Limitations of the Sample Clauses

Limitations of the. PROMISe methodology‌ A review article from Xxxxxxxx and colleagues (published as Xxxxxxxx et al, 2012) describes the issues and complexities involved in estimating the clinical and economic outcomes of CIs performed by community pharmacies. The article argues that it may be ethically questionable to conduct an RCT of CIs given that it is already part of standard practice in some countries (including Australia). The article acknowledges that expert opinion provides a relatively low level of evidence but may nonetheless be useful in the absence of studies that provide higher levels of evidence. The methodological framework used in the PROMISe studies is described, with reference to the shortcomings of previous studies that have used expert opinion to estimate the consequences of a patient not receiving the CI (i.e. counterfactual state). Several limitations of the expert opinion approach are noted in the article. One limitation relates to the broad definition of each consequence and the values assigned to the parameters. It is assumed that a given consequence will result in the same level of disability and health resource utilisation in every patient, regardless of age and co-morbidities, which is a simplification of reality. A second limitation is that the methodology assumes total compliance with the outcomes of the CI for the intended duration of follow up, which will generate an over-estimate of the benefits resulting from the CI.