Building interdisciplinary research

Building interdisciplinary research

Building an evidence-base for medication optimization, in day-to-day clinical practice and the potential role of pharmacy are key research priorities for funders such as the NIHR and UKRI. More widely, funders emphasise the use of innovative research methods, such as Conversation Analysis, and the importance of stakeholder engagement in developing research projects. Here we report some externally unfunded work when an inter-disciplinary team of motivated researchers laid the foundations for future research in primary care.

Conversation Analysis

Conversation analysis emphasises that how and when we say things is equally important to what we say. We can all remember a GP, nurse, or pharmacist, who made us feel at ease from their reassurance when we were worried about a health problem.  

Community Pharmacy is the most accessible of healthcare professions. But that accessibility, the tension between commercial and clinical work, and the shared informal nature of community pharmacy can create barriers to research. These perhaps may partly explain why many questions about how to optimise communication in community pharmacy remain unaddressed. Conversation Analysis has been used in a range of healthcare settings, including General Practice consultations and in Accident and Emergency Departments to understand patient-practitioner interaction, and is increasingly used to develop evidence-based communication training for healthcare professionals.

We want to explore how we could use Conversation Analysis in community pharmacy. In the work we report here, our focus was the practicalities and some of the ethical challenges related to using Conversation Analysis in community pharmacy prior to a grant application.

Stakeholder Engagement

Rightly, the NIHR focus on the importance of PPIE (patient and public involvement and engagement) across diverse communities. We propose that true stakeholder engagement also considers the views of practitioners. We therefore conducted four stakeholder events: two involving users of community pharmacy (PPIE) and two involving community pharmacy staff (practitioner engagement).

People with lived experience were identified via the Nuffield Department of Primary Care Health Sciences’ standing panel of PPI contributors, and through social media. Many people with lived experience were interested in being involved, shown by applicants reaching twice the targeted amount. A selection process was conducted, with considerations to ensure that participants came from wide variety of backgrounds. Pharmacy staff were identified via professional links and social media. This was somewhat challenging, particularly as after one social media post, we received nearly 100 emails from various Gmail accounts. Subsequently, these were identified as likely “imposters” (1).

Interdisciplinary Collaboration

Previous work by multiple members of the team has found that medication optimisation is complex and will require a team approach linking patients/family carers, practitioners, and academics (2) (3). A key feature of this work was the interdisciplinary academic collaboration involving medicine, pharmacy, and methodologists. This collaboration has been facilitated and supported by building links via both the Society of Academic Primary Care (SAPC) and the School for Primary Care Research (SPCR). This inclusive approach, working across organisational boundaries was a key strength of our work.

Challenges

This work was externally unfunded. Everyone involved (CA, CCG, IM, CW, JS) gave their time freely within their overall job plan. Participants, both patients and pharmacy staff, were reimbursed for their time in line with NIHR guidance. This reimbursement was funded via a personal research account.

Small amounts of money are not easy to obtain. We estimated the total cost, including opportunity costs, for this project was about £10,000. Ideally, there needs to be readily accessible small pockets of funding to support this type of work, which can then build into larger grant applications.

Overall, this work generated crucial learning to inform our subsequent grant application; including thoughts from all stakeholders on overall acceptability, challenges (and how we may overcome them), and advice on consent and recruitment procedures.

Ian Maidment (Professor in Clinical Pharmacy, Aston University), Charlotte Albury (Senior Researcher in Health Behaviours, University of Oxford), Carolyn Chew-Graham (Professor of General Practice Research, Keele University), Jessica Shinta (Administrative Assistant, University of Oxford), Catherine Woods (Research Fellow, University of Southampton).

References

1. Ridge D, Bullock L, Causer H, Fisher T, Hider S, Kingstone T, et al. ‘Imposter participants’ in online qualitative research, a new and increasing threat to data integrity? Heal Expect. 2023;1–4.

2. Maidment ID, Lawson S, Wong G, Booth A, Watson A, McKeown J, Zaman H, Mullan J, Bailey S. MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation (MEMORABLE): a realist synthesis. NIHR Journals Libr. 2020;8. Available from: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr08260/#/abstract

3. Stuart B, Leydon G, Woods C, Gennery E, Elsey C, Summers R, Stevenson F, Chew-Graham C, Barnes R, Drew P, Moore M, Little P. The elicitation and management of multiple health concerns in GP consultations. Patient Educ Couns. 2019; 102:687–93. Available from: https://www.sciencedirect.com/science/article/pii/S0738399118303720?via%3Dihub