Browsing by Subject "Pharmacist"

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    Analysis of experienced pharmacist clinical decision-making for drug therapy management in the ambulatory care setting
    (2013-05) Bartels, Christine E.
    Objectives: The overarching objective of this research study was to document drug therapy decision-making processes of experienced pharmacists in the ambulatory care setting. The specific aims of this study were to examine the current clinical decisionmaking of experienced pharmacists in the context of the ambulatory care clinic setting, to compare and contrast pharmacist clinical decision-making with current decision-making models, and to identify enabling factors and barriers to clinical decision-making in the specific context of ambulatory care. Methods: This study used the thematic hermeneutic phenomenological human science methodology influenced by Dr. van Manen. After a feasibility pilot study of two experienced pharmacists in the Twin Cities of Minnesota, the main component of the dissertation research project included six experienced pharmacists throughout Minnesota and Iowa. Recruitment was done via e-mail request of eligible pharmacists known by faculty in Minnesota or Iowa and public information with a state association (the Minnesota Pharmacists Association). Three audio-taped data collection methods of participant observation, semi-structured interview, and personal audio-taping were utilized and exactly transcribed to provide textual data for analysis. Thematic analysis provided emerging themes of experienced pharmacist clinical decision-making which were further subdivided into subsuming themes after much reflection and interpretation of the entire study data. Results: Other health professions have identified experienced clinical decision-making to encompass the Hypothetico-Deductive Reasoning Model, Decision Analysis, intuition and pattern recognition. Pharmacists’ clinical decision-making processes are considered in light of other health professionals’ decision-making techniques; however the results show that experienced pharmacists use a different model of clinical decision-making using constant dialogue between two different types of knowledge (objective and context-related). The pharmacist must perform an active modification step necessary to combine the objective, factual information with the contextual, patient-related knowledge. With this modification, pharmacists are able to have complete situational understanding necessary for the final clinical decision. Although experienced, the pharmacist may have inadequate information to conduct the modification step necessary for understanding to make the clinical decision. The analysis suggests that the enabling factors and barriers to clinical decision-making are unique for each context. The availability of time to spend with patients and the effort in consulting with other health professional colleagues have enabled experienced pharmacists to ensure more patientcentered decisions in the general ambulatory care clinic setting; however, practicing within certain disease specialties and potential limited knowledge presented possible barriers in making more optimal clinical decisions. Conclusions: This research study may ultimately increase interprofessional work since there may be significant similarity between pharmacists’ and other health professionals’ experienced clinical decision-making. The cross-communication between different health professions may further improve decision-making processes and collaborative practice agreements. Also, this research may guide pharmacy education necessary to advance patient experiences for clinical decision-making based on better understanding of the practices of those experienced pharmacists with 5+ years of practice. Increased objective teaching should be encouraged in classrooms to provide for longer-lasting learning experiences for students. Finally, this study provides evidence for better understanding of the current pharmacy practice including clinical decision-making in the ambulatory care clinic setting, which may further expand the success of pharmacists’ contributions to improving patient care.
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    The medication experience of African-American women living with kidney-related diseases: A phenomenological inquiry
    (2023-07) Hillman, Lisa
    Chronic kidney disease affects 37 million Americans (14.0%), results in poor quality of life and mortality, is costly for the US Healthcare system and disproportionately impacts Black Americans. The optimal time to intervene in the course of chronic kidney disease is early, making treatment of the disease and risk factors, often with medications, a priority. The African-American woman’s lived experience lies at the intersection of race, gender, and other relevant social factors impacting medication use. Knowledge of the experience of medication taking of these women in the context of their everyday lives may shed meaningful insight into person-centered interventions aimed to improve patients’ use and experience with medications. Objectives are (1) Explore the medication experiences of African-American women taking medications for chronic diseases related to chronic kidney disease, and (2) Reveal individuals’ prioritization of medication-related decisions in the context of their everyday lives. A phenomenological approach was undertaken. One-on-one interviews were conducted with seventeen African-American adult women taking at least one medication for chronic kidney disease or a chronic disease that places them at high risk (hypertension or diabetes mellitus) for chronic kidney disease. The existential structures of the lifeworld as described by French Philosopher Merleau-Ponty were used to guide thematic analysis of data and was based in traditions of phenomenology. Five themes of (1) guided by a personal agency with medications, (2) sense of personal duty to care for self and others, (3) making sense of the body and self with medications, (4) staying on track with medications and with life, and (5) desire to living freely with medications and from their constraints are described. Priorities with medication taking behaviors in daily living experience were revealed to be: (1) safety and security, (2) singularity of experience, and (3) autonomy and vitality. Patient-centered care needs to consider the patient and their medication taking from the perspective of their priorities and daily living. Health care professionals need to practice self-awareness and listen attentively to understand the experiences their patients have with their medications. Knowledge of the medication experience can then inform strategies and interventions that are meaningful to patients.