Clinical Pharmacy[JOURNAL]
Sun
200 papers
Treatment recommendations for recurrent vulvovaginal candidiasis across complementary and conventional disciplines: a national survey of Australian healthcare professionals.
Everingham-Gordon R, Steels E, Watson CJ … +1 more , Steadman KJ
Int J Clin Pharm · 2026 May · PMID 42189444 · Publisher ↗
INTRODUCTION: Management of recurrent vulvovaginal candidiasis remains challenging. It is treated by healthcare professionals across disciplines including general practice, pharmacy, and complementary medicine. Conventio...
INTRODUCTION: Management of recurrent vulvovaginal candidiasis remains challenging. It is treated by healthcare professionals across disciplines including general practice, pharmacy, and complementary medicine. Conventional antifungal regimens supported by formal treatment guidelines are the standard of care. No standardised guidance exists for complementary medicine, and the treatments used in contemporary practice remain largely undocumented. AIM: To identify treatments recommended for recurrent vulvovaginal candidiasis across healthcare disciplines and the sources used to inform clinical decisions. METHOD: A national cross-sectional, open, anonymous, self-administered online survey of Australian healthcare professionals from conventional and complementary medicine disciplines was conducted between November 2022 and September 2023 using a 19-item questionnaire. The questionnaire captured treatment recommendations for recurrent or persistent Candida-related vulvovaginal symptoms, including conventional and complementary medicines, over-the-counter products, and lifestyle strategies such as dietary and hygiene advice, and information sources used in diagnosis and management. RESULTS: A total of 223 healthcare professionals from 13 disciplines met the inclusion criteria, comprising 68 conventional medicine and 155 complementary medicine practitioners. Overall, 122 different treatments were identified, including 69 distinct herbal medicines, reflecting substantial variation in clinical recommendations across disciplines. Conventional medicines were recommended by 43.9% of respondents, herbal medicines by 65.0%, and nutrient-based interventions by 86.1%. Oral fluconazole and intravaginal clotrimazole were the most frequently recommended conventional agents. Probiotics, administered either orally or intravaginally, were cited across professional groups. Frequently recommended herbal medicines included Allium sativum (garlic), Handroanthus impetiginosus (pau d'arco), and Pseudowintera colorata (horopito). Common lifestyle strategies included reducing dietary sugar, alcohol moderation, avoiding synthetic underwear, and modifying post-toileting hygiene practices. Information sources also differed by discipline, with conventional medicine practitioners more often consulting the Therapeutic Guidelines (eTG) and complementary medicine practitioners more commonly consulting peer-reviewed journal articles. CONCLUSION: Practitioner-reported recurrent vulvovaginal candidiasis management included a broad range of treatment strategies across healthcare disciplines. The heterogeneity of recommendations, together with overlap across disciplines, supports further evaluation of selected treatments and evidence-informed cross-disciplinary guidance to support safer, more coordinated care.
A multi-method study of unlicensed medicine risk assessment: a cross-sectional survey of pharmacy procurement leads and policy analysis across NHS trusts in England.
Sugiura G, Gregory S, Greco F … +2 more , Grant D, Patel N
Int J Clin Pharm · 2026 May · PMID 42189443 · Publisher ↗
INTRODUCTION: Medicines which lack a marketing authorisation, referred to as unlicensed medicines, are used across healthcare systems internationally. Their use carries recognised quality and safety risks, yet no publish...
INTRODUCTION: Medicines which lack a marketing authorisation, referred to as unlicensed medicines, are used across healthcare systems internationally. Their use carries recognised quality and safety risks, yet no published evidence describes how healthcare institutions assess and mitigate these risks at a system level. AIM: This study aimed to explore the processes and variation in risk assessment for unlicensed medicines across NHS trust hospital pharmacies in England. METHOD: A multi-method design was used. An online questionnaire was distributed to pharmacy procurement leads across NHS trusts in England (n = 37). Concurrently, unlicensed medicines policies from 40 NHS trusts were analysed using a structured coding framework developed through iterative refinement. The questionnaire collected data on unlicensed medicines risk assessment volume, scope, and governance; policies were analysed to identify organisational intended practice. Datasets were independently analysed and compared at code level across eighteen shared elements to examine variations between practice and policy. RESULTS: Approximately three quarters of questionnaire respondents (73%; 27/37) reported completing both quality and clinical risk assessments for all unlicensed medicines procured, and most trusts (92%; 34/37) had an unlicensed medicine policy; however, only 65% (24/37) reported clearly defined governance oversight, and 57% (21/37) cited formal approval of unlicensed medicine use. Practices were heterogeneous: risk assessments frequently focused on product identity (e.g., 86%; 32/37, considered country of manufacture) but rarely examined processes of manufacturing or sterilisation. A minority (16%; 6/40) used a formal risk scoring system, and review cycles were inconsistent, with 41% of policies (16/40) not mandating review periods. Policies typically mandated risk assessment and recording on a register but varied in technical detail and rarely indicated that quality checks were required upon receipt. Comparison of findings revealed probable duplication of effort in risk assessment for commonly procured unlicensed medicines and divergence between policy emphasis and practitioner focus. CONCLUSION: NHS trusts routinely risk assess unlicensed medicines yet do so independently, with variation in risk assessment content, limited use of structured scoring, and gaps in post-receipt- verification. A national minimum dataset for risk assessment and a shared repository of completed assessments could reduce duplication, improve consistency, and strengthen patient safety.
