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.
University of Minnesota Ph.D. dissertation. May 2013. Major: Social and Administrative Pharmacy. Advisor: Barbara F. Brandt, PhD. 1 computer file (PDF); xiv, 156 pages, appendices A-J.
Bartels, Christine E..
Analysis of experienced pharmacist clinical decision-making for drug therapy management in the ambulatory care setting.
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