Clinical Pharmacy[JOURNAL]
Sun
200 papers
Designing a computerized decision support system for asthma chronic disease management in community pharmacies.
Ning TX, Li T, Kellar J … +4 more , Tadrous M, Crown N, Dolovich L, Gupta S
Int J Clin Pharm · 2026 Apr · PMID 42043691 · Publisher ↗
INTRODUCTION: We previously built and validated the Electronic Asthma Management System (eAMS)-a clinic-based asthma computerized clinical decision support system (CDSS) which is in clinical use. AIM: Herein, we sought t...
INTRODUCTION: We previously built and validated the Electronic Asthma Management System (eAMS)-a clinic-based asthma computerized clinical decision support system (CDSS) which is in clinical use. AIM: Herein, we sought to adapt and optimize the eAMS for implementation in community pharmacy practice. METHOD: We iteratively developed a system prototype (the eAMS-Pharm) with input from clinical pharmacists, and asthma, knowledge translation, and eHealth experts. After face-validation by three external community pharmacists, we used a rapid-cycle development process for optimization of system design (format), content, and user workflows (usability). This involved a sequential and repeated three-stage process: (1) system prototype demonstration and testing in 90 min, semi-structured virtual focus groups with target end-users; (2) analysis of focus group findings; and (3) corresponding modifications to the prototype, then re-testing in another focus group. This process continued until we reached pre-defined stopping criteria. We used a questionnaire to gather demographic information and further usability data and feedback. Community pharmacy team members were recruited from an existing pharmacy database. RESULTS: Stopping criteria were met after six focus group cycles with 28 participants [23 (83%) pharmacists, 4 (14%) registered pharmacy technicians/assistants, and 1 (3%) pharmacy student]. User feedback and corresponding system improvements spanned usability, workflow, and prescriber communication domains. The optimized system consisted of a pharmacy portal with a patient dashboard, patient and provider versions of a point-of-care questionnaire, an interactive CDSS producing guideline-based recommendations, automated documentation, and pre-formatted prescriber communications. The System Usability Scale score was 82.9 ± 16.8 (maximum 100), and user responses to Likert scale-based assessments of eAMS-Pharm design, content, workflow, impact, and overall impressions were highly favorable. CONCLUSION: We built and optimized a chronic disease CDSS for use in community pharmacies, identifying and addressing pharmacy-specific barriers to implementation. The system achieved a high system usability score and highly favorable ratings for perceived system benefits, likelihood of clinical use, and patient benefits. The eAMS-Pharm can now be evaluated for uptake, care impact, and outcome impact in real-world settings. Our findings surrounding users' design, content, and usability/workflow preferences, and our unique development strategy, can also inform future pharmacy-based chronic disease CDSS design.
Performance evaluation of large language models in real-world perinatal medication consultations: a cross-sectional study.
Wang R, Li Y, Feng X … +1 more , Feng X
Int J Clin Pharm · 2026 Apr · PMID 42043690 · Publisher ↗
INTRODUCTION: Perinatal medication consultation is a core clinical pharmacy service that involves a complex benefit-risk assessment for both maternal and fetal safety. Large language models (LLMs) have emerged as potenti...
INTRODUCTION: Perinatal medication consultation is a core clinical pharmacy service that involves a complex benefit-risk assessment for both maternal and fetal safety. Large language models (LLMs) have emerged as potential tools to improve access to medication information, yet their performance and safety in real-world, pharmacist-led perinatal consultation settings, particularly in non-English contexts, remain insufficiently evaluated. AIM: To evaluate and compare the performance of multiple advanced large language models in addressing real-world Chinese perinatal medication consultation queries and to assess their potential role as supervised adjunctive tools within clinical pharmacy services. METHOD: This cross-sectional study evaluated seven LLMs using real-world clinical data from pharmacist-led medication consultations at the Pharmacy Clinic of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A standardized test set of 64 perinatal medication consultation questions was developed from 15,280 electronic consultation records collected between April 2014 and April 2024. The evaluated models included international (GPT-5.1, Grok 3, Gemini 3.0) and domestic (DeepSeek, Wenxin Yiyan, Kimi K2, Tongyi Qianwen) models. Senior clinical pharmacologists independently assessed responses across four dimensions-relevance, accuracy, usefulness, and empathy-using a 10-point Likert scale. Results are reported primarily as median (IQR), with mean ± SD additionally provided as a secondary descriptor to facilitate comparison with prior literature. RESULTS: Among the 448 model-generated responses, inter-rater consistency was excellent (ICC = 0.91, 95% CI 0.88-0.94). Significant differences in overall performance were observed among the models (Kruskal-Wallis H = 187.4, p < 0.001; ε = 0.41, large effect). GPT-5.1 achieved the highest median total score [9.3 (IQR: 8.8-9.6); mean ± SD: 9.1 ± 0.8], outperforming all other models (all Bonferroni-corrected p < 0.01; all r > 0.50, large effect sizes), followed by Kimi K2 [8.5 (IQR: 7.9-9.1); mean ± SD: 8.4 ± 1.2] and DeepSeek [8.3 (IQR: 7.6-8.9); mean ± SD: 8.2 ± 1.1]. Tongyi Qianwen demonstrated the lowest overall performance [6.7 (IQR: 5.9-7.4); mean ± SD: 6.8 ± 1.3]. Accuracy was the primary determinant of performance differences. Performance gaps were more pronounced in complex clinical scenarios involving comorbidities or benefit-risk trade-offs, whereas domestic models demonstrated relative advantages in consultations involving traditional Chinese medicine. CONCLUSION: LLMs have demonstrated variable performance in response to perinatal medication consultation queries. While high-performing models show potential to support pharmacist-led perinatal medication consultations by improving access to information, their current performance supports use only as supervised, adjunctive decision-support tools rather than independent sources of medication counseling, with human oversight essential prior to broader integration.