Analysis of textual responses to explore barriers, enablers, and motivators for cultivating research capacity: a statewide study of hospital pharmacy staff.
Zamri NI, Ghahreman-Falconer N, Johnson JL … +4 more , Marotti SB, McCourt E, Miller-Waugh S, Hattingh L
Int J Clin Pharm · 2026 May · PMID 42171871 · Publisher ↗
INTRODUCTION: Studies show that embedding research within healthcare services is associated with improved patient outcomes, enhanced workforce satisfaction, and increases in system performance. However, limited evidence...
INTRODUCTION: Studies show that embedding research within healthcare services is associated with improved patient outcomes, enhanced workforce satisfaction, and increases in system performance. However, limited evidence exists regarding the research culture and capacity among hospital pharmacy staff in Australia. AIM: This research aimed to assess the research barriers, enablers, and motivators of a statewide public hospital pharmacy service at the organizational, team, and individual levels in Queensland, Australia. METHOD: This study forms part of a statewide, prospective, cross-sectional survey conducted across 16 public hospitals and health services in Queensland, Australia. Using the validated Research Capacity in Context Tool, data were collected via a survey that included open-ended questions to explore research barriers, enablers, and motivators. Reflexive, inductive thematic analysis was conducted to identify key themes and subthemes in free-text responses, with subthemes mapped against the Capability-Opportunity-Motivation-Behaviour model and the Theoretical Domains Framework. RESULTS: Of the 481 survey participants, 401 provided open-ended responses. Six overarching themes and 14 subthemes were developed that influence research engagement. Themes are time and workload constraints, building research capacity, support from management, career progression and personal satisfaction, altruistic motivators, and navigating research processes. Lack of protected research time, limited access to resources, and variation in leadership support were prominent barriers to research uptake. Enablers of research uptake included availability of mentorship, interdisciplinary collaboration, intrinsic interest, and desire to contribute to patient-centered care. CONCLUSION: This study underscores the multifaceted barriers and enablers that act as motivators to cultivate research capacity within hospital pharmacy departments. Addressing concerns such as protected research time, mentorship, and streamlined governance processes is essential to nurturing a sustainable research culture.
Access to clinical data for direct oral anticoagulant prescriptions in community pharmacy and implications for medication optimisation: a mixed-methods study.
van Paassen JG, Deneer VHM, Kempen TGH … +1 more , Bouvy ML
Int J Clin Pharm · 2026 May · PMID 42171870 · Publisher ↗
INTRODUCTION: Inappropriate direct oral anticoagulant (DOAC) prescribing is a frequent cause of harm to patients. Pharmacists could play an important role in optimising prescribing, but they need access to relevant clini...
INTRODUCTION: Inappropriate direct oral anticoagulant (DOAC) prescribing is a frequent cause of harm to patients. Pharmacists could play an important role in optimising prescribing, but they need access to relevant clinical data to do so. Little is known about community pharmacists' access to clinical data to assess the appropriateness of DOAC prescriptions. AIM: To investigate the availability of relevant clinical data for DOAC prescriptions and whether additionally requesting such data supports community pharmacists in assessing and optimising DOAC prescriptions. This study also explored behavioural factors influencing pharmacists' decisions to request additional clinical data. METHOD: In this mixed-methods study, 166 community pharmacies were approached to collect quantitative data. This included the prevalence of missing clinical data, pharmacists' requests for missing data including reasons for requesting these data, and prescription adjustments made by the pharmacist. Missing clinical data was defined as absence of patient information on the DOAC prescription to assess its appropriateness: treatment indication, renal function, body weight, treatment duration, or concomitant use of antithrombotics. A random sample of 10 participating pharmacies was approached for semi-structured interviews on perceptions whether to request missing clinical data. Quantitative data were analysed descriptively. Interviews were thematically analysed using the Capability, Opportunity, Motivation, Behaviour (COM-B) framework to understand behaviour. Quantitative and qualitative data were triangulated through discussion of the findings. RESULTS: We collected quantitative data of 583 DOAC prescriptions in 92 pharmacies and interviewed 11 pharmacists from 10 approached pharmacies. On 92.8% (n = 541) of DOAC prescriptions clinical data were missing. Additional clinical data (particularly, treatment indication and renal function) were requested in 51.9% (n = 281), mainly for dose evaluation (39.6% (n = 231)), leading to 5.0% (n = 14) adjustments of these prescriptions. Pharmacists applied clinical reasoning to determine the need for additional data, with providing optimal patient care as their primary motivation. The main opportunity was collaboration with other healthcare professionals. CONCLUSION: Using their clinical reasoning competence, pharmacists frequently requested missing clinical data, particularly treatment indication and renal function, to verify DOAC prescriptions and to ensure optimal patient care. Clinical data sharing could be optimised by streamlined collaboration between healthcare professionals.
