Clinical Pharmacy[JOURNAL]
Sun
200 papers
A qualitative study exploring the views of healthcare professionals regarding patients who have difficulty swallowing medicines.
Harnett A, Murphy C, Sahm LJ … +3 more , Byrne S, Lyons D, O'Driscoll M
Int J Clin Pharm · 2026 Apr · PMID 41920496 · Publisher ↗
BACKGROUND: In the hospital setting healthcare professionals (HCPs) are involved in medicines management for patients with difficulty swallowing solid oral dose forms (SODF), which can present unique challenges. AIM: To...
BACKGROUND: In the hospital setting healthcare professionals (HCPs) are involved in medicines management for patients with difficulty swallowing solid oral dose forms (SODF), which can present unique challenges. AIM: To investigate HCPs' views and identify resulting appropriate behaviour change strategies for HCPs to optimise the care of patients with difficulty swallowing SODF in an acute hospital setting. METHOD: Between 3rd June and 12th July 2024 qualitative, semi-structured, in-person/online interviews with HCPs working in an Irish hospital, were conducted. Initial open coding of transcripts generated non-hierarchical codes with subsequent categorisation into themes. The Theoretical Domains Framework (TDF) provided predetermined codes and facilitated a directed content analysis. Dominant TDF domains were identified and mapped to the Capability Opportunity Motivation-Behaviour (COM-B) model and Behavioural Change Wheel. RESULTS: A total of 13 HCPs participated in the study (n = 12 female; n = 4 doctors, n = 3 nurses, and n = 2 dietitians, speech & language therapists and pharmacists respectively), with average interview length of 22 min (range 12-32 min). Eight TDF domains were found to be dominant: Memory Attention & Decision Processes; Environment, Context and Resources; Knowledge; Social/Professional Role and Identity; Goals; Beliefs about Consequences; Behavioural Regulation and Intentions. HCPs identified swallow assessments for medicines, decision support tools and multidisciplinary team (MDT) input as important enablers of safe patient care. CONCLUSION: HCPs require the provision of education, and training, suitable infrastructure and access to evidence-based information to appropriately care for patients with difficulty swallowing SODF in the acute hospital setting. Future work should seek to address these issues through tailored interventions.
Drug-induced fever: a pharmacovigilance analysis based on the FDA adverse event reporting system.
Li X, Zhang W, Wen X … +2 more , Lin D, Luo X
Int J Clin Pharm · 2026 Apr · PMID 41920495 · Publisher ↗
INTRODUCTION: Drug-induced fever is a common but often under-recognized adverse reaction that can complicate clinical management. AIM: This study aimed to systematically evaluate the risk of drug-induced fever using real...
INTRODUCTION: Drug-induced fever is a common but often under-recognized adverse reaction that can complicate clinical management. AIM: This study aimed to systematically evaluate the risk of drug-induced fever using real-world pharmacovigilance data and to characterize its temporal onset patterns and clinical features. METHOD: A pharmacovigilance study was conducted utilizing data from the FAERS, covering reports from the first quarter of 2004 to the fourth quarter of 2024. The detection of adverse drug event signals was conducted using disproportionality analysis. The robustness of identified fever signals was assessed through sensitivity analysis. Furthermore, a time-to-onset analysis was undertaken to elucidate factors associated with the development of drug-induced fever. RESULTS: Disproportionality analysis revealed that antineoplastic and immunomodulating agents were the most frequently associated, followed by antiinfectives for systemic use, alimentary tract and metabolism, musculo-skeletal system, nervous system, blood and blood forming organs, dermatologicals, genito urinary system and sexhormones. The top-five drugs with drug-induced fever signals by case number were rituximab (3650 cases), immunoglobulin human normal (2478 cases), zoledronic acid (2304 cases), lamotrigine (1843 cases), dabrafenib (1803 cases). Sensitivity analysis confirmed that the majority of the positive signals remained robust. Analysis of the time-to-onset revealed that drug-induced fever occurred predominantly during the early phase of treatment. Furthermore, female patients experienced an earlier onset compared to males. CONCLUSION: This large-scale pharmacovigilance analysis identified drugs and patient characteristics associated with drug-induced fever and revealed early-onset patterns, providing evidence to support its early recognition and monitoring in clinical practice.
Evaluation of large language models in supporting autoimmune liver disease diagnosis and clinical decision-making: advantages of reasoning-based models.
Guo T, Ma X
Int J Clin Pharm · 2026 Mar · PMID 41879927 · Publisher ↗
INTRODUCTION: Large-language models (LLMs) have demonstrated increasing potential in healthcare, including applications in clinical information retrieval, medical reasoning, and decision support. Autoimmune liver disease...
INTRODUCTION: Large-language models (LLMs) have demonstrated increasing potential in healthcare, including applications in clinical information retrieval, medical reasoning, and decision support. Autoimmune liver diseases (AILDs), including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and IgG4-related liver disease, are rare and heterogeneous conditions that often present with nonspecific features and require specialized expertise for accurate diagnosis and management. In resource-limited settings, limited access to hepatology subspecialists may contribute to delayed diagnoses and suboptimal care. Although reasoning-oriented LLMs are designed to support structured clinical inference, their performance on AILD-related tasks has not been systematically evaluated. AIM: To evaluate and compare the accuracy, safety, readability, comprehensiveness, and diagnostic performance of six large language models for addressing AILD-related clinical questions and real-world cases. METHOD: We developed 26 clinically relevant questions spanning the key domains of AILDs, including pathogenesis, risk factors, clinical presentation, diagnosis, treatment, and prognosis. Six publicly available LLMs (o1-preview, Claude-3.5-Sonnet, GPT-4o, GPT-4o-mini, GPT-3.5-Turbo, and LLaMA-3.1-405B) generated responses that were independently evaluated by 11 board-certified hepatologists with more than 10 years of specialty experience. Accuracy, safety, readability, comprehensiveness, and clinical helpfulness were assessed by using predefined rating scales. Diagnostic performance was further evaluated in three models (o1-preview, GPT-4o, and GPT-3.5-Turbo) using 21 confirmed real-world AILD cases, with accuracy determined by comparison with gold-standard clinical diagnoses. RESULTS: Among the six models, the o1-preview demonstrated the highest overall performance. It achieved the greatest proportion of accurate responses (78.3%), the highest mean safety score, and the most favorable readability profile, despite generating the longest responses. Comprehensiveness and helpfulness ratings were also highest for o1-preview. In diagnostic testing, the o1-preview achieved an overall accuracy of 81.0%, outperforming GPT-4o and GPT-3.5-Turbo, particularly in single-entity AILD diagnoses. All models demonstrated reduced diagnostic accuracy for autoimmune hepatitis-primary biliary cholangitis overlap syndrome. CONCLUSION: Reasoning-based LLMs, particularly o1-preview, demonstrate potential value in supporting clinical information delivery and diagnostic reasoning for AILDs, especially in resource-limited settings. However, LLM outputs should serve as adjunctive support rather than substitutes for specialist judgment. Further domain-specific refinement and multicenter validation are necessary to ensure safe and effective integration into hepatology and clinical pharmacy practices.
