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

From PCN to PhD: Why should pharmacists get involved in research?
Pharmacist and researcher Tom Kallis

Pharmacist Tom Kallis combines patient care with academic interests – practicing one day a week in a general practice and the remainder of the time working on a PhD entitled ‘polypharmacy, pharmacists and clinical uncertainty’.

‘Traditionally, pharmacists are quite underrepresented in the world of research,’ he tells The Pharmacist.

But with research skills embedded in the pharmacist undergraduate programme, Tom says the profession is well-placed to integrate research into their workplaces.

‘We think differently to other healthcare professionals, we do have those scientific skills, which a lot of healthcare professionals don't have so heavily in their initial training,’ the former community pharmacist says.

And he suggests that research skills can be ‘absolutely fantastic’ in terms of career development.

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‘As we move into the realm of advanced clinical practice, research is one of those four advanced pillars that we have to demonstrate,’ Tom says.

While advanced roles like being a consultant pharmacist are well established in fields like antimicrobial resistance and secondary care, they are less available in primary care, despite the variety of clinical expertise in this setting, Tom adds.

‘We've got a real case to make as a profession. We're autonomous clinicians. If we can integrate research with our practice, that can inform our practice and deliver better outcomes for our patients. And it also gives the opportunity for us to develop and be recognised as consultants in the future.

‘In terms of career progression, I think that would be an absolutely fantastic thing, but we're a long way from it at the moment,’ Tom says.

Want to get involved in pharmacy research? Tom Kallis gives his top tips for getting started

Pharmacists need to see themselves as ‘very much equitable partners in producing evidence which can help improve practice’, Tom says.

His own journey into academia was ‘incredibly torturous’, he says, ‘because there's no set career pathway for pharmacists’.

But he says that for pharmacists currently looking to get into research, ‘the time is now’.

‘Have a chat to some of your local research leads. There's very much a big drive from the NIHR around having more pharmacists in research,’ Tom says.

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‘There are ways for pharmacists to get involved with research without having to give everything up and have a radical change,’ he suggests.

Pharmacists can get involved in research delivery via networks like the NIHR’s research delivery networks (RDNs), as well as any research that a GP practice might be involved with.

But he says that more could be done to support pharmacists to ‘dip their toe in the water of research alongside their clinical roles’.

To develop research skills, he suggests applying for funding through Pharmacy Research UK, which enables clinicians to undertake training modules and courses.

Employers can also play a big role in supporting their employees by freeing up their time to allow them to attend courses, encouraging them to apply for opportunities, and linking research with career progression around advanced practice.

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Tom suggests patients, pharmacists and employers could benefit from pharmacists being involved in research.

‘It makes me it makes me think very differently around evidence and around how I practise. I think, certainly I hope that my research will ultimately inform better practice. ‘

And good research that leads to improved practice ‘ultimately will enhance the care that we deliver and the outcomes we get from patients’, he adds.

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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