Advancing Pharmacy Practice Through Social Theory

Although there is a substantial role for social theory in explaining patients’ health behaviors, it does not appear that pharmacists commonly use such theories to provide patient care. This paper attempts to demonstrate an explicit link between social theory and pharmacy practice. The theory of structure and agency and the practice problem of poor medication adherence (MA) in patients with HIV/AIDS are used as exemplars to illustrate such a link. Factors influencing MA were identified from qualitative studies of adherence in patients with HIV/AIDS. All factors identified were stratified into one of four categories: agency related factors that facilitate MA; agency related factors that are barriers to MA; structural factors that facilitate MA; structural factors that are barriers to MA. Stratifying MA in this manner allows pharmacists to identify clinical interventions that are targeted towards the specific cause of MA problems. Introduction Pharmacy does not appear to be a profession that sits comfortably upon a theoretical foundation. There are a number of practice models described in the literature but these are largely descriptions of what pharmacists do. 1-7 They do not readily serve as conceptual frameworks that explain any of the various phenomena (e.g. the component parts of recommending a self-care regimen, how they are structured and organized and the thought processes behind that organization) that constitute the practice of pharmacy. They are primarily practice change tools that describe what pharmacy may change to (e.g. pharmaceutical care) and how. Models describe, while theory explains. Theory provides a base upon which practice change can occur. As pharmacy moves towards a more patient-focused practice, having a better understanding of the theoretical underpinnings of practice will be necessary. The most recent American Council on Pharmacy Accreditation standards for the professional degree makes numerous mentions of the role of the social sciences in pharmacy and pharmacy education. 8 However, the term theory appears only once in a 97page document, and that single mention concerns the role of economic theory in making health care resource allocation decisions. Corresponding Author: John Rovers, PharmD, MIPH, Professor of Pharmacy Practice, Drake University, Des Moines, IA 50311, Email: [email protected] Office: 515-271-4981, Fax: 515-271-1867 Given the prominent role of theory in medical sociology and the equally established role of social science in pharmacy education and practice, this is, perhaps, surprising. Consequently, it may be a useful exercise to explore if there are ways to more explicitly tie social theory to practice. If pharmacists have a better understanding of some of the theoretical foundations that explain patient behaviors, they may be more effective in providing patient counseling and other forms of patient care. Thus, the objective of this paper is to demonstrate that a link between theory and pharmacy practice is feasible. The role of the sociological theory of structure and agency in promoting medication adherence (MA) will be discussed. The specific practice problem of MA in HIV/AIDS will serve as an example of such a link. Practitioners will find such a link helpful to provide more effective patient care because it illustrates how patients behave, which in turn gives the pharmacist cues for which types of clinical interventions are most likely to be successful. Pharmacy educators will be able to use it develop teaching examples for students who will then graduate with a better understanding of patient behaviors and their effects on practice. Choosing a Theory Structure and Agency The sheer number, diversity and complexity of theories in the social sciences may well lead practitioners to avoid any meaningful consideration of social theory. Thus, selecting a theory that pharmacists find both comprehensible and clinically applicable is vital. The concept of structure and agency appears to meet this requirement and the