Therapeutic decision-making in primary care pharmacy practice

Abstract

Background: Therapeutic decision-making is a core element of pharmacy practice, however, little has been documented about how it is enacted in practice and how it can be theorised.

Objective(s): This study aims to contribute to pharmacy education and practice theory by investigating the correspondence between explanations from primary care pharmacists in clinical practice roles about how they make decisions related to medicines therapy and a theoretical model of therapeutic decision-making.

Methods: In this qualitative study, interview data from 10 pharmacists in primary care settings were analysed using a general inductive approach. The emergent themes were compared to a theoretical model of therapeutic decision-making.

Results: Eight themes were identified from the explanations of how participants were making therapeutic decisions in practice. The themes were found to correspond to at least one of the four steps of therapeutic decision-making in the model. Themes corresponding to the information gathering step were described most vividly, whereas, the themes corresponding to the reasoning, judgement, and decision steps were less well-articulated.

Conclusions: These findings suggest that the theoretical model can be useful to interpret empirical data about therapeutic decision-making in practice. These findings might provide a means for pharmacists to adopt language to better describe the steps in their therapeutic decision-making process to others, and especially, their colleagues and patients. Findings can be used by pharmacy educators to design learning opportunities for students about therapeutic decision-making.

Keywords: Clinical reasoning; Information gathering; Judgement; Pharmacy practice; Primary care; Therapeutic decision-making.