Aim

A literature review was undertaken to provide a critical and comprehensive overview of the published evidence relating to the contribution of pharmacy to health development, both in the UK and internationally from 1990-2001

Method

Electronic databases were searched from 1990 onwards: MEDLINE, EMBASE, Cochrane Library and International Pharmaceutical Abstracts. Hand searches for the same period were undertaken of key journals and conference abstracts. Data abstracted from publications included: Participants/setting; Intervention and training; Outcome measures; Key findings. A sample of papers was abstracted by two of the researchers. A matrix of abstracted data was constructed and a narrative was produced.

Results

All of the published studies identified were in the community pharmacy setting. The review covers 35 trials/experimental studies reported in 40 papers (18 UK; 14 US and Canada; 8 Other Europe) and 34 descriptive studies (14 UK; 12 US and Canada; 8 other). The studies were heterogeneous in terms of design and outcome measures, and the robustness of study design was variable.

Most of the trials and experimental studies demonstrated a positive effect from pharmacists' input, although many were small in scale. There is good clinical and cost-effectiveness evidence from UK randomised controlled trials (RCTs) in smoking cessation, and from US and Canadian RCTs in lipid management in the prevention of heart disease. This evidence supports the wider provision of these services through community pharmacies. Substantive evidence was also found on emergency hormonal contraception supply and immunization. Other activities look promising, for example diabetes, anti-coagulation monitoring and weight-reduction programmes, but would benefit from further research. Better quality research is also needed in other areas, for example, to test the effectiveness of pharmacy-based programmes using patient medication records for case finding to identify target groups and invite them to attend for specific services.

The review showed pharmacists to be positive about their potential contribution to health development although the constraining effects of pharmacists' current working practices, existing remuneration arrangements and some community pharmacy premises are well-described. Training appears to be key in changing community pharmacists' practice to incorporate health development activities and embedding a more holistic approach. The review found that pharmacists are currently more likely to engage in health development activities that are linked to medicines use in some way. Furthermore, at present, pharmacists tend to take a reactive rather than proactive approach to health development. There is some evidence that this may result from pharmacists' concerns that unsolicited advice about non medicine-related subjects may be rejected by clients.

Conclusions

The published literature clearly demonstrates the potential of pharmacists to contribute to health development. The evidence is comprehensive in the areas of smoking cessation and lipid management, emergency contraception and immunization. The different national settings of some studies need to be taken into account when considering the generalisability of the findings.

Acknowledgements

The work was funded and commissioned jointly by the Pharmacy Healthcare Scheme and the Royal Pharmaceutical Society of Great Britain. We would like to acknowledge the contributions of Dr Alison Hill (external peer reviewer) and of the Steering Group at the RPSGB.