Pharmacy practice research/Response

The authors assert that generalizability is one of the barriers to widespread implementation of pharmacy practice research. We agree that the generalizability of pharmacy practice research may be limited by the relatively low proportion of pharmacists who participate in such studies. We feel that early adopters have a significant impact when promoting practice change. The authors also assert that the reason that many disease management protocols have not been implemented into most community pharmacies is that they are "labor intensive." Disease management is laborious, but the alternative - to provide watered-down half measures - will likely have no impact on patient outcomes. Furthermore, the authors assert that one of the reasons for lack of uptake of disease management programs is that they "require pharmacists to provide rigorous and frequent care." Are they implying that suboptimal care is the alternative? Although we did not present any of our specific ideas in the editorial, [Ross T. Tsuyuki] et al. have predetermined that our paradigm represents "watered-down half measures" and "suboptimal care" that will "likely have no impact on patient outcomes." They even suggest that our efforts may damage our profession and we should conform to "become part of the solution." Perhaps they need to be reminded that the "solution" has not yet been found. Patient outcomes have not been influenced to any significant degree in community pharmacy risk reduction studies, even in the most highly regarded publications. As such, there is a great need to explore new ideas as well as refine traditional paradigms. However, Tsuyuki et al. argue against the value of investigating small changes on the premise that "low power" and "type 2 errors" will not "help our cause." We believe our "cause" is to facilitate better patient outcomes by improving on what we do. We are in the midst of an epidemic of nonadherence that needs our immediate attention. The reference to this critical issue as a "moot" point is puzzling, to say the least.