What do we want to know?

This review aimed to systematically map research literature that has investigated the effectiveness and appropriateness of public health services that are currently provided by community pharmacies. It highlights service areas where the research evidence shows particular promise for further development and potential gaps where specific public health services and/or topics appear not to have been researched.

The map presents findings about: the nature of public health service provision via community pharmacies that have been researched within OECD countries, and the extent and characteristics of the available research, including the types of evaluation conducted. The study was designed to address the following questions:

1. What empirical research has been conducted, from 2000 until November 2017, into public health service provision by community pharmacies?
2. What are the characteristics of studies that investigate public health service provision in community pharmacies (i.e. country, questions addressed, intervention types, health condition, service provision, setting and study design features - including the outcomes and processes evaluated - and additional demographic characteristics)?
3. What are the gaps in research evidence for key public health interventions delivered through community pharmacies?

Who wants to know?

This project was commissioned by the Department of Health and Social Care in England (DHSC) and will also be of interest to other policymakers (e.g. NHS England and Improvement), as well as to Local Authorities, pharmacy professionals, pharmacy and public health organisations, research commissioners, health and social care professionals, patients and researchers.

This evidence map and online searchable database are important resources that highlight the scope and breadth of public health services delivered through community pharmacies. Pharmacy professionals and researchers who are interested in undertaking or commissioning a systematic review or a new primary research project may be particularly interested in the accompanying online searchable database of the included studies in the map, which enables exploration of the details of individual studies.                

What did we find?

The extent of empirical research conducted, from 2000 until November 2017, into public health service provision by community pharmacies: We located and included 289 studies in the review. We identified expanding and diverse research literature seeking to provide evidence on public health interventions that are provided by community pharmacies in OECD countries, with particular growth in the last five years.

Characteristics of studies that investigate public health service provision in community pharmacies: We found that the UK and USA are the predominant sources of research evidence. The studies described a broad range of community pharmacy public health interventions.

The studies were grouped into three domains: 1) priority health topics identified by Public Health England (PHE) and DHSC; 2) other health topics; and 3) cross-cutting studies on community pharmacy for public health.

Just over two-thirds of the studies addressed PHE and DHSC priority health topics: diabetes and cardiovascular health; alcohol and substance misuse; sexual and reproductive health; immunisation; obesity and weight management; health checks and antimicrobial resistance. Over half of these studies focused on diabetes, cardiovascular health and sexual and reproductive health. Diabetes and cardiovascular health alone accounted for over a third of the studies that addressed priority health areas. Alcohol and drug abuse and misuse interventions were a key focus of UK research, all but two studies on this issue were UK-based. 

We found a total of 233 intervention evaluations; approximately a quarter of which used a controlled design. The majority of controlled studies presented findings about intervention outcomes, such as the results of screening, physiological changes or health behaviours, while others evaluated processes such as the acceptability or feasibility of providing specific interventions at community pharmacies. 

We found 56 UK-based studies that focused on the views of service providers, users and other stakeholders about community pharmacy for public health without examining a specific service.

Almost half of the evaluation studies examined interventions involving referral to another healthcare practitioner. Interventions that involved screening or testing for particular conditions to identify those at risk or who might not readily consider seeking assistance from other healthcare sources was also close to half of the total number of studies.

Gaps in research evidence for key public health interventions: A noticeable lack of research was identified on antimicrobial resistance. Other areas where more research would be beneficial were: hard to reach populations, provision of HIV testing in UK community pharmacies, dementia risk and identification of dementia in the elderly, cancer risk and identification and studies that focus on children.

N.B. Due to the number of detailed studies focused on smoking cessation interventions, it was decided that smoking cessation would not be included in this review.

What are the conclusions?
 

• The research literature on public health interventions provided by community pharmacies is expanding and diverse, showing particular growth in the last five years.
• A broad range of community pharmacy public health interventions has been evaluated.
• The UK and USA are the predominant sources of research evidence.
• Community pharmacy would benefit from a greater number of experimental studies in the form of randomised controlled trials.
• Key evidence gaps exist around: Antimicrobial resistance (i.e. when bacteria and viruses become resistant to the medicines designed to treat them); particular hard to reach populations; UK studies on HIV testing; studies that focus on dementia risk and identification in the elderly; cancer risk and identification studies; and public health service provision for children.

How did we get these results?

We searched 25 databases and websites for publications dating from the 1^st January 2000 to the end of November 2017 and checked reference lists from relevant systematic reviews. References were uploaded to specialist systematic review software for screening. Titles and abstracts were screened hierarchically against explicit criteria to identify potentially relevant studies. Full texts of potentially relevant studies were retrieved and re-screened. Included studies were descriptively coded according to a classification system developed specifically for this review. Screening and coding processes were initially piloted by multiple reviewers; once a high level of inter-rater reliability was achieved reviewers worked independently.

This report should be cited as:

Stokes G, Rees R, Khatwa M, Stansfield C, Burchett H, Dickson, K, Brunton G, Thomas J (2019) Public health service provision by community pharmacies: a systematic map of evidence. London: EPPI Centre, Social Science Research Unit, Institute of Education, University College London.