Assessment and diagnostic performance in community pharmacy patient consultations - a systematic review

Abstract

Title: A qualitative systematic review of community pharmacies’ staff assessment and diagnostic performance in patient consultations

V. Sinopoulou a, M. Gordon a, P. Rutter a
a University of Central Lancashire, Preston
email: VSinopoulou@uclan.ac.uk

Introduction: Promotion of self-care has led to an increase in patients seeking advice at pharmacies. To facilitate staff establishing a diagnosis, mnemonic standardised protocols have been developed and promoted. These tend to be easily remembered and used, however, their usefulness has not been proven. Clinical reasoning, a combination of evidence-based knowledge, professional experience and practice, is a more complex process, however, it can be more accurate and improve diagnostic ability. It has not been established how mnemonic and clinical reasoning criteria are used in literature assessing pharmacy consultations which require a diagnostic assessment.

Aims/Objectives: The primary aim of this review was to summarise the criteria authors use to assess pharmacy staff’s diagnostic performance and to what degree they conform with a clinical reasoning and a mnemonic framework. A secondary aim of the review was to characterise staff performance in the studies, based on the authors comments of their results.

Research design/Methodology: Three online databases were searched to identify suitable papers for review. After an initial scoping, a search algorithm was decided and two rounds of searches were carried out. Two of the authors performed the screening while the third author acted as arbitrator. Only peer-reviewed studies that used simulated patients or vignettes to assess and describe staff performance were included. All study designs were acceptable for inclusion. Data were extracted about how each study’s criteria conformed with clinical reasoning and mnemonic frameworks. For this, each framework was broken down into 4 characteristics based on researchers’ assessment of staff’s decision-making process. Study texts were qualitatively analysed and coded for passages that corresponded to each characteristic. A value of one was assigned for each characteristic exhibited, meaning each study could score between 0 and 4. No ethical approval was needed for this review.

Results: Sixty-eight studies from 29 countries, published between 1989 and 2017, were included in the review. Based on our scoring system, the studies had an average score of 2.71/4 for elements of mnemonic criteria in their frameworks and an average score of 0.96/4 for clinical reasoning elements. Fifty-one of the studies reported negative comments in their assessment of staff performance, 9 used positive comments and 8 used a mix of positive and negative comments.

Conclusion/Discussion: On average, studies utilise more mnemonic than clinical reasoning elements when assessing community pharmacies’ staff diagnostic performance. Performance, as reported by study authors, was generally poor. Researchers should include more clinical reasoning criteria in their assessment frameworks, which will allow for the relevance of the gathered information to be assessed, as well as staff’s evidence-based knowledge and experience and their ability to interpret and synthesise information. Furthermore, community pharmacy staff should receive appropriate training for the quality of the consultations to improve. Strengths of this review include the low risk of interviewer and recall bias, however, there’s bias risk due to the exclusion of grey literature and studies not written in English.