Purpose Despite international guidelines’ recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. Methods In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: “pharmacist or pharmacy” and “spirometry or pulmonary function test or lung function test.” Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. Results A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. Conclusion Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.
Numerous training interventions on patient handoffs have been initiated in the last few years, in part to meet new residency program accreditation requirements. Most of these programs focus on increasing the structure, comprehensiveness, and accuracy of the information conveyed by the outgoing clinician in either verbal or written format. Our team has developed online training that can augment these programs with how to foster resilient communication that increases overall system resilience, and thus reduces unintended patient harm. It is anticipated that improving communication competencies with resilient strategies during real-time verbal exchanges conducted at the shift change will increase the likelihood of detecting and addressing erroneous diagnostic assessments, prognoses, and inappropriate elements of treatment plans.
Patient handovers are a critical point in the patient care process. Software to identify differences in communication content and strategies across different types of patient handovers could be helpful in customizing physician training programs. To determine whether there were differences, Linguistic Inquiry and Word Count (LIWC) software was used. The primary measure was the LIWC output score, which is the frequency of mention of words in a construct category divided by the total number of words in the handover transcript. Two types of constructs were investigated: 1) content, which included name/age, care plan, prognosis, and family, and 2) strategy, which included questioning and collaborative cross-checks. We hypothesized that the Emergency Department (ED) to hospital transfer compared to Intensive Care Unit (ICU) sign-outs would have more discussion of family and less of the patient's prognosis, as well as more collaborative cross-checks. A two-tailed t-test was used to detect differences. One hypothesis was confirmed, that there was less discussion of prognosis in the ED as compared to the ICU handover. Unexpected findings were less discussion of the care plan and more questioning in the ED as compared to the ICU handover. Findings confirm that both communication content and strategies are different for the two types of patient handovers and that an automated analysis approach can detect differences across a set of handover transcripts.
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