Eosinophilia-related adverse events reporting associated with medications: a disproportionality and regression analysis of the FDA Adverse Event Reporting System.
Liu H, Li X, Sun Y … +5 more , Song S, Cheng S, Liao Y, Wang W, Yi F
Int J Clin Pharm · 2026 Mar · PMID 41879926 · Publisher ↗
INTRODUCTION: Eosinophilia encompasses a wide spectrum of hematologic and non-hematologic disorders, and may lead to clinically significant organ damage. Although numerous medications have been implicated in eosinophilia...
INTRODUCTION: Eosinophilia encompasses a wide spectrum of hematologic and non-hematologic disorders, and may lead to clinically significant organ damage. Although numerous medications have been implicated in eosinophilia and related hypersensitivity reactions, their overall drug-associated risk remains unclear. Real-world pharmacovigilance data can provide important insights into rare but serious eosinophilia-related adverse events (AEs). This study investigated the demographic and drug-related risk factors for eosinophilia-associated AEs using a large dataset from the US Food and Drug Administration Adverse Event Reporting System (FAERS). AIM: To comprehensively evaluate the associations between a broad range of medications and eosinophilia-related AEs. METHOD: FAERS reports from 2004 Q1 to 2025 Q1 were analyzed. Four disproportionality algorithms-reporting odds ratio, proportional reporting ratio, Multi-item Gamma Poisson Shrinker, and Bayesian Confidence Propagation Neural Network-were applied to identify drugs with significant safety signals. LASSO regression was used for variable selection, followed by a multivariate logistic regression analysis. The Bonferroni correction was applied for multiple comparisons. The time to onset of eosinophilia-related AEs was evaluated. RESULTS: In total, 55,456 eosinophilia-related AEs were identified. Using all four disproportionality methods, 173 drugs were significantly associated with eosinophilia. These included anti-infective medications (82/173), cardiovascular agents (20/173), nervous system drugs (16/173), antineoplastic and immunomodulatory therapies (14/173), digestive system drugs (9/173), respiratory system drugs (9/173) and other medications (23/173). LASSO followed by multivariate logistic regression identified 60 drugs that were independently associated with higher reporting odds within the FAERS database along with several demographic characteristics. Male sex and age 56-69 years were also significantly associated with higher reporting odds (adjusted p < 0.01). Among reports with available timelines, the median time to onset of eosinophilia-related AEs was 20 days (interquartile range 7-44 days). CONCLUSION: This large pharmacovigilance study identified the key demographic and drug-related risk factors for eosinophilia-associated AEs. These findings highlight the need for increased clinical vigilance, especially during the early weeks of therapy and among patients with identified risk factors. Although causality cannot be established from the FAERS data, the results offer valuable real-world evidence to support the early detection, risk mitigation, and post-marketing safety monitoring of medications associated with eosinophilia.
Development and evaluation of an e-learning program on drug-related problems for community pharmacists.
Vogt CJ, Reuther A, Wurmbach VS … +7 more , Weißenborn M, Bittmann JA, Wien K, Lampert A, Eknes EMB, Schäfer P, Seidling HM
Int J Clin Pharm · 2026 Mar · PMID 41879925 · Publisher ↗
INTRODUCTION: Community pharmacists (CPs) are pivotal in the management of drug-related problems (DRPs), yet a need for additional training has been recognized. AIM: The aim was to develop and evaluate an e-learning prog...
INTRODUCTION: Community pharmacists (CPs) are pivotal in the management of drug-related problems (DRPs), yet a need for additional training has been recognized. AIM: The aim was to develop and evaluate an e-learning program to enhance pharmacists' ability to detect and manage DRPs. METHOD: The e-learning program provided a self-paced learning experience with 10 modules, each focusing on a DRP. The DRPs were chosen as part of a previous Delphi consensus study. The development team, consisting of researchers, clinical pharmacists, and CPs, considered DRPs applicable if they occurred frequently and could be solved in a pharmacy. Moreover, a predefined checklist was established to guide the development of new modules and specify quality standards. Each module was structured into an educational phase (tutorials, pre- and post-knowledge quizzes, in-depth exercises), and a practical phase (documentation of anonymized patient encounters). After completing all modules, participants took a final comprehensive quiz with 2 questions per module (in total 20 questions). The program was evaluated on multiple levels: pharmacists' knowledge change, how they implemented this knowledge in practice, and their feedback. Data were analyzed descriptively. Comparison between the quizzes were calculated using the Wilcoxon test. RESULTS: A total of 203 pharmacists registered to participate in the study, with participation declining across modules (184 participants completed Module 1 pre-knowledge quiz vs. 119 in Module 10). Across all modules, a significant knowledge increase was observed when comparing pre- and post-knowledge-quizzes (p < 0.001). Knowledge levels remained high in the final quiz (on average 1.63 ± 0.61 correct answers). Participants documented 13,778 patient encounters, thereof 5073 encounters with at least one DRP. According to the participants, most of the DRPs (90.1%, n = 4550) could be resolved. A total of 1137 feedbacks were received. Overall, feedback was positive, with participants highlighting improved abilities to engage with patients (85.2%, n = 969) and to identify DRPs (82.0%, n = 629). CONCLUSION: By bridging the gap between theoretical learning and practical application, this e-learning program improves pharmacists' skills in DRP management.
Personalized prediction of initial valproic acid dose in children with epilepsy using machine learning techniques.
Zhang Y, Ren S, Yu J … +8 more , Xu S, Zhang Y, Zhang J, Li X, Shao J, Lu L, Gao F, Tian J
Int J Clin Pharm · 2026 Jun · PMID 41879924 · Full text
INTRODUCTION: Valproic acid (VPA) is widely prescribed antiepileptic drug in children because of its broad-spectrum efficacy. However, marked inter-individual variability in pharmacokinetics makes dose optimization chall...
