1
|
Brata C, Wibowo YI, Setiawan E, Halim SV, Razanah A, Sholikhah IM, Lailla PR, Rahmadini A, Putri IAERS, Schneider CR. Pharmacists' clinical decision making when responding to a self-medication request for a cough in a developing country. Res Social Adm Pharm 2024; 20:880-892. [PMID: 38762365 DOI: 10.1016/j.sapharm.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 12/23/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Some studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated. OBJECTIVES To describe Indonesian pharmacists' clinical decision making when handling self-medication cases for a cough. METHODS An open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants' statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted. RESULTS A total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants. CONCLUSION The ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists' differential diagnostic skills for triage.
Collapse
Affiliation(s)
- Cecilia Brata
- Centre of Medicine Information and Pharmaceutical Care, Faculty of Pharmacy, The University of Surabaya, Gedung FF Lantai 5, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia.
| | - Yosi Irawati Wibowo
- Centre of Medicine Information and Pharmaceutical Care, Faculty of Pharmacy, The University of Surabaya, Gedung FF Lantai 5, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Eko Setiawan
- Centre of Medicine Information and Pharmaceutical Care, Faculty of Pharmacy, The University of Surabaya, Gedung FF Lantai 5, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Steven Victoria Halim
- Centre of Medicine Information and Pharmaceutical Care, Faculty of Pharmacy, The University of Surabaya, Gedung FF Lantai 5, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Afina Razanah
- Faculty of Pharmacy, The University of Surabaya, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Ima Mar'atus Sholikhah
- Faculty of Pharmacy, The University of Surabaya, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Putri Rohmatu Lailla
- Faculty of Pharmacy, The University of Surabaya, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | - Azilah Rahmadini
- Faculty of Pharmacy, The University of Surabaya, Jalan Raya Kalirungkut, Surabaya, Jawa Timur, 60293, Indonesia
| | | | - Carl R Schneider
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Pharmacy and Bank Building (A15) Science Road, NSW, 2006, Australia
| |
Collapse
|
2
|
Showande SJ, Akinbode TE. Nonsteroidal anti-inflammatory drug use by patients: Impact of modular educational training on pharmacists' questioning, counselling and risk assessments. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 15:100494. [PMID: 39257532 PMCID: PMC11385433 DOI: 10.1016/j.rcsop.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/12/2024] Open
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs)-related morbidity and mortality can be reduced through medication counselling and risk reduction. Objectives This study evaluated the impact of short online modular NSAID training on the type and quality of questions asked, risk factors assessed, and counselling offered by community pharmacists to NSAID users. Methods A cross-sectional questionnaire-guided survey conducted in Ibadan, Nigeria, among 87 pharmacists evaluated the frequency of counselling, NSAID risk factor assessment and barriers to risk assessment. Additionally, a before-and-after RCT was used to evaluate the impact of short online modular NSAID training for the intervention group (IG) on the type and quality of the questions asked, counselling provided, and risk assessed by the pharmacists. Eight standardised patients, aged 25-43 years, four at pre- and postintervention, presented four standardised scenarios at community pharmacies [IG, n = 22, control group (CG, n = 30)] to assess these outcomes. The quality of each outcome (questions asked, counselling offered and risk assessed) was classified as poor (0-≤20%), fair (>20-≤40%), moderate (>40 - ≤60%), or optimal (>60-100%). The data are presented with descriptive statistics. Results The community pharmacists reported counselling patients on NSAID precautions (80-86%) and dosages (51-69%). Gastrointestinal bleeding risk was assessed by 61-89% of the pharmacists, and time constraints (39-42%) and patient impatience (47-75%) were some barriers to risk assessment. Online modular educational intervention significantly improved the types and quality of questions asked by pharmacists (CG: poor to fair, 16%-21%; IG: poor to moderate, 14%-45%), NSAID risk factors assessed (CG: poor to poor, 10%-9%; IG: poor to fair, 11%-27%) and counselling offered (CG: poor to poor, 6%-7%; IG: poor to fair, 6%-22%). Conclusions Short online modular educational training on NSAIDs improved the types and quality of the questions asked, NSAID risk factors assessed, and counselling provided by community pharmacists to patients during consultations.