Pharmacist involvement in antifungal stewardship programs: a systematic review of clinical, utilization, and economic outcomes.
Kara E, Sahin N, Yumrucu FG … +1 more , Metan G
Int J Clin Pharm · 2026 Apr · PMID 42029838 · Publisher ↗
INTRODUCTION: Antifungal stewardship programs are increasingly implemented to optimize antifungal use. Pharmacists are frequently involved in these programs; however, their specific contributions and impact have not been...
INTRODUCTION: Antifungal stewardship programs are increasingly implemented to optimize antifungal use. Pharmacists are frequently involved in these programs; however, their specific contributions and impact have not been systematically characterized. AIM: The aim of this systematic review was to synthesize the available evidence regarding the role and impact of pharmacists in antifungal stewardship programs, specifically focusing on clinical, utilization, and economic outcomes, using a narrative synthesis approach. METHOD: A systematic review was conducted. PubMed/MEDLINE and Scopus databases were searched for studies published from database inception to January 2026. Two reviewers independently screened titles, abstracts, and full texts according to predefined eligibility criteria. Data extraction was performed independently using a standardized form. Due to heterogeneity in study designs and outcomes, a narrative synthesis approach was applied. The review was reported in accordance with the PRISMA reporting guidelines. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. RESULTS: Fifteen studies met the inclusion criteria, the majority of which were quasi-experimental pre-post intervention studies conducted in tertiary care hospitals. Key pharmacist-driven interventions included antifungal dose optimization, de-escalation or discontinuation of therapy, facilitation of early appropriate antifungal treatment, therapeutic drug monitoring, and education or protocol development. Across studies, pharmacist involvement was associated with improvements in antifungal prescribing quality and stewardship process outcomes, including potential improvements in duration of antifungal therapy, antifungal consumption (measured by defined-daily-doses or days-of-therapy), time to appropriate therapy, and antifungal-related costs. Effects on clinical outcomes such as mortality and length of hospital stay were variable and generally not statistically significant. The overall certainty of the evidence is low to very low by the observational nature and the moderate-to-serious risk of bias of the included studies. CONCLUSION: Pharmacist participation in multidisciplinary antifungal stewardship teams may be associated with improved antifungal utilization and adherence to guidelines in hospitalized adults. The findings support that pharmacists are important members of multidisciplinary teams in antifungal stewardship.
Perspectives on shared decision making related to medications from patients with multiple long-term conditions transitioning from hospital to home: a qualitative study.
Glatkauskas M, Syversen MO, Mathiesen L … +4 more , Scott M, Svensberg K, Denstad BG, Lea M
Int J Clin Pharm · 2026 Apr · PMID 42012752 · Publisher ↗
INTRODUCTION: Shared decision making is particularly important for patients with multiple long-term conditions due to the nature of long-term treatments and frequent changes in medication regimens. However, the complexit...
INTRODUCTION: Shared decision making is particularly important for patients with multiple long-term conditions due to the nature of long-term treatments and frequent changes in medication regimens. However, the complexity of the medication regimens could exclude these vulnerable patients from shared decision making. There is little knowledge about how patients with multiple long-term conditions experience and perceive shared decision making. AIM: The aim was to explore the perspectives and experiences of patients with multiple long-term conditions regarding shared decision making related to medications before, during and after a hospital stay. METHOD: Semi-structured interviews with 21 patients and three next of kin were conducted. Patients ≥ 18 years, usually living at home, on at least four medications for at least two separate conditions were included. These patients were purposively sampled from two geriatric wards and one internal medicine ward at a university hospital in Norway and interviewed approximately 14 days post hospital discharge. The inclusion and interviews lasted from December 2022 to February 2024. A semi-structured interview guide was used, and the qualitative data were analyzed using directed content analysis guided by the three-talk model developed by Elwyn et al. from 2017. RESULTS: Patients reported not being invited to be part of the shared decision-making process and perceived their limited medical knowledge as a barrier to being invited to participate. They reflected on themselves being primarily focused on single details regarding one medication option they had received. Furthermore, they were not encouraged by the healthcare professionals to discuss and compare different medication options. Both patients and next of kin described an expectation that decisions being made by healthcare professionals would be accepted although the patient did not necessarily understand the treatment plan adequately. Several patients reported that healthcare professional led decisions left little to no room for further discussion and that medication decisions and patient health goals were almost solely in the hands of the healthcare professional. Although most patients trusted the healthcare professional to act in their best interests, this reliance resulted in further disengagement from their own treatment. CONCLUSION: Patients with multiple long-term conditions were in general unfamiliar with and uninvolved in shared decision making related to medications. Additionally, the patients reflected on a lack of invitation to team talk which resulted in limited patient involvement both in option and decision talk.
Concurrent use of medicines with similar adverse drug reaction profiles in older adults: identifying potential deprescribing opportunities using population-level dispensing data.
Widagdo I, Bui T, Cortis L … +2 more , Andrade A, Roughead E
Int J Clin Pharm · 2026 Apr · PMID 42012751 · Publisher ↗
INTRODUCTION: Older adults are more vulnerable to medicine-related harm. Identifying concurrent use of medicines with similar adverse drug reaction (ADR) profiles may support opportunities for safer prescribing and depre...
