Introduction
A pharmacy practice research project failed to recruit patients for medication reviews despite appropriate funding, support from a local Research Advisory Team (RAT) and the best efforts of the researcher. The research was based in a London Primary Care Trust and was developed to inform the implementation of the community pharmacy contractual framework. The Research Advisory Team (RAT) recognised that research governance indicated that the research project was compromised and should be reviewed.

Objectives

there were two objectives:
- to determine why patients had not been recruited for medication reviews.
- to determine if root cause analysis(rca) could be applied to pharmacy practice research

Method
Five members of the RAT completed a structured rca. The key issues were collated and disseminated within the group to ensure that the findings were a true reflection of the process.

Results
Root cause analysis was considered to be an effective tool. The rca identified the following medication review related issues:
- patients generally wanted their GP's permission to have their medication reviewed
- patients wanted to know the selection criteria for the medication review
- medication reviews should be integrated in managed care pathways
- communication systems need to support the patient prior and post medication review
- reviews should include prescribed and over the counter medicines as well as complementary/alternative therapies
- community pharmacists needed a formal appointment system for medication reviews
- patients expected a legitimise process
- it may not be appropriate to complete a medication review process in one visit
- community pharmacists who failed to undertake medication reviews lacked confidence in their skills and undervalued their input into the process
- dedicated medication review pharmacists may be required to support the service
- the primary care team should endorse pharmacists as having the skills and knowledge to review medicines.
The following issues were identified associated with the research process:
- independent researchers should not be allowed to work in isolation
- robust governance and facilitation systems re needed for research projects in the community pharmacy setting
- primary care research collaboratives should prevent delays in processing invoices
- systems should monitor project milestones;
- RATs should be empowered to withhold funding if the project is failing to proceed.
- Members of the RAT should have protected time to support the research process.

Conclusion

The RCA concluded the factors affecting the recruitment of patients for medication reviews were complex and multi-factorial and that RCA can be applied to pharmacy practice research.

Discussion
Patient information leaflets provided by GPs and NHS were thought to be an appropriate patient recruitment method. The RAT determined that further investment in this research project could not be supported and funding was withdrawn.