Differential diagnosis in pharmacy practice: Time to adopt clinical reasoning and decision making

Abstract

The delivery of healthcare in most developed countries is under increasing pressure. Ageing populations with increasingly complex needs, coupled with financial constraints and imbalances in workforce, mean that healthcare policies look to contain cost and utilise resource as effectively as possible. Self-care is now widely advocated as a mechanism to manage acute presentations with pharmacy identified as a key resource to support such policy. Pharmacy teams are ideally positioned to facilitate the management of patients who present with acute illness. However, current evidence suggests that patient assessment and establishing a differential diagnosis could be better. It appears that how pharmacists are taught at Schools of Pharmacy adopts a protocol driven approach, which assumes presentation of low acuity conditions, and we argue that this method must be replaced with a curriculum that adopts clinical reasoning. This paper sets out the process of clinical reasoning and how the profession could embrace this as a better model in establishing a diagnosis.

Uma proposta de ontologia para a Assistência Farmacêutica a partir das páginas da Revista Ciência & Saúde Coletiva

“…The number of articles written in English or both Portuguese and English was greater in the period 2016-2019. The type of institution of origin (C) that contributed most to the theme was public universities (141), across all years, followed by the Oswaldo Cruz Foundation (48) or Fiocruz (acronym in Portuguese). The annual number of articles produced by these types of institutions grew steadily throughout the period, while the number produced by private universities (35) and foreign institutions (10) fell.…”

“…The topics brought by the articles on PS, such as pharmacoepidemiology, resource allocation, and technology assessment, are increasingly finding shared identity outside Brazil. In addition, the study of the advances made by the SUS -right to health and universal access to health care -reinforces the importance of studying system disparities brought about by context and disruption phenomena, which generate inequalities -leading for example to health-related litigation to gain access to medicines -and draw interest from the international community [45][46][47][48] .…”

Community Pharmacist Consultation Service: A Survey Exploring Factors Facilitating or Hindering Community Pharmacists’ Ability to Apply Learnt Skills in Practice

“…Pharmacists who had qualified post-2000 were more likely to report applying concise and accurate clinical records skills and conducting clinical assessments. One possible explanation for this is that pharmacists who have qualified post-2000 may be more familiar with applying clinical skills, as these skills were introduced during their undergraduate pharmacy training [ 21 ]. Also, previous research has indicated that younger professionals may be more willing to adapt to change [ 22 ].…”

Life Long Learning in Pharmacy Virtual Conference Proceedings 2021

“…In addition, pharmacists' roles are developing such that they are responsible for primary diagnoses and working clinical hypotheses. Clinical reasoning describes the thinking and decision-making processes associated with clinical practice (Cooper & Frain, 2017) and is an essential skill to expanding pharmacy practice (Rutter & Harrison, 2020). Pharmacy educators need to revise their curriculums to incorporate clinical reasoning skills from day one of initial training.…”