Impact of preoperative dual antiplatelet therapy vs. aspirin monotherapy on perioperative outcomes in carotid endarterectomy patients: a retrospective cohort study.
Yang W, Hu W, Pan Y … +4 more , Meng X, Tang L, Chen J, Xu H
Int J Clin Pharm · 2026 May · PMID 42171869 · Publisher ↗
INTRODUCTION: The preoperative use of dual antiplatelet therapy (DAPT) in patients undergoing carotid endarterectomy (CEA) is controversial. AIM: This study aimed to compare perioperative major bleeding and major adverse...
INTRODUCTION: The preoperative use of dual antiplatelet therapy (DAPT) in patients undergoing carotid endarterectomy (CEA) is controversial. AIM: This study aimed to compare perioperative major bleeding and major adverse cardiovascular events (MACEs) between patients receiving aspirin alone and those receiving DAPT (clopidogrel plus aspirin). METHOD: This retrospective cohort study included patients with carotid artery stenosis who underwent CEA between January 2020 and December 2024. Patients were grouped according to preoperative antiplatelet therapy (DAPT vs. aspirin), and inverse probability of treatment weighting (IPTW) was applied to adjust for baseline imbalances. The primary outcome was 30-day post-CEA major bleeding (neck hemorrhage requiring reoperation or intracranial hemorrhage). The secondary outcome was 30-day post-CEA MACEs (ischemic stroke, myocardial infarction, or death). Multivariate logistic regression was performed to identify the predictors of major bleeding. RESULTS: A total of 741 patients were included (aspirin, n = 504; DAPT, n = 237). Patients in the DAPT group had a higher prevalence of symptom, prior stroke, coronary artery disease, hyperlipidemia, and prior revascularization. After IPTW adjustment, DAPT was associated with a higher risk of major bleeding than Aspirin (OR 4.21, 95% CI 1.81-9.78), with no significant difference in MACEs (OR 1.49, 95% CI 0.57-3.85). Multivariate analysis confirmed DAPT as an independent predictor of major bleeding (OR 3.40, 95% CI 1.42-8.19, p = 0.006), whereas preoperative statin use was independently associated with a reduced risk (OR 0.13, 95% CI 0.03-0.51, p = 0.003). CONCLUSION: Compared with aspirin monotherapy, preoperative DAPT was associated with an increased risk of perioperative major bleeding without a reduction in perioperative MACEs in patients undergoing CEA. Larger multicenter prospective studies are needed to confirm these findings.
Oral anticoagulant switching in patients with atrial fibrillation: a long-term cohort study using population-level administrative data.
Adelakun AR, Turgeon RD, De Vera MA … +3 more , McGrail K, Safari A, Loewen PS
Int J Clin Pharm · 2026 May · PMID 42171868 · Publisher ↗
INTRODUCTION: Patient characteristics and clinical factors could necessitate switching between oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF), a phenomenon whose causes and consequences are...
INTRODUCTION: Patient characteristics and clinical factors could necessitate switching between oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF), a phenomenon whose causes and consequences are understudied. AIM: Our objectives were to describe longitudinal patterns of OAC switching in patients with AF and to identify factors associated with switching. METHOD: A cohort of adult AF patients were identified in Canadian administrative health data from 1996 to 2019. An OAC switch was defined as a change from one OAC to a different OAC with a gap of ≤ 30 days between prescriptions. Switch events were characterized, and factors associated with switches were analyzed using Cox regression. RESULTS: The cohort comprised 30,264 patients. One quarter experienced an OAC switch and 22% of those had ≥ 2 switch events. Vitamin K antagonist (VKA) to direct-acting oral anticoagulant (DOAC) was the most frequent switch type (63%). Switching to a previous OAC occurred commonly (19%-26%). A quarter of patients who switched from warfarin to a DOAC switched back to warfarin. Hospitalizations for AF, acute renal failure, vascular disease, gastrointestinal bleeding, and/or stroke ≤ 90 days before a switch had the highest hazards for VKA to DOAC switch. Hospitalizations for AF, stroke, major bleeding, vascular disease, and/or heart failure (HF) ≤ 90 days before a switch had the highest hazards for DOAC to VKA switch. Hospitalizations for AF, major bleeding, acute renal failure, vascular disease, stroke, and/or HF ≤ 90 days before a switch had the highest hazards for switch between DOACs. CONCLUSION: OAC switching is frequently required in AF patients, with many needing to return to a previously used agent. Switches may reflect an intention to maximize stroke prevention effectiveness and safety, but further research is needed to assess the risks and benefits of OAC switching.
Retraction Note: Real-world data and Mendelian randomization analysis in assessing adverse reactions of rilonacept.
Liu L, Chi Z, Zhang Z
Int J Clin Pharm · 2026 May · PMID 42126767 · Publisher ↗
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Deprescribing opportunities for patients with advanced non-small cell lung cancer: an observational study of potentially inappropriate medications and stakeholders' perspectives.
de Vries F, Verbeek E, Smit A … +3 more , van den Heuvel M, Ter Heine R, Franssen E
Int J Clin Pharm · 2026 May · PMID 42126766 · Publisher ↗
INTRODUCTION: Polypharmacy (concurrent use of ≥ 5 medications) is common in patients with non-small cell lung cancer and increases the risk of potentially inappropriate medication use, particularly in those with advanced...
