Clinical Pharmacy[JOURNAL]
Sun
200 papers
Patient preferences for community pharmacy service models in diabetes care: a discrete choice experiment.
Sun Y, Jia Z, Lan L … +3 more , Xie X, Xie H, Ji C
Int J Clin Pharm · 2026 Jun · PMID 41838371 · Full text
INTRODUCTION: With the rising global prevalence of diabetes, traditional hospital-centered healthcare models are becoming increasingly inadequate to meet patients' long-term management needs. Community pharmacy services...
INTRODUCTION: With the rising global prevalence of diabetes, traditional hospital-centered healthcare models are becoming increasingly inadequate to meet patients' long-term management needs. Community pharmacy services have the potential to address these gaps. However, systematic research on patient preferences for such services remains limited. AIM: This study aimed to determine the factors influencing diabetic patients' preferences for community pharmacy service models using a discrete choice experiment (DCE), and to explore how these preferences vary according to glycemic control status. METHOD: Attributes and levels of DCE were identified through literature review, expert consultation, and patient pretesting. Six attributes were included: service content, service provider, follow-up program, reduction in cardiovascular events, reduction in hypoglycemic events, and service costs. A mixed orthogonal design generated 18 choice sets, with one scenario serving as reference. The survey was conducted face-to-face with patients with type 2 diabetes attending three community health service centers in Nanjing, China. Conditional logit models were applied to estimate attribute importance and subgroup analyses were performed based on HbA1c levels. RESULTS: Of the 237 respondents, 190 provided valid responses (response rate: 80.1%). Across the overall sample, the most influential attributes were pharmacy service content (Wald = 389.188, relative attribute importance [RAI] = 4.59), followed by the frequency of hypoglycemic reactions (Wald = 284.155, RAI = 4.19), service cost (Wald = 168.079, RAI = 4.07), reduction in cardiovascular events (Wald = 144.608, RAI = 3.38), service providers (Wald = 142.913, RAI = 3.29), and follow-up programs (Wald = 50.644, RAI = 1.15). Patients preferred drug effectiveness assessments over counselling or adverse reaction monitoring, valued collaborative care involving pharmacists and physicians, and demonstrated willingness to pay approximately ¥20 per session. Subgroup analyses revealed that patients with HbA1c ≤ 8% were more cost-sensitive and favored fixed-interval follow-up, whereas those with HbA1c > 8% preferred individualized follow-up programs and placed less emphasis on service costs. CONCLUSION: Patients with diabetes prioritize service quality, outcome-driven care, and multidisciplinary collaboration when selecting community pharmacy services. While hypoglycemia reduction and cost are important across groups, preferences vary according to glycemic control, highlighting the need for tailored patient-centered service models. These findings provide evidence to guide the development of sustainable and responsive community pharmacy services.
How direct healthcare professional communications are operationalised by general practitioners and community pharmacists in Ireland: a national cross sectional study.
Ryan PE, Doherty AS, Dahly DL … +5 more , Byrne S, Curran S, Scully D, Sharma R, Wallace E
Int J Clin Pharm · 2026 Mar · PMID 41811630 · Publisher ↗
INTRODUCTION: Direct Healthcare Professional Communications (DHPCs) alert healthcare professionals of important safety information relating to medication(s) and of the need to adapt practices with respect to these. Inter...
