Defining pharmacist activities in ambulatory heart failure clinics: North American survey and modified Delphi study
Why this work is in the frame
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Bibliographic record
Abstract
Abstract Background Pharmacists are key members of multidisciplinary heart failure (HF) clinics; however, there is variation in their roles and activities. This study aimed to: (1) define current roles of HF clinic pharmacists and (2) develop a consensus‐based list of key activities for HF clinic pharmacists. Methods In part 1, we invited Canadian and American HF clinic pharmacists to complete a survey on activities currently performed in the HF clinic. Part 2 consisted of a three‐round modified Delphi study including only Canadian participants to define key activities for ambulatory HF pharmacists among 44 candidates. In each round, participants rated a list of candidate activities based on importance and priority on a 9‐point Likert scale. Consensus was reached for inclusion when ≥75% of participants rated both criteria ≥7, or exclusion when both criteria ≤6. Participants received personal responses alongside aggregate ratings after each round to facilitate attainment of consensus. Results Eighty‐four pharmacists participated in part 1, and 29 (of 55 invited) participated in part 2 (24 retained for all three rounds). Current pharmacist activities were similar between American and Canadian participants, with an emphasis on patient assessment and clinical activities including modification of HF‐specific pharmacotherapy. The final consensus‐based list included 32 activities, with high priority placed on activities involving optimization of medications for HF and common comorbidities, engaging in shared decision‐making, assessing adherence, reviewing lab tests, and assessing and modifying medications due to pharmacokinetic/pharmacodynamic parameters, which closely mirrored activities in current practice. Conclusion Current activities of ambulatory HF pharmacists are largely consistent within North America, focusing on patient assessment and HF‐specific pharmacotherapy modification. Our consensus‐based list defined 32 activities integral to the future role of pharmacists in HF clinics, which builds upon activities being currently performed. This provides a framework to standardize and expand the scope of practice for clinical pharmacy services in HF clinics.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it