INTRODUCTION: Older adults are more vulnerable to medicine-related harm. Identifying concurrent use of medicines with similar adverse drug reaction (ADR) profiles may support opportunities for safer prescribing and deprescribing. AIM: To examine the frequency of concurrent use of medicines with overlapping ADR profiles in older adults. A secondary aim was to examine the contribution of potentially inappropriate medicine (PIMs) to overlapping ADR profiles. METHOD: We used data from the 10% sample of dispensing claims from the Australian Pharmaceutical Benefits Scheme between April and June 2022. Medicines were classified by ADR risk using an adapted version of the 2018 Scottish cumulative toxicity tool, which identifies 13 ADR types based on product information. PIMs were identified using the 2024 Australian PIMs list. Individuals aged 65 years or older who were dispensed at least one medicine associated with a listed ADR were included. The outcome of interest was the percentage of persons with an overlapping ADR (dispensed at least two medicines associated with the same ADR). A secondary analysis examined changes in overlapping ADR profiles under a hypothetical scenario excluding PIMs. RESULTS: Our analysis included 323,599 older adults, of which 75.5% (n = 244,331) had at least one overlapping ADR risk, while 64% (n = 206,815) had two or more overlapping ADR risks. Falls/fractures 70.1% (n = 226,873), constipation 53.5% (n = 173,287), and renal injury 38.5% (n = 124,471) were the most common overlapping ADR risks. Under a hypothetical scenario excluding PIMs, an additional 13,803 people would have no falls/fracture overlapping ADR risk, and 19,396 would have no overlapping ADR risk. CONCLUSION: Concurrent use of medicines with similar ADR profiles is common among older adults. Structured tools to identify the use of medicines with similar ADR risks may support deprescribing and safer medicine use in this population.
Comparative predictive performance of anticholinergic burden scales for anticholinergic-related hospitalisation and emergency department visits in older adults: a population-based study of model development and temporal validation.
Srikartika VM, Youens D, Moorin R … +1 more , Ha N
Int J Clin Pharm · 2026 Apr · PMID 41995941 · Publisher ↗
INTRODUCTION: Anticholinergic burden scales are widely used to guide medication review in older adults, yet their ability to predict clinically important adverse outcomes remains uncertain, as most evidence is based on a...
INTRODUCTION: Anticholinergic burden scales are widely used to guide medication review in older adults, yet their ability to predict clinically important adverse outcomes remains uncertain, as most evidence is based on associations rather than validated risk prediction. In the absence of a gold standard, the clinical value of these scales depends on whether they can discriminate between individuals at risk and provide accurate absolute risk estimates. AIM: To compare the predictive performance of six anticholinergic burden scales for hospitalisation/emergency department (ED) visits related to anticholinergic adverse effects, assess internal and temporal validation of cognitive impairment models across scales, and examine the risk gradient across increasing anticholinergic burden levels for cognitive impairment across scales. METHOD: A retrospective cohort study using linked population-level administrative health data of adults aged ≥ 65 years in Western Australia (2015-2019). Development cohorts were from 2015-16 (N = 323,682) and 2016-17 (N = 334,304), and the temporal validation cohort was from 2017-18 (N = 330,684). Six anticholinergic burden scales were calculated annually. Logistic regression models with common predictor structure including demographic and clinical predictors were used to predict any hospitalisation/ED visit related to anticholinergic adverse events (falls/fractures/dizziness, cognitive impairment, or constipation/urinary retention). Model performance was assessed using the c-statistic, calibration slope, and Brier score. Cognitive impairment models were further evaluated using bootstrap internal validation (200 replications), temporal validation, and predicted risk estimation across exposure deciles. RESULTS: Across initial model comparisons, Korean Anticholinergic Burden Scale (KABS) showed the highest c-statistics for each outcome, although between-scale differences were small. Cognitive impairment showed the highest discrimination across scales and was selected for further validation. In temporal validation, c-statistics for cognitive impairment ranged from 0.795 to 0.806, with the highest value observed for KABS, and calibration slopes ranging from 1.024 to 1.032 across scales. Predicted risk of cognitive impairment increased across exposure deciles for all scales, with the highest-decile risk ranging from 5.27% for TSDD-SAMS to 7.58% for KABS. CONCLUSION: KABS showed slightly higher and more consistent predictive performance than the other scales, particularly for cognitive impairment, although between-scale differences were modest. Presenting validated absolute risk estimates across exposure groups may improve clinical interpretability and support risk stratification, but wider validation and clinical judgement remain essential before routine use.
Association between unresolved drug-related problems and 6-month hospital readmissions following pharmacist-led medication reviews: a retrospective observational study.
Zorjan K, Tašker B, Marovič A … +1 more , Petre M
Int J Clin Pharm · 2026 Apr · PMID 41995940 · Publisher ↗
INTRODUCTION: Unresolved drug-related problems may cause preventable medication-related harm and contribute to hospital readmissions. Comprehensive medication reviews conducted by clinical pharmacists are used to identif...