Collapse
Affiliation(s)
- Segun Johnson Showande
- University of Ibadan, Department of Clinical Pharmacy and Pharmacy Administration, Ibadan, Nigeria
| | - Tolulope Eunice Akinbode
- University of Ibadan, Department of Clinical Pharmacy and Pharmacy Administration, Ibadan, Nigeria
| |
Collapse
|
3
|
Chiang V, Guirguis L, Warren AL, Topps D, Anderson SJ, Hecker KG. Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100357. [PMID: 38023635 PMCID: PMC10663664 DOI: 10.1016/j.rcsop.2023.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Prescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. Objectives To explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. Methods Eight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. Results There were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. Conclusions This study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.
Collapse
Affiliation(s)
- Vincent Chiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada
| | - Amy L. Warren
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - David Topps
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Sarah J. Anderson
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Canada
| | - Kent G. Hecker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Faculty of Veterinary Medicine, University of Calgary, Canada
| |
Collapse
|
4
|
Lelie-van der Zande R, Koster ES, Teichert M, Bouvy ML. Barriers and facilitators for providing self-care advice in community pharmacies: a qualitative study. Int J Clin Pharm 2023:10.1007/s11096-023-01571-3. [PMID: 37029859 PMCID: PMC10082626 DOI: 10.1007/s11096-023-01571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/03/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Community pharmacies are easily accessible for self-care advice. Guidelines for providing self-care advice were introduced in several countries, including the Netherlands in the 1990s. Previous studies have indicated room for improvement in self-care advice in daily pharmacy practice. AIM To identify barriers and facilitators for providing self-care advice. METHOD Semi-structured interviews were conducted face-to-face or online with pharmacists and pharmacy assistants using a topic guide based on the Theoretical Domains Framework. The interviews were audio-recorded and transcribed verbatim. The transcripts were deductively analysed to identify barriers and facilitators for self-care counselling. COREQ guidelines were followed. RESULTS In total, 13 pharmacists and 12 pharmacy assistants were interviewed to reach data saturation. In general, most themes addressed by pharmacists and pharmacy assistants belonged to similar domains. The following domains were frequently mentioned: environmental context and resources (e.g. priority for prescription drugs, privacy, collaboration with general practitioners, access to patients' records), intentions (providing reliable advice), skills (communication, decision-making), knowledge (ready guideline knowledge), beliefs about consequences (patient safety), social influences (patient awareness of pharmacist role), reinforcement (lack of reimbursement for relatively time-consuming advice). CONCLUSION This study identifies barriers and facilitators for evidence-based self-care advice. Pharmacists should first support pharmacy assistants by helping them keep their knowledge and skills up to date and creating suitable pharmacy preconditions to facilitate improvements in self-care counselling. Second, collaboration with general practitioners regarding minor ailments should be improved.
Collapse
Affiliation(s)
- Rian Lelie-van der Zande
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Ellen S Koster
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martina Teichert
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel L Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
5
|
Mertens JF, Koster ES, Deneer VHM, Bouvy ML, van Gelder T. Clinical reasoning by pharmacists: A scoping review. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1326-1336. [PMID: 36123233 DOI: 10.1016/j.cptl.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical reasoning is considered a core competency for pharmacists, but there is a lack of conceptual clarity that complicates teaching and assessment. This scoping review was conducted to identify, map, and examine evidence on used cognitive processes and their conceptualization of clinical reasoning by pharmacists. METHODS In March 2021, seven databases were searched for relevant primary research studies. Included were studies that examined cognitive processes in pharmacists while addressing a clinical scenario in a pharmacy-related setting. Using descriptive analysis, study characteristics, conceptualizations, operationalizations, and key findings were mapped, summarized, and examined. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS From 2252 abstracts, 17 studies were included that examined clinical reasoning in the context of forming a diagnosis (n = 9) or determining medication appropriateness (n = 4). Most studies conceptualized clinical reasoning as a context-dependent cognitive process whereby pharmacists apply and integrate knowledge and clinical experience to interpret available clinical data. Different terms labelled pharmacists' reasoning that showed analytical and intuitive approaches to clinical scenarios, either separately or combined. Medication review studies reported a predominance of analytical reasoning. The majority of diagnosis-forming studies in primary care identified no distinct cognitive reasoning pattern when addressing self-care scenarios. IMPLICATIONS This overview reflects a small but growing body of research on clinical reasoning by pharmacists. It is recommended that this competence be taught by explicating and reflecting on clinical reasoning as separate stage of the clinical decision-making process with transparent cognitive processes.
