Exploring community pharmacists' clinical decision-making using think aloud and protocol analysis.

Area of Science:

• Pharmacy Practice and Pharmaceutical Sciences
• Clinical Decision-Making Research
• Healthcare Systems Analysis

Background:

• Clinical decision-making (CDM) is crucial for pharmacists to provide evidence-based, quality, safe, and effective patient care.
• The evolving, patient-focused role of pharmacists necessitates enhanced CDM skills for optimal patient outcomes.

Purpose of the Study:

• To investigate the cognitive processes community pharmacists employ when addressing clinical problems.
• To identify factors that either facilitate or impede clinical decision-making in community pharmacy settings.

Main Methods:

• A qualitative study involving 15 New Zealand community pharmacists presented with a bacterial conjunctivitis case.
• Employed Think Aloud and protocol analysis to capture cognitive processes during case management.
• Utilized semi-structured interviews and thematic analysis to explore influencing factors on CDM.

Main Results:

• Pharmacists utilized pattern recognition and analytical reasoning for diagnosis and treatment recommendations.
• Key barriers identified: suboptimal community pharmacy environment (privacy), outdated clinical knowledge (limited resources), and patient-related factors (time, attitudes, language).
• Uncertainty led to patient referral to General Practitioners (GPs), reflecting a cautious approach to scope of practice.

Conclusions:

• Pharmacists demonstrated dual processing for familiar cases, but complex or ambiguous cases require further investigation.
• Environmental and knowledge barriers in community pharmacies impede effective CDM, potentially limiting pharmacists' professional expansion.
• Addressing these barriers is essential for community pharmacists to fully contribute to the modern healthcare system.