A philosophical framework for pharmacy in the 21st century guided by ethical principles

Pharmacists and pharmacy students' perceptions on how a new teaching model supports their clinical decision-making

BACKGROUND AND PURPOSE

Clinical decision-making (CDM) is crucial in pharmacy practice, necessitating effective teaching in undergraduate and postgraduate pharmacy education. This study aims to explore undergraduates and postgraduates' perceptions of how a new teaching model supports their CDM when addressing patient cases.

EDUCATIONAL ACTIVITY AND SETTING

Implemented in a full-day CDM course for pharmacy students and a half-day course for pharmacists in the Netherlands, the model, accompanied by a learning guide, facilitated CDM in patient cases. Eight courses were conducted between September 2022 to June 2023, followed by an online survey measuring participants' agreement on how the model supported their CDM, using a 5-point Likert scale. Additionally, three open-ended questions were included to elicit learning outcomes and self-development opportunities.

FINDINGS

Of 175 invited participants, 159 (91%) completed the survey. Most agreed the teaching model supported their CDM, particularly in considering the patient's healthcare needs and context (96%), and exploring all available options (96%). Participants found the model provided a clear structure (97%), and fostered critical thinking (93%). The most frequently mentioned learning outcomes and self-development opportunities included collecting sufficient relevant information, maintaining a broad perspective, and decelerating the process to avoid premature closure.

SUMMARY

Participants agreed that the teaching model helped them to make clinical decisions. Both undergraduate and postgraduate pharmacy education could possibly benefit from the teaching model's implementation in supporting pharmacy students and pharmacists conducting CDM in pharmacy practice.

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION

Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists.

METHODS

To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups.

RESULTS

600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism.

CONCLUSIONS

The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

Relationships Between Stigma, Risk Tolerance, and Buprenorphine Dispensing Intentions Among Community-Based Pharmacists: Results From a National Sample

BACKGROUND

Concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists' endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, we assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions.

METHODS

A sample of 207 active community-based pharmacists practicing in the United States responded to survey items measuring stigma, risk tolerance, and intentions to dispense buprenorphine. The survey included 2 vignettes in which patients presented to the pharmacy with a prescription for buprenorphine, and respondents rated their comfort with dispensing and decisions regarding dispensing in the vignette.

RESULTS

Results suggest that both stigma toward patients taking buprenorphine to treat OUD and tolerance for risk in pharmacy settings are related to differences in pharmacists' intentions to and willingness to dispense buprenorphine for OUD.

CONCLUSIONS

Findings support the need for interventions to reduce stigma associated with buprenorphine use among pharmacists and suggest that risk tolerance is an important determinant of pharmacists' behavior that merits further study.

Social Prescribing Competence among Community Pharmacists and Pharmacy Students in Norway

Background and aim: Social prescribing, which links patients to non-clinical services and involves general physicians, has been gaining traction. Community pharmacists, who are integral to primary healthcare, have untapped potential in social prescribing. This study explores social prescribing competence among Norwegian community pharmacists and pharmacy students. Method: A cross-sectional study utilizing an anonymous online questionnaire to collect quantitative data was conducted. Inspired by the limited relevant literature, the questionnaire was constructed, pilot-tested, and distributed in a one-week window within a Facebook group for Norwegian pharmacists. The questionnaire comprised 23 questions categorized into demographic details and competence assessment, covering general knowledge, attitude, and barriers/facilitators related to social prescribing. Statistical analyses were employed to determine the competence of the participants. Results: The online questionnaire collected data from 96 participants, primarily females (79.2%), aged 25-34 (40.6%), who were identified as community pharmacists (49.0%). Most (91.7%) worked in community pharmacies, with 31.3% having over 10 years of experience. Despite positive client relationships (93.8%), statistical analysis revealed no significant associations between competence and variables such as work experience, education, or gender. The custom scoring system yielded an average competence score of 1.98 on a 5-point scale, with attitudes and perceptions of participants scoring 3.82. Overall competence was calculated at 3.4, indicating a moderate level. Conclusions: The findings of this study reveal that the participants had limited knowledge regarding social prescribing, emphasizing the need for education. However, the participants showed strong enthusiasm for competence development. This groundwork paves the way for future investigations centered on pilot-testing strategies to boost social prescribing knowledge and engagement among Norwegian community pharmacists and pharmacy students.

Designing and psychometric evaluation of pharmacists' attitude toward ethical challenges questionnaire in pharmacy practice: A mixed‑method study

PURPOSE

Knowledge advancement exposes the pharmacists to new ethical and professional challenges in providing pharmaceutical care. The pharmacist's attitude towards the ethical challenges of pharmacy practice could be of great help in assessing pharmacist's ethical sensitivity. This study aimed to design a valid and reliable questionnaire for measuring pharmacists' attitudes.