INTRODUCTION: Unresolved drug-related problems may cause preventable medication-related harm and contribute to hospital readmissions. Comprehensive medication reviews conducted by clinical pharmacists are used to identify and address drug-related problems in hospital settings. However, the clinical relevance of drug-related problems that remain unresolved after identification, particularly in relation to hospital readmissions, remains unexplored. AIM: To examine the association between unresolved drug-related problems and 6-month all-cause hospital readmission, and to describe drug-related problem identification, intervention acceptance, and resolution during pharmacist-led comprehensive medication reviews. METHOD: A retrospective observational study was conducted in a tertiary hospital (2019-2022). Inpatients and outpatients referred by doctors for a pharmacist-led comprehensive medication review with ≥ 1 identified drug-related problem were included. The primary outcome was all-cause hospital readmission within 6 months following the medication review. Additional process measures included doctors' acceptance of pharmacists' recommendations, drug-related problem resolution status assessed based on follow-up documentation at 6 months, and the number of additional drug-related problems identified by pharmacists beyond those detected by doctors. RESULTS: A total of 177 patients undergoing 185 comprehensive medication reviews were included, in whom 505 drug-related problems were identified (mean 2.7 per review, standard deviation 2.0). Clinical pharmacists identified 73.9% of all drug-related problems and proposed interventions for 88.9% of them. Overall, 70.2% of pharmacists' recommendations were accepted by doctors. In a patient-level multivariable analysis adjusting for age, sex, comorbidities, medication count, total drug-related problem count, and the number of comprehensive medication reviews, the presence of any unresolved drug-related problems (OR = 4.02, 95% CI: 1.12-14.39, p = 0.033) and the number of unresolved drug-related problems (OR = 1.74, 95% CI: 1.10-2.74, p = 0.017) were independently associated with higher readmission risk, as was comorbidity count (OR = 1.47, 95% CI: 1.01-2.15, p = 0.046). CONCLUSION: In this retrospective study, the presence of unresolved drug-related problems following pharmacist-led comprehensive medication reviews was independently associated with four-fold higher odds of hospital readmission within 6 months. These findings highlight unresolved drug-related problems as a strong, independent marker of increased readmission risk. Prospective studies are needed to determine whether interventions that successfully resolve DRPs can causally reduce readmissions.
Development of a real-world, therapeutic drug monitoring-informed model to predict teicoplanin daily dose in pediatric intensive care unit patients with bacterial infections.
Wang F, Zhang M, Ye S … +8 more , Yan J, Li X, Zhang J, Yu X, Wang Y, Yu Z, Gao F, Wu J
Int J Clin Pharm · 2026 Apr · PMID 41995939 · Publisher ↗
INTRODUCTION: Teicoplanin is commonly used to treat Gram-positive bacterial infections in the intensive care unit (ICU). However, evidence to support individualized therapeutic drug monitoring (TDM)-guided daily dosing o...
INTRODUCTION: Teicoplanin is commonly used to treat Gram-positive bacterial infections in the intensive care unit (ICU). However, evidence to support individualized therapeutic drug monitoring (TDM)-guided daily dosing of teicoplanin in pediatric ICU patients remains limited despite substantial interpatient variability in pharmacokinetics and clinical response. AIM: To develop and validate a real-world TDM-informed machine learning model to predict physician-adjusted teicoplanin daily dose in pediatric ICU patients, with the goal of supporting individualized dosing decisions in clinical pharmacy practice. METHOD: Clinical and TDM data from pediatric ICU patients receiving teicoplanin at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University between June 2020 and June 2023 were retrospectively collected. The outcome variable was the daily teicoplanin dose administered during routine TDM-guided clinical care. After univariate screening and sequential forward selection, the dataset was divided into training and test sets (8:2). Missing values were imputed using the random forest approach. Nine machine learning and deep learning algorithms, including gradient boosting, XGBoost, LightGBM, and TabNet, were developed and evaluated using tenfold cross-validation, with model performance assessed using the coefficient of determination (R), root mean square error (RMSE), and mean absolute error (MAE). RESULTS: A total of 257 pediatric ICU patients (595 teicoplanin dosing records) were included in the study. Weight, age, height, teicoplanin trough concentration (TDM), glucose, creatine kinase isoenzyme-MB, total protein, concomitant imipenem and meropenem use, and upper respiratory infection were identified as key predictors. Among the nine models, the TabNet algorithm demonstrated the best performance on the test set (R = 0.82, RMSE = 53.96 mg/day, MAE = 39.93 mg/day). The proportion of predictions within ± 30% of the observed daily dose was 81.51%. CONCLUSION: This real-world TDM-informed TabNet model shows strong performance in predicting the daily dose of clinician-adjusted teicoplanin in pediatric ICU patients. The model may serve as a clinical decision-support tool for pharmacists and physicians to assist individualized teicoplanin dosing within routine TDM workflows, potentially improving dosing consistency, and supporting safe and effective antimicrobial therapy.
Evaluating the impact of pharmacists in outpatient mental health settings: a systematic review.
Vaughan M, Donovan M, Byrne S … +4 more , Bedani F, O'Brien S, Halleran C, Sahm LJ
Int J Clin Pharm · 2026 Apr · PMID 41984298 · Publisher ↗
INTRODUCTION: Mental disorders are estimated to affect one in seven people globally and are often linked to premature mortality. Psychotropic medicines play an important role in the management of many mental health condi...