INTRODUCTION: Polypharmacy (concurrent use of ≥ 5 medications) is common in patients with non-small cell lung cancer and increases the risk of potentially inappropriate medication use, particularly in those with advanced disease. Deprescribing may reduce medication-related harm; however, its implementation in oncology remains limited and is insufficiently informed by stakeholder perspectives. AIM: This study aimed to determine the prevalence of potentially inappropriate medications in patients with advanced non-small cell lung cancer and explore the attitudes and beliefs of patients, caregivers, and healthcare professionals regarding deprescribing to inform feasible implementation strategies for routine clinical practice. METHOD: A retrospective analysis was conducted in a cohort of 817 patients with stage IV non-small cell lung cancer to identify potentially inappropriate medications using the OncoSTRIP checklist. Perspectives on deprescribing were collected using validated questionnaires: the revised Patients' Attitudes Toward Deprescribing (rPATD) for patients and caregivers and the Comprehensive Healthcare Providers' Opinions, Preferences, and Attitudes Toward Deprescribing (CHOPPED) for medical clinicians and pharmacists, which were completed by 37 patients, 15 caregivers, 24 medical clinicians (physicians and specialist nurses), and 24 pharmacists. RESULTS: Potentially inappropriate medications were algorithm-flagged in 793 of the 817 (97.1%) patients. Among these, 1,686 (40.8%) were confirmed by clinical evidence, while 2,448 (59.2%) were unconfirmed (defined as medications flagged by the checklist but lacking sufficient electronic health record data, such as laboratory values or specific indications, to definitively justify their use). The primary classifications were the risk of adverse drug events (47.3%) and unnecessary therapy (30.0%). Most patients (33, 89.2%) and caregivers (11, 73.3%) were willing to discontinue their medications if advised by a physician. Perceived barriers influenced medical clinicians' and pharmacists' willingness: medical clinicians were most affected by collaboration- and competence-related concerns, whereas pharmacists were constrained by competence- and patient-related factors. CONCLUSION: The high algorithm-flagged prevalence of potentially inappropriate medications with 40.8% confirmed by clinical evidence, in patients with advanced non-small cell lung cancer underscores the urgent need for deprescribing. Successful implementation requires a patient-centered approach, active involvement of patients and caregivers, interprofessional collaboration, and targeted strategies to address systemic and professional barriers to ensure safe and sustainable medication optimization.
Inappropriate antibiotic prescribing in Ethiopian hospitals: a systematic review.
Yabeyu AB, Wise S, Hayen A … +1 more , Carland JE
Int J Clin Pharm · 2026 May · PMID 42118399 · Publisher ↗
INTRODUCTION: Inappropriate antibiotic prescribing is a major driver of antimicrobial resistance globally, and its consequences are more severe in low- and middle-income countries such as Ethiopia. Although antibiotics a...
INTRODUCTION: Inappropriate antibiotic prescribing is a major driver of antimicrobial resistance globally, and its consequences are more severe in low- and middle-income countries such as Ethiopia. Although antibiotics are commonly prescribed for inpatients in Ethiopian hospitals, evidence on their appropriateness remains limited and inconsistent. AIM: This systematic review aimed to assess the prevalence, prescribing characteristics, and factors associated with inappropriate antibiotic prescribing in Ethiopian hospitals. METHOD: We searched MEDLINE, Embase, Scopus, Web of Science from inception to 4 May 2025, and also searched Google Scholar and manually reviewed the reference lists of eligible studies. Primary studies conducted in Ethiopian hospitals that reported on the appropriateness of inpatient antibiotic prescribing were included. Two authors independently screened studies and extracted data. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Because of the heterogeneity in study population, definitions and outcome measures, findings were synthesised descriptively. The review was registered in PROSPERO (CRD420251051881). RESULTS: Fifty-three studies were included from seven Ethiopian regions, most from Amhara (n = 16). Overall, study quality was variable, with common limitations including unclear sampling and incomplete methodological reporting. Most studies focused on adult patients (n = 24) and used the Ethiopian Standard Treatment Guideline (n = 32). Cephalosporins were most frequently assessed (n = 45), ceftriaxone the most commonly evaluated antibiotic (n = 44). Prophylactic and empiric prescribing were commonly reported (n = 29 and n = 28) respectively. The prevalence of inappropriate prescribing reported per patient was a median of 56.8% (range, 10.2% to 91.4%) in 43 studies, and per prescription was a median of 40.7% (range, 19.2% to 66.9%) in nine studies. Indication, dose, dosing frequency, and duration were the prescribing characteristics most frequently reported. Patient-related factors, including comorbidity and polypharmacy were frequently associated with inappropriate prescribing. CONCLUSION: Inappropriate antibiotic prescribing was common in Ethiopian hospitals, although prevalence varied widely. Inconsistencies in guideline use and prescribing criteria likely contribute to this variability. Frequent empiric and prophylactic prescribing and reliance on ceftriaxone may reflect limited diagnostic capacity and raise concerns about antimicrobial resistance. Strengthening antimicrobial stewardship through standardised prescribing audits and improved diagnostic services is urgently needed to support appropriate antibiotic use in Ethiopia.