INTRODUCTION: Direct Healthcare Professional Communications (DHPCs) alert healthcare professionals of important safety information relating to medication(s) and of the need to adapt practices with respect to these. International evidence suggests that their implementation varies in clinical practice. To date, few studies have examined implementation of DHPCs in primary care. AIM: To examine how general practitioners (GPs) and community pharmacists implement DHPCs in Ireland and their preferences for receiving medication safety updates. METHOD: A national cross-sectional survey of GPs and pharmacists in collaboration with the Irish Health Products Regulatory Authority (HPRA), was conducted in June 2024. GPs and CPs were invited to participate via national gatekeepers (Irish College of GPs, Pharmaceutical Society of Ireland). Following piloting, the questionnaire were administered via email using Qualtrics. Data was analysed using R and R Studio. RESULTS: A total of 277 GPs and 219 pharmacists completed the questionnaire, a response rate of 6% and 8% respectively. Most GPs (n = 227, 82%) and pharmacists (n = 196, 89%) reported DHPCs as their preferred source of medication safety updates. Practice protocols for sharing DPHCs once received differed across the two professional groups. For example, DHPCs were more likely to be disseminated and discussed at a pharmacy practice meeting (n = 64 pharmacists, 29%) compared with GP practice meetings (n = 24 GPs, 9%). More than one-third of GPs (n = 98, 35%) identified time constraints as the most important barrier to DHPC implementation, followed by absence of prescribing notifications on patient electronic health records (EHRs), n = 36 GPs (13%), n = 39 CPs (18%). A total of 257 GPs (93%) and 198 CPs (90%) identified patient EHR prescribing alerts, aligned with DHPC recommendations, integrated at the point of patient care as a preferred way to support implementation. CONCLUSION: Surveyed GPs and pharmacists use DHPCs as their primary information source for new medication safety alerts and most reported these communications as very useful. Repeated DHPC communications across different modalities were valued. Barriers to implementation included time constraints and lack of point of care alerts for both GPs and pharmacists. Remote clinical support is acceptable to GPs and pharmacists and may support the implementation of DHPC recommendations to optimise medication safety in primary care.
Burden of mental disorders in working-age populations (15-64 years) from 1990 to 2021 with projections to 2045: a global analysis of India, China and the United States.
Jiang R, Wang L, Tian Y … +3 more , Zhao Z, Kuo A, Cao M
Int J Clin Pharm · 2026 Jun · PMID 41811629 · Full text
BACKGROUND: Mental disorders constitute a major global public health concern, particularly among the working-age population. Their impact extends beyond reduced productivity and long-term economic loss. This study presen...
BACKGROUND: Mental disorders constitute a major global public health concern, particularly among the working-age population. Their impact extends beyond reduced productivity and long-term economic loss. This study presents a comprehensive assessment of the global burden of mental disorders among working-age adults and compares trends in the three most populous countries, India, China, and the United States, from 1990 to 2021, with projections through 2045. AIM: To evaluate age-, sex-, and country-specific trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of mental disorders among working-age adults, and to forecast future disease burden using advanced modeling techniques. METHOD: Data for individuals aged 15-64 years were derived from the Global Burden of Disease Study 2021. The analysis was stratified by sex, age, country, and type of disorder. Age-standardized prevalence and incidence rates were calculated and temporal trends were quantified using the estimated annual percentage change. Significant inflection points were detected using the Joinpoint regression. Future DALYs (2022-2045) were projected using the Nordpred age-period-cohort model based on historical trends and population forecasts. All analyses were conducted using the R software (version 4.4.3). RESULTS: Globally, the overall burden of mental disorders remained relatively stable from 1990 to 2021; however, substantial heterogeneity was observed across sex, age groups and countries. Females consistently demonstrated a higher prevalence of depressive and anxiety disorders, whereas males exhibited higher rates of schizophrenia, attention deficit/hyperactivity disorder, and autism spectrum disorders. In the United States, both the prevalence and incidence increased markedly for most mental disorders, whereas China and India showed overall declining trends. Age-stratified analyses revealed a high disease burden among adolescents and young adults, alongside a pronounced and continuing increase in the middle-aged and older populations. Projections through 2045 suggest a further rise in DALYs, particularly among females and individuals aged 50-54 years, indicating a worsening global burden of mental disorders. CONCLUSION: This study provides the most detailed, age-stratified evaluation of mental disorder burden among working-age populations to date. The findings highlight persistent gender and regional disparities and demonstrate the urgent need for scalable, culturally sensitive mental health interventions, workforce-based support systems, and the integration of mental health care into primary and occupational health frameworks.
Antidepressant drug use in Europe: past consumption, prescribing patterns and forecast until 2030.