INTRODUCTION: Mental disorders are estimated to affect one in seven people globally and are often linked to premature mortality. Psychotropic medicines play an important role in the management of many mental health conditions particularly where symptoms are moderate to severe, persistent, or complex. Pharmacists are increasingly recognised as key members of multidisciplinary mental health teams, with their role focusing on safe and effective use of psychotropic medicines. Mental healthcare is increasingly delivered in outpatient settings, however, the impact of pharmacists on these services remains underexplored. AIM: To systematically review and evaluate the impact of pharmacist-led or pharmacist-involved interventions specifically within outpatient mental health settings globally, across the full spectrum of mental disorders. METHOD: A systematic search of five electronic databases (MEDLINE, Embase, CINAHL, CENTRAL, and PsycINFO) was conducted from inception to October 2025. Grey literature sources including ClinicalTrials.gov and Google Scholar were also searched. Inclusion criteria were: (i) evaluation of a pharmacist-led or pharmacist-involved intervention with a measurable outcome; (ii) conducted in an outpatient mental health setting involving adults with a diagnosed mental disorder classified according to ICD (up to and including ICD-11) or DSM criteria (up to and including DSM-5), excluding dementia; and (iii) inclusion of a comparator or control group. Study screening, data extraction, and quality appraisal, were performed independently by two reviewers. Due to heterogeneity in study design and outcomes, a narrative synthesis was conducted. RESULTS: Twenty-three studies met the inclusion criteria: 11 randomised controlled trials and 12 non-randomised studies. Pharmacist interventions varied, but most commonly included medication reviews, psychoeducation, adherence support and monitoring for side effects or drug interactions. Outcomes were grouped into seven domains: patient-reported, symptom-related, treatment-related, medication adherence, cost, monitoring and hospitalisations. Pharmacist impact was associated with improvements across multiple domains, particularly in medication adherence, treatment-related and symptom-related outcomes. While outcome measures varied between studies, a majority (82.6%) reported positive trends in at least one domain, favouring pharmacist-led or pharmacist-involved care over usual care. CONCLUSION: Pharmacist-led interventions in outpatient mental health settings are associated with positive clinical and healthcare-related outcomes across a range of mental disorders globally. These findings support the integration of pharmacists into multidisciplinary outpatient mental health teams and highlight the need for more high-quality, standardised research to inform service development and policy.
Cost-effectiveness of toripalimab plus bevacizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma in China and the United States healthcare systems.
Yang J, Ding H
Int J Clin Pharm · 2026 Apr · PMID 41984297 · Publisher ↗
INTRODUCTION: Toripalimab combined with bevacizumab has demonstrated significant clinical efficacy and survival benefits in patients with advanced hepatocellular carcinoma (HCC). However, the high cost of this combinatio...
INTRODUCTION: Toripalimab combined with bevacizumab has demonstrated significant clinical efficacy and survival benefits in patients with advanced hepatocellular carcinoma (HCC). However, the high cost of this combination therapy raises concerns regarding its cost-effectiveness in healthcare systems in China and the U.S. AIM: This study evaluated the cost-effectiveness of toripalimab plus bevacizumab compared with sorafenib from the perspectives of the Chinese and U.S. healthcare systems. The findings are intended to inform value-based pricing strategies, reimbursement decisions, and clinical resource allocation. METHOD: A partitioned survival model (PSM) was developed to estimate incremental cost-effectiveness ratios (ICERs) from the healthcare system perspective. Willingness-to-pay (WTP) thresholds were set at $40,011 per quality-adjusted life year (QALY) in China and $100,000-$150,000 per QALY in the U.S. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model outcomes. RESULTS: In China, toripalimab plus bevacizumab produced an ICER of $55,764.00/QALY compared with sorafenib, exceeding the local WTP threshold of $40,011/QALY. In the U.S., the ICER was $460,054.17/QALY, which also exceeded the commonly accepted WTP thresholds. Sensitivity analyses indicated that the discount rate and the proportion of patients receiving subsequent anti-cancer therapies were the primary cost drivers in China and the United States, respectively. Probabilistic sensitivity analysis showed a 0.7% and 1.5% probability of cost-effectiveness at WTP thresholds of $100,000/QALY and $150,000/QALY in the U.S., respectively. In China, the probability of cost-effectiveness was 3.2% at a WTP threshold of $40,011/QALY. CONCLUSION: At current pricing levels, toripalimab plus bevacizumab is unlikely to be cost-effective compared with sorafenib in either China or the U.S. These findings highlight the need for value-based pricing strategies and more efficient allocation of healthcare resources.
Evolution of community pharmacy services in the European Union and beyond: a cross-country survey of 33 national pharmacy organisations.
Batista JPB, Weidmann AE, Mallarini E … +2 more , Henman MC, Passarani I
Int J Clin Pharm · 2026 Apr · PMID 41984296 · Publisher ↗
INTRODUCTION: Community pharmacy practice in Europe has evolved, expanding beyond dispensing roles to include preventive, counselling, and clinical services. However, evidence on the implementation, reimbursement, and re...
