School of Pharmacy and Biomedical Sciences, University of Central Lancashire, United Kingdom.
School of Medicine, University of Central Lancashire, United Kingdom.
Res Social Adm Pharm. 2019 Sep;15(9):1068-1079. doi: 10.1016/j.sapharm.2018.10.003. Epub 2018 Oct 11.
Increases in patients seeking advice at pharmacies has led to pharmacy staff engaging in diagnostic behaviours. Approaches to diagnosis include using mnemonics and clinical reasoning.
The primary aim of this review was to assess the degree to which the criteria researchers use to evaluate diagnostic performance in pharmacy consultations, in studies that have simulated patients or vignettes, conform with a clinical reasoning and a mnemonic framework. A secondary aim of the review was to characterize staff performance in the studies, based on the authors' comments of their results.
MEDLINE, EMBASE and Web of Science were searched between October 2016 and April 2017. Only peer-reviewed studies assessing pharmacy staff's diagnostic performance using simulated patients or vignettes were eligible for inclusion. Data were extracted about how each study's criteria conformed with clinical reasoning and mnemonic frameworks. A scoring system between 0 and 4 was devised to determine the degree to which studies aligned to these two approaches. Risk of bias was assessed using the NHI Study Quality Assessment Tools. The review was registered in PROSPERO with identification number CRD42017054827.
Sixty-eight studies (55 cross-sectional, 11 educational interventions and 2 RCTs) with sample sizes between 10 and 2700 were included in the review. Most studies were of poor or fair quality. Performance of pharmacy staff was overwhelmingly reported as poor by study authors. This was the case regardless of geography, scenario used, or assessment framework adopted. Scrutiny on how authors arrived at these conclusions revealed that mnemonic criteria were employed to assess pharmacy staff's diagnostic performance rather than a clinical reasoning approach.
Potentially important aspects of the decision-making process, such as clinical reasoning, were left unexplored. The number and geographic distribution of the included studies is a strength of this review; however, a validated tool was not employed.
寻求药剂师建议的患者人数增加，导致药剂师开始进行诊断行为。诊断方法包括使用记忆技巧和临床推理。
本综述的主要目的是评估在模拟患者或病例的研究中，研究人员用于评估药房咨询中诊断性能的标准在多大程度上符合临床推理和记忆技巧框架。综述的次要目的是根据作者对结果的评论，描述研究中工作人员的表现。
在 2016 年 10 月至 2017 年 4 月期间，检索了 MEDLINE、EMBASE 和 Web of Science。只有使用模拟患者或病例评估药房工作人员诊断性能的同行评审研究才符合纳入标准。提取了关于每个研究的标准如何符合临床推理和记忆技巧框架的数据。设计了一个 0 到 4 分的评分系统，以确定研究与这两种方法的一致性程度。使用 NHI 研究质量评估工具评估偏倚风险。综述已在 PROSPERO 中注册，注册号为 CRD42017054827。
共有 68 项研究（55 项横断面研究、11 项教育干预研究和 2 项 RCT）纳入本综述，样本量在 10 至 2700 之间。大多数研究的质量较差或为中等。研究作者报告说，药剂师的表现几乎都是很差的。无论地理位置、使用的场景或采用的评估框架如何，情况都是如此。仔细审查作者得出这些结论的过程表明，记忆技巧标准被用来评估药剂师的诊断性能，而不是采用临床推理方法。
决策过程中一些重要的方面，如临床推理，没有得到探讨。纳入研究的数量和地理分布是本综述的一个优势；然而，并没有采用经过验证的工具。
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