Bindel LJ, Seifert R
Int J Clin Pharm · 2026 Jun · PMID 41806133 · Full text
INTRODUCTION: Mental disorders represent a significant global burden, with a high proportion of depressive disorders. Antidepressants (ADs) are the most prescribed drugs for treating mental disorders, with broad indicati...
INTRODUCTION: Mental disorders represent a significant global burden, with a high proportion of depressive disorders. Antidepressants (ADs) are the most prescribed drugs for treating mental disorders, with broad indications, e.g. depression, anxiety disorders, and off-label use. AIM: This study assesses current and historical changes in AD consumption in 25 European countries, predicts future developments, and further analyses ATC subgroup consumption in 13 countries. METHOD: Consumption data for ADs (ATC code N06A) were collected from the OECD Data Explorer. Subgroup data came from publicly available sources. The time span covered is 1980 to 2024. Changes in defined daily doses per 1000 population per day (DID) were analysed, and projections to 2030 were made using Auto Regressive Integrated Moving Average models. Treatment coverage for depressive disorder prevalence was also calculated. RESULTS: In 2023, AD consumption ranged from 26.3 DID (Latvia) to 164.7 DID (Iceland). Use increased in nearly all countries, except Luxembourg (- 0.3 DID between 2013 and 2022). Increases ranged from + 5.9% (Austria) to + 157.8% (Latvia). Forecasts predict further increases in most countries (+ 0.1 to + 80.9%), with decreases projected for Hungary, Austria, the UK, and Luxembourg (- 3.4 to - 21.7%). Selective serotonin reuptake inhibitors (SSRIs) are the most used subgroup, with mixed developments. The second most used is miscellaneous, with growing shares in most countries. Non-selective monoamine reuptake inhibitors (NSMRIs) are declining, while monoamine oxidase inhibitors (MAO-Is) and monoamine oxidase A inhibitors (MAOA-Is) have very low shares. Northern Europe shows the highest AD use versus Eastern Europe the lowest. All regions primarily use SSRIs. Northern Europe has a higher miscellaneous share, while Eastern Europe uses more NSMRIs. CONCLUSION: AD use has increased and is projected to continue rising in most countries, with changing subgroup preferences. The dominance of SSRIs reflects first-line treatment recommendations. Increased miscellaneous use may indicate more individualised treatment and better tolerability. NSMRIs are declining due to adverse effects, and MAO-Is as well as MAOA-Is are rarely used due to safety concerns. Prescribing patterns vary across regions, influenced by health systems, cultural differences, stigma, and healthcare resources.
Proposed ICD-10 framework for identifying emergency department visits that may be impacted by community pharmacy care clinics.
Ramrattan DA, Al Hamarneh YN, Tsuyuki RT … +1 more , Simpson SH
Int J Clin Pharm · 2026 Jun · PMID 41746568 · Full text
Primary care is critical for supporting health, yet access to family physicians and nurse practitioners is less than ideal in many countries. One solution to improve access to primary care is to expand the scope of pract...
Primary care is critical for supporting health, yet access to family physicians and nurse practitioners is less than ideal in many countries. One solution to improve access to primary care is to expand the scope of practice for other primary healthcare professionals, such as pharmacists. Building on this approach, some countries have created community pharmacy care clinics to further improve access to primary care services provided by pharmacists working to full scope of practice. As the role of pharmacists in primary care increases and community pharmacy care clinics become more prevalent, it is important to assess the effect on health service utilization and health outcomes. While the emergency department visit rate is a widely accepted indicator for access to primary care, there is currently no framework to evaluate the impact of pharmacists on emergency department visits. Frameworks based on International Classification of Diseases codes provide health services researchers with a standardized approach to present and analyze administrative health data. In this commentary, we describe the development of a framework to identify and classify emergency department visits that may be impacted by pharmacists providing primary care services in a community pharmacy care clinic. The framework covers three mutually exclusive groups of conditions: a subset of primary care sensitive conditions that can be managed by community pharmacists, conditions attributable to an adverse medication event, and conditions attributable to medically appropriate referrals to an emergency department. The conditions included within these groups provide a broad overview of potential benefits and unintended harms that may occur when pharmacists are involved in providing primary care services. This framework can be used to characterize changes in health service utilization and health outcomes that may occur as pharmacists become more actively involved in providing primary care services.