Collapse
Affiliation(s)
- Josephine F Mertens
- Leiden University Medical Center, Department of Clinical Pharmacy and Toxicology, Postbus 9600, 2300 RC Leiden, the Netherlands.
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Vera H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
6
|
Lelie - van der Zande R, Koster ES, Teichert M, Bouvy ML. Allergic rhinitis self-care advice in community pharmacies: A simulated patient study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100086. [PMID: 35479849 PMCID: PMC9031372 DOI: 10.1016/j.rcsop.2021.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Pharmacists and pharmacy assistants can support consumers by identifying minor ailments and providing evidence-based advice about treatment options. In the Netherlands, advice is based on national minor ailment guidelines and structured WWHAM questions (Who, What, How long, Action, Medication). Objectives To study whether pharmacy assistants provide guideline-compliant advice for allergic rhinitis based on WWHAM and condition-specific questions (When and Familiarity) and their association with appropriate self-care advice. Methods A retrospective study of the assessments of simulated patient (SP) visits regarding one condition- and two symptom-based cases of allergic rhinitis in Dutch community pharmacies. Pharmacies that participated in 2014, 2016 and 2018 were selected. SPs documented their observations of the problem analysis, dispensing and client interaction on a standardized scoresheet. Dispensing of an oral antihistamine according to the guideline recommendation was considered as the correct outcome. Chi-square tests were used to analyze differences in scores for problem analysis of pharmacies with correct and incorrect advice provision in 2014 and 2018. Predictors for correct outcome were identified by univariate and multivariate logistic regression analysis. Results Data from 673 pharmacies were available for all three years. In 2014 and 2018, problems were presented as a symptom (running nose), and 41.2% and 21.1% of pharmacies dispensed an antihistamine. For the condition-based problem (allergy) in 2016, 96.0% of participating pharmacies dispensed an antihistamine. Both in 2014 and 2018, each additional problem analysis question increased the odds ratio of providing correct advice. Questions asked about ‘hay fever symptoms’, ‘medication’, ‘when symptoms occurred’, and ‘familiar symptoms’ were significant predictors of correct advice provision. Conclusions Most pharmacies provided appropriate advice for a condition-based request but less than half of them provided appropriate advice for a symptom-based request. More questions asked was associated with an increased chance of providing correct advice. Addition of condition-specific questions may improve the WWHAM-method. An increasing number of questions asked increased the chance of providing correct advice The question ‘when symptoms occur’ at least doubled the odds ratio of correct advice Solving problems presented as conditions was shown to be easier than those presented as symptoms
Collapse
|
7
|
Waghorn J, Bates I, Davies JG, Jubraj B, Rakow T, Stevenson JM. Clinical Judgement Analysis: An innovative approach to explore the individual decision-making processes of pharmacists. Res Social Adm Pharm 2021; 17:2097-2107. [PMID: 34059473 DOI: 10.1016/j.sapharm.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacy stands increasingly on the frontline of patient care, yet current studies of clinical decision-making by pharmacists only capture deliberative processes that can be stated explicitly. Decision-making incorporates both deliberative and intuitive processes. Clinical Judgement Analysis (CJA) is a method novel to pharmacy that uncovers intuitive decision-making and may provide a more comprehensive understanding of the decision-making processes of pharmacists. OBJECTIVES This paper describes how CJA potentially uncovers the intuitive clinical decision-making processes of pharmacists. Using an illustrative decision-making example, the application of CJA will be described, including: METHOD: An illustrative study was used, applying an established method for CJA. The decision to initiate anticoagulation, alongside appropriate risk judgements, was chosen as the context. Expert anticoagulation pharmacists were interviewed to define and then refine variables (cues) involved in this decision. Decision tasks with sixty scenarios were developed to explore the effect of these cues on pharmacists' decision-making processes and distributed to participants for completion. Descriptive statistical and regression analyses were conducted for each participant. RESULTS The method produced individual judgement models for each participant, for example, demonstrating that when judging stroke risk each participant's judgements could be accurately predicted using only 3 or 4 out of the possible 11 cues given. The method also demonstrated that participants appeared to consider multiple cues when making risk judgements but used an algorithmic approach based on one or two cues when making the clinical decision. CONCLUSION CJA generates insights into the clinical decision-making processes of pharmacists not uncovered by the current literature. This provides a springboard for more in-depth explorations; explorations that are vital to the understanding and ongoing development of the role of pharmacists.
