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

Abstract

Background: 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. Objectives: The primary aim of
this review was to assess the degree to which the criteria authors use to evaluate diagnostic performance in pharmacy
consultations, in studies that use simulated patients or vignettes, 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. Methods: MEDLINE, EMBASE and Web of Science were searched between October 2016
and April 2017. Only peer-reviewed studies assessing pharmacy staff’s diagnostic performance by 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. Results: 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 whichever
assessment framework was utilised. 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.
Conclusions: Potentially important aspects of the decision-making process, that clinical reasoning accounts for, were
left unexplored. The scope of the number and locations of the included studies is a strength of this review, however,
the system employed does not represent a validated tool.