Defining an ‘older’ patient in the context of therapeutic decision making: perspectives of Australian pharmacists and nurses

Abstract

OBJECTIVE: To explore Australian nurses and pharmacist's perspectives on defining an 'older' patient in the context of decision-making around pharmacotherapy. DESIGN: A qualitative study was conducted using semi-structured interviews, facilitated by a purpose-designed interview guide. SETTING: Practitioners were recruited from the primary care setting (i.e., registered community pharmacists, registered community nurses, general practice nurses) and tertiary care setting (i.e., referral hospitals, specialist clinics). PARTICIPANTS: Non-prescribing health professionals directly involved in medication management (i.e., nurses, pharmacists) with experience in caring for in older patients. RESULTS: This exploratory study identified three key themes: 1) defining 'older' patients is difficult, given the heterogeneity of the population; 2) age is more than a number and therefore alone cannot be used for tailoring and managing a patient's treatment; and 3) a contemporary definition of an 'older' patient needs to be integrated into guidelines for treating aged patients. Overall, Australian nurses and pharmacists shared similar perspectives about defining an 'older' patient, favouring holistic assessments of individual patients. CONCLUSIONS: Non-prescribing health practitioners, such as nurses and pharmacists, advocate an individualised approach, rather than a number-based approach, to decision-making in older patients.

Clinical Judgement Analysis: An innovative approach to explore the individual decision-making processes of pharmacists

“…6 Existing studies investigating clinical decision-making in pharmacy have been in community pharmacy and employ methods, such as think-aloud techniques, designed to capture approaches that are readily articulated. [7][8][9][10][11][12][13] Whilst these studies provide useful insights into the Figure 1 The hierarchical levels of pharmacists' decision-making, where prevalence has been estimated from published surveys of pharmacy practice reviewed by Campagna (3) 6 Formal analyses based on the Judgement Analysis approach (or Lens Model framework) have been used to model the decisions of individuals in a range of domains and settings. When used in clinical practice, it is often referred to as Clinical Judgement Analysis (CJA).…”