Diagnostic Reasoning by Hospital Pharmacists: Assessment of Attitudes, Knowledge, and Skills

Chernushkin, Kseniya; Loewen, Peter; Lemos, Jane de; A, Aulakh; Jung, Joanne; Dahri, Karen

doi:10.4212/cjhp.v65i4.1155

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…Two studies demonstrated less correct responses for post-test probability estimation with LRs (described in words in one and numerical in the other) compared with sensitivity and specificity presented numerically. 27 30 One study demonstrated similarly poor post-test probability estimation for LRs (described in words) compared with sensitivity and specificity (presented numerically). 40 Two studies demonstrated more correct responses for post-test probability estimation with LRs (described in words or using the categorical approach) compared with sensitivity and specificity presented numerically.…”

Section: Resultsmentioning

confidence: 99%

“… 17 19 20 22–32 36–42 44 Nine studies used the terms ‘sensitivity’, ‘specificity’, or ‘false-positive rate’, seven provided a text description equivalent to these terms, one used both 39 and in five it was unclear whether terms or test descriptions were provided. 27 29 36–38 …”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies provided test accuracy information to help with interpretation of a positive test result, one study provided information for a negative test result, 42 and five provided information for both a positive and a negative test result. 27 36 37 39 40 In one study it was unclear whether the test result provided should be interpreted as positive or negative 23 and in one study participants were questioned on how they interpreted test results in general. 41 Most participants overestimated the post-test probability of disease given a positive test result; where reported (4 studies) overestimates ranged between 46 and 73%.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies assessed the effects of providing test accuracy information using LRs (LRs), 20 27 30 38 40 44 only two of these studies provided information on the positive LR (LR+) and the negative LR (LR−). 27 40 Three studies provided a text description rather than using the term ‘likelihood ratio’, 30 40 44 and in one study a categorical approach based on the LR was used (‘quite useless’, ‘weak’, ‘good’, ‘strong’, or ‘very strong’). 38 Two studies included an additional scenario in which the LR information was provided graphically—one provided the information as a probability modifying plot, 44 the other as a graphic featuring five circles in a row in which an increasing number of circles were coloured black to correspond with increasing positive LRs or decreasing negative LRs.…”

Section: Resultsmentioning

confidence: 99%

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How well do health professionals interpret diagnostic information? A systematic review

et al. 2015

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ObjectiveTo evaluate whether clinicians differ in how they evaluate and interpret diagnostic test information.DesignSystematic review.Data sourcesMEDLINE, EMBASE and PsycINFO from inception to September 2013; bibliographies of retrieved studies, experts and citation search of key included studies.Eligibility criteria for selecting studiesPrimary studies that provided information on the accuracy of any diagnostic test (eg, sensitivity, specificity, likelihood ratios) to health professionals and that reported outcomes relating to their understanding of information on or implications of test accuracy.ResultsWe included 24 studies. 6 assessed ability to define accuracy metrics: health professionals were less likely to identify the correct definition of likelihood ratios than of sensitivity and specificity. –25 studies assessed Bayesian reasoning. Most assessed the influence of a positive test result on the probability of disease: they generally found health professionals’ estimation of post-test probability to be poor, with a tendency to overestimation. 3 studies found that approaches based on likelihood ratios resulted in more accurate estimates of post-test probability than approaches based on estimates of sensitivity and specificity alone, while 3 found less accurate estimates. 5 studies found that presenting natural frequencies rather than probabilities improved post-test probability estimation and speed of calculations.ConclusionsCommonly used measures of test accuracy are poorly understood by health professionals. Reporting test accuracy using natural frequencies and visual aids may facilitate improved understanding and better estimation of the post-test probability of disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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How well do health professionals interpret diagnostic information? A systematic review

et al. 2015

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“…Similarly, issues of integration, provision of a clear role definition, and appropriate training will be important for existing and new memory clinic pharmacists to succeed. A recent study of hospital pharmacists by Chernushkin et al 65 is in part illustrative. In that study, the great majority (>85%) of surveyed pharmacists agreed that it is important to have skills related to diagnosing drug therapy–related problems, yet overall, they demonstrated inadequate levels of knowledge and a suboptimal ability to apply concepts of diagnostic reasoning to 3 pharmacotherapeutic clinical case scenarios.…”

Section: Qualification Training and Issues And Additional Activities Conducted By The Pharmacistsmentioning

confidence: 99%

An Interdisciplinary Memory Clinic

2014

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Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.

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Questionnaire survey on pharmacists’ roles among non- and health care professionals in medium-sized cities in Japan

Horio

Ikeda

Kouzaki

et al. 2023

Sci Rep

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Although the scope of pharmacists’ work has expanded in Japan, people’s perception of this is unclear. To contribute to medical care together with non- and health care professionals, clarifying the perceptions of these groups is important to best utilize pharmacist professionals. We conducted a cross-sectional questionnaire survey among non-health care professionals (n = 487) and nurses (n = 151), medical doctors (n = 133), and pharmacists (n = 204) regarding the work of pharmacists. The questionnaire comprised 56 items in four categories associated with the roles of pharmacists. For each questionnaire item, we performed logistic regression analysis to compare pharmacists’ opinions with those of other professionals and non-health care professionals. Opinions were similar between pharmacists and nurses or medical doctors regarding “collecting patient information” and “providing drug information to patients.” However, there were differences in perceptions regarding “medical collaboration” (nurses; 8/23 items, physicians; 11/23 items) and “community medicine” (nurses; 9/15 items, physicians; 11/15 items), and pharmacists themselves perceived greater roles related to health care collaboration and community health care. Perceptions of non-health care professionals were poorer than those of pharmacists in all categories (47/56 items). These results suggest that pharmacists must actively communicate to help others understand their specialty and build trusting relationships to improve patient care.

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Diagnostic Reasoning by Hospital Pharmacists: Assessment of Attitudes, Knowledge, and Skills

Cited by 6 publications

References 13 publications

How well do health professionals interpret diagnostic information? A systematic review

How well do health professionals interpret diagnostic information? A systematic review

An Interdisciplinary Memory Clinic

Questionnaire survey on pharmacists’ roles among non- and health care professionals in medium-sized cities in Japan

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