Community pharmacists’ practices and clinical reasoning towards hospital discharge prescription : a study using simulations and retrospective think-aloud methodology

Article Article scientifique Article Community pharmacists’ practices and clinical reasoning towards hospital discharge prescription : a study using simulations and retrospective think-aloud methodology eng 2025-08-26 author Solh Dost Léa 0000-0001-5767-1305 School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Pharma24, Academic Community Pharmacy, Geneva, Switzerland. 835266 author Guignard Bertrand 0009-0002-4328-0375 Pharmacy, Geneva University Hospitals, Geneva, Switzerland. 604263 author Gastaldi Giacomo Gianni Giuseppe 0000-0001-6327-7451 Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 107300 Département de médecine (DEMED) author Hasan Hamzo Aveen School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland. 908078 author Nendaz Mathieu 0000-0003-3795-3254 Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 33708 Unité de développement et de recherche en éducation médicale (UDREM) author Audetat Voirol Marie-Claude Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 824859 Unité de développement et de recherche en éducation médicale (UDREM) author Schneider Voirol Marie Paule 0000-0002-7557-9278 School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. marie.schneider@unige.ch.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland. marie.schneider@unige.ch.,Pharma24, Academic Community Pharmacy, Geneva, Switzerland. marie.schneider@unige.ch. 604314 Section des sciences pharmaceutiques (FARMA) 10.1007/s11096-025-01978-0 40856961 2210-7703 https://link.springer.com/10.1007/s11096-025-01978-0 Background: The roles of community pharmacists have evolved from dispensing medications to clinical decision makers. This shift requires a clearer understanding of pharmacists' clinical reasoning. Managing hospital discharge prescriptions requires analytical reasoning to ensure patient safety through medication reconciliation and patient education. Aim: This study assessed community pharmacists' practices and their clinical reasoning towards hospital discharge prescriptions. Method: This mixed-method study consisted of two phases. First, community pharmacists participated in a simulated encounter in their pharmacy, where a patient presented a discharge prescription. Their practices and the structure of the encounter were assessed using a structured checklist of practices adapted from the MEDICODE checklist. Following the simulation, participants verbalised their thought processes in a retrospective think-aloud session. These semi-structured interviews were transcribed and analysed using both inductive and deductive qualitative methods. Charlin et al.'s model was used to assess clinical reasoning, while the Calgary-Cambridge model evaluated communication structure. Results: Among 14 participating pharmacists, 13 performed medication reconciliation, and 10 contacted the simulated prescriber to address discrepancies. While most provided adherence aids, only seven assessed non-adherence, and five actively collaborated with the patient. Pharmacists exhibited diverse interview structures, often revisiting previous discussion points. Clinical reasoning misconceptions, such as assumptions or premature closure, were observed at multiple stages of the clinical reasoning process. Conclusion: Community pharmacists demonstrate strong medication-related skills but face challenges in clinical reasoning for discharge prescriptions. Clinical reasoning training, semi-structured consultations, and greater patient engagement would help tailor and improve post-discharge care. Clinical reasoning Community pharmacist Continuity of patient care Decision making Medication Reconciliation Patient simulation Dewey 613 Dewey 610/370 Dewey 615 Dewey 616 Dewey 617 48 Unité de développement et de recherche en éducation médicale 204 31 Section des sciences pharmaceutiques 17 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 56 Département de médecine 221 201 Institut de médecine de premier recours 22A9 false 1312 Raisonnement clinique et contextes de soin 1018 1344 Adhésion thérapeutique et interprofessionnalité 887 Pharmacie hospitalière et clinique 395 Acquisition de l'expertise médicale 662 b6bb4aa5-cb95-4866-b62e-c915abd3f29d UDREM Raisonnement clinique International journal of clinical pharmacy 8a217025-8baa-4bac-8608-541bc702336f Article (Published version) Public Article_scientifique_from_unpaywall.pdf 908327 application/pdf CC BY-4.0 12d0fdc19466cd3bf7d2071ef4a8110826c44528ce2eff2ce56db0c4aa2a5e77 f2d87475-0ea0-4089-bb4d-cd599903f21d Supplemental data Public 11096_2025_1978_MOESM1_ESM.docx 16143 application/vnd.openxmlformats-officedocument.wordprocessingml.document 9f128d9aa472df204780b898ad0a5d00131cfbecab54ef37b9ee7f2ed6628e14 820acd69-f461-4225-be90-e6c95d7d4d40 Supplemental data Public 11096_2025_1978_MOESM2_ESM.docx 17018 application/vnd.openxmlformats-officedocument.wordprocessingml.document 3858fd4ed33ff6188f57abe4a0a024809be3dce0004af3305bc34d35f4b2ee19 edb8d92d-c08b-406b-b0fa-5557ef15282f Supplemental data Public 11096_2025_1978_MOESM3_ESM.docx 25075 application/vnd.openxmlformats-officedocument.wordprocessingml.document c0465e904051edbbc1fb8747fc9e152553117d4087c33436fc4ec7170725547f be8f520d-1aac-4f03-bb14-9a0a81fe669d Supplemental data Public 11096_2025_1978_MOESM4_ESM.docx 140190 application/vnd.openxmlformats-officedocument.wordprocessingml.document 7174cfe8874d5c72a8fa858297ca52879978af847f44917194ec3cd63e4ad38c openAccess Faculté de médecine / Unité de développement et de recherche en éducation médicale Faculté des sciences / Section des sciences pharmaceutiques Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de médecine de premier recours

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Community pharmacists’ practices and clinical reasoning towards hospital discharge prescription : a study using simulations and retrospective think-aloud methodology	International journal of clinical pharmacy			2025	24	256

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