INTRODUCTION: Valproic acid (VPA) is widely prescribed antiepileptic drug in children because of its broad-spectrum efficacy. However, marked inter-individual variability in pharmacokinetics makes dose optimization challenging. Inappropriate initial dosing can lead to subtherapeutic exposure or toxicity, including hepatotoxicity, encephalopathy, and hematological adverse effects. Despite the importance of early dose selection, reliable methods for predicting individualized initial daily doses of VPA in pediatric epilepsy are lacking. AIM: This study aimed to develop and internally validate a predictive model for the initial daily dose of VPA in pediatric epilepsy patients based on a real-world clinical database using artificial intelligence techniques. METHOD: A retrospective cohort of pediatric epilepsy patients treated with VPA was recruited from Baoding Children's Hospital between December 2017 and November 2023. Eligible patients were aged 1-16 years, received oral VPA therapy, and underwent therapeutic drug monitoring. Data pre-processing included z-score standardization, one-hot encoding, and Random Forest imputation for missing values. Variable selection was performed by univariate analysis and sequential forward selection. The dataset (306 VPA dose samples from 184 patients) was randomly divided into training (80%) and testing (20%) sets. Ten machine learning and deep learning algorithms-CatBoost, XGBoost, LightGBM, Random Forest, Support Vector Machine, Multilayer Perceptron, Artificial Neural Network, Transformer, AdaBoost, and TabNet-were trained with tenfold cross-validation. The model performance was assessed using the coefficient of determination (R2), root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE). RESULTS: Age, weight, total protein, creatinine, and lactate dehydrogenase were the five most influential predictors of initial daily VPA dose. Among all the models, the TabNet algorithm achieved the best predictive performance, with R = 0.730, RMSE = 0.153, MAE = 0.116, and MAPE = 18.19% in the test set. The proportions of predictions within ± 30, ± 40, and ± 50% of the actual dose were 85.48, 91.94, and 95.16%, respectively. CONCLUSION: The TabNet-based model demonstrated strong predictive ability for estimating individualized initial VPA doses in pediatric epilepsy in a single-center cohort with internal validation only. By integrating readily available demographic and laboratory parameters, the model and its accompanying online tool have the potential to offer a practical decision-support resource for clinicians and pharmacists to improve dosing precision, enhance safety, and optimize therapeutic outcomes; however, the generalizability of this internally validated model to other hospitals, populations, and ethnic groups is unknown, and external validation is required before clinical implementation.
Embedding onsite pharmacists in nursing home practice: qualitative findings from a pilot study.
Damiaens A, Frisson A, Foulon V
Int J Clin Pharm · 2026 Mar · PMID 41879923 · Publisher ↗
INTRODUCTION: Enhancing the role of pharmacists may help reduce medication errors in nursing homes (NHs). To launch the embedding of onsite pharmacists in Flemish NHs, KU Leuven developed a postgraduate course. AIM: This...
INTRODUCTION: Enhancing the role of pharmacists may help reduce medication errors in nursing homes (NHs). To launch the embedding of onsite pharmacists in Flemish NHs, KU Leuven developed a postgraduate course. AIM: This pilot study aimed to (1) evaluate the course and (2) to explore pharmacists' tasks and activities in NHs. METHOD: The course consisted of three main components: (1) an e-learning, (2) a NH internship, and (3) round table discussions with fellow pharmacists completing the course. Pharmacists also maintained a portfolio, documenting their tasks and activities. Data were collected during two consecutive course cycles, i.e. in 2022 and 2023. Round table discussions were considered as focus groups and included in the evaluation, as were pharmacists' portfolios. Additionally, focus groups were held with NH staff. All round table discussions and focus groups were audio-taped and transcribed verbatim. All data were analysed using an inductive thematic framework. RESULTS: Nineteen pharmacists and 36 NH staff members participated. Six themes emerged: (1) a promising e-learning with opportunities for improvement, (2) the crucial but challenging NH internship, (3) a variety of tasks performed by onsite pharmacists, 4) round table discussions as sources of inspiration and reassurance, (5) call for structural embedding of pharmacists in NHs, (6) consensus on the need for onsite pharmaceutical expertise. CONCLUSION: The pilot study highlighted the potential role of onsite pharmacists in NHs, emphasizing resident-level and system-level contributions. It also identified opportunities to optimize the postgraduate course and calls for the structural embedding of pharmacists in NH practice.
Global burden shift from infectious to non-communicable neurological disorders in adolescents and young adults (10-24 years): findings from the global burden of disease study 1990-2021.
Gu T, Jiang R, Tian Y … +3 more , Zhao Z, Wang L, Cao M
Int J Clin Pharm · 2026 Mar · PMID 41863762 · Publisher ↗
INTRODUCTION: Neurological disorders are a leading cause of disability and death worldwide; however, their age- and sex-specific patterns among adolescents and young adults remain poorly characterized. Understanding thes...
INTRODUCTION: Neurological disorders are a leading cause of disability and death worldwide; however, their age- and sex-specific patterns among adolescents and young adults remain poorly characterized. Understanding these trends is essential for developing targeted health strategies and optimizing pharmacotherapy in this population. AIM: This study aimed to assess global trends and sex-specific patterns in the burden of neurological and neurodevelopmental disorders among individuals aged 10-24 years from 1990 to 2021, providing evidence to inform clinical pharmacy practice and global health policies. METHOD: Data for 34 neurological conditions among individuals aged 10-24 years were extracted from the 2021 Global Burden of Disease database. Age-standardized prevalence and disability-adjusted life-year (DALY) rates were analyzed according to sex and disorders. Estimated annual percentage changes were derived using log-linear regression models. Joinpoint regression identified significant shifts in the temporal trends. Heatmaps were generated to rank disorders by prevalence and DALYs across global and specific regions. Analyses were conducted using R, version 4.4.3. RESULTS: Between 1990 and 2021, infectious neurological diseases, including malaria, cysticercosis, rabies, meningitis, encephalitis, and tetanus, have declined substantially in both prevalence and DALYs. Conversely, perinatal and developmental disorders showed marked increases, particularly neonatal encephalopathy, preterm birth complications, and neonatal sepsis in both measures. Migraine and tension-type headaches remain the most prevalent conditions in 2021 with minimal temporal changes. Pronounced sex disparities emerged: multiple sclerosis increased more rapidly in females, while alcohol use disorders declined faster in males. Regional inequalities persisted, with infectious burdens concentrated in low- SDI areas, and chronic disorders predominant in high-SDI regions. CONCLUSION: Neurological disease burden among adolescents and young adults has transitioned from infectious to chronic, neonatal, and behavioral conditions, accompanied by significant sex-specific and regional differences. These results highlight the importance for youth-centered prevention, early diagnosis, and equitable access to care. Integrating pharmacists into multidisciplinary neurological care teams can enhance medication optimization, adherence support, and the long-term management of chronic neurological conditions, ultimately improving health outcomes in this vulnerable population.