Collapse
Affiliation(s)
- Janique Waghorn
- Department of Pharmacy, Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, United Kingdom.
| | - Ian Bates
- University College London, School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, United Kingdom
| | - John Graham Davies
- Department of Pharmacy, Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, United Kingdom
| | - Barry Jubraj
- Department of Pharmacy, Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, United Kingdom
| | - Tim Rakow
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Jennifer M Stevenson
- Department of Pharmacy, Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, United Kingdom; Pharmacy Department, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH, United Kingdom
| |
Collapse
|
8
|
Mallinder A, Martini N. Exploring community pharmacists' clinical decision-making using think aloud and protocol analysis. Res Social Adm Pharm 2021; 18:2606-2614. [PMID: 33985891 DOI: 10.1016/j.sapharm.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/30/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical decision-making (CDM) is the dynamic process used to gather, interpret and evaluate data to select an evidence-based choice of action. As the role of the pharmacist becomes more patient-focused, effective CDM skills are increasingly vital to achieve patient outcomes centred on quality, safety and efficacy. OBJECTIVE To examine how community pharmacists reason through a clinical problem and what factors assist or hinder decision-making. METHOD Fifteen New Zealand registered community pharmacists in central Auckland were presented with a bacterial conjunctivitis case. Think Aloud and protocol analysis were employed to examine pharmacists' cognitive processes when working through the case. Factors that affect CDM were explored through semi-structured interviews and analyzed using thematic analysis. RESULTS Pharmacists used pattern recognition and analytical reasoning to diagnose and recommend treatment. Three main factors affecting CDM were: 1. community pharmacy environment, where pharmacy size and layout prevented patient privacy; 2. clinical knowledge, which was outdated and limited by poor access to up-to-date resources; and 3. patient factors, where CDM was affected by time, patient's attitudes, and language barriers. When uncertain, pharmacists typically referred patients to their GP to ensure patient safety and believed offering treatment was not within their scope of practice. CONCLUSION Pharmacists used dual processing when encountering a familiar case. Further research is required to explore how pharmacists apply CDM when exposed to less familiar, more complex cases presenting greater ambiguity. Barriers in community pharmacy deter effective CDM skills and could inhibit community pharmacists from fulfilling their expanding role within the modern healthcare system.
Collapse
Affiliation(s)
- Alice Mallinder
- School of Pharmacy, University of Nottingham, United Kingdom; School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Nataly Martini
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| |
Collapse
|
9
|
Collins JC, Chong WW, de Almeida Neto AC, Moles RJ, Schneider CR. The simulated patient method: Design and application in health services research. Res Social Adm Pharm 2021; 17:2108-2115. [PMID: 33972178 DOI: 10.1016/j.sapharm.2021.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/06/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
The simulated patient method is becoming increasingly popular in health services research to observe the behaviour of healthcare practitioners in a naturalistic setting. This method involves sending a trained individual (simulated patient among other names), who is indistinguishable from a regular consumer, into a healthcare setting with a standardised scripted request. This paper provides an overview of the method, a brief history of its use in health services research, comparisons with other methods, ethical considerations, and considerations for the development of studies using the simulated patient method in health services research, with examples from pharmacy and other fields. Methods of analysis, mixed-methods, and the use of simulated patients with feedback are also discussed.