Analysis of adverse event reporting with casimersen: a pharmacovigilance study based on the United States food and drug administration adverse event reporting system database.
Hao Z, Jiang K, Zhang J … +1 more , Zhao L
Int J Clin Pharm · 2026 Jun · PMID 41746567 · Full text
INTRODUCTION: Casimersen is an antisense oligonucleotide used to treat patients with Duchenne muscular dystrophy (DMD), with mutations amenable to exon 45 skipping. However, real-world safety data are limited. AIM: This...
INTRODUCTION: Casimersen is an antisense oligonucleotide used to treat patients with Duchenne muscular dystrophy (DMD), with mutations amenable to exon 45 skipping. However, real-world safety data are limited. AIM: This study used the Food and Drug Administration Adverse Event Reporting System (FAERS) database to describe post-marketing adverse event reporting patterns associated with casimersen, identify disproportionality signals at the preferred term level, and characterize their onset patterns and affected organ systems. METHOD: FAERS reports from 2004 to 2024 involving casimersen were extracted, deduplicated, and coded using the Medical Dictionary for Regulatory Activities (MedDRA). Disproportionality analyses were performed using four validated algorithms: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN) and Empirical Bayesian Geometric Mean (EBGM). Signals that met all four criteria were considered statistically significant. Time-to-onset and subgroup analyses according to age and sex were also performed. RESULTS: Among 21,964,449 FAERS reports, 598 listed casimersen as the primary suspect, predominantly in males (98.5%) and patients aged < 18 years (62.0%). The median time to AE onset was 253 days (range, 101-490 days). Twenty-one System Organ Classes (SOCs) were implicated, including injury, poisoning, procedural complications (n = 377), vascular disorders (n = 85), product issues (n = 80), and social circumstances (n = 13). Using all four algorithms, 30 significantly preferred terms (PTs) were identified, encompassing heterogeneous reporting categories, including clinically oriented terms as well as administration-related, medication use, and non-specific descriptors, such as product dose omission, poor venous access, proteinuria, hematuria, chromaturia, underdose, illness, and infusion-site extravasation. CONCLUSION: This study characterized post-marketing adverse event reporting patterns associated with casimersen using FAERS data. By summarizing the preferred term-level reporting distributions, affected organ system categories, and time-to-onset characteristics, the findings provide a descriptive overview of real-world reporting patterns following casimersen use. These results may inform post-marketing pharmacovigilance activities and support hypothesis generation in future studies.
Development and validation of a LASSO-logistic regression model for predicting subtherapeutic infliximab trough concentrations in patients with Crohn's disease.
Song J, Li X, Wu W … +4 more , Peng X, Xie J, He X, Wang Y
Int J Clin Pharm · 2026 Feb · PMID 41739409 · Publisher ↗
BACKGROUND: Infliximab (IFX), a monoclonal antibody that neutralizes tumor necrosis factor-α, is widely used as a biologic treatment for Crohn's disease (CD). Despite its established efficacy, a substantial proportion of...