A qualitative process evaluation of a clinical trial on bedside model-informed precision dosing of vancomycin in critically ill children.
Kinnaer LM, Amza A, De Cock P
Int J Clin Pharm · 2026 Mar · PMID 41854777 · Publisher ↗
INTRODUCTION: Model-Informed Precision Dosing (MIPD) is increasingly used to optimize vancomycin therapy in critically ill patients. However, process evaluations randomized controlled trials (RCTs) of MIPD remain rare, p...
INTRODUCTION: Model-Informed Precision Dosing (MIPD) is increasingly used to optimize vancomycin therapy in critically ill patients. However, process evaluations randomized controlled trials (RCTs) of MIPD remain rare, particularly in neonatal and pediatric intensive care. They provide however valuable insights about how and why interventions work. AIM: This study explored healthcare professionals' (HCPs) experiences with using the MIPD software for vancomycin during the BENEFICIAL-RCT in critically ill children and examined contextual factors influencing its use. METHOD: A qualitative descriptive exploratory study was conducted after the BENEFICIAL-RCT in 8 Belgian hospitals. Semi-structured interviews and focus groups were held between January and May 2025 with physicians, clinical pharmacists, clinical biologists, and trial nurses. Data were analyzed thematically. RESULTS: Twenty-one HCPs participated. Four overarching themes emerged: enhanced clinical confidence and professional empowerment, experienced workflow barriers, clinical and healthcare-system implications and conditions for sustained MIPD-adoption. Participants described that beyond faster attainment of target AUC, the software fostered professional empowerment through its visualizations and the ability to retain final decision authority. Experiences also underscored how infrequent clinical exposure to adopting MIPD hindered continuity of MIPD expertise. This was pertinent in settings with low vancomycin case volumes or frequent rotating medical staff. As experienced workflow barriers especially the pivotal role of nurses in ensuring accurate documentation of sampling and infusion times was mentioned. These documentation uncertainties were perceived as affecting trust in the dosing workflow. Participants also highlighted night-time operational challenges for which workarounds set up during the RCT would not be feasible for routine practice. Concerning conditions for sustained MIPD-implementation, HCPs emphasized the importance of MIPD integration in electronic health records and automated dose calculation. The need for local MIPD champions was recurrently emphasized, particularly to support onboarding of new HCPs in MIPD. CONCLUSION: The results highlight that to support broader implementation of MIPD in pediatric critical care, hospitals should prioritize electronic record integration, streamline workflows, and appoint internal MIPD champions. These measures may reduce workload and errors, and support sustainable use in daily practice.
Interprofessional team members' experiences collaborating with pharmacists in team-based primary care in British Columbia, Canada: a qualitative evaluation.
Salil A, Nemir A, Kapanen AI … +1 more , Zed PJ
Int J Clin Pharm · 2026 Mar · PMID 41854776 · Publisher ↗
INTRODUCTION: The profession of pharmacy has been continuously evolving, redefining scope of practice in every practice settings to meet the ongoing needs of the health care system and to meet patient expectations and ne...
INTRODUCTION: The profession of pharmacy has been continuously evolving, redefining scope of practice in every practice settings to meet the ongoing needs of the health care system and to meet patient expectations and need. Pharmacists are increasingly becoming part of primary care teams in countries such as Canada, the United Kingdom and Australia. In British Columbia, Canada, the Pharmacists in Primary Care Network (PCN) Program integrated primary care clinical pharmacists (PCCPs) as core members of the interprofessional team (IPT). The IPT members' experiences of collaborating with a pharmacist in a team-based primary care setting have not been extensively studied. AIM: To describe the experiences of IPT members and PCCPs while working collaboratively for the shared care of mutual patients to identify the enablers, barriers, and development of interprofessional collaborations within the primary care setting in a province-wide program. METHOD: Based upon the evaluation of the Pharmacists in the PCN Program, this work was informed by Qualitative Description methodology. Interview and focus group data were performed during two time periods (T1 and T2) of program implementation. Study participants included PCCPs, prescribers (family physicians and nurse practitioners), and PCN IPT members (social workers, dieticians, physiotherapists, and clinical counsellors). Each participant was invited via e-mail to attend a Zoom interview or focus group session. RESULTS: In T1 we interviewed 15 PCCPs and in T2, we interviewed 39 PCCPs, 12 IPT members and 11 prescribers. Data analysis developed four themes: (i) awareness shaping early acceptance and role clarity; (ii) deepening interprofessional collaboration over time; (iii) communication strategies which facilitated relationship building with the PCN providers; and (iv) impact of the co-location model on teamwork and improved care coordination. CONCLUSION: The interprofessional collaboration between PCCPs, prescribers, and IPT members was strengthened through efforts of relationship building, improved role clarity, and easily accessible communication methods. The PCN teams addressed the initial integration challenges and provided the support for effective shared patient care.
Pharmaceutical competency among physicians: a multidimensional assessment incorporating self-perceived and objective measures.
Liu C, Guo H, Li B … +2 more , Liu P, Yao W
Int J Clin Pharm · 2026 Mar · PMID 41849096 · Publisher ↗
BACKGROUND: The rapid expansion of available pharmacotherapies and increasingly complex medication regimens has increased the risk of medication-related complications in clinical practice. Concerns have been raised that...