Collapse
Affiliation(s)
- Jack C Collins
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Rebekah J Moles
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carl R Schneider
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
10
|
Ashour A, Phipps DL, Ashcroft DM. The role of non-technical skills in community pharmacy practice: an exploratory review of the literature. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:203-209. [PMID: 33793789 DOI: 10.1093/ijpp/riaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Non-technical skills (NTS) are the cognitive and social skills that complement technical skills in safe and efficient practice, and include leadership, teamwork, task management, decision-making and situation awareness. Other areas within healthcare have heavily invested in producing taxonomies to aid training and assessment of NTS within their disciplines, and have found them to be essential for improving patient safety. In pharmacy, no validated taxonomy has been produced, nor has the existing literature been appraised to aid the future development of a validated taxonomy. OBJECTIVE(S) To examine the literature on NTS within a community pharmacy setting and establish the research conducted thus far on each NTS and how they are applied by community pharmacists. METHODS A literature search of six electronic databases (EMBASE, PsychINFO, Medline, SCOPUS, CINAHL Plus and HMIC) using the generic list of NTS identified in previous studies. Only empirical studies were included. Examples of behaviours or skills were extracted and categorised within each NTS. KEY FINDINGS Seventeen studies were identified that contained one or more examples of NTS specific to community pharmacy practice. Altogether, 16 elements were extracted. Four elements were identified within leadership and task management. A further three were identified within situation awareness and decision-making, and a final two within teamwork and communication. CONCLUSION A framework consisting of the skills and how they're applied has been presented which describe the NTS required by community pharmacists from the published literature. This framework can provide a foundation for further investigation into NTS use within pharmacy practice.
Collapse
Affiliation(s)
- Ahmed Ashour
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University The University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Denham L Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University The University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University The University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,NIHR School of Primary Care Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| |
Collapse
|
11
|
Community pharmacists’ clinical reasoning: a protocol analysis. Int J Clin Pharm 2019; 41:1471-1482. [DOI: 10.1007/s11096-019-00906-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
|
12
|
Showande SJ, Adelakun AR. Management of uncomplicated gastric ulcer in community pharmacy: a pseudo-patient study. Int J Clin Pharm 2019; 41:1462-1470. [PMID: 31529269 DOI: 10.1007/s11096-019-00905-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/07/2019] [Indexed: 11/30/2022]
Abstract
Background Increasing role of community pharmacists sometimes demands the diagnoses of minor ailments using appropriate questioning skills and recommendation of over-the-counter medications to patients seeking self-care. Objective To evaluate community pharmacists' questioning and diagnostic skills of minor ailment complaints, and the appropriateness of medication(s) recommendations made. Setting One hundred and thirty-one community pharmacies in Ibadan, Nigeria. Method A cross-sectional survey employing pseudo-patient study method. The pseudo-patient visited 131 community pharmacies from June 2017 to January 2018 and complained of stomach ache. The conversation between the pharmacists and pseudo-patient were audio-taped and transcribed verbatim. Two criteria were used to evaluate the questioning skill of the community pharmacists. One of the criteria was developed by a six-membered panel and had 13 questions while the other contained five questions:-Who is it for? What are the symptoms? How long have the symptoms been present? Action taken? and Medication used.? Questioning skill of the community pharmacists was classified based on the median scores of these two criteria as: poor, moderate and optimal. The diagnoses made by the community pharmacists from the pseudo-patients complaints were compared with the expected diagnosis of uncomplicated gastric ulcer caused by the use of ibuprofen. Recommendations for the pseudo-patients minor ailment were also compared with the Nigeria standard treatment guideline. Main outcome measure Pharmacists' questioning skill, types of diagnosis made and appropriateness of medications recommended. Results The median scores for the questioning skill criterion containing 5 and 13 questions were 2 and 4, respectively; showing poor questioning skill. Differential diagnoses of gastric ulcer, dyspepsia, gastroesophageal reflux, and hyperacidity were made by 92 (67.4%) pharmacists but 3 (2.3%) correctly diagnosed the pseudo-patients' minor ailment as uncomplicated gastric ulcer caused by short-term use of ibuprofen. Antacids were recommended in line with the standard treatment guideline by 46 (35.7%) pharmacists while proton pump inhibitors were recommended by 6 (4.7%) pharmacists. None advised the withdrawal of the provocative factor according to the treatment guideline. Conclusion The questioning skill of the community pharmacists in this setting was poor. Few community pharmacists diagnosed the pseudo-patients' minor ailment correctly. Also, recommendations were mostly inappropriate compared with the standard treatment guideline.