Learning, adopting, and sustaining the pharmacist-clinician role in clinical practice: a qualitative study among early adopters in the Netherlands.
Klerk-Bos KL, Hennus MP, Ehlert M … +3 more , Kluijtmans M, Egberts TCG, Wilting I
Int J Clin Pharm · 2026 May · PMID 42101552 · Publisher ↗
INTRODUCTION: Hospital pharmacists are increasingly involved in direct patient care; however, little is known about how to learn, adopt, and sustain this pharmacist-clinician role in practice. AIM: This study aimed to ex...
INTRODUCTION: Hospital pharmacists are increasingly involved in direct patient care; however, little is known about how to learn, adopt, and sustain this pharmacist-clinician role in practice. AIM: This study aimed to examine the implementation of the pharmacist-clinician role by exploring the key factors that shape its learning, adoption, and sustainment in clinical practice. METHOD: Early adopters of the pharmacist-clinician role in Dutch hospitals were recruited through purposive sampling via professional networks and national outreach. A semi-structured interview was conducted with the respondents. Data were analysed inductively using thematic analysis and were subsequently interpreted using the Normalisation Process Theory (NPT) to investigate key factors in learning, adopting, and sustaining the pharmacist-clinician role. RESULTS: A total of 21 Dutch pharmacists working in a hospital were included. Factors, grouped into four themes (Scope and role enactment of the pharmacist-clinician role, interprofessional collaboration as the driver for adoption, experiential workplace learning is more important than formal learning, and organisational conditions shape sustainment and scalability) described how the pharmacist-clinician role develops from local sense-making and interprofessional adoption to enactment through workplace learning. Although individual initiative enabled early uptake, the role remained highly context-dependent. An NPT-informed synthesis showed that long-term sustainment relied mainly on organisational support and structural embedding, and less on individual factors. CONCLUSION: Our findings imply that embedding the pharmacist-clinician role should be approached as an organisational effort rather than merely as an expansion of professional competencies. Its sustainable development requires deliberate implementation, clear role definition, and organisational support for embedding the role in everyday practice.
Correction: Economic cost-benefit analysis of person-centred medicines reviews by general practice pharmacists.
O'Mahony C, Dalton K, O'Hagan L … +6 more , Murphy KD, Kinahan C, Coyle E, Sahm LJ, Byrne S, Kirke C
Int J Clin Pharm · 2026 Jun · PMID 42084672 · Full text
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Correction: 52nd ESCP Symposium on Clinical Pharmacy. Implementing and scaling sustainable clinical pharmacy practice.
Int J Clin Pharm · 2026 Jun · PMID 42084671 · Full text
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Ketoproof? A systematic classification of pharmaceutical excipients for ketogenic diet therapy.
El Abdouni S, den Uil MG, Kafa Z … +4 more , Ribeiro TS, van der Louw EJTM, Ruijgrok EJ, Nijstad AL
Int J Clin Pharm · 2026 May · PMID 42084670 · Publisher ↗
INTRODUCTION: Ketogenic diet therapy (KDT) is an evidence-based treatment for refractory epilepsy, particularly in children. Strict adherence to carbohydrate restriction is essential to maintain ketosis, yet many medicat...
INTRODUCTION: Ketogenic diet therapy (KDT) is an evidence-based treatment for refractory epilepsy, particularly in children. Strict adherence to carbohydrate restriction is essential to maintain ketosis, yet many medications contain excipients that can disrupt this balance. Pharmacists play a crucial role in evaluating and adjusting medication regimens for patients on KDT, but limited transparency regarding excipient content often makes this process inefficient and inconsistent. Although some regional databases exist, no systematic and comprehensive resources have been developed for broader use. AIM: This study aimed to systematically classify pharmaceutical excipients and label all medications marketed in the Netherlands according to their compatibility with KDT ("Ketoproof" status) using a transparent, reproducible framework that can serve as the foundation for safer prescribing and international standardization. METHOD: A retrospective cross-sectional database analysis was conducted using data from the Dutch G-Standaard (June 2023-March 2024), a national pharmaceutical reference database used in the Netherlands. All excipients authorized in medications marketed in the Netherlands were extracted and classified based on chemical composition, metabolic fate, and administration route. Excipients were assigned a Ketoproof status through a structured decision flowchart, expert consensus, and quality control review. Finally, pharmaceutical products were labeled by cross-referencing their excipient profiles against the classified dataset. RESULTS: A total of 1047 excipients were identified. Of these, 778 (74%) were successfully classified: 590 (56%) as Ketoproof and 188 (18%) as non-Ketoproof. The remaining 269 (26%) were unclassified. Excipients requiring expert consensus included polyols and sugar alcohols, organic acids, and coloring and flavoring agents, which were carefully assessed for clinical relevance. Among 28,721 pharmaceutical products analyzed, 41% (n = 11,781) were labeled as Ketoproof. The full dataset was integrated into KetoMed, a web-based tool designed to support healthcare professionals in reviewing medications for patients on KDT. CONCLUSION: This study presents the first systematic classification of pharmaceutical excipients for KDT compatibility. The transparent, evidence-informed framework enables structured labeling of medications and supports safer prescribing for patients undergoing KDT. Broader adoption and international collaboration are recommended to establish consensus on excipient classification, enhance regulatory transparency, and integrate Ketoproof labeling into clinical decision-support systems to optimize ketogenic therapy management.