METHODS

The present study is the second phase of a sequential exploratory mixed‑method study for designing and psychometric evaluation of the questionnaire. In the first phase the questionnaire was developed using semi-structured interviews followed by content analysis. The psychometric evaluation of the questionnaire was performed examining the validity (face, content, and construct), and reliability (internal consistency and Intraclass Correlation Coefficient and Standard Error of Measurement) in a sample of pharmacists practicing in community pharmacies in Tehran and Tabriz, Iran (n = 504). The construct validity of the questionnaire was determined using exploratory and confirmatory factor analysis.

RESULTS

The Scale‑Content Validity Index/Average (S‑CVI/AVE) was calculated at 0.84. The results of exploratory factor analysis supported 22 items in four factors including regulations and rules, professional communications, providing and supplying medicine, and consultation and providing pharmaceutical care that are explained by a total of 49.50% of the variance. Also, confirmatory factor analysis confirmed goodness of fit indices and model fit. Cronbach's alpha Coefficient was 0.919 and ICC was 0.914.

CONCLUSIONS

The psychometric evaluation of the present questionnaire shows a native, valid and reliable instrument to assess pharmacists' attitudes toward ethical challenges which could be a mirror of pharmacists ethical sensitivity.

Cognitive and Metacognitive Processes Demonstrated by Pharmacy Students When Making Therapeutic Decisions

Objective. To characterize the types of cognitive and metacognitive processes demonstrated by third-year pharmacy students during a therapeutic reasoning activity.Methods. A qualitative, descriptive study following a think-aloud protocol was used to analyze the cognitive (analytical) and metacognitive processes observed by third-year pharmacy students as they completed a 25-minute therapeutic reasoning activity. Using a deductive codebook developed from literature about reasoning, two independent coders characterized processes from students' audio-recorded, transcribed think-aloud episodes while making therapeutic decisions about simulated clinical cases.Results. A total of 40 think-aloud episodes were transcribed among the cohort. Categorization of the think-aloud transcriptions revealed a series of cognitive analytical and metacognitive processes demonstrated by students during the therapeutic decision-making activity. A total of 1792 codes were categorized as analytical processes, falling into six major themes: 69% gathering information (1232/1792), 13% processing information (227/1792), 7% making assessments (133/1792), 1% synthesizing information (19/1792), 7% articulating evidence (117/1792), and 4% making a recommendation (64/1792). In comparison to gathering information, a much lower frequency of processing and assessment was observed for students, particularly for those that were unable to resolve the case. Students' movement between major analytical processes co-occurred commonly with metacognitive processes. Of the 918 codes categorized as metacognitive processes, two major themes arose: 28% monitoring for knowledge or emotions (257/918) and 72% controlling the planning of next steps or verification of correct information (661/918). Sequencing the codes and co-occurrences of processes allowed us to propose an integrated cognitive/metacognitive model of therapeutic reasoning for students.Conclusion. This study categorizes the cognitive (analytical) and metacognitive processes engaged during pharmacy students' therapeutic reasoning process. The findings can inform current instructional practices and further research into educational activities that can strengthen pharmacy students' therapeutic reasoning skills.

Corporate social responsibility and customer loyalty during the Covid-19 pandemic: evidence from pharmacy practice

Purpose

In recent years, corporate social responsibility (CSR) has taken on a more prominent role in both large and small businesses because of its significant impact on various aspects of business performance. To date, a growing body of literature has demonstrated the mechanisms whereby CSR practices affect organizational outcomes; however, there has been little research examining how CSR practices contribute to customer loyalty within the pharmacy context. As such, this study aims to explore how CSR practices influence the loyalty of pharmacy customers, particularly in relation to the mediatory effects of customer-company identification (CCI) and customer trust.

Design/methodology/approach

A survey questionnaire was developed and administered to collect the required data from the pharmacy context. The resultant data were subjected to exploratory factor analysis to identify the scale dimensions, followed by multiple regression analysis to test the hypotheses.

Findings

Analysis of the results (n = 528) revealed that perceived CSR indirectly impacts loyalty through the mediatory effects of trust and CCI. All hypothesized effects were also confirmed via empirical testing.

Originality/value

The findings of this research suggest that not only are CSR activities responsive to societal concerns, but they can also promote customer identification with pharmacies and strengthen customer trust, which can, in turn, lead to long-term customer loyalty.

