Pharmacy, NHS Forth Valley, Larbert, UK
Pharmacy, NHS Lothian, Edinburgh, Edinburgh, UK.
Eur J Hosp Pharm. 2024 Apr 23;31(3):267-273. doi: 10.1136/ejhpharm-2022-003369.
To evaluate the use of a risk stratification tool and explore the contributing factors to variation in practice by clinical pharmacists.
The quantitative phase was a prospective evaluation of adherence to the risk stratification tool. Patients were selected by convenience sampling from medical wards across two hospital sites. Researchers applied the risk stratification tool to each patient, documented the code, accessed health records in subsequent days, and recorded the code assigned by the pharmacist. These codes were compared. The kappa (κ) coefficient test was performed using SPSS software as a statistical measure of agreement. The qualitative phase was designed using focus groups with clinical pharmacists. One focus group was conducted at each of the two study sites. Participants were grouped to ensure a mix of experience levels. To augment the discussion, participants completed a short survey. Focus groups were recorded and a thematic analysis undertaken.
The final cohort for quantitative analysis was 73. Researchers and pharmacists allocated the same code to 19 (26%) patients. The highest match rate was observed between researchers and rotational pharmacists. The κ coefficient was 0.039 (slight agreement) with p value=0.52 (not significant). Ten pharmacists participated in the focus groups: three from site 1 and seven from site 2. All participants reported using the principles of the risk stratification tool every day, but they rarely accessed the tool. Pharmacists reported using the tool as a workload management and communication system.
Variation in application of the risk stratification tool exists among pharmacists. Focus group participants described multiple scenarios where non-patient factors were considered in assigning a priority code for the patient. A schedule of regular review of the criteria; training and peer review; tool validation; and research identifying the relationship between structured professional judgement and risk stratification tools is recommended.
评估风险分层工具的使用情况，并探讨临床药师在实践中的变异性的影响因素。
定量阶段是对风险分层工具的依从性进行前瞻性评估。通过便利抽样，从两个医院的医疗病房中选择患者。研究人员对每个患者应用风险分层工具，记录代码，在随后的几天中访问健康记录，并记录药师分配的代码。比较这些代码。使用 SPSS 软件进行 Kappa（κ）系数检验，作为一致性的统计测量。定性阶段采用临床药师的焦点小组设计。在两个研究地点分别进行一次焦点小组讨论。参与者分组以确保经验水平的混合。为了增强讨论，参与者完成了一项简短的调查。记录焦点小组会议并进行主题分析。
定量分析的最终队列为 73 名患者。研究人员和药剂师为 19 名（26%）患者分配了相同的代码。研究人员和轮班药剂师之间观察到的匹配率最高。κ系数为 0.039（轻度一致），p 值=0.52（不显著）。十名药师参加了焦点小组讨论：三个来自站点 1，七个来自站点 2。所有参与者都报告说每天都在使用风险分层工具的原则，但很少访问该工具。药剂师报告说，该工具可用作工作量管理和沟通系统。
药剂师在应用风险分层工具方面存在差异。焦点小组参与者描述了在为患者分配优先级代码时考虑了多个非患者因素的情况。建议定期审查标准；培训和同行评审；工具验证；以及研究确定结构化专业判断和风险分层工具之间的关系。
