Managing Common Ambulatory Conditions: Exploring Clinical Decision Making Performance Between Pharmacists and Family Physicians

Overview

Journal Explor Res Clin Soc Pharm

Date 2023 Nov 29

PMID 38023635

Authors

Vincent Chiang

Lisa Guirguis

Amy L Warren

David Topps

Sarah J Anderson

Kent G Hecker

Affiliations

Soon will be listed here.

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.

References

Poh E, McArthur A, Stephenson M, Roughead E . Effects of pharmacist prescribing on patient outcomes in the hospital setting: a systematic review. JBI Database System Rev Implement Rep. 2018; 16(9):1823-1873. DOI: 10.11124/JBISRIR-2017-003697. View

Al Hamarneh Y, Johnston K, Marra C, Tsuyuki R . Pharmacist prescribing and care improves cardiovascular risk, but is it cost-effective? A cost-effectiveness analysis of the REACH study. Can Pharm J (Ott). 2019; 152(4):257-266. PMC: 6610508. DOI: 10.1177/1715163519851822. View

Carter M, Chapman S, Watson M . Multiplicity and complexity: a qualitative exploration of influences on prescribing in UK general practice. BMJ Open. 2021; 11(1):e041460. PMC: 7802664. DOI: 10.1136/bmjopen-2020-041460. View

Weeks G, George J, MacLure K, Stewart D . Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev. 2016; 11:CD011227. PMC: 6464275. DOI: 10.1002/14651858.CD011227.pub2. View

Gregory P, Whyte B, Austin Z . How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario. Can Pharm J (Ott). 2016; 149(2):90-8. PMC: 4813515. DOI: 10.1177/1715163515625656. View

Shearer B, Ng S, Dunford D, Kuo I . Training Needs of Manitoba Pharmacists to Increase Application of Assessment and Prescribing for Minor Ailments into Practice: A Qualitative and Quantitative Survey. Pharmacy (Basel). 2018; 6(3). PMC: 6165543. DOI: 10.3390/pharmacy6030082. View

Keijsers C, Brouwers J, de Wildt D, Custers E, Cate O, Hazen A . A comparison of medical and pharmacy students' knowledge and skills of pharmacology and pharmacotherapy. Br J Clin Pharmacol. 2014; 78(4):781-8. PMC: 4239972. DOI: 10.1111/bcp.12396. View

Mansell K, Bootsman N, Kuntz A, Taylor J . Evaluating pharmacist prescribing for minor ailments. Int J Pharm Pract. 2014; 23(2):95-101. DOI: 10.1111/ijpp.12128. View

Akhtar S, Rutter P . Pharmacists' thought processes in making a differential diagnosis using a gastro-intestinal case vignette. Res Social Adm Pharm. 2014; 11(3):472-9. DOI: 10.1016/j.sapharm.2014.09.003. View

10.

Adams A, Weaver K . The Continuum of Pharmacist Prescriptive Authority. Ann Pharmacother. 2016; 50(9):778-84. DOI: 10.1177/1060028016653608. View

11.

Luetsch K . Attitudes and attributes of pharmacists in relation to practice change - A scoping review and discussion. Res Social Adm Pharm. 2016; 13(3):440-455.e11. DOI: 10.1016/j.sapharm.2016.06.010. View

12.

Famiyeh I, McCarthy L . Pharmacist prescribing: A scoping review about the views and experiences of patients and the public. Res Social Adm Pharm. 2016; 13(1):1-16. DOI: 10.1016/j.sapharm.2016.01.002. View

13.

Mansur J . Medication Safety Systems and the Important Role of Pharmacists. Drugs Aging. 2016; 33(3):213-21. DOI: 10.1007/s40266-016-0358-1. View

14.

Frankel G, Austin Z . Responsibility and confidence: Identifying barriers to advanced pharmacy practice. Can Pharm J (Ott). 2013; 146(3):155-61. PMC: 3676211. DOI: 10.1177/1715163513487309. View

15.

Tannenbaum C, Tsuyuki R . The expanding scope of pharmacists' practice: implications for physicians. CMAJ. 2013; 185(14):1228-32. PMC: 3787169. DOI: 10.1503/cmaj.121990. View

16.

Dawoud D, Griffiths P, Maben J, Goodyer L, Greene R . Pharmacist supplementary prescribing: a step toward more independence?. Res Social Adm Pharm. 2011; 7(3):246-56. DOI: 10.1016/j.sapharm.2010.05.002. View

17.

Habicht D, Ng S, Dunford D, Shearer B, Kuo I . Incorporating assessment and prescribing for ambulatory ailments skills into practice: An environmental scan of continuing education for pharmacist prescribing in Canada. Can Pharm J (Ott). 2017; 150(5):316-325. PMC: 5582678. DOI: 10.1177/1715163517723352. View

18.

Austin Z, Ensom M . Education of pharmacists in Canada. Am J Pharm Educ. 2009; 72(6):128. PMC: 2661159. DOI: 10.5688/aj7206128. View

19.

Gregory P, Austin Z . Pharmacists' lack of profession-hood: Professional identity formation and its implications for practice. Can Pharm J (Ott). 2019; 152(4):251-256. PMC: 6610506. DOI: 10.1177/1715163519846534. View

20.

Houle S, Bascom C, Rosenthal M . Clinical outcomes and satisfaction with a pharmacist-managed travel clinic in Alberta, Canada. Travel Med Infect Dis. 2018; 23:21-26. DOI: 10.1016/j.tmaid.2018.02.011. View