From PCN to PhD: Why should pharmacists get involved in research?

Tom’s research: ‘polypharmacy, pharmacists and clinical uncertainty’
Tom’s PhD research focuses on understanding how pharmacists in general practice navigate clinical uncertainty when reviewing polypharmacy.
And he’s looking into how decision making can be improved in these situations.
Clinical uncertainty is made up of three elements, Tom tells The Pharmacist: probability, ambiguity and complexity.
Pharmacists may not be able to tell patients whether a medication is going to be effective or not, but may be able to give them a probability.
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‘For example, if you prescribed a painkiller, you might say, “This has a 30% chance of working for you,”’ Tom explains.
Ambiguity occurs when the clinician does not have all the information or evidence they might want to inform their decisions.
And complexity is added when it’s difficult to determine the harms or benefits that adding or taking away a medicine from a complex regimen may have on someone's other medicines or their conditions.
‘That clinical uncertainty would be there regardless of how much clinical knowledge a pharmacist would or wouldn't have,’ Tom adds.
His work is ‘more about how we're taught as pharmacists, how we tolerate clinical uncertainty and how we can work through it when we're reviewing these complex patients’.
He suggests that multidisciplinary working between pharmacists and GPs or other healthcare professionals ‘can help pharmacists mitigate and navigate clinical uncertainty and hopefully optimise that medication review process’.
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A pharmacist’s workplace – including whether they work remotely or within a practice – can influence their ability to talk through polypharmacy prescribing decisions in the face of clinical uncertainty, Tom suggests.
‘There's lots of nuance attached to it,’ he says.
Having researched the available literature in the area, Tom plans to take audio recordings of real structured medication reviews.
He also hopes to interview pharmacists about how they approach polypharmacy, how they feel when they encounter clinical uncertainty, and how education and training for pharmacists can be improved.
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And he will talk to patients, to understand their perceptions of pharmacist-delivered care.
This will then feed into a final round of workshops, which Tom hopes to then develop into recommendations for education or a workplace-based intervention.
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