ESCP Workshop on Clinical Pharmacy. 5 steps of medication safety: medication without harm, where are we now? : 19-20 February 2026, Innsbruck, Austria.
Int J Clin Pharm · 2026 May · PMID 42084669 · Publisher ↗
Abstract loading — click title to view on PubMed.
Barriers and facilitators for the implementation of medication safety recommendations: focus groups with stakeholders.
Oude Lansink MAM, Vervloet M, van Tholen L … +5 more , Dankers M, Heringa M, van den Bemt BJF, van Dijk L, Huiskes VJB
Int J Clin Pharm · 2026 Apr · PMID 42060234 · Publisher ↗
INTRODUCTION: Multiple medication safety recommendations to reduce preventable medication-related hospitalisations have been introduced in the Netherlands. Still, these hospitalisations remain prevalent. This might be du...
INTRODUCTION: Multiple medication safety recommendations to reduce preventable medication-related hospitalisations have been introduced in the Netherlands. Still, these hospitalisations remain prevalent. This might be due to suboptimal implementation in clinical practice. Therefore, more insight is needed into barriers and facilitators for the implementation of these medication safety recommendations across healthcare sectors. AIM: This study aimed to identify barriers and facilitators for implementing medication safety recommendations across healthcare sectors from the perspective of various stakeholders. METHOD: A selection of 17 Dutch medication safety recommendations targeting medications responsible for a large proportion of medication-related hospitalisations was evaluated in focus groups to identify barriers and facilitators to their implementation. These included recommendations for: reducing fall risk in elderly; initiating prophylactic medication; monitoring patients at risk of electrolyte disorders; clarifying responsibilities for patient care; informing patients about alarm symptoms; and prescribing antithrombotics on strict indication. Stakeholders were selected through purposive sampling based on their profession and healthcare sector. Transcripts of audio-recordings were analysed inductively, after which implementation factors were categorised using the Consolidated Framework for Implementation Research. RESULTS: Thirty stakeholders were divided into five focus groups. These included community pharmacists (n = 9), general practitioners (n = 4), hospital pharmacists (n = 3), representatives from healthcare knowledge organisations (n = 3), patient representatives (n = 2), medical specialists (n = 2), nurses (n = 2), and other stakeholders (n = 5). Forty-nine barriers and facilitators were identified. Key themes were lack of specified responsibilities, limited information exchange, local collaboration and protocol adherence. Recommendations with a lower level of implementation often required collaboration with multiple healthcare providers, whereas recommendations with a higher level of implementation were frequently supported by clinical decision support systems. CONCLUSION: A broad range of barriers and facilitators to the implementation of medication safety recommendations was identified. Overall, the findings highlight the need for recommendations with specified responsibilities, improved information exchange, strengthened local collaboration, and increased protocol adherence.
Incidence and duration of hospital-initiated opioids, benzodiazepines and antipsychotics: a retrospective cohort study.
de Ruijter-van Dalem J, Janssen MJA, Driessen JHM … +4 more , Siegert CEH, Marmorale A, Weir DL, Karapinar-Çarkit F
Int J Clin Pharm · 2026 Apr · PMID 42060233 · Publisher ↗
INTRODUCTION: Many patients receive temporarily indicated medications, such as opioids, benzodiazepines, and antipsychotics (potentially inappropriate medications (PIMs) of interest) in hospitals. This could result in PI...
INTRODUCTION: Many patients receive temporarily indicated medications, such as opioids, benzodiazepines, and antipsychotics (potentially inappropriate medications (PIMs) of interest) in hospitals. This could result in PIM use thereafter, when medication is continued. AIM: This study aimed to investigate the incidence and duration of hospital-initiated PIM use. METHOD: This retrospective cohort study included patients aged ≥ 18 years who visited a Dutch teaching hospital between January 2019-May 2023 and received a new prescription for an opioid, benzodiazepine, or antipsychotic initiated at discharge or outpatient visit and continued thereafter. Patients were followed for one year using data from the hospital's information system and community pharmacy dispensing records. The primary outcomes were the incidence of PIMs of interest and duration of use. Secondary outcomes included duration of PIM use across age categories and the proportion of prescriptions classified as actually inappropriate medication based on the documented indications in a subset of patients. Descriptive data analysis was used. Chi-square tests were used to assess differences between age categories and duration of continued use. RESULTS: Among 6,835 patients with a new prescription of one of the medications, 82.7% were prescribed and dispensed an opioid (n = 5,652, mean age 61.1 years, 57.3% female), 14.7% a benzodiazepine (n = 1,005, mean age 60.7 years, 53.3% female) and 2.6% an antipsychotic (n = 178, mean age 69.2 years, 48.9% female). A significant proportion used the medication > 182 days following the hospital visit (13.4% opioids, 20.9% benzodiazepine, 36.0% of antipsychotics). PIMs were not more frequently discontinued in older adults. Among 156 randomly evaluated prescriptions, a clear justification for continued use was often lacking, mainly for benzodiazepines (83.1%) and opioids (76.0%). CONCLUSION: Potentially temporarily indicated medications were often continued following a hospital visit without justification for continued use. These results highlight the importance of carefully assessing the timely discontinuation or specifying a discontinuation date for PIMs.