BACKGROUND: The rapid expansion of available pharmacotherapies and increasingly complex medication regimens has increased the risk of medication-related complications in clinical practice. Concerns have been raised that physicians' pharmaceutical competencies may not fully meet the demands for safe and rational medication use. Existing assessments of physicians' pharmaceutical competency have largely focused on theoretical pharmacology, with limited multidimensional evaluations incorporating medication monitoring, guidance, and interprofessional collaboration. AIM: This study aimed to comprehensively assess pharmaceutical competency among Chinese physicians during the continuing medical education phase and examine its association with professional titles, presence of clinical pharmacists, hospital-provided pharmaceutical training, and implementation of rational drug use systems. METHOD: A cross-sectional survey was conducted using purposive sampling among physicians from public Grade A tertiary hospitals in 11 provinces, autonomous regions, and municipalities in China. Pharmaceutical competency was assessed using the combined approach of subjective self-assessment and objective testing. Descriptive statistics and subgroup analyses were performed to evaluate differences across professional titles, departmental allocation of clinical pharmacists, hospital pharmaceutical training, and rational drug use system implementation. RESULTS: In total, 1,044 valid questionnaires were included in the analysis. The median (Q1, Q3) subjective self-assessment score for pharmaceutical competency (maximum score = 5) was 3.92 (3.72, 4.28), while the median (Q1, Q3) objective accuracy rate (maximum = 100%) was 51.11% (41.11%, 61.11%). No significant differences in pharmaceutical competency were observed across professional titles (all P > 0.05). With the exception of self-directed pharmaceutical learning, clinicians working in departments with clinical pharmacists and those receiving hospital-provided pharmaceutical training reported significantly higher subjective competency scores (P < 0.05). In addition, hospital pharmaceutical training and the implementation of rational drug use systems were associated with significantly higher objective assessment scores across multiple competency domains (P < 0.05). CONCLUSION: Physicians demonstrated relatively high self-assessed pharmaceutical competency, but comparatively low objective performance, suggesting a tendency to overestimate pharmaceutical competency. These findings highlight the need to strengthen the pharmaceutical education and medication management support for physicians. Pharmacist involvement, pharmacist-led training, and rational drug use systems may play important roles in supporting physicians' pharmaceutical competency and promoting safer and more rational medication use.
ABCC2 rs2273697 is an independent determinant of tacrolimus intra-patient variability during the first year after kidney transplantation.
You J, Liu H, Yang Y … +7 more , Fu J, Sui M, Zhao W, Yuan Z, Ma T, Wang Z, Wang X
Int J Clin Pharm · 2026 Mar · PMID 41849095 · Publisher ↗
INTRODUCTION: Tacrolimus is a critical immunosuppressive agent in kidney transplantation, but its pharmacokinetic variability, especially intra-patient variability (IPV), can lead to suboptimal outcomes. Genetic polymorp...
INTRODUCTION: Tacrolimus is a critical immunosuppressive agent in kidney transplantation, but its pharmacokinetic variability, especially intra-patient variability (IPV), can lead to suboptimal outcomes. Genetic polymorphisms in CYP3A5 and ABCC2 may influence tacrolimus metabolism and transport, affecting dosing requirements and IPV. However, their combined impact during the first year after kidney transplantation remains insufficiently characterized. AIM: This study aimed to evaluate the influence of CYP3A5*3 (rs776746) and ABCC2 (rs3740066, rs2273697) polymorphisms on tacrolimus exposure, IPV (C0-IPV and C0/D-IPV), and short-term renal allograft function in kidney transplant recipients, with a focus on the first post-transplant year. METHOD: A prospective cohort of 60 kidney transplant recipients was followed for one year. Tacrolimus trough concentrations (C0) were measured on postoperative Day 7, Day 14, Month 1, Month 3, Month 6, and Year 1. IPV was assessed using C0-IPV and dose-adjusted C0/D-IPV. Genotyping was performed using the SNaPshot platform. Multivariable regression models identified predictors of IPV and renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) at Year 1. RESULTS: CYP3A5*3 expressers required significantly higher tacrolimus doses than non-expressers from Day 7 through Month 3 (P < 0.05) and showed correspondingly lower C0/D values during this period (P < 0.01). ABCC2 rs3740066 was associated with C0/D at Month 6 (P = 0.037) and with the daily dose at Year 1 (P = 0.045). In the multivariable analysis, the ABCC2 rs2273697 variant (β = 8.429, 95% CI: 1.301-15.557, P = 0.021) was independently associated with tacrolimus C0-IPV. No significant associations were observed between IPV (C0-IPV or C0/D-IPV) and eGFR at Year 1. CONCLUSION: CYP3A5 genotyping remains valuable for optimizing initial tacrolimus dosing, while ABCC2 polymorphisms, particularly rs2273697, contribute to tacrolimus C0-IPV during the first post-transplant year. Personalized dosing strategies using pharmacogenetic data could improve tacrolimus exposure stability. Larger studies with extended follow-up are needed to assess the long-term clinical implications of these findings.
Development and validation of an artificial intelligence-based model for predicting teicoplanin plasma concentrations in intensive care unit patients with pulmonary infections: a retrospective study.
Zhang Q, Zhang Q, Wang B … +6 more , Shao J, Yu J, Man J, Liu X, Sun L, Zheng W
Int J Clin Pharm · 2026 Jun · PMID 41849094 · Full text
INTRODUCTION: Teicoplanin is widely used to treat pulmonary infections, particularly in critically ill patients with gram-positive bacterial infections. However, its plasma concentration varies substantially between indi...
INTRODUCTION: Teicoplanin is widely used to treat pulmonary infections, particularly in critically ill patients with gram-positive bacterial infections. However, its plasma concentration varies substantially between individuals owing to heterogeneity in renal function, comorbidities, and concomitant medications, leading to subtherapeutic or toxic exposures. Therapeutic drug monitoring (TDM) remains the standard approach for individualized dosing; however, its application in intensive care unit (ICU) is limited by resource and timing constraints. Hence, developing reliable predictive models to estimate teicoplanin plasma concentrations could enhance the precision and efficiency of TDM, and support pharmacist-led dosing decisions. AIM: This study aimed to develop and validate machine learning (ML)-based models to predict the teicoplanin plasma concentration in ICU patients with pulmonary infections using real-world clinical data, thereby advancing personalized antibiotic therapy in clinical pharmacy practice. METHOD: This retrospective cohort study was conducted between June 2018 and September 2023 in ICU patients receiving teicoplanin therapy at a tertiary hospital in China. After the univariate analysis to exclude irrelevant factors, sequential forward selection was performed to identify the optimal feature subset. The dataset was divided into a training set (80%) and a test set (20%), and ten ML algorithms were developed to predict teicoplanin plasma concentrations. Model performance was evaluated by ten-fold cross-validation of the training set and validated using an independent external cohort. RESULTS: A total of 270 eligible patients were included in the training and test sets, and additional 118 patients formed the external validation cohort. Seven variables were identified as the most predictive features: daily dose, diabetes, hemodialysis, imipenem, human serum albumin, urea, and red blood cell count. Among the ten algorithms tested, the TabNet model achieved the best predictive performance on the test set (R = 0.88, RMSE = 3.24, MAE = 2.64, MAPE = 17.88%, ± 30% accuracy = 81.54%) and maintained robust external validation (R = 0.79, ± 30% accuracy = 85.59%). CONCLUSION: This study developed a TabNet model based on real-world data, which can accurately and interpretably predict the teicoplanin plasma concentration of patients with pulmonary infection in the ICU. The derived online prediction tool provides references for the application of artificial intelligence-assisted precision medicine in antibacterial treatment and the optimization of drug monitoring for ICU patients.