Collapse
Affiliation(s)
- Segun J Showande
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Adenike R Adelakun
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
13
|
Haider I, Luetsch K. Pharmacists' advice and clinical reasoning in relation to cardiovascular disease risk factors - A vignette case study. Res Social Adm Pharm 2019; 16:568-573. [PMID: 31383600 DOI: 10.1016/j.sapharm.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pharmacists are increasingly providing public health services like the screening and monitoring for cardiovascular disease risk factors. Information on risk factors should be integrated into an assessment of absolute cardiovascular disease risk. Limited information is available on how pharmacists interpret test results and information related to cardiovascular disease risk factors. OBJECTIVE To investigate the potential advice to clients featured in vignette case studies and reasoning of pharmacists in relation to multiple cardiovascular disease risk factors. METHODS Three vignette case studies representing clients with varying degrees of absolute cardiovascular disease risk who requested blood pressure and cholesterol level testing and related advice were designed and distributed to practicing pharmacists. Vignettes contained all necessary information for absolute cardiovascular disease risk assessment. Two open ended questions asked what advice pharmacists would provide and what influenced their decisions to give specific advice. Responses were analysed using content analysis and assessed for appropriateness in relation to cardiovascular guidelines. RESULTS Replies of twenty-nine pharmacists were analysed. Advice to hypothetical clients was mainly appropriate when it concentrated on lifestyle modifications. Pharmacists' reasoning indicated a focus on individual risk factors in their decision making on advice rather than consideration of absolute cardiovascular disease risk, which resulted in inappropriate recommendations of referral and follow up. CONCLUSION Advice provided in relation to case studies and underlying clinical reasoning indicate potential knowledge gaps, anchoring bias and a framing effect in how pharmacists interpret multiple cardiovascular disease risk factors.
Collapse
Affiliation(s)
- Ibrahim Haider
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
| | - Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
| |
Collapse
|
14
|
Wigmore BC, Collins JC, Schneider CR, Arias D, Moles RJ. Ability of Pharmacy Students, Pharmacists and Pharmacy Support Staff to Manage Childhood Fever via Simulation. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6445. [PMID: 30643307 PMCID: PMC6325453 DOI: 10.5688/ajpe6445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 11/16/2017] [Indexed: 06/09/2023]
Abstract
Objective. To ascertain how pharmacy students (novices) and pharmacy staff (experts) respond to a childhood fever scenario. Methods. Data were collected from 65 second year students and 51 fourth (final) year students in an over-the-counter fever scenario during assessment tasks. Data from pharmacy staff were collected via mystery shopping conducted over nine weeks between March and October 2015. All encounters were immediately scored by the trained simulated client, and immediate feedback was provided for pharmacy staff and fourth year students. Questioning scores and proportions of competent participants were collected in all groups. Statistical comparative analyses were made between fourth year students and pharmacy staff. Pharmacy staff scores were also tracked over time. Results. Second year students performed well, achieving a median questioning score of 100%. Conversely, pharmacy staff scored 22%. A large proportion of the fourth year students and pharmacy staff achieved appropriate outcomes (92% and 65%, respectively); however, a smaller proportion of second year students performed well (52%). The pharmacy staff achieved statistical improvements over time for median questioning scores. Conclusion. Protocol compliant questioning appears to decline with experience. However, experienced counselors are more likely to provide appropriate patient advice. Further improvements in outcomes can also occur when staff are provided feedback and coaching. Mystery shopping simulations can be used as a valuable educational tool.