BACKGROUND: Infliximab (IFX), a monoclonal antibody that neutralizes tumor necrosis factor-α, is widely used as a biologic treatment for Crohn's disease (CD). Despite its established efficacy, a substantial proportion of patients develop subtherapeutic IFX trough concentrations (< 3 μg/mL), leading to diminished clinical response and treatment failure. Early identification of high-risk individuals remains challenging due to the multifactorial nature of IFX pharmacokinetics. AIM: This study integrated Least Absolute Shrinkage and Selection Operator (LASSO)-based variable selection with multivariable logistic regression to identify CD patients at risk for subtherapeutic IFX trough levels during induction. METHOD: A total of 347 patients diagnosed with CD who commenced IFX induction therapy at the Sixth Affiliated Hospital of Sun Yat-sen University from January to December 2023 were retrospectively reviewed in this study. Comprehensive demographic, clinical, and biochemical data were retrieved from electronic records. Variable selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO), after which a multivariable logistic model was developed. Model discrimination, calibration and clinical usefulness were assessed through the area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis (DCA) and clinical impact curves (CIC). RESULTS: Of the 347 participants, 148 (42.7%) exhibited subtherapeutic IFX trough concentrations. LASSO and multivariable logistic analyses identified four independent predictors: older age at diagnosis (> 40 years), elevated anti-drug antibody levels, higher erythrocyte sedimentation rate and reduced albumin (P < 0.05). The model demonstrated an AUC of 0.737 (95% CI 0.684-0.790), with a bootstrap-adjusted AUC of 0.726 (95% CI 0.697-0.739) based on 1000 resamples. Calibration demonstrated close alignment with observed outcomes, validated by a non-significant Hosmer-Lemeshow test (χ = 8.447, P = 0.391). DCA and CIC analyses indicated meaningful clinical utility. CONCLUSION: The proposed LASSO-logistic regression model demonstrates promising predictive performance for identifying subtherapeutic IFX exposure in CD patients. By leveraging readily available clinical data, it enables early risk stratification and individualized therapeutic decision-making, thereby facilitating more effective treatment optimization.
ESCP best practice: development, implementation and evaluation of sick day guidance in primary care in the Netherlands.
Coppes T, Koster ES, Philbert D … +2 more , van Gelder T, Bouvy ML
Int J Clin Pharm · 2026 Apr · PMID 41739408 · Full text
INTRODUCTION: To prevent acute kidney injury, guidelines recommend temporary adjustment of high-risk medications in patients with impaired renal function during so-called 'sick days'. Sick days are periods with increased...
INTRODUCTION: To prevent acute kidney injury, guidelines recommend temporary adjustment of high-risk medications in patients with impaired renal function during so-called 'sick days'. Sick days are periods with increased risk of dehydration, such as diarrhoea, fever or vomiting. Currently, awareness of sick day guidance among patients and healthcare professionals is low, which hampers implementation in daily practice. AIM: To develop, implement and evaluate sick day guidance for patients with pre-existing impaired renal function on maintenance treatment with high-risk medication. SETTING: Over a 12 month study period, community pharmacies collaborated with at least one affiliated general practitioner (GP) to implement sick day guidance in primary care. DEVELOPMENT: Training materials, including an E-learning module for healthcare professionals and patient information materials were developed. IMPLEMENTATION: In total, 21 community pharmacies completed the 12 month study period, in which 373 patients received oral and written instructions to report sick days to the GP or pharmacist. The median age of included patients was 78 years (IQR 73-83), 42% were male, and 68% used ≥ 2 high-risk medications. The implementation process of sick day guidance was evaluated with the Consolidated Framework for Implementation Research (CFIR), including a start interview in every pharmacy, registration of agreements, monthly telephone evaluations and an end-evaluation interview. EVALUATION: Successful implementation was facilitated by adequate training, strong team engagement and support, and making pharmacy technicians responsible for information provision as well as providing in-person counselling to patients. Implementation barriers related to a lack of support from the information system, a lack of reimbursement and a low number of reported sick days. Patients reported 8 sick days, although a telephone survey amongst 188 patients showed that 12 more sick days had occurred. CONCLUSION: While training healthcare professionals supports appropriate medication adjustments when sick days are reported, patient education alone does not consistently lead to reporting. Additional implementation efforts, such as involving informal caregivers, may be needed to support patients in signalling and managing sick days.
Oral low-dose methotrexate improves infliximab pharmacokinetics, immunogenicity, and endoscopic outcomes in Crohn's disease: a propensity score-adjusted real-world study.
Huang S, Li D, Qin T … +12 more , Tang F, Ma R, Shen Y, Liu H, Gong J, Huang Q, Ke M, Wang L, Dai A, Li J, Liao J, Xiao F
Int J Clin Pharm · 2026 Jun · PMID 41739407 · Full text
INTRODUCTION: The effectiveness of infliximab in Crohn's disease is often compromised by immunogenicity. Oral low-dose methotrexate may offer a promising strategy to optimize infliximab therapy, yet its real-world effect...