INTRODUCTION: Community pharmacy practice in Europe has evolved, expanding beyond dispensing roles to include preventive, counselling, and clinical services. However, evidence on the implementation, reimbursement, and regulation of these services across the European Union (EU) remains limited, especially after the COVID-19 pandemic. Understanding these developments is crucial to inform workforce planning, funding frameworks, and the integration of pharmacists into primary care. With limited healthcare resources, investing in pharmacy-based public health interventions leverages pharmacies' accessibility, geographic distribution, trusted patient relationships, and skilled workforce. AIM: This study aimed to update the mapping of community pharmacy services (CPS) across Europe, comparing 2025 data with pre-pandemic (2020) findings, and to examine trends in service provision, reimbursement, and regulatory barriers from a health policy perspective. METHOD: A cross-sectional survey was conducted among national pharmacy associations in all 27 EU Member States and six neighbouring countries (n = 33), to contextualise EU findings within the wider European pharmacy practice landscape. A previously validated instrument was used to collect data on 47 CPS, including implementation level and reimbursement status. Responses were validated through national review, and data were analysed descriptively and compared with 2020 results. RESULTS: Across the 33 countries, a median of 26 services per country was reported (range: 9-43). Using a consistent data collection instrument and methodology, 77% (n = 36) of mapped CPS were available in a greater number of countries in 2025 than in 2020. Notable growth was observed in vaccination (10-19 countries), medication reconciliation (7-15), and first-time dispensing interventions (11-16). Public reimbursement increased for 49% (n = 23) of services between 2020 and 2025, with the largest increases in vaccination (+ 5 countries), screening (+ 4 countries), and dose administration aids (+ 3 countries). Despite this progress, variation between countries persists, alongside regulatory and operational barriers (remuneration, workforce capacity and interprofessional integration). CONCLUSION: Since 2020, CPS have expanded across Europe, with wider availability and, in some cases, progression from pilots or individual provision to national implementation. Wider and more sustainable implementation appears to depend on supportive regulatory frameworks and public remuneration.
Comment on "evaluation of high dose post-dialytic versus daily beta-lactam dosing in hemodialysis patients using Monte Carlo simulation".
Aljumaa SA, Al Musawa M, El Lababidi R … +3 more , Abidi E, Ghazi I, El Nekidy WS
Int J Clin Pharm · 2026 Jun · PMID 41984295 · Full text
This correspondence acknowledges the authors' efforts in addressing an important clinical question and evaluating a practical dosing approach for patients undergoing hemodialysis. We highlight several methodological assu...
This correspondence acknowledges the authors' efforts in addressing an important clinical question and evaluating a practical dosing approach for patients undergoing hemodialysis. We highlight several methodological assumptions within the simulation model that may limit the clinical interpretability of the results, including the extrapolation of PK/PD targets from individuals with normal kidney function, the use of non-standard avibactam thresholds, and the unvalidated implications of prolonged sub-MIC intervals in hemodialysis populations. We further emphasize the need for dedicated PK/PD investigations and supporting clinical outcome data before these dosing strategies can be confidently integrated into practice.
Authors' response to comment on evaluation of high dose post-dialytic versus daily beta-lactam dosing in hemodialysis patients using Monte Carlo simulation.
Lewis SJ, Bauman AJ, Caiazza OG … +4 more , Wan N, Payer S, Pauly OG, Shoemaker S
Int J Clin Pharm · 2026 Jun · PMID 41984294 · Full text
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Evaluation of consistency in adverse event reporting between trial registry and publications in COVID-19 pharmacological intervention trials.
Strikić M, Pranić SM
Int J Clin Pharm · 2026 Apr · PMID 41973364 · Publisher ↗
INTRODUCTION: Complete and consistent reporting of adverse events (AE) affects decisions in clinical practice. We conducted a cross-sectional study aiming to assess transparency and completeness of reported adverse event...
INTRODUCTION: Complete and consistent reporting of adverse events (AE) affects decisions in clinical practice. We conducted a cross-sectional study aiming to assess transparency and completeness of reported adverse events from randomized clinical trials (RCTs) on pharmacological interventions, including biologicals, to treat Coronavirus disease 2019 (COVID-19) registered on ClinicalTrials.gov on or after January 1, 2020, and updated on or before May 31, 2021, along with corresponding publications. AIM: We aimed to assess the completeness and consistency of adverse event and all-cause mortality reporting between ClinicalTrials.gov and corresponding publications. METHOD: We conducted a cross-sectional comparison of safety reporting between ClinicalTrials.gov registry and peer-reviewed publications of RCTs investigating COVID-19 pharmacological interventions, including biologicals. Two authors evaluated RCTs to reach κ ≥ 0.80. RESULTS: A total of 68 trials were assessed for discrepancies in adverse event and all-cause mortality data. Thirty-one (46%) were industry-funded, and 44 (65%) were double-blind randomized clinical trials. Forty-nine (72%) publications had discordant counts of serious adverse events (SAE) descriptions, 35 (51%) had discrepancies in the number of patients affected by SAE, and 11 (16%) omitted all-cause mortality compared to the records in the ClinicalTrials.gov registry. CONCLUSION: Discrepant reporting of AEs and essential trial data was high in trials on COVID-19 therapeutics.
ESCP symposium on clinical pharmacy. From interprofessional education to interprofessional practice : 26-28 November 2025, Grenoble, France.
Int J Clin Pharm · 2026 Jun · PMID 41961360 · Publisher ↗
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Impact of clinical pharmacist-led behavioural theory-based discharge service to promote medication adherence in patients with acute coronary syndrome: a randomised controlled trial.
Demirci MY, Mutlu B, Sancar M … +1 more , Okuyan B
Int J Clin Pharm · 2026 Apr · PMID 41945242 · Publisher ↗
INTRODUCTION: Medication non-adherence is common in patients with acute coronary syndrome (ACS) and may increase the risk of cardiac readmissions and mortality. AIM: To evaluate the effect of a clinical pharmacist-led, b...
