How Community Pharmacists Use Their Know-Who When Dispensing Medicines: A Qualitative Study.

RATIONAL: Recent studies indicate that physicians' and nurses' clinical reasoning partly relies on relational and contextual knowledge, known as 'Know-Who.'

AIM: This study investigated whether community pharmacists also use 'Know-Who' in pharmaceutical interventions concerning antimicrobial prescriptions and how it shapes their decision-making.

METHOD: This qualitative study involved face-to-face interviews with fifteen French community pharmacists. Two independent researchers analysed the data thematically using an integrative approach.

RESULTS

Pharmacists reported that their decisions relied not only on theoretical and practical knowledge but also on 'Know-Who'-their understanding of prescribers, patients, and peers. They form implicit mental maps of prescribers based on experience, observation, and, at times, stereotypes. These maps influence confidence in prescriptions, the tailoring of counselling strategies, and the anticipation of prescribers' reactions. Patients' behaviour, understanding, and financial constraints also shape the content, duration, and tone of counselling. While initial prescription analysis was similar across staff, final decision-making was often guided by the pharmacy owner. Overall, 'Know-Who' complements theoretical and procedural knowledge, enabling pharmacists to evaluate information credibility, adapt communication and decisions, and anticipate reactions in contextually complex situations.

CONCLUSION

Community pharmacists integrate 'Know-Who' with theoretical and practical knowledge to make contextually informed, patient-centered decisions. This relational dimension enables them to manage uncertainty, optimise communication, and foster effective interprofessional collaboration. These findings underscore the importance of incorporating relational and contextual knowledge into pharmacy education and training, and suggest that acknowledging the role of 'Know-Who' could enhance both the safety and quality of pharmaceutical care.