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Practising prioritisation: exploring variation in applying a clinical pharmacy risk stratification tool.

Fiona B McIntyre^1,2, Lauren Vickers^3,4, Alexandra Wallem^3,5

¹Pharmacy, NHS Forth Valley, Larbert, UK fiona.mcintyre3@nhs.scot.

European Journal of Hospital Pharmacy : Science and Practice

|January 5, 2023

Summary

Clinical pharmacists show significant variation in using a risk stratification tool, often prioritizing non-patient factors. Regular training and tool validation are recommended to improve consistency in patient care.

Keywords:

CLINICAL PHARMACY Education, Pharmacy, Continuing HEALTH SERVICES ADMINISTRATION PHARMACY ADMINISTRATION PHARMACY SERVICE, HOSPITAL

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Area of Science:

Pharmacy practice
Health services research

Background:

Risk stratification tools are essential for optimizing clinical pharmacist workload.
Understanding practice variation is key to improving patient care and resource allocation.

Purpose of the Study:

To evaluate the adherence and consistency of clinical pharmacists using a specific risk stratification tool.
To identify factors contributing to variations in the application of this tool.

Main Methods:

A mixed-methods approach combining quantitative prospective evaluation and qualitative focus groups.
Quantitative phase: Comparison of researcher-assigned codes versus pharmacist-assigned codes for 73 patients.
Qualitative phase: Thematic analysis of focus group discussions with 10 clinical pharmacists.

Main Results:

Low agreement between researchers and pharmacists (26% match rate, kappa coefficient = 0.039).
Pharmacists rarely accessed the tool directly, using its principles for workload management and communication.
Qualitative data revealed that non-patient factors influenced coding decisions.

Conclusions:

Significant variation exists in the application of the risk stratification tool among clinical pharmacists.
Recommendations include regular criteria review, enhanced training, peer review, and tool validation.
Further research is needed to explore the interplay between professional judgment and structured risk stratification.