.1.4	 Using Evidence to Influence Practice
	1.2	 Evidence-Based Pharmacy
		1.2.1	 From Drugs to Services
		1.2.2	 HSR and Pharmacy
			1.2.2.1	 Quality of Research
			1.2.2.2	 Systematic Reviews of Pharmacy-Related Research
		1.2.3	 Importance of Right Outcome
	1.3	 The Policy, Practice, and Research Triangle in Pharmacy
		1.3.1	 Research Informing Policy
			1.3.1.1	 Smoking Cessation
			1.3.1.2	 Repeat Dispensing
			1.3.1.3	 New Medicines Service
			1.3.1.4	 Pincer
		1.3.2	 Research to Support a Planned Policy
		1.3.3	 Research to Confirm the Appropriateness of Implemented Policy
			1.3.3.1	 Pharmacist Prescribing
			1.3.3.2	 Primary Care Pharmacy
		1.3.4	 Research to Inform Future Service Review
		1.3.5	 An Integrated Example
	1.4	 Challenges
		1.4.1	 Expertise, Time and Money!
		1.4.2	 Engaging Colleagues
		1.4.3	 Changing the Status Quo
		1.4.4	 Public Patient Involvement (PPI)
		1.4.5	 Negative Findings
		1.4.6	 Funding
		1.4.7	 Duplication of Research
		1.4.8	 Communicating with Policymakers
	1.5	 Conclusion
	References
Chapter 2: Qualitative Methods in Pharmacy Practice Research
	2.1	 Why Qualitative Methods in Pharmacy Practice?
		2.1.1	 Introduction
		2.1.2	 Steps in Qualitative Research
	2.2	 Interviews
		2.2.1	 Types of Interviews
			2.2.1.1	 Individual Interviews
			2.2.1.2	 Focus Group Interviews
		2.2.2	 Preparing Interviews
		2.2.3	 Sampling
		2.2.4	 Conducting the Interviews
		2.2.5	 Ethics
		2.2.6	 Analyzing Interviews
		2.2.7	 Strengths and Weaknesses of Interviews
	2.3	 Observation
		2.3.1	 Types of Observation
			2.3.1.1	 Nonparticipatory Observation
			2.3.1.2	 Participant Observation
		2.3.2	 Preparing the Observation
		2.3.3	 Analyzing the Observation
		2.3.4	 Strengths and Weaknesses of Observations
	2.4	 Documentary Methods
		2.4.1	 Types and Sources of Documents
		2.4.2	 Preparing for the Documentary Analysis
		2.4.3	 Analyzing Documentary Material
		2.4.4	 Strengths and Weaknesses of Document Analysis
	2.5	 Netnography
		2.5.1	 Analyzing Netnographic Material
		2.5.2	 Strengths and Weaknesses of Netnography
	2.6	 Visual Research/Visual Methods
		2.6.1	 Types of Visual Methods
		2.6.2	 Preparing Visual Methods
		2.6.3	 Analyzing Visual Methods
		2.6.4	 Strengths and Weaknesses of Visual Methods
	2.7	 Validity and Transferability in Qualitative Studies
		2.7.1	 Validity
		2.7.2	 Transferability
	2.8	 Strengths and Limitations of Qualitative Studies
		2.8.1	 Strengths
		2.8.2	 Limitations
	2.9	 Summary
	References
		Further Reading
Chapter 3: Action Research in Pharmacy Practice
	3.1	 Introducing Action Research (AR)
	3.2	 History and Related Concepts
	3.3	 Strengths, Weaknesses, and Data Quality in AR
	3.4	 Core Features of AR Methodology
		3.4.1	 The Role of the Action Researcher
		3.4.2	 Diagnosing and Analyzing Problems
		3.4.3	 Planning
		3.4.4	 Taking Action
		3.4.5	 Evaluate
	3.5	 Recommendations for How to Plan an Action Research Study
	3.6	 Moving Forward
	3.7	 Examples of Action Research in Pharmacy Practice
		3.7.1	 Study 1: Introducing Pharmaceutical Care to Primary Care in Iceland: An Action Research Study (Blondal et al. 2017c)
			3.7.1.1	 Objective
			3.7.1.2	 Materials, Methods, and Settings
			3.7.1.3	 Results
			3.7.1.4	 Conclusions
		3.7.2	 Study 2: Roles and Competencies of District Pharmacists: A Case Study from Cape Town (Bradley 2013)
		3.7.3	 Study 3: MEDISAM: Implementation of a Home Medicines Review (HMR) Collaboration Model for Pharmacists, Pharmacy Interns, and Doctors
