A Practice-Based Research Network (PBRN) is “a group of ambulatory practices devoted principally to the primary care of patients, affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community based practice” . PBRNs first were formed in primary care practices in the late 1970s [2-3] and involved community-based clinicians and their staffs in activities designed to help understand and improve primary care . The goal was to link relevant practice questions with rigorous research methods in community settings to provide information that was reliable, valid, and transferable into everyday practice.
Thought leaders within pharmacy have begun developing and implementing Pharmacy Practice-Based Research Networks . The advantages of such networks to patient care and to society are rooted in the use of medications by almost all members of society during their lifetime and the accessibility that pharmacies provide to the public. The use of medications is likely to be the only treatment modality with which people interact on a daily basis. Over 500 million times a day in the United States, individuals make the decision to-take or not-to-take a prescription medication . In addition there are approximately 6 million pharmacy visits per day . Arguably, these are the most frequently occurring health care events, far outpacing such things as the number of physician office visits (2.6 million per day) , hospital inpatient procedures (123,287 per day) , and hospital discharges (108,041 per day) . Eighty percent of the way chronic diseases are prevented and managed is with medications . In any given week, 81% of U.S. adults take at least one medication, and nearly one-third take five or more different medications [9-10]. Over a lifetime, it is estimated that a typical person will take 14,000 pills . When one considers that a 60-year span of adulthood is about 22,000 days, the frequency with which individuals interact with medications is astounding.
A person’s regular interaction with medications is not only a frequently and consistently occurring health care event, it also interfaces with almost all other aspects of his or her health care. For example, according to the World Health Organization, adherence to medication therapies is the primary determinant of treatment success and the consequences of poor adherence are poor health outcomes and increased health-care costs . When transitions in care, such as hospitalization, are experienced by individuals, they become especially vulnerable for medical errors as a result of incomplete or inaccurate communication about medication therapies. After hospital and intensive care unit discharges, individuals are at high risk for unintentional discontinuation of medications with proven efficacy for treating chronic diseases . Avoidable hospital readmissions are directly related to medication-related events about one-third of the time .
Developing capacity for research in networks of community pharmacies could help fill gaps in our understanding of the medication use process by focusing upon (1) questions encountered by pharmacist practitioners in their practices, (2) issues that are relevant to members of diverse communities served by these practices, and (3) research that can be shared quickly with pharmacy practice and the broader healthcare community. The advantages of such an approach are clear. In the U.S. there are more than 70,000 pharmacies in all types of health care facilities including more than 56,000 community pharmacies. The geographic locations of pharmacies are based upon community members’ preferences for convenience and access, making them a logical site though which care can be studied and enhanced . Pharmacists are central to the medication use process and are the most frequently encountered health professionals for many patients. In addition to access and convenience, studies in community pharmacy settings afford the opportunity to observe self-care behaviors that overlay prescribed therapies including over-the-counter drugs and nutritional supplements . For patients under the care of multiple prescribers, the pharmacy serves as an “ideal place for studying and improving the continuity and coordination of care across settings” . Since many patients visit pharmacies at frequent and regular intervals it is an ideal place to examine the quality, safety, efficiency, and effectiveness of many prescribed treatments for chronic care .
Such access to patients at the point of procuring most of the medications utilized in the U.S. presents a unique opportunity for pharmacists and pharmacies to help contribute to an understanding of the medication use process. Pharmacy-Based PBRNs can focus on collecting information in real-world settings (pharmacies) to help address societal, community, or professional questions that relate to medication use. Such a focus would expand upon existing work and begin to collect information for the purpose of addressing societal and community questions related to the medication use process. In this domain, pharmacy PBRNs can serve as natural laboratories in the field setting to address a variety of questions.
The Minnesota Pharmacy Practice-Based Research Network (MPPBRN)
The Minnesota Pharmacy Practice-Based Research Network (MPPBRN) was launched on February 26, 2008. Its stated purpose is to collect information using a network of pharmacies for the purpose of addressing societal and community questions related to the medication use process. Such a network serves as a natural laboratory and represents a novel way to address societal needs related to health and wellness. The MPPBRN is a collaboration among the Minnesota Pharmacists Association, University of Minnesota, and Pharmacist Practitioners and has been designed to serve as a meeting point for sharing and generating new ideas that are relevant to the interface among the practice of pharmacy, health care, health systems, health technologies, communities, and society overall. Guiding principles for this PBRN can be found in Appendix A.