Concept generation of cognitive enhancement: healthcare professionals' approach towards the impact and utilization of cognitive enhancers in academic context

Cognitive enhancers (CEs) encompass a wide range of drugs, including prescription medications for attention deficit disorders and pharmacological compounds for cognitive enhancement. It is well-documented that the students are the leading cohort of CEs users. Exploring how healthcare professionals perceive the use of CEs for academic accomplishments is significant to understand their encouragement of CE use. Hence, the purpose of the current study was to look at healthcare professionals' attitudes and perceived understanding about the usage of CEs in academic contexts. The study was a quantitative cross-sectional research design conducted in different healthcare and academic settings of Karachi. The respondents were approached either through social media platforms or the official email addresses of their working organizations. Data were collected through a web link of an online questionnaire that included four sections; inquiring about the respondents' demographics characteristics, their knowledge about CEs, their attitudes towards the use and impact of CEs, and their inclination to use a hypothetical prescription-only CE. The response rate of the study was 73.3%. The majority of the respondents negated to permit university students to using CEs for cognitive boost (n = 360, 67.1%), to concentrate (n = 406, 75.7%), to increase vigilance (n = 394, 73.5%) or to mitigate the effects of other medicines (n = 312, 58.2%). The pharmacists were more likely to refute that using CEs by the students is safe (pharmacists 10.8% vs. physicians 8.3%, p=<0.001), beneficial (pharmacists 12.7% vs. physicians 5.3%, p=<0.001), or necessary (pharmacists 17.6% vs. physicians 12.8%, p=<0.001). The major reasons for not encouraging the use of CEs were fear of misuse (n = 510, 95.1%), safety concerns (n = 495, 92.3%), and their consideration for CE as unnecessary medical intervention (n = 441, 82.2%). The findings indicated that overall, respondents have a clear consensus of not letting university students use CEs for cognitive improvement or any other purpose implying that cognitive enhancement is not yet a common or approved medical practice by the healthcare professionals in Pakistan.

Exploring Pharmacists' Roles during the 2019-2020 Australian Black Summer Bushfires

Background: Australians are no strangers to sudden natural disasters, such as bushfires. The effects of a natural disaster can devastate local communities and health care services. Currently, limited research has explored the role of the pharmacist during a natural disaster. This study explores the role of the Australian pharmacist during the 2019/2020 Black Summer Bushfires. Methods: Semi-structured phone interviews were conducted with ten community pharmacists who worked through the Black Summer Bushfires whose daily tasks and work environment were directly affected by the bushfires. Thematic analysis using NVivo^®, a qualitative data analysis software was conducted. Results: Analysis of the transcripts generated six main themes: collaboration; trauma and mental health; power and communication; acute presentations; triaging and emergency prescribing. Pharmacists worked in close collaboration with doctors and members of the local community. They provided triaging services, timely health advice about chronic health problems, and managed acute issues, including wound and burn management and mental health support in traumatic conditions, sometimes without power and communication amenities. The challenges presented to pharmacists during the bushfires warranted creative and flexible approaches at times. Conclusion: This study highlights the need for mental health support and training for pharmacists, provisional prescribing privileges, and a clearer set of contingency regulations and legislation related to emergencies and natural disasters. Further research is warranted to gain greater insight into the roles undertaken by Australian pharmacists during natural disasters and their autonomy in decision making processes during such times.

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

BACKGROUND

Pharmacy stands increasingly on the frontline of patient care, yet current studies of clinical decision-making by pharmacists only capture deliberative processes that can be stated explicitly. Decision-making incorporates both deliberative and intuitive processes. Clinical Judgement Analysis (CJA) is a method novel to pharmacy that uncovers intuitive decision-making and may provide a more comprehensive understanding of the decision-making processes of pharmacists.

OBJECTIVES

This paper describes how CJA potentially uncovers the intuitive clinical decision-making processes of pharmacists. Using an illustrative decision-making example, the application of CJA will be described, including: METHOD: An illustrative study was used, applying an established method for CJA. The decision to initiate anticoagulation, alongside appropriate risk judgements, was chosen as the context. Expert anticoagulation pharmacists were interviewed to define and then refine variables (cues) involved in this decision. Decision tasks with sixty scenarios were developed to explore the effect of these cues on pharmacists' decision-making processes and distributed to participants for completion. Descriptive statistical and regression analyses were conducted for each participant.

RESULTS

The method produced individual judgement models for each participant, for example, demonstrating that when judging stroke risk each participant's judgements could be accurately predicted using only 3 or 4 out of the possible 11 cues given. The method also demonstrated that participants appeared to consider multiple cues when making risk judgements but used an algorithmic approach based on one or two cues when making the clinical decision.