INTRODUCTION: Medication non-adherence is common in patients with acute coronary syndrome (ACS) and may increase the risk of cardiac readmissions and mortality. AIM: To evaluate the effect of a clinical pharmacist-led, behavioural theory-based discharge service designed to promote medication adherence on 30-day cardiac readmissions (primary outcome) and on clinical, humanistic, and healthcare utilisation outcomes over 360 days in patients with ACS. METHOD: In this single-centre, parallel-group randomised controlled trial, adult patients hospitalised with ACS were assigned by permuted block randomisation (block size 8) to the intervention or control group. The intervention comprised a clinical pharmacist-led, behavioural theory-based discharge service to promote medication adherence. The intervention consisted of medication reconciliation, medication review and patient counselling based on components of the behaviour change technique taxonomy and Health Belief Model. The primary outcome was 30-day hospital readmission for cardiac reasons. Secondary outcomes included all-cause and cardiac readmissions, emergency department visits, all-cause and cardiac mortality, medication adherence, LDL (low-density lipoprotein) target attainment, and quality of life over 360 days. RESULTS: A total of 167 patients were analysed (intervention: n = 80; control: n = 87). The primary outcome occurred in 0/80 (0.0%) in the intervention group versus 5/87 (5.7%) in the control group (risk difference - 5.7%, 95% CI - 12.8 to 2.1%; p >0.050). Over 360 days, the control group had higher adjusted odds of cardiac readmission (aOR 4.4; 95% CI 1.2-16.0; p = 0.027), all-cause readmission (aOR 3.7; 95% CI 1.1-11.7; p = 0.029), and non-adherence at 30 days (aOR 2.4; 95% CI 1.1-5.2; p = 0.028). At 180 days, the control group had lower adjusted odds of LDL target attainment (aOR 0.4; 95% CI 0.2-0.9; p = 0.038). CONCLUSION: This intervention reduced 30-day cardiac readmission, but the effect was not statistically significant. According to findings of secondary outcomes, this behavioural theory-based discharge service at discharge might be effective in reducing healthcare utilisation in the long term and improving the short-term target for medication adherence in patients with acute coronary syndrome. TRIAL REGISTRATION: ClinicalTrials.gov NCT05153707.
A novel predictive model for evaluating thrombus regression in postpartum venous thromboembolism patients.
Yu M, Jia C, Zhou Z … +6 more , Chen Q, Di X, Zhang N, Zhang X, Xu Z, Zhang H
Int J Clin Pharm · 2026 Apr · PMID 41945241 · Publisher ↗
INTRODUCTION: Antithrombotic evaluation of postpartum venous thromboembolism (VTE) after anticoagulant therapy is challenging because of the lack of high-quality clinical evidence. AIM: To identify and validate a machine...
INTRODUCTION: Antithrombotic evaluation of postpartum venous thromboembolism (VTE) after anticoagulant therapy is challenging because of the lack of high-quality clinical evidence. AIM: To identify and validate a machine learning model to predict thrombus regression in postpartum VTE patients. METHOD: This study constructed three cohorts of postpartum VTE patients receiving low-molecular-weight heparin (LMWH): retrospective (n = 200), prospective (n = 50), and external (n = 29) cohorts. The main endpoint was imaging-based thrombus regression. Based on clinical guidelines and literature, we screened 16 potential predictors. The retrospective dataset was analyzed using eight machine learning models to predict thrombus regression after anticoagulant therapy. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC-ROC), residual analysis, accuracy, sensitivity and specificity. The optimal model was selected based on its comprehensive performance and further validated on the prospective and external cohorts. Model interpretability was analyzed using variable importance and partial dependence plots. RESULTS: Thrombus regression was significantly associated with anti-Xa activity (p = 0.009), antithrombin III levels (p = 0.028), and D-dimer levels (p = 0.024). Of the eight models, the random forest (RF) model demonstrated the best predictive performance, with the AUC-ROC value of 0.831(95%CI 0.696-0.967), accuracy of 0.77, sensitivity of 0.45, specificity of 0.89, and the highest accuracy in predicting thrombus regression events in the prospective (94.29%) and external (90.00%) postpartum VTE datasets. The key predictive variables were anti-Xa activity, antithrombin III levels, D-dimer levels, and body mass index (BMI). CONCLUSION: Based on data from the three cohorts of patients with postpartum VTE, the RF model was identified as the optimal model for predicting thrombus regression events, with anti-Xa activity, antithrombin III levels, D-dimer levels, and BMI serving as key predictors. This study may help assess changes in the thrombotic state of postpartum VTE patients and guide clinical precision medication.
Facilitators and barriers in using barcode technology to ensure safe medication dispensing, preparation, and administration in a children's hospital: a focus group study for clinical pharmacists.
Laakkonen L, Kvarnström K, Janhunen K … +2 more , Linden-Lahti C, Kuitunen S
Int J Clin Pharm · 2026 Apr · PMID 41925998 · Publisher ↗
INTRODUCTION: Barcode technology is widely used in hospitals to improve medication safety. Although this technology is considered effective for making system-wide improvements, its implementation faces several challenges...
INTRODUCTION: Barcode technology is widely used in hospitals to improve medication safety. Although this technology is considered effective for making system-wide improvements, its implementation faces several challenges. Hospital pharmacists play a key role in supporting this process. AIM: To explore clinical pharmacists' perceptions of the facilitators and barriers to using barcode technology in a pediatric hospital setting. METHOD: A qualitative focus group study. Fourteen clinical pharmacists working in the pediatric department of a university hospital were chosen for the focus groups (n = 3) using purposive sampling to identify the individuals who regularly use barcode technology in clinical practice. The focus group discussions, guided by a semi-structured interview guide with six questions, were recorded and transcribed verbatim. Two researchers independently conducted inductive content analysis, which was later thoroughly reviewed by the entire research group. RESULTS: The data revealed four main themes: factors encouraging the adoption of barcode technology, factors complicating barcode workflow, ideas to improve workflow efficiency, and at-risk behaviors. Factors encouraging the adoption of barcode technology were associated with the benefits and usability of barcode technology, increased expertise and teamwork, positive user experience, and supportive functions of the electronic health record (EHR) system. Factors complicating barcode workflow included deficiencies related to barcodes in labels and drug packages, negative attitudes of users, organizational factors, the use of the EHR system, and deficiencies in workstations and equipment. These factors were found to contribute to at-risk behaviors, while ideas to improve workflow efficiency focused on removing factors complicating barcode workflow and reducing at-risk behaviors. CONCLUSION: Various factors can influence the implementation of barcode technology in clinical practice, underscoring the importance of an organizational process to identify system deficiencies and continuously improve usability. Building on previous studies, our research emphasized the issues related to dispensing and preparation workflows, as well as the need for pediatric-specific EHR system customization as key development areas. Our findings can guide risk management efforts in implementing and maintaining barcode technology in hospitals.