	References
Chapter 4: Quality Improvement Methods in Pharmacy Practice Research
	4.1	 Introduction
	4.2	 What Is Quality and How Do We Improve It?
		4.2.1	 Quality Theory
		4.2.2	 Service Improvement Theory
	4.3	 Quality Improvement Models
		4.3.1	 Business Process Reengineering
		4.3.2	 Plan-Do-Study-Act
		4.3.3	 Lean and Six Sigma
	4.4	 Quality Improvement Methods and Tools
		4.4.1	 Audit
		4.4.2	 Root Cause Analysis
		4.4.3	 Failure Modes and Effects Analysis
		4.4.4	 Process Mapping
		4.4.5	 Control Charts
	4.5	 Reporting Quality Improvement Studies
	4.6	 The Importance of Quality Improvement for Pharmacy Practice
	4.7	 Conclusions
	References
Chapter 5: Covert and Overt Observations in Pharmacy Practice
	5.1	 Introduction
	5.2	 Participant and Non-participatory Observation
	5.3	 Covert Observation
		5.3.1	 Applicability of Covert Observation in Pharmacy Practice
		5.3.2	 Evaluation of Performance
		5.3.3	 Scenarios
		5.3.4	 Recording the Interaction
		5.3.5	 Checklists
		5.3.6	 Ethical Aspects in Covert Observation
	5.4	 Overt Observation
		5.4.1	 Applicability of Overt Observation in Pharmacy Practice
	5.5	 Impact of Observation Research Methods in Practice
	5.6	 Conclusion
	References
Chapter 6: Realist Research in Pharmacy Practice
	6.1	 Introduction to Realist Research
	6.2	 Causation and Complexity in Realist Research
	6.3	 Importance of Programme Theory in Realist Research
	6.4	 Using Realist Approaches
	6.5	 Realist Reviews
	6.6	 How to Perform a Realist Review?
	6.7	 Define the Scope of the Review
	6.8	 Search for and Appraise the Evidence
	6.9	 Extract and Synthesise Findings
	6.10	 Develop a Narrative
	6.11	 Realist Evaluations
	6.12	 How to Do a Realist Evaluation?
	6.13	 Example of a Realist Evaluation: Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study
	6.14	 Realist Synthesis
	6.15	 Guidance and Resources for Undertaking Realist Research
	6.16	 Strength and Limitations of Realist Research
	Definition of Common Terms Used in Realist Research (Wong et al. 2015b)
	References
Chapter 7: Importance of Mixed Methods Research in Pharmacy Practice
	7.1	 Introduction
	7.2	 Current Definition of Mixed Methods Research
		7.2.1	 Advantages of Mixed Methods Research
		7.2.2	 Limitations of Mixed Methods Research
	7.3	 Mixed Methods Research in Pharmacy Practice
	7.4	 Typologies of Mixed Methods Research
		7.4.1	 Concurrent Design
		7.4.2	 Sequential Design
		7.4.3	 The Embedded Design
	7.5	 Integrating Findings in Mixed Methods Research
		7.5.1	 Case Study: Application of a Triangulation Protocol in a Mixed Methods Project with a Sequential Design
	7.6	 Enhancing Rigour and Reporting in Mixed Methods Research
	7.7	 Conclusion
	References
Chapter 8: Grounded Theory in Pharmacy Practice Research
	8.1	 Introduction
	8.2	 The Development of Grounded Theory: Debates Between the Authors
	8.3	 Building the Grounded Theory
		8.3.1	 Phase One: Research Design and Philosophies in Using Grounded Theory
		8.3.2	 Phase Two: Data Collection Phase
		8.3.3	 Phase Three and Four: Data Ordering and the Analytical Elements of Grounded Theory
		8.3.4	 Phase Five: Data Analysis and Literature Comparison
	8.4	 The Interpretation and Development of the Story Line
	8.5	 Grounded Theory in Pharmacy Practice Research
	8.6	 Chapter Summary: Challenges and Future Opportunities in Using Grounded Theory in Pharmacy Practice Research
	References
Chapter 9: Pharmacoepidemiological Approaches in Health Care
	9.1	 Pharmacoepidemiology and the Need for Pharmacoepidemiological Research
	9.2	 Major Research Questions in Pharmacoepidemiology
		9.2.1	 Drug Utilization Research
		9.2.2	 Drug Safety and Effectiveness Research
		9.2.3	 Importance of a Well-Defined Research Question
	9.3	 Sources of Data in Pharmacoepidemiology
		9.3.1	 Main Computer-Based Data Sources
		9.3.2	 Data Linkage
	9.4	 Study Designs and Methods in Pharmacoepidemiology
		9.4.1	 Selecting the Study Population
		9.4.2	 Defining Exposures and Outcomes
