Elgebli Ali, Hall Jason, Phipps Denham L
Division of Pharmacy & Optometry, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK.
Int J Pharm Pract. 2023 Sep 30;31(5):504-511. doi: 10.1093/ijpp/riad056.
Community pharmacists (CPs) are the last healthcare professional to check the clinical appropriateness of prescribed medicines before being dispensed to patients. This process is known as 'clinical checking' and is intended to ensure the prescribed medications are safe and effective. This study aims to explore how CPs carry out clinical checking in practice, and the main factors affecting their clinical decisions.
The study was qualitative in nature, and data were collected by means of semi-structured interviews. The interview questions aimed to explore how CPs carry out clinical checking in practice. A purposive sampling strategy was employed to recruit a sample representative of CPs in England. Interview transcripts were subjected to thematic template analysis.
Twelve CPs of various professional backgrounds participated in the interviews. The analysis yielded three overarching themes, namely: pharmacists' perception of the clinical checking process; clinical checking as a naturalistic decision-making process and barriers to effective clinical checking. Interviewees described being faced with a trade-off between examining each prescription thoroughly and maintaining the throughput of prescriptions, due to the highly pressurised environment they work within. A number of factors inform this trade-off: (1) assuming the safety of repeat medicines; (2) lacking access to sufficient clinical information and (3) working under challenging circumstances (such as a lack of resources).
Clinical checking is a complex, variable and experience-driven process which is heavily influenced by the surrounding environment and information accessibility. Further research should investigate the cognitive process involved in clinical checking and explore the practicalities and potential benefits of the recommendations identified in this study.
社区药剂师是在药品配发给患者之前检查处方临床适宜性的最后一道医疗保健专业环节。这一过程被称为“临床检查”，旨在确保所开药物的安全性和有效性。本研究旨在探讨社区药剂师在实际工作中如何进行临床检查，以及影响其临床决策的主要因素。
本研究性质为定性研究，数据通过半结构化访谈收集。访谈问题旨在探讨社区药剂师在实际工作中如何进行临床检查。采用目的抽样策略招募英格兰社区药剂师的代表性样本。对访谈记录进行主题模板分析。
12名不同专业背景的社区药剂师参与了访谈。分析得出三个总体主题，即：药剂师对临床检查过程的认知；作为自然决策过程的临床检查以及有效临床检查的障碍。受访者表示，由于工作环境压力极大，他们在彻底检查每张处方与维持处方处理量之间面临权衡。有若干因素影响这一权衡：（1）假定重复用药的安全性；（2）无法获取足够的临床信息；（3）在具有挑战性的情况下工作（如资源匮乏）。
临床检查是一个复杂、多变且受经验驱动的过程，受到周围环境和信息可获取性的严重影响。进一步的研究应调查临床检查中涉及的认知过程，并探索本研究中所确定建议的实用性和潜在益处。