A cross-sectional evaluation of community pharmacists' opinions on caring for visually impaired patients: pharmacist experiences, confidence and recommendations for improved care.
Goodwin-Boers A, Bennett-Lenane H
Int J Clin Pharm · 2026 Mar · PMID 41849093 · Publisher ↗
INTRODUCTION: Health inequalities and medication management challenges are apparent for people with disabilities, including those who are visually impaired (VI). Community pharmacists are well placed to provide advice an...
INTRODUCTION: Health inequalities and medication management challenges are apparent for people with disabilities, including those who are visually impaired (VI). Community pharmacists are well placed to provide advice and support to VI patients. It is imperative for appropriate care that they are adequately prepared to adapt practice for these patients. AIM: The study aimed to elucidate current experiences, perceived confidence and priorities of community pharmacists when caring for VI patients. It also aimed to understand current barriers and recommendations for practice adaptations to improve care of this cohort. METHOD: This study utilised an online cross-sectional questionnaire comprising multiple choice, Likert scale and open text questions. This questionnaire was disseminated to registered community pharmacists in Ireland. Responses were coded and analysed quantitatively using descriptive and inferential statistics-whereby p < 0.05 denotes statistical significance. Open-text responses were analysed using conventional content analysis. RESULTS: Data were collected from 235 pharmacists (5.4% response rate). Approximately 70% (69.8%, n = 164) had previous experience providing care to VI patients, while over 90% (91.9%, n = 214) believed that VI patients are at increased risk of medication related harm. Pharmacists with over 10 years' experience (75.4% n = 98) were significantly more likely to feel confident caring for VI patients than those less experienced (52.9%, n = 18), p < 0.05. Only 10.3% (n = 24) believed the pharmacy teams they work with were adequately trained to care for VI patients, while 69.0% (n = 162) do not believe they have been provided with sufficient training and guidance on this topic. Most pharmacists would welcome training to identify (90.6%, n = 213) and guide management of VI patients (92.3%, n = 216). Open text responses revealed recommendations of adaptions to care. Respondent recommendations related to pharmacy physical layouts, patient identification, tailored medication dispensing practices, use of technology and improved communication methods. CONCLUSION: This study revealed valuable insights into Irish community pharmacists' experiences, confidence and recommendations for adapting care for VI patients. Current barriers in addition to confidence and knowledge deficits and a lack of relevant training amongst pharmacists were identified. Further emphasis on this topic in undergraduate pharmacy programmes and continuing professional development training can help community pharmacists provide equitable care to VI patients.
Effectiveness, safety, and pharmacoeconomic profile of Sophora flavescens film in the treatment of postpartum vaginal dysbiosis: a non-randomized controlled trial.
Zhao J, Li X, Tan S … +13 more , Pan Y, Yang Z, Sun S, Lan J, Zhang R, Zhao H, Hu L, Wang J, Zheng W, He R, Xu C, Zeng X, Zhang J
Int J Clin Pharm · 2026 Jun · PMID 41849092 · Full text
INTRODUCTION: Sophora flavescens film (SFF), a topical traditional Chinese medicine that primarily contains matrine, has been approved in China since 2009 for chronic gynecological inflammation. However, evidence regardi...
INTRODUCTION: Sophora flavescens film (SFF), a topical traditional Chinese medicine that primarily contains matrine, has been approved in China since 2009 for chronic gynecological inflammation. However, evidence regarding its clinical value in the management of postpartum vaginal dysbiosis (PVD) remains limited. AIM: This study aimed to evaluate the effectiveness, safety, and pharmacoeconomic profile of SFF as an adjunct to conventional therapy in women with PVD. METHOD: This single-center, open-label, non-randomized controlled trial was conducted among postpartum women (6-8 weeks after delivery) diagnosed with PVD. Participants were self-selected into either the SFF group (SFF plus conventional therapy) or the control group (conventional therapy alone). The primary outcome was the overall therapeutic effectiveness based on composite vaginal ecosystem indicators. Secondary outcomes included Vaginal Health Index Score (VHIS), Vaginal Inflammation Score (VIS), EQ-5D-5L health utility, EQ-VAS, and adverse events (AEs). Pharmacoeconomic evaluation was performed using a decision tree model to estimate the incremental cost-effectiveness ratio (ICER). Statistical analyses incorporated logistic regression and analysis of covariance (ANCOVA) with directed acyclic graph (DAG)-based confounder adjustments. RESULTS: In total, 126 participants (63 per group) completed the study. The SFF group demonstrated a significantly higher overall effectiveness than the control group (adjusted odds ratio = 3.68, 95% confidence interval [CI]: 1.49-9.09, P = 0.005). Significant post-treatment improvements were observed in VHIS (mean difference [MD] = 2.420, 95% CI: 1.808-3.032, P < 0.001, η = 0.332), VIS (MD = - 0.425, 95% CI: - 0.642 to - 0.208, P < 0.001, η = 0.109), EQ-5D-5L (MD = 0.029, 95% CI: 0.016-0.041, P < 0.001, η = 0.150), and EQ-VAS (MD = 6.329, 95% CI: 2.978-9.680, P < 0.001, η = 0.102). No serious AEs occurred, and the mild local irritation resolved spontaneously. Pharmacoeconomic analysis showed that SFF achieved a 1% increase in treatment effectiveness at an incremental cost of ¥244.23 compared with conventional therapy. CONCLUSION: When combined with conventional care, SFF significantly improved clinical, symptomatic, and quality-of-life outcomes in women with PVD, with favorable tolerability and short-term cost-effectiveness. These results support its potential clinical utility. However, confirmation through multicenter, double-blind, randomized controlled trials is warranted.
Comparison of treatment efficacy of targeted therapies approved in China for non-small cell lung cancer before and after the introduction of accelerated drug marketing registration procedures.
