Abstract
Objective
To (1) characterize community pharmacists’ and community pharmacy residents’ decision making and unmet information needs when conducting comprehensive medication reviews (CMRs) as part of medication therapy management and (2) explore any differences between community pharmacists and community pharmacy residents in CMR decision making and unmet information needs.
Design
Thirty-to 60-minute semistructured interviews framed using a clinical decision-making model (CDMM) were conducted with community pharmacists and residents.
Setting and participants
Participants were recruited from practice-based research networks and researchers’ professional networks. Eligible participants had completed or supported the completion of at least 2 CMRs in the last 30 days.
Outcome measures
Two researchers independently coded transcripts using a combination of inductive and deductive methods to identify themes pertaining to community pharmacists’ and residents’ decision making and unmet information needs in the provision of CMRs. Discrepancies among researchers’ initial coding decisions were resolved through discussion.
Results
Sixteen participants (8 pharmacists and 8 residents) were interviewed. Themes were mapped to 5 CDMM steps. Participants primarily used subjective information during “case familiarization”; objective information was secondary. Information used for “generating initial hypotheses” varied by medication therapy problem (MTP) type. During “case assessment,” if information was not readily available, participants sought information from patients. Thus, patients’ levels of self-management and health literacy influenced participants’ ability to identify and resolve MTPs, as described under “identifying final hypotheses.” Finally, participants described “decision-making barriers,” including communication with prescribers to resolve MTPs. Although pharmacist and resident participants varied in the types of MTPs identified, both groups cited the use and need of similar information.
Conclusion
Community pharmacists and residents often rely primarily on patient-provided information for decision making during CMRs because of unmet information needs, specifically, objective information. Moreover, confidence in MTP identification and resolution is reduced by communication challenges with prescribers and limitations in patients’ ability to convey accurate and necessary information.
Date of this Version
2020
Recommended Citation
McPherson, Kacie L.; ADEOYE-OLATUNDE, OMOLOLA A.; Osborne, Jayna M.; Doucette, William R.; Gernant, Stephanie A.; Jaynes, Heather; Phansalkar, Shobha; Russ-Jara, Alissa L.; and Snyder, Margie E., "Community pharmacists’ and residents’ decision making and unmet information needs when completing comprehensive medication reviews" (2020). Department of Pharmacy Practice Faculty Publications. Paper 7.
https://docs.lib.purdue.edu/phprpubs/7
Comments
This is the author-accepted manuscript of Community pharmacists’ and residents’ decision making and unmet information needs when completing comprehensive medication reviews McPherson, Kacie L. et al. Journal of the American Pharmacists Association, Volume 60, Issue 3, S41 - S50.e2 . Copyright Elsevier, it is made available here CC-BY-NC-ND, and the version of record is available at DOI: 10.1016/j.japh.2019.12.009.