Patient perspectives on atrial fibrillation management and pharmacist roles in outpatient clinics: a qualitative study.
Dennehy M, Seoighe A, Cadogan C … +5 more , Burke K, Murtagh E, Collins R, Hayden D, McAuliffe C
Int J Clin Pharm · 2026 Apr · PMID 42053740 · Publisher ↗
INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and mortality. Effective management requires both patient engagement and clear understanding of...
INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and mortality. Effective management requires both patient engagement and clear understanding of treatment goals yet evidence suggests persistent gaps in knowledge and involvement in care. Pharmacists are increasingly involved in AF clinics, yet little is known about how patients perceive their role, particularly in the context of potential pharmacist prescribing. AIM: To explore patients' perspectives on the management of AF and the role of pharmacists in an Irish outpatient AF clinic, including attitudes toward potential pharmacist prescribing. METHOD: A qualitative study was conducted using 15 one-to-one semi-structured interviews with adults aged ≥ 65 years attending a specialist AF clinic at Tallaght University Hospital, Dublin, Ireland. Interviews took place between March and May 2025. Participants were purposively sampled to capture a range of clinical and demographic characteristics. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's six-step reflexive thematic analysis. An inductive approach was adopted. Coding and theme development were conducted iteratively, with a subset of transcripts independently reviewed by supervisors to enhance analytical rigour and consistency. RESULTS: Five overarching themes were identified relating to understanding of AF, pharmacotherapy, satisfaction with care, perceptions of the pharmacist's role, and views on pharmacist prescribing. Participants demonstrated variable understanding of AF, with limited awareness of stroke risk despite consistent recognition of anticoagulant therapy. Knowledge of anticoagulant safety, particularly bleeding risk, was strong and well retained, whereas understanding of rate-control medicines was limited. Satisfaction with care was high; however, most participants adopted a passive role in decision-making, expressing trust in healthcare professionals. Pharmacists were frequently misidentified as doctors or nurses, reflecting limited role visibility. Once recognised, pharmacist input, particularly in anticoagulant counselling and medication advice, was highly valued. Views on pharmacist prescribing were mixed: while participants acknowledged pharmacists' expertise in medicines, many preferred doctors to retain prescribing responsibility due to established trust. CONCLUSION: While patients spoke positively about pharmacists' input, many struggled to identify the pharmacist within the clinic and were unclear about the scope of their role. Gaps in understanding of stroke risk and broader treatment goals highlight the need for structured patient education. As Ireland considers expanding pharmacist prescribing beyond the current common conditions scheme in community pharmacy, strengthening patient education and fostering trust will be essential to optimise pharmacist-led AF services.
Post-marketing safety surveillance of EGFR-targeted agents and disseminated intravascular coagulation risk: a disproportionality analysis based on the FDA Adverse Event Reporting System.
Liu HY, Qu MY, Wang SY … +3 more , Liu JJ, Wang SY, Hou RG
Int J Clin Pharm · 2026 Apr · PMID 42047936 · Publisher ↗
INTRODUCTION: The epidermal growth factor receptor (EGFR) serves as a principal therapeutic target in oncology, with EGFR inhibitors representing essential agents in cancer treatment. Although thrombotic complications re...
INTRODUCTION: The epidermal growth factor receptor (EGFR) serves as a principal therapeutic target in oncology, with EGFR inhibitors representing essential agents in cancer treatment. Although thrombotic complications related to EGFR inhibitors have been reported in the literature, the evidence remains insufficient. Notably, EGFR inhibitor-associated disseminated intravascular coagulation (DIC) constitutes a potentially fatal condition that currently lacks comprehensive systematic investigation. AIM: To systematically assess the signal and clinical characteristics of DIC potentially associated with EGFR inhibitors using pharmacovigilance data. METHOD: Individual case safety reports (ICSRs) from the FDA Adverse Event Reporting System (FAERS) were extracted, with the 11 currently approved EGFR inhibitors designated as the primary suspect agents. Each drug's data was extracted from the initial approval date (or January 1, 2004, if approved prior to 2004) to December 31, 2024. After deduplication, disproportionality analyses were performed using four algorithms: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). Positive and negative controls were used to evaluate potential reporting bias. RESULTS: In FAERS, 104 ICSRs of DIC potentially associated with EGFR inhibitors were identified, of which 64 (61.54%) were fatal. Healthcare professionals accounted for the predominant proportion (82.69%) of ICSR submissions. All seven drugs with reports-cetuximab, panitumumab, gefitinib, erlotinib, afatinib, osimertinib and lapatinib-generated significant disproportionality signals. Cetuximab and gefitinib displayed the strongest disproportionality signals. ICSRs were predominantly reported from Asia, with Japan accounting for 43 ICSRs (41.35%). The median patient age was 68 years, with a balanced gender distribution. Non-small cell lung cancer (NSCLC) was the primary indication (24.04%). CONCLUSION: DIC may represent a pharmacovigilance signal associated with EGFR inhibitors, and may exhibit a potential class effect. Further clinical validation is required to establish causality. Proactive monitoring for DIC in patients receiving EGFR inhibitors is recommended.