The MPPBRN membership roster is kept on a spread sheet that remains confidential at the request of some of the MPPBRN members. Some members wish to keep their identities confidential so that their contact for potential participation in projects is only through the MPPBRN directors and not from other sources. A summary of the current capabilities of the Minnesota Pharmacy PBRN can be found in Appendix C. As of February 2012, the Minnesota Pharmacy PBRN consisted of 366 geographically dispersed pharmacies and 23 principal investigators from the University of Minnesota (see Appendix D). A summary of projects that have utilized the Minnesota Pharmacy PBRN can be found in Appendix E.
Projects conducted so far have utilized PBRN pharmacies for (1) patient access, (2) data access, (3) pharmacist participation, and (4) practice change demonstrations. In addition to reports and doctoral dissertations that have resulted from the PBRN projects, dissemination of findings has been accomplished through peer-reviewed presentations and publications. During 2011, our PBRN was contacted by several states in which PBRNs were being formed. As more Pharmacy-Based PBRNs are launched throughout the United States, we will have new opportunities for collaboration. We are entering our fifth year as a PBRN and we believe that areas for growth include things such as:
Oversight for the MPPBRN is accomplished through a “Guidance and Oversight Board.” This five-member board meets quarterly and consists of the PBRN coordinators (Jon Schommer, Julie Johnson), one of the principal investigators (Ron Hadsall), a representative from one of the PBRN pharmacies (currently, this position is open), and a representative from the public domain (currently filled by a member of MPhA staff). This board typically meets in person, but also has met via distance technology (telephone, interactive television, etc.). In-person meetings have taken place at MPhA offices, the University of Minnesota, and at professional conferences. If you are interested in serving on the Guidance and Oversight Board, please let Jon Schommer (email@example.com) or Julie Johnson (firstname.lastname@example.org) know.
 Alter N. “AHRQ Support for Primary Care Practice-Based Research Networks (PBRNs),” http://www.ahrq.gov/research/pbrn/pbrnfact.htm. accessed July 28, 2008.
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 Nelson EC, Kirk JW, Bise B, et al. “The Cooperative Information Project: Part 1: A Sentinel Practice Network for Service and Research in Primary Care, Journal of Family Practice, 1981, 13: 641-649.
 Lipowski EE. “Pharmacy Practice-Based Research Networks: Why, What, Who, and How,” Journal of the American Pharmacists Association, 2008, 48(2): 142-152.
 Schondelmeyer, Stephen W. “Recent Economic Trends in American Pharmacy,” Pharmacy in History, 2009, Vol. 51, No. 3, www.aihp.org, article 103, 22 pages.
 Centers for Disease Control and Prevention. “Ambulatory Care Use and Physician Visits,” accessed at: http://www.cdc.gov/nchs/fastats/docvisit.htm, October 13, 2011.
 Centers for Disease Control and Prevention. “Hospital Utilization,” accessed at: http://www.cdc.gov/nchs/fastats/hospital.htm, October 13, 2011.
 McGinnis, Terry, Linda M. Strand, and C. Edwin Webb. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes, Patient-Centered Primary Care Collaborative, 2010, Washington, DC.
 Kaufman, David W., Judith P. Kelly, Lynn Rosenberg, Theresa E. Anderson, and Allen A. Mitchell. “Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States,” JAMA, 2002, Vol. 287, No. 3, 337 – 344.
 The Chain Pharmacy Industry Profile, National Association of Chain Drug Stores. 2001, Alexandria, VA.
 Camporesi, Silvia. “Pharmacopoeia, or How Many Pills Do We Take in a Lifetime?” Humanities and Health, April 28, 2011, King’s College London.
 World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. 2003, Geneva, Switzerland.
 Bell, Chaim M., Stacey S.Brener, Nadia Gunraj, Cindy Huo, et al. “Association of ICU or Hospital Admission with Unintentional Discontinuation of Medications for Chronic Diseases,” JAMA, 2011, Vol. 306, No. 8, 840 – 847.
 van Walraven, Carl, Alison Jennings, Monica Taljaard, Irfan Dhalla, et al. “Incidence of Potentially Avoidable Urgent Readmissions and Their Relation to All-Cause Urgent Readmissions,” CMAJ, 2011, DOI: 10.1503/cmaj.110400,.
 Knapp KK, Ray MD. “A Pharmacy Response to the Institute of Medicine’s 2001 Initiative on Quality in Health Care,” American Journal of Health-System Pharmacy,” 2002, 59: 2443-2450.
Five Useful Web Sites for More Information about Practice-Based Research Networks