CONCLUSION

CJA generates insights into the clinical decision-making processes of pharmacists not uncovered by the current literature. This provides a springboard for more in-depth explorations; explorations that are vital to the understanding and ongoing development of the role of pharmacists.

Professionals' attitudes towards the use of cognitive enhancers in academic settings

INTRODUCTION AND AIMS

The non-medical use of prescription stimulants such as methylphenidate, dexamphetamine and modafinil is increasing in popularity within tertiary academic settings. There is a paucity of information on awareness, attitudes, and acceptability by professionals of use in this context. This study aimed to investigate professionals' knowledge of and attitudes towards the use of cognitive enhancers (CEs) in academic settings, and their willingness to use a hypothetical CE.

DESIGN AND METHODS

A mail survey was sent to doctors, pharmacists, nurses, accountants and lawyers in New Zealand. These disciplines were chosen as they require professional registration to practice. The questionnaire comprised four sections: (1) demographics, (2) knowledge of CEs, (3) attitudes towards the use of CEs, and (4) willingness to use hypothetical CEs.

RESULTS

The response rate was 34.5% (414/1200). Overall, participants strongly disagreed that it was fair to allow university students to use CEs for cognitive enhancement (Mdn = 1, IQR: 1,3), or that it is ethical for students without a prescription to use cognitive enhancers for any reason (Mdn = 1, IQR: 1,2). Professions differed in their attitudes towards whether it is ethical for students without a prescription to use CEs for any reason (p = 0.001, H 31.527).

DISCUSSION AND CONCLUSION

Divergent views and lack of clear consensus within professions and between professionals on the use of CEs have the potential to influence both professionals and students as future professionals. These divergent views may stem from differences in the core values of self-identity as well as extrinsic factors of acceptability within the profession in balancing the elements of opportunity, fairness and authenticity in cognitive enhancement. Further research is required to inform the development of policy and guidelines that are congruent with all professions.

Students' perceptions of playing a serious game intended to enhance therapeutic decision-making in a pharmacy curriculum

BACKGROUND AND PURPOSE

Therapeutic decision-making is a critical part of the skill set required by practicing pharmacists. A potentially straightforward way to teach and evaluate decision-making skills is use of real-time simulations. This study aimed to evaluate pharmacy students' perceptions of using a real-time simulation game to treat their own virtual patient.

EDUCATIONAL ACTIVITY AND SETTING

Second professional year (Y2) and fourth professional year (Y4) pharmacy students were provided an opportunity to use a virtual patient simulation in their courses. Student perceptions of the game and use of the game for decision-making were evaluated by a questionnaire. The qualitative findings were analysed using an inductive thematic analysis.

FINDINGS

The questionnaire was completed by 120 Y2 and 115 Y4 students. Four themes arose from the analysis that reflected the students' perceptions of autonomy in their learning and practice, the difficulty in committing to a decision, and having fun while learning.

SUMMARY

This work provides an initial exploration of the perceptions of pharmacy students about playing a real-time, autonomous, simulation-based game for treating a patient. Future research should focus on more detailed evaluation of this game for learning therapeutic decision-making.

Measuring the Development of Therapeutic-Decision-Making Skills by Practicing Pharmacists Undertaking a University-Based Postgraduate Clinical Qualification at Distance

(1) Background: The processes and skills required to make decisions about drug therapy have been termed "therapeutic decision-making" in pharmacy practice. The aim of this study was to evaluate a tool constructed to measure the development of therapeutic-decision-making skills by practicing pharmacists undertaking a university-based continuing professional development program. (2) Methods: A pre- and post-intervention crossover study design was used to investigate the qualitative and quantitative features of practicing pharmacists' responses to two clinical vignettes designed to measure the development of therapeutic-decision-making skills. The vignettes were assigned a score using a five-point scale and compared pre- and post-intervention. (3) Results: There was a median increase in score of 2 units on the five-point scale in the post-intervention scores compared to pre-intervention (p < 0.0001). (4) Conclusions: The results were interpreted to suggest that the participants' responses to the vignettes are a reasonable measure of student learning. Therefore, we infer that the teaching and learning intervention successfully enabled the development of therapeutic-decision-making skills by practicing pharmacists.

Therapeutic decision-making in primary care pharmacy practice

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.

Perspectives of Pharmacy Graduates Toward an Undergraduate Ethics Course and Its Potential Impact on Their Professional Practice

PURPOSE

The aim of this study was to gauge the opinions and attitudes of pharmacy graduates toward an undergraduate ethics course they received and to explore if the ethics course was relevant to their practice.

