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Community pharmacists' clinical reasoning: a protocol analysis.

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Pharmacists primarily use analytical clinical reasoning for medication appropriateness. While competent, their decision-making knowledge is often reconstructed during hindsight, blending intuitive and analytical methods.

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Area of Science:

  • Pharmacy Practice
  • Cognitive Science
  • Clinical Decision Making

Background:

  • Clinical reasoning involves intuitive and analytical approaches.
  • These approaches are underexplored in pharmacy medication appropriateness decisions.
  • Understanding pharmacist decision-making is crucial for patient safety.

Purpose of the Study:

  • Identify cognitive actions (operators) pharmacists use in clinical reasoning.
  • Describe the overall clinical reasoning approach for medication appropriateness.
  • Investigate the interplay between intuitive and analytical reasoning in pharmacy.

Main Methods:

  • Simulated patient-pharmacist interactions with new prescriptions.
  • Concurrent and retrospective think-aloud verbal reports collected via video recording.
  • Protocol analysis of transcribed verbal reports from 17 Canadian chain pharmacists.

Main Results:

  • Most pharmacists employed analytical clinical reasoning for prescription checks.
  • Three pharmacists demonstrated no clinical reasoning.
  • 50% used analytical approaches for specific decision models (indication, efficacy, safety, adherence), with 33% of these decisions made in hindsight.

Conclusions:

  • The majority of pharmacists utilize analytical decision-making in clinical reasoning.
  • Prompted decisions revealed a blend of intuitive and analytical reasoning.
  • Pharmacists possess medication appropriateness checking competency, though knowledge is often restructured retrospectively.