		9.4.3	 Study Designs
			9.4.3.1	 Cohort Studies
			9.4.3.2	 Case-Control Studies
			9.4.3.3	 Nested Case-Control Studies
			9.4.3.4	 Within-Subject Methods (Case-Only Designs)
			9.4.3.5	 Cross-Sectional Studies
			9.4.3.6	 Ecological Studies
			9.4.3.7	 Quasi-Experimental Study Designs
	9.5	 Common Measures for Medication Use
		9.5.1	 Drug Utilization Metrics
		9.5.2	 Medication Adherence Metrics
	9.6	 Challenges of Pharmacoepidemiologic Studies
		9.6.1	 Misclassification
		9.6.2	 Selection Bias
		9.6.3	 Confounding
	9.7	 Common Design Options and Analytical Techniques
		9.7.1	 Study Design Options
		9.7.2	 Analytic Options
		9.7.3	 Confounder Summary Scores
		9.7.4	 Instrumental Variable
		9.7.5	 Time-Varying Confounding
	9.8	 The Future of Pharmacoepidemiology
	References
Chapter 10: Randomised Controlled Trials and Pharmacy Practice Research
	10.1	 Introduction
	10.2	 Hierarchy of Evidence
	10.3	 Randomised Controlled Trials: Purpose, Structure and Limitations
		10.3.1	 Hypothesis
		10.3.2	 Study Population
		10.3.3	 Sample Size
		10.3.4	 Randomisation
		10.3.5	 Blinding
		10.3.6	 Limitations
	10.4	 Cluster Randomised Controlled Trials, How These Differ and Their Place in Health Services Research
	10.5	 Randomised Controlled Trials in Pharmacy Practice
		10.5.1	 Evaluation of Non-dispensing Services
		10.5.2	 Home-Based Interventions
		10.5.3	 A Service in Rest Home/Similar Facilities
		10.5.4	 Other Settings: Pharmacist Services via Telepharmacy
		10.5.5	 Multidisciplinary Research, i.e. Physician/Pharmacist Interventions
	10.6	 Economics and RCTs
	10.7	 Recommendations
	10.8	 Conclusion
	References
Chapter 11: Information Sources for Pharmacy Practice Researchers
	11.1	 Introduction
	11.2	 Information Literacy
	11.3	 Information Sources
		11.3.1	 Primary, Secondary, and Tertiary Sources
		11.3.2	 Official and Nonofficial Information Sources
	11.4	 Searching the Literature
		11.4.1	 Bibliographic Databases and Search Engines
		11.4.2	 Search Strategies
		11.4.3	 Critical Evaluation of the Literature
	11.5	 Scientific Publishing
		11.5.1	 Editorial Process
		11.5.2	 Types of Journals
		11.5.3	 Journal Metrics
	11.6	 Ethics in Publishing
		11.6.1	 Data Sharing
	References
Chapter 12: Systematic Reviews and Meta-Analysis in Pharmacy Practice
	12.1	 The Importance of Evidence-Based Practice
	12.2	 The Many Forms of Reviews
	12.3	 Inception of Systematic Approach to Reviews
	12.4	 Systematics Reviews and Meta-Analysis in Pharmacy Practice
	12.5	 Quality of Systematic Reviews and Meta-Analysis in Pharmacy Practice
	12.6	 Systematic Review Process: A Quick Guide
	12.7	 The Meta-Analysis
	12.8	 Direct and Indirect Evidence Models
	12.9	 Pooling Effect Sizes
		12.9.1	 The Fixed-Effect Model
		12.9.2	 The Random Effects Model
		12.9.3	 The Quality Effects Model
		12.9.4	 The Network Meta-Analysis
	12.10	 Homogeneity Test
	12.11	 Conclusion
	References
Chapter 13: The Future of Pharmacy Practice Research
	13.1	 Introduction
	13.2	 Population Demographics
	13.3	 Technology
	13.4	 Role of Pharmacy as ‘Institution’ and ‘Profession’
		13.4.1	 Community Pharmacy as ‘Institution’
		13.4.2	 The Pharmacy Profession
	13.5	 Role and Expectations of Consumers
	13.6	 New Horizons for Pharmacy Practice Research
		13.6.1	 From Uniform Pharmacy Practice/Pharmacist Implemented Interventions to Cross-Disciplinary or Interprofessional Collaboration and Team Work with Patients
		13.6.2	 From Describing and Measuring Outcomes of Interventions Towards Systematising and Understanding Implementation of Large-Scale Initiatives
		13.6.3	 Patients Are Increasingly Culturally Diverse and Active Analysers and Decision Makers Who Use IT to Their Advantage
		13.6.4	 Blurring of Boundaries Between What Has Been Termed Pharmacy Practice Research and Related Fields
	13.7	 Future Uses of Methods in Pharmacy Practice Research
	13.8	 Futuristic Model of Pharmacy Practice
	13.9	 Summary
	References