Leverage points for establishing clinical decision-maker as a vital component of pharmacists' professional identity.

This commentary explores how a change in the professional identity of pharmacists from medicines supplier to clinical decision-maker might take place. Three leverage points are identified that support this change. The first leverage point involves workplace culture. Pharmacists require workplaces that support them to assume direct responsibility for drug therapy decisions that may not have traditionally been part of pharmacy practice. The second leverage point involves terminology. Pharmacists need to be able to name and describe the process they use when making decisions about drug therapy. The third leverage point encompasses pharmacy education. Future pharmacists require a foundation that enables them to mobilize their knowledge and skills about drug therapy to act as clinical decision-makers with patients that require complex care. By acting on multiple leverage points, advocates for change in the pharmacy profession can assist pharmacists to establish themselves as decision-makers about drug therapy, shift their professional identity, and reformulate their view of the profession.

Therapeutic decision-making in primary care pharmacy practice.

BACKGROUND: Therapeutic decision-making is a core element of pharmacy practice, however, little has been documented about how it is enacted in practice and how it can be theorised. OBJECTIVE(S): This study aims to contribute to pharmacy education and practice theory by investigating the correspondence between explanations from primary care pharmacists in clinical practice roles about how they make decisions related to medicines therapy and a theoretical model of therapeutic decision-making. METHODS: In this qualitative study, interview data from 10 pharmacists in primary care settings were analysed using a general inductive approach. The emergent themes were compared to a theoretical model of therapeutic decision-making. RESULTS: Eight themes were identified from the explanations of how participants were making therapeutic decisions in practice. The themes were found to correspond to at least one of the four steps of therapeutic decision-making in the model. Themes corresponding to the information gathering step were described most vividly, whereas, the themes corresponding to the reasoning, judgement, and decision steps were less well-articulated. CONCLUSIONS: These findings suggest that the theoretical model can be useful to interpret empirical data about therapeutic decision-making in practice. These findings might provide a means for pharmacists to adopt language to better describe the steps in their therapeutic decision-making process to others, and especially, their colleagues and patients. Findings can be used by pharmacy educators to design learning opportunities for students about therapeutic decision-making.

Measuring the Development of Therapeutic-Decision-Making Skills by Practicing Pharmacists Undertaking a University-Based Postgraduate Clinical Qualification at Distance.

(1) Background: The processes and skills required to make decisions about drug therapy have been termed "therapeutic decision-making" in pharmacy practice. The aim of this study was to evaluate a tool constructed to measure the development of therapeutic-decision-making skills by practicing pharmacists undertaking a university-based continuing professional development program. (2) Methods: A pre- and post-intervention crossover study design was used to investigate the qualitative and quantitative features of practicing pharmacists' responses to two clinical vignettes designed to measure the development of therapeutic-decision-making skills. The vignettes were assigned a score using a five-point scale and compared pre- and post-intervention. (3) Results: There was a median increase in score of 2 units on the five-point scale in the post-intervention scores compared to pre-intervention (p < 0.0001). (4) Conclusions: The results were interpreted to suggest that the participants' responses to the vignettes are a reasonable measure of student learning. Therefore, we infer that the teaching and learning intervention successfully enabled the development of therapeutic-decision-making skills by practicing pharmacists.

Understanding the process of clinical judgement for pharmacists when making clinical decisions.

Clinical decision-making is arguably the most important and underappreciated skill in pharmacy. It can be described as four discrete steps: information gathering, clinical reasoning and judgement and, the decision process. The information gathering and decision negotiation steps and to some extent clinical reasoning are addressed either implicitly or explicitly by practitioners and educators. Clinical judgement, however, remains a largely unexplored concept for clinical decision-making in healthcare therapeutics. It defines how practitioners arrive at a favourable treatment strategy and, due to the often complicated benefit:risk evaluations, is often linked with concepts relating to ambiguity. In this article, we use game theory to explore the judgement stage of clinical decision-making. Game theory allows us to provide a quantitative evaluation of clinical judgement and explore concepts such as ambiguity and its sources in healthcare. Clarifying the elements involved in the judgement stage of clinical decision-making will enable a better understanding of how pharmacists contribute patient care in healthcare teams.

Clinical decision-making: An essential skill for 21st century pharmacy practice.

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.

A philosophical framework for pharmacy in the 21st century guided by ethical principles.

Pharmacy has a long history of providing products and services for healthcare. In the last century, these roles have taken a strong focus on clinical care with the provision of medicines review, medicines optimisation, and prescribing services being at the forefront. The profession, however, is diverse. Pharmacists operate across a wide range of healthcare practices that often embrace both historic and contemporary roles simultaneously. The purpose of this article is to provide an overarching philosophical framework for pharmacy that encompasses roles that the modern pharmacist may assume. In doing this, we explore how pharmacy services align with healthcare and how different services require different approaches to clinical decision making.