Liu C, Lyu L, Zhang Y … +4 more , Tian Y, Yuan J, Li C, Hu Y
Int J Clin Pharm · 2026 Mar · PMID 41843046 · Publisher ↗
INTRODUCTION: The introduction of Accelerated Drug Marketing Registration Procedures (ADMRPs) in China has improved patient access to innovative therapies, but concerns remain about the robustness and consistency of effi...
INTRODUCTION: The introduction of Accelerated Drug Marketing Registration Procedures (ADMRPs) in China has improved patient access to innovative therapies, but concerns remain about the robustness and consistency of efficacy evidence. AIM: This study aimed to compare the treatment efficacy of approved targeted therapies for non-small cell lung cancer (NSCLC) before and after the implementation of ADMRPs. METHOD: In this retrospective study, we analyzed targeted therapies for NSCLC approved in China as of December 31, 2024. Approvals were categorized as pre-policy or post-policy groups based on the July 1, 2020 implementation of ADMRPs. Descriptive statistics were used to examine approved indications and pivotal trial designs. Meta-analysis and meta-regression compared pre-approval efficacy outcomes, including overall survival (OS), progression-free survival (PFS), disease-free survival, and objective response rate (ORR), between groups. Sensitivity analyses evaluated post-marketing OS data and the robustness of results. RESULTS: A total of 59 indications supported by 72 trials were approved. Post-policy approvals increased markedly (41 vs 18), with rises in domestic drugs (16.7% pre-policy vs 61.0% post-policy) and uncommon targets (5.6% pre-policy vs 43.9% post-policy) (both P < 0.05). Pivotal trials shifted from primarily Phase III-IV randomized controlled trials (RCTs) (76.0%) pre-policy to Phase I-II single-arm designs (68.1%) post-policy, mainly supporting drugs for uncommon or resistance mutations, whereas approvals for classical targets remained predominantly based on RCTs (90.0% pre-policy vs 93.8% post-policy; P = 0.416). Meta-analyses found no significant differences in pre-approval efficacy between groups for PFS (HR: 0.52 [0.45-0.61] vs 0.44 [0.36-0.54]; P = 0.206) or ORR (0.63 [0.55-0.70] vs 0.65 [0.59-0.70]; P = 0.705). However, OS meta-analysis was only feasible in the pre-policy group, whereas OS data in the post-policy group remained immature, with a median follow-up of 17 months (IQR 8-34) after approval. CONCLUSION: After the introduction of ADMRPs, approvals of targeted therapies for NSCLC increased substantially, without significant loss of pre-approval treatment efficacy. However, due to the limited follow-up, definitive survival benefits for the post-policy group cannot yet be established. The increased reliance on single-arm trials underscores the necessity of rigorous confirmatory post-marketing studies.
Evaluating time-based outcomes of a pharmacist-doctor collaborative discharge medication reconciliation model: an observational study.
Soudah S, Percival M, Noble A … +4 more , Dalziel J, Edmunds C, Hill K, Hattingh HL
Int J Clin Pharm · 2026 Mar · PMID 41843045 · Publisher ↗
INTRODUCTION: Medication reconciliation at hospital discharge is essential to prevent medication discrepancies and ensure continuity of care. Competing clinical priorities often delay reconciliation, reducing discharge e...
INTRODUCTION: Medication reconciliation at hospital discharge is essential to prevent medication discrepancies and ensure continuity of care. Competing clinical priorities often delay reconciliation, reducing discharge efficiency and increasing the risk of medication-related harm. Collaborative pharmacist-doctor models have potential to improve the quality and timeliness of discharge medication processes. AIM: To evaluate the impact of a pharmacist-doctor collaborative discharge medication reconciliation model on discharge timeliness, reconciliation quality, and pharmacist resource utilisation. METHOD: This observational study was conducted in a large tertiary hospital across two inpatient units over 12 weeks: six weeks usual care (1 September-12 October 2025) followed by 6 weeks intervention (13 October-28 November 2025). In the intervention phase, clinical pharmacists performed reconciliation planning, which involved preparing the draft discharge medication reconciliation plan for subsequent medical officer review and authorisation. Time-and-motion methodology captured discrete intervals across the discharge workflow. Quantile regression analysed time-based outcomes, and Poisson regression evaluated count-based outcomes including prescription adjustments. The primary outcome was time from discharge confirmation to patient departure; secondary outcomes included reconciliation completion rates, prescribing adjustments, and pharmacist workload. RESULTS: A total of 116 patients were included (control n = 65; intervention n = 51). The collaborative model improved discharge efficiency, reducing the median time from discharge confirmation to leaving the ward by 78 min (p = 0.022). Time from decision to discharge to reconciliation completion was more than halved (30 vs 76 min, p < 0.001). Reconciliation completeness was significantly higher in the intervention group (90.2% vs 67.7%, p = 0.007), with fewer partial completions and no missing reconciliations. Analysis demonstrated earlier availability of discharge prescriptions (40 vs 80 min, p = 0.011) and shorter intervals between reconciliation completion and medication list preparation (14 vs 32 min, p = 0.008). Importantly, reconciliation planning by the pharmacist required a median of only 3 min per patient, confirming that improved timeliness required minimal additional pharmacist resourcing. CONCLUSION: A pharmacist-doctor collaborative discharge medication reconciliation model improved discharge efficiency and reconciliation accuracy without increasing pharmacist workload. These findings support broader implementation of collaborative models to enhance patient safety and hospital workflow performance. Further research should explore cost-effectiveness and patient-centred outcomes.
Safety evaluation of afatinib in patients with a history of interstitial lung disease using data from an administrative claims database in Japan.
Inose R, Hayashi K, Sakaeda T
Int J Clin Pharm · 2026 Mar · PMID 41843044 · Publisher ↗
INTRODUCTION: Afatinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is an effective treatment agent for lung cancer with uncommon epidermal growth factor receptor (EGFR) mutations. EGFR-TKIs...
