BY ALISON HERMAN
The National Institute for Health Research’s Public Health Research programme in the UK recently conducted a meta-analysis to determine the role of community pharmacies as sites for crucial interventions related to the nation’s top public health priorities. Taking into account standards for quality, scientific replicability and accuracy, an independent research team selected 24 studies out of 14,000 citations related to this type of work in community pharmacies.
Among their major findings was showing that community pharmacies effectively and cost-efficiently encourage people to quit smoking through interventions like behavioral support and nicotine replacement therapy.
Unfortunately, as they point out in the limitations section of their review, little information was available to explain why the features of these interventions in particular were successful compared to others or no intervention at all. At the same time, they were unable to draw conclusions about the success of similar interventions in the realms of weight loss and healthy alcohol use due to a lack of primary research in those areas . The only relevant studies related to weight loss and healthy alcohol use were too different in their setups to be comparable or synthesizable with the other identified studies in order to make any general conclusions. Therefore, even though they find smoking cessation interventions to be successful, the meta-analysis does not provide any conclusive evidence about the mechanisms of successful community pharmacy interventions.
In addition to analyzing the effectiveness of community pharmacies in public health interventions, a primary objective of the study was to determine how demographic features, like race, gender, or socioeconomic status, affected the success of the interventions for different subsets of the population. Of the 24 studies analyzed, however, none included detailed information of the participants’ demographic features. As a result of this lack of evidence, they were unable to draw any conclusions in this section of the report. Given that demographic data was not a consideration in any of the studies analyzed, making demographic effects a central part of their analysis seems like an futile choice. Instead, these considerations should have been included in sections related to the limitations of the studies examined or discussed as future directions for research in this field.
An additional limitation of the study was that their claim that very few studies targeted disadvantaged populations is in tension with their claim that most community pharmacies exist in the “areas of highest deprivation.” This fact complicates the issue of the targeted population, since it would seem that, by default, community pharmacies treat and therefore target economically disadvantaged populations. The researchers do little to reconcile their claims that demographic features are unknown and yet, that they know that the studies do not target disadvantaged populations.
Nine of the 24 studies examined took place in the United Kingdom, so the conclusions of the meta-analysis are generalizable to the UK pharmacy context. Given the success of community pharmacies in smoking cessation, a recent news report announcing that the Department of Health plans to cut funding for community pharmacies in the UK could be worrisome for local communities. The meta-analysis carries implications for whether these cuts should move forward or not; as such, the public should be informed in a clear and accessible manner about the benefits of community pharmacies for important public health initiatives.
Brown, TJ, A. Todd, CL O’Malley, HJ Moore, AK Husband, C. Bambra, A. Kasim, FF Sniehotta, L. Steed, and CD Summerbell. “Community Pharmacy Interventions for Public Health Priorities: A Systematic Review of Community Pharmacy-delivered Smoking, Alcohol and Weight Management Interventions.” Accessed October 18, 2016.
McKee, Selina. “Gov’t Announces Cuts to Community Pharmacy Budget.” Pharma Times, October 21, 2016. http://www.pharmatimes.com/news/govt_announces_cuts_to_community_pharmacy_budget_1173167.
The Role of Community Pharmacies in Public Health. January 16, 2014. Public Health England.