SAMPLE AND METHODS

This online questionnaire-based study involved pharmacy college graduates (alumni) who, at the time of the study, were practicing in different practice settings and who had all graduated from the same college of pharmacy in Qatar. An online questionnaire comprising 27 items related to attitudes, perceptions, and impact of the undergraduate ethics course on professional practice was distributed through email to all eligible alumni. Both descriptive and inferential statistics were performed for data analyses, with a p-value <0.05 considered statistically significant.

RESULTS

Of 119 invited graduates, 62 (52.1%) responded to the survey. About 73% of the respondents were satisfied with the ethics course received and 77.5% agreed that the course helped them in applying ethical principles in practice. Over 57% of the respondents discussed ethical issues in practice and 84.2% of these reported that the discussions were influenced by having had the ethics course. Barriers to applying ethical principles and discussing ethical issues in practice included lack of time (41%) and lack of reliable resources (23.1%). Participants' years of experience did not influence their attitudes toward the ethics course and its impact on professional practice (p>0.05 for both). However, practicing in a hospital setting or completing postgraduate education had a significant influence on the perception of the impact of the course on professional practice (p=0.036 and p=0.035, respectively).

CONCLUSION

A large proportion of pharmacy graduates value the ethics course received during their undergraduate program in pharmacy. The course appeared to have a positive influence on graduates' professional practice. Future studies should investigate specific areas that need to be reinforced in the curriculum and reliable reference resources should be developed and/or identified.

Understanding the process of clinical judgement for pharmacists when making clinical decisions

Clinical decision-making is arguably the most important and underappreciated skill in pharmacy. It can be described as four discrete steps: information gathering, clinical reasoning and judgement and, the decision process. The information gathering and decision negotiation steps and to some extent clinical reasoning are addressed either implicitly or explicitly by practitioners and educators. Clinical judgement, however, remains a largely unexplored concept for clinical decision-making in healthcare therapeutics. It defines how practitioners arrive at a favourable treatment strategy and, due to the often complicated benefit:risk evaluations, is often linked with concepts relating to ambiguity. In this article, we use game theory to explore the judgement stage of clinical decision-making. Game theory allows us to provide a quantitative evaluation of clinical judgement and explore concepts such as ambiguity and its sources in healthcare. Clarifying the elements involved in the judgement stage of clinical decision-making will enable a better understanding of how pharmacists contribute patient care in healthcare teams.

Consumers' expectations and experiences with chain community pharmacies in Lahore, Pakistan: a qualitative exploratory study

Background The model of community pharmacy practice is changing remarkably not only in the West but also in developing countries, which has led retail pharmacies to transform into chain community pharmacies. However, very little is known about consumers' expectations and experiences with chain community pharmacies in developing countries. Objective This study aims to assess the expectations and experiences of consumers with services provided by chain community pharmacies in Lahore, Pakistan. Setting Four random chain community pharmacies. Methods A qualitative study design was employed and face-to-face, audio-recorded, interviews were conducted with 12 consumers attending 4 randomly selected chain community pharmacies. All interviews were transcribed verbatim and the interview data were analysed thematically using NVivo^® software. Main outcome measure Consumers' expectations and experiences with chain community pharmacies. Results The results contributed to a deeper understanding of the consumers' expectations and experiences with the services provided by chain community pharmacies. Six themes emerged from interview data including; access to pharmacists, quality use of medicines, range of distinct services, staff's behaviour, inventory management, and scope of services. The consumers reported that pharmacists working in chain community pharmacies were building trusting relationships and encouraging them to take an active role in healthcare. Pharmacists working there were providing them medication information and counselling services, which they normally do not expect from traditional pharmacies. Consumers mentioned that they had access to pharmacists and quality services, but the inventory of pharmacies was limited. Conclusions This exploratory study provides preliminary evidence that some of the consumers' expectations and experiences were aligned. However, some deficiencies were highlighted by the consumers that need to be addressed by relevant stakeholders. Further research is needed to assess the expectations and experiences of pharmacists working in the chain community pharmacy sector.

Clinical decision-making: An essential skill for 21st century pharmacy practice

Clinical decision-making skills are recognized as a central component of professional competency but are under-developed in pharmacy compared to other health professions. There is an urgent need for a comprehensive understanding of how pharmacists can best develop and use therapeutic decision-making skills in clinical practice. The aims of this commentary are to define clinical decision-making in pharmacy practice, and to present a model for clinical decision-making that aligns with a philosophical framework for pharmacy practice. The model has utility in education programs for pharmacists and provides a framework for understanding patient-facing clinical services in practice.