Collapse
Affiliation(s)
- Beatrice C. Wigmore
- King’s College, London, United Kingdom
- The University of Sydney, Sydney, Australia
| | | | | | | | | |
Collapse
|
15
|
Sinopoulou V, Gordon M, Rutter P. A systematic review of community pharmacies' staff diagnostic assessment and performance in patient consultations. Res Social Adm Pharm 2018; 15:1068-1079. [PMID: 30342907 DOI: 10.1016/j.sapharm.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increases in patients seeking advice at pharmacies has led to pharmacy staff engaging in diagnostic behaviours. Approaches to diagnosis include using mnemonics and clinical reasoning. OBJECTIVES The primary aim of this review was to assess the degree to which the criteria researchers use to evaluate diagnostic performance in pharmacy consultations, in studies that have simulated patients or vignettes, conform with a clinical reasoning and a mnemonic framework. A secondary aim of the review was to characterize staff performance in the studies, based on the authors' comments of their results. METHODS MEDLINE, EMBASE and Web of Science were searched between October 2016 and April 2017. Only peer-reviewed studies assessing pharmacy staff's diagnostic performance using simulated patients or vignettes were eligible for inclusion. Data were extracted about how each study's criteria conformed with clinical reasoning and mnemonic frameworks. A scoring system between 0 and 4 was devised to determine the degree to which studies aligned to these two approaches. Risk of bias was assessed using the NHI Study Quality Assessment Tools. The review was registered in PROSPERO with identification number CRD42017054827. RESULTS Sixty-eight studies (55 cross-sectional, 11 educational interventions and 2 RCTs) with sample sizes between 10 and 2700 were included in the review. Most studies were of poor or fair quality. Performance of pharmacy staff was overwhelmingly reported as poor by study authors. This was the case regardless of geography, scenario used, or assessment framework adopted. Scrutiny on how authors arrived at these conclusions revealed that mnemonic criteria were employed to assess pharmacy staff's diagnostic performance rather than a clinical reasoning approach. CONCLUSIONS Potentially important aspects of the decision-making process, such as clinical reasoning, were left unexplored. The number and geographic distribution of the included studies is a strength of this review; however, a validated tool was not employed.
Collapse
Affiliation(s)
- Vassiliki Sinopoulou
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom.
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, United Kingdom
| | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom
| |
Collapse
|
16
|
Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study. Contraception 2018; 98:243-246. [DOI: 10.1016/j.contraception.2018.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
|
17
|
Clinical decision-making: An essential skill for 21st century pharmacy practice. Res Social Adm Pharm 2018; 15:600-606. [PMID: 30100198 DOI: 10.1016/j.sapharm.2018.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 11/20/2022]
Abstract
Clinical decision-making skills are recognized as a central component of professional competency but are under-developed in pharmacy compared to other health professions. There is an urgent need for a comprehensive understanding of how pharmacists can best develop and use therapeutic decision-making skills in clinical practice. The aims of this commentary are to define clinical decision-making in pharmacy practice, and to present a model for clinical decision-making that aligns with a philosophical framework for pharmacy practice. The model has utility in education programs for pharmacists and provides a framework for understanding patient-facing clinical services in practice.
Collapse
|
18
|
Thinking in Pharmacy Practice: A Study of Community Pharmacists' Clinical Reasoning in Medication Supply Using the Think-Aloud Method. PHARMACY 2017; 6:pharmacy6010001. [PMID: 29301223 PMCID: PMC5874540 DOI: 10.3390/pharmacy6010001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022] Open
Abstract
Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists’ clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply.