Feasibility and acceptability of pharmacist-led remote patient monitoring for carvedilol dose titration in clinically significant portal hypertension.
Rodda S, McAinch C, Hunter J … +5 more , Saxby E, Kirsa S, Pianko S, Bell S, Le S
Int J Clin Pharm · 2026 Apr · PMID 42047935 · Publisher ↗
INTRODUCTION: Carvedilol reduces the risk of hepatic decompensation and improves survival in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). Remote patient monitoring (RPM) has...
INTRODUCTION: Carvedilol reduces the risk of hepatic decompensation and improves survival in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). Remote patient monitoring (RPM) has demonstrated benefits in other chronic conditions but has yet to be investigated for carvedilol titration in CSPH. AIM: We aimed to evaluate the feasibility and acceptability of a novel pharmacist-led, technology enabled model of care called Optimising One Medication for Patients with Cirrhosis (OOMPa-C). METHOD: In this prospective mixed-methods feasibility study, participants were provided with a Bluetooth-enabled blood pressure (BP) and heart rate (HR) monitor linked to a smartphone app during a home visit from a nurse. Initial education on how to take daily BP and HR readings was provided by a pharmacist via telehealth. Two pharmacists then conducted RPM of BP and HR and regular telehealth visits with patients to titrate carvedilol, following a protocol, to a maximum of 12.5 mg daily as tolerated. Semi-structured interviews with participants and stakeholders were undertaken to explore acceptability of the program. RESULTS: Twenty-two participants were recruited, 20 of whom achieved successful dose optimisation. Readings were transmitted on at least 90% of study days by 20 (91%) participants and 18 (82%) were taking the target dose of 12.5 mg daily at study completion. Despite issues with internet connectivity and the telehealth application, the program was broadly perceived as easy to use. Participants reported benefits including convenience and greater self-efficacy, while stakeholders noted advantages in efficiency and quality of care. Participants described apprehension in using new technologies, but family and carers were seen to facilitate participation. Nurses involved with the program described time constraints due to unfamiliarity with digital navigation processes. CONCLUSION: Our study established the feasibility, acceptability and implementation outcomes of a new pharmacist-led model of care for carvedilol dose optimisation. We provide practical insights to inform the implementation of similar technology enabled multidisciplinary models of care at scale for patients with cirrhosis.
A consolidated framework for implementation research (CFIR) informed exploration of a primary care intervention to support deprescribing for problematic polypharmacy in older adults living with frailty (DEPPLOY) in England: a qualitative study.
Breen L, Daffu-O'Reilly A, Darr A … +10 more , Benn J, Fylan B, Silcock J, Peat G, Raynor DKT, Petty DR, Zaidi ST, Bravington A, Butt N, Alldred DP
Int J Clin Pharm · 2026 Apr · PMID 42043692 · Publisher ↗
INTRODUCTION: The incorporation of deprescribing into structured medication reviews (SMR) is a patient-centred and cost-effective practice in primary care settings. Pharmacists have a key role in deprescribing among olde...
INTRODUCTION: The incorporation of deprescribing into structured medication reviews (SMR) is a patient-centred and cost-effective practice in primary care settings. Pharmacists have a key role in deprescribing among older people to improve quality of life and reduce adverse events, but patients and healthcare professionals may be resistant to reducing their medication, and evidence around how deprescribing happens in practice is currently lacking. This study explores the implementation of a co-designed intervention in a single English General Practice (UK). AIM: To explore key stakeholders' perceptions of a co-designed primary care intervention to involve patients and their families in deprescribing and its broader intervention context, guided by the Consolidated Framework for Implementation Research (CIFR). METHOD: Qualitative semi-structured interview study with a purposive sample of staff, and patients with frailty, to explore perceptions of the deprescribing initiative. Data were analysed using an a priori framework structured by the domains of the CIFR. RESULTS: Interviews (24 in total) were conducted with 13 staff involved in delivering the intervention and 5 patients living with frailty who completed a structured medication review with recommended medication changes. Key factors (mapped to CFIR domains) included: an imperative for formal training around the intervention delivery (Inner setting), engagement with SMR delivery linked to payment through national agendas (Outer setting); the importance of the fit of the intervention with existing processes around prescribing practice and infrastructure (Inner setting); increased understanding of the aims of deprescribing among patients and recognition of the extended pharmacist role in primary care deprescribing (Individuals); recognition that the successful delivery of the intervention was a team effort (Implementation process). CONCLUSION: Structured medication reviews are a suitable mechanism to discuss and make deprescribing decisions as part of a shared consultation. Resources which support the patient through the deprescribing process can engage patients and promote greater satisfaction with service delivery. Operationally, staff can also benefit from tools which facilitate greater understanding of the process and fit within their usual practice plus improving patient care and saving medication costs. Barriers and facilitators to implementation success should be noted and addressed for upscaling and process sustainability.
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