INTRODUCTION: Afatinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is an effective treatment agent for lung cancer with uncommon epidermal growth factor receptor (EGFR) mutations. EGFR-TKIs should be administered with caution in patients with a history of interstitial lung disease (ILD); however, such patients are often excluded from clinical trials, and evidence on afatinib safety in this population remains limited. AIM: To exploratorily evaluate the safety profile of afatinib in patients with a history of ILD using an administrative claims database and investigate whether severe ILD events occur uniformly across patient backgrounds or cluster within specific patient profiles. METHOD: We analyzed data of patients who received afatinib between May 1, 2014 and November 30, 2020 from the administrative claims database provided by Medical Data Vision Co., Ltd. Severe ILD was defined using two claims-based operational definitions: (1) a broader primary definition combining ILD diagnostic codes and high-dose intravenous corticosteroid administration; (2) a stricter definition requiring intravenous methylprednisolone for sensitivity analysis. Classification and Regression Trees (CART) were used to exploratorily identify patient profiles associated with severe ILD. RESULTS: Among 2,174 patients treated with afatinib, 12.3% (267/2,174) had a history of ILD. Using the primary definition, severe ILD occurred in 6.0% (16/267) of these patients, whereas 3.4% (9/267) met the stricter definition. Although CART analyses yielded different split variables and cutoff values across the two definitions, both consistently indicated that severe ILD events were concentrated within specific patient profiles rather than being uniformly distributed across the population. CONCLUSION: In patients with a history of ILD, the incidence of severe ILD following afatinib treatment was clarified. CART-derived findings should be interpreted as exploratory signals suggesting clustering of severe ILD events within particular patient profiles. However, as severe ILD was identified using claims-based operational definitions, outcome misclassification cannot be excluded despite sensitivity analyses. Further studies are warranted to validate these findings in independent real-world datasets with richer clinical detail and to support more precise stratification of severe ILD occurrence.
Exploring the current status of pharmacist prescribing in Middle Eastern Arab countries: a scoping review.
Alajmi RH, Barry HE, Almalag HM … +1 more , Hughes CM
Int J Clin Pharm · 2026 Jun · PMID 41843043 · Full text
INTRODUCTION: The practice of prescribing by healthcare professionals other than physicians is called non-medical prescribing. Pharmacist prescribing (PP) is established in various countries and is expanding globally. In...
INTRODUCTION: The practice of prescribing by healthcare professionals other than physicians is called non-medical prescribing. Pharmacist prescribing (PP) is established in various countries and is expanding globally. In Middle Eastern Arab countries, there are significant developments in pharmacy education and practice with an expansion in the scope of practice; however, little is known about PP in these nations. AIM: This scoping review aimed to explore the current status of PP in Middle Eastern Arab countries. The objectives were to identify countries reporting on proposed or developing PP initiatives and to describe pre-implementation planning, including reported qualifications, models of prescribing, and contributing barriers and facilitators. METHOD: A search was conducted for published studies using nine databases from inception to October 2024. Full texts of papers focusing on PP, conducted in Middle Eastern Arab countries, and written in English and Arabic were obtained. All eligible papers were uploaded into Covidence. Duplicate papers were removed, and titles and abstracts were independently screened by two reviewers. Full-text screening was conducted by two reviewers. Data were extracted into a charting table with the following characteristics: author, publication year, aim, study design, setting, country, model of prescribing, qualifications, facilitators, barriers, and study recommendations. Data were synthesised narratively in line with the review objectives. RESULTS: In total, 202 papers were identified and following screening, 16 papers were included in this review. Most studies (n = 9) originated from Saudi Arabia, with others from Qatar (n = 5), Jordan (n = 1), and the United Arab Emirates (n = 1). The included studies were published between 2019 and 2024 in English. Most studies were conducted in hospital settings (n = 12), particularly within specialised clinics describing two prescribing models: collaborative and independent. The findings reflect inconsistency in reporting the qualifications required for prescribing. Facilitators were categorised into regulation, education/training, professional competence, interprofessional collaboration, infrastructure, awareness, and international collaboration. Barriers encompassed regulatory gaps, organisational deficiencies, professional limitations, interprofessional resistance, resource constraints, and limited evidence. CONCLUSION: This review provides an overview of the current landscape of pharmacist prescribing in Middle Eastern Arab countries, key facilitators, and barriers. While the evidence base remains limited, findings suggest growing interest and early developments.
Multifaceted and educational interventions to improve prescribing indicators in the Middle East and North Africa Region: a systematic review and meta-analysis.
Ilyas M, Chivese T, Hadi MA … +2 more , Ncube NBQ, Khan MN
Int J Clin Pharm · 2026 Jun · PMID 41843042 · Full text
INTRODUCTION: Rational prescribing is challenging due to global antibiotic resistance and widespread polypharmacy. Evidence on effective interventions to improve prescribing practices in MENA is limited. AIM: This system...
INTRODUCTION: Rational prescribing is challenging due to global antibiotic resistance and widespread polypharmacy. Evidence on effective interventions to improve prescribing practices in MENA is limited. AIM: This systematic review and meta-analysis evaluated the effectiveness of multifaceted and educational interventions in improving WHO/INRUD prescribing indicators in the Middle East and North Africa (MENA). METHOD: We searched PubMed, Scopus, and CINHAL up to June 10, 2025, for experimental studies evaluating the effectiveness of multifaceted interventions on WHO/INRUD prescribing indicators. Searches were supplemented by screening reference lists of relevant reviews, first 20 pages of Google Scholar results, and ResearchRabbit.ai for citation-chaining to identify additional records. Primary outcomes included WHO/INRUD prescribing indicators: average number of drugs per prescription, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed, percentage of drugs prescribed by generics, and percentage of drugs prescribed from the essential medicines list. Methodological quality was assessed with the MASTER scale. Meta-analysis used a bias-adjusted inverse-variance heterogeneity model adjusted with quality score. Heterogeneity and publication bias were assessed using I, the Doi plot, and LFK index. RESULTS: Sixteen studies (seven RCTs, six pre-post, three quasi-experimental) from Iran, UAE, Egypt, Sudan, Lebanon, Saudi Arabia, and Palestine were included. Multifaceted interventions modestly reduced the average number of drugs per prescription (weighted mean difference WMD - 0.10, (95% CI - 0.18 to -0.02; I = 99.8%). There was a downward trend in the odds of prescriptions with antibiotics (OR 0.65; 95% CI 0.41 to 1.03, I = 93.5%) and injections (OR 0.93, 95% CI 0.82 to 1.04, I = 25.3%), though these did not reach statistical significance and confidence intervals included the possibility of no effect. Meta-analysis revealed extreme statistical heterogeneity (I up to 99.8%), and the GRADE certainty of evidence was low to very low for all outcomes. CONCLUSION: Multifaceted interventions in the MENA region demonstrate potential for modest improvements in prescribing indicators, though evidence certainty remains low to very low. With non-significant pooled effects for antibiotics and injections, these exploratory findings suggest that context-specific stewardship and prescribing quality programs can achieve targeted improvements, but also highlight the need for more locally led, rigorous research with longer follow-up to inform policy decisions.
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