A theoretically informed interview study of strategic stakeholders on their readiness to implement a pharmacist competency framework for hospital practice.
Stoll JT, Böhmdorfer-McNair B, Lutters M … +1 more , Weidmann AE
Int J Clin Pharm · 2026 Jun · PMID 41925997 · Full text
INTRODUCTION: Introducing a pharmacist competency framework into a healthcare system has the potential to improve patient care but also poses several challenges. Assessing the readiness of all healthcare stakeholders in...
INTRODUCTION: Introducing a pharmacist competency framework into a healthcare system has the potential to improve patient care but also poses several challenges. Assessing the readiness of all healthcare stakeholders in position of policy influence is an essential step to identify the correct implementation approach. In Austria, efforts to implement a competency framework for hospital pharmacists are ongoing, yet empirical evidence on the readiness of key healthcare stakeholders remains limited. AIM: The aim of this study was to explore the readiness of key healthcare policy stakeholders on the possible implementation of a hospital pharmacist competency framework into Austrian hospital practice. METHOD: A qualitative interview study underpinned by the Consolidated Framework for Implementation Research (CFIR) with 20 key healthcare policy stakeholders was conducted across Austria. A topic guide and additional study material were developed based on the CFIR. Interview questions were validated and piloted. Interviews were audio-recorded, transcribed ad verbatim and coded in accordance with the CFIR by two researchers independently. Transcripts were analysed using thematic analysis until saturation of themes. RESULTS: Facilitators and barriers emerged across all five CFIR domains. Key facilitators were aspects of innovation, inner setting and implementation (e.g., relief for physicians due to reducing their workload, teamwork and communication to support implementation, etc.) while key barriers were also related to inner and outer setting, as well as the implementation, specifically the need for adequate structural and financial resources and a sensitive implementation process to not interrupt well-established workflow processes. CONCLUSION: This theory-informed study has highlighted the positive attitudes of participants stating their general readiness for implementation. Careful implementation will be necessary not to overwhelm the healthcare system by a sudden change in working structures, processes and hierarchy. These results have impacted policy and educational change for hospital pharmacists across Austria.
Key performance indicators for hospital clinical pharmacy services: results of a global Delphi study.
Magedanz L, Galato D, Clinical Pharmacy KPI research team … +1 more , Fernandez-Llimos F
Int J Clin Pharm · 2026 Apr · PMID 41920497 · Publisher ↗
INTRODUCTION: The contribution of clinical pharmacy services (CPS) to patient outcomes and system performance is still not consistently measured. Most key performance indicators (KPIs) have been suggested only by pharmac...
INTRODUCTION: The contribution of clinical pharmacy services (CPS) to patient outcomes and system performance is still not consistently measured. Most key performance indicators (KPIs) have been suggested only by pharmacists, without formal piloting or validation, and without benchmarking reference values. KPIs are indicators used to quantify pharmacists' clinical activities and their association with improvements in patient safety, therapeutic outcomes, and healthcare costs. There is a need for a globally informed, multi-stakeholder consensus on a core set of KPIs for hospital clinical pharmacy services that are explicitly outcome-based and suitable for international use. AIM: This study aimed to reach a consensus on a core set of KPIs for clinical pharmacy activities in hospital settings, achieved through a multi-stakeholder consensus process. METHOD: The 3-round Delphi technique was used to reach a consensus. Panellists were systematically selected from three groups of stakeholders: 'Clinical Pharmacy KPI Experts', 'Healthcare Systems Assessment Experts', and 'Patient Association Representatives'. The initial set of KPIs was based on themes identified in a previous review study. During the three rounds, the consensus thresholds increased from 60 to 70% and then to 80%. Panellists could suggest new KPIs and propose modifications to those already suggested. RESULTS: Of the 480 potential experts initially identified, 342 valid email addresses were found, of which 49 (from 25 countries) committed to the Delphi study, including 22 clinical pharmacy experts, 21 patient representatives, and six healthcare systems assessment experts. A total of 43 panellists from 23 different countries completed the third round. Starting with 12 KPIs (plus one added in the first round), the panellists agreed on five KPIs, which were distributed as follows: Three clinical KPIs (adverse drug event rate, medication-related near miss event rate and medication goal achievement rate); one economic KPI (average optimised treatment cost difference); and one humanistic outcome KPI (patient satisfaction survey results). A manual containing the KPI information sheets was created. CONCLUSION: A global panel of stakeholders, including pharmacists, other healthcare professionals, and patient representatives, agreed on a core set of KPIs for hospital-provided CPS. This set comprises five measures covering three types of outcomes: economic, clinical, and humanistic.
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