INTRODUCTION: The effectiveness of infliximab in Crohn's disease is often compromised by immunogenicity. Oral low-dose methotrexate may offer a promising strategy to optimize infliximab therapy, yet its real-world effectiveness and safety remain uncertain. AIM: This study aimed to compare the effectiveness and safety of infliximab plus oral low-dose methotrexate versus infliximab monotherapy. METHOD: In this single-center retrospective cohort study, 119 patients with Crohn's disease received either infliximab monotherapy (n = 99) or combination therapy with oral low-dose methotrexate (10-15 mg/week; n = 20). The primary outcome was endoscopic remission (Simple Endoscopic Score for Crohn's Disease ≤ 2) at week 26. Propensity score methods, including nearest-neighbor matching and inverse probability of treatment weighting, were used to adjust for confounding. Conditional and weighted logistic regression were used to estimate treatment effects. RESULTS: After propensity score adjustment, combination therapy was associated with a significantly higher rate of endoscopic remission (aOR 3.70, 95% CI 1.16-11.75; P = 0.027). No significant differences were observed in endoscopic response or clinical outcomes. In a pharmacokinetic subgroup, combination therapy resulted in numerically higher infliximab trough concentrations and no detectable anti-drug antibodies (0% vs. 16.7%). Higher trough concentrations were associated with endoscopic remission (P = 0.033). The incidence of elevated liver enzymes was higher in the combination group (20.0% vs. 4.0%), but this difference was not statistically significant after adjustment (P = 0.058). CONCLUSION: In patients with Crohn's disease, oral low-dose methotrexate combined with infliximab was associated with significantly improved endoscopic remission at week 26 compared to infliximab monotherapy, without a statistically significant increase in adverse events.
Comparative pharmacovigilance analysis of suicidality-related adverse events among GLP-1 and non-GLP-1 anti-obesity drugs in the FDA Adverse Event Reporting System.
Seijas-Amigo J, Salgado-Barreira Á, Rodriguez-Penas D … +4 more , Cardeso-Paredes B, Ribeiro-Ferreiro M, Rodriguez-Mañero M, Gonzalez-Juanatey JR
Int J Clin Pharm · 2026 Jun · PMID 41739406 · Full text
INTRODUCTION: Regulatory reviews in 2023-2024 reignited concern about possible suicidality with Glucagon-like peptide-1 (GLP-1) receptor agonists used for weight management. While clinical trials and real-world studies h...
INTRODUCTION: Regulatory reviews in 2023-2024 reignited concern about possible suicidality with Glucagon-like peptide-1 (GLP-1) receptor agonists used for weight management. While clinical trials and real-world studies have not confirmed an increased risk, comparative post-marketing analyses across all anti-obesity agents are scarce. AIM: To compare disproportional reporting of suicidality-related adverse events among GLP-1/dual incretin versus non-GLP-1 anti-obesity drugs in the FDA Adverse Event Reporting System (FAERS). METHOD: We conducted a retrospective disproportionality study using FAERS (January 2012-February 2025). Reports submitted from the United States with the study drug listed as primary suspect were retrieved via openFDA. Suicidality terms were predefined (MedDRA Preferred Terms: suicidal ideation, suicide attempt, completed suicide). Reporting Odds Ratios (RORs) with 95% confidence intervals (CIs) were calculated for each drug and at class level (GLP-1/dual incretin vs non-GLP-1). Haldane-Anscombe corrections were applied where needed. RESULTS: Among approximately 78,000 anti-obesity reports, 207 (approximately 0.3%) involved suicidality-related events. For semaglutide, RORs were 1.39 (95% CI 0.99-1.94) for suicidal ideation, 1.38 (0.46-4.15) for suicide attempt, and 1.72 (0.62-4.74) for completed suicide, none statistically significant. Liraglutide showed ROR 1.01 (0.66-1.55) for suicidal ideation and 18.11 (6.96-47.15) for completed suicide based on 14 cases. Tirzepatide yielded RORs below unity for all outcomes. Naltrexone/bupropion showed elevated disproportional reporting for suicidal ideation (