Collapse
|
19
|
Collins JC, Schneider CR, Naughtin CL, Wilson F, de Almeida Neto AC, Moles RJ. Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study. BMJ Open 2017; 7:e019462. [PMID: 29247115 PMCID: PMC5735410 DOI: 10.1136/bmjopen-2017-019462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To determine whether repeated mystery shopping visits with feedback improve pharmacy performance over nine visits and to determine what factors predict an appropriate outcome. DESIGN Prospective, parallel, repeated intervention, repeated measures mystery shopping (pseudopatient) design. SETTING Thirty-six community pharmacies in metropolitan Sydney, Australia in March-October 2015. PARTICIPANTS Sixty-one University of Sydney pharmacy undergraduates acted as mystery shoppers. Students enrolled in their third year of Bachelor of Pharmacy in 2015 were eligible to participate. Any community pharmacy in the Sydney metropolitan region was eligible to take part and was selected through convenience sampling. INTERVENTION Repeated mystery shopping with immediate feedback and coaching. OUTCOME MEASURES Outcome for each given scenario (appropriate or not) and questioning scores for each interaction. RESULTS Five hundred and twenty-one visits were analysed, of which 54% resulted in an appropriate outcome. Questioning scores and the proportion of interactions resulting in an appropriate outcome significantly improved over time (P<0.001). Involvement of pharmacists, visit number, increased questioning score and the prescribed scenario were predictors of an appropriate outcome (P=0.008, P=0.022, P<0.001 and P<0.001, respectively). Interactions involving a pharmacist had greater scores than those without (P<0.001). CONCLUSIONS Repeated mystery shopping visits with feedback were associated with improved pharmacy performance over time. Future work should focus on the role of non-pharmacist staff and design interventions accordingly.
Collapse
Affiliation(s)
- Jack Charles Collins
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Frances Wilson
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Rebekah Jane Moles
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Sinopoulou V, Summerfield P, Rutter P. A qualitative study on community pharmacists' decision-making process when making a diagnosis. J Eval Clin Pract 2017; 23:1482-1488. [PMID: 28990319 DOI: 10.1111/jep.12837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Self-care policies are increasingly directing patients to seek advice from community pharmacists. This means pharmacists need to have sound diagnostic decision-making skills to enable them to recognise a variety of conditions. The aim of this study was to investigate the process by which pharmacists manage patient signs and symptoms and to explore their use of decision-making for diagnostic purposes. METHODS Data were collected through semi-structured, face-to-face interviews with community pharmacists working in England, between August 2013 and November 2014. Pharmacists were asked to share their experiences on how they performed patient consultations, and more specifically how they would approach a hypothetical headache scenario. As part of the interview, their sources of knowledge and experience were also explored. Framework analysis was used to identify themes and subthemes. RESULTS Eight interviews were conducted with pharmacists who had a wide range of working practice, from 1 year through to 40 years of experience. The pharmacists' main motivations during consultations were product selection and risk minimisation. Their questioning approach and decision-making relied heavily on mnemonic methods. This led to poor quality information gathering-although pharmacists acknowledged they needed to "delve deeper" but were often unable to articulate how or why. Some pharmacists exhibited elements of clinical reasoning in their consultations, but this seemed, mostly, to be unconscious and subsequently applied inappropriately. Overall, pharmacists exhibited poor decision-making ability, and often decisions were based on personal belief and experiences rather than evidence. CONCLUSIONS Community pharmacists relied heavily on mnemonic methods to manage patients' signs and symptoms with diagnosis-based decision-making being seldom employed. These findings suggest practicing pharmacists should receive more diagnostic training.
Collapse
Affiliation(s)
- Vassiliki Sinopoulou
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Paul Rutter
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, Lancashire, UK
| |
Collapse
|
21
|
How pharmacists check the appropriateness of drug therapy? Observations in community pharmacy. Res Social Adm Pharm 2017; 13:349-357. [DOI: 10.1016/j.sapharm.2016.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/23/2022]
|
22
|
Rutter P. Role of community pharmacists in patients' self-care and self-medication. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:57-65. [PMID: 29354520 PMCID: PMC5741028 DOI: 10.2147/iprp.s70403] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This review highlights the growing prominence of self-care and explores the contribution of community pharmacy. Firstly, background to self-care is discussed, followed by placing self-care in context with regard to the general public and accessing community pharmacy. From this perspective the contribution community pharmacy currently makes is assessed, paying particular attention to the factors that negatively impact on the ability of community pharmacy to facilitate self-care.
Collapse
Affiliation(s)
- Paul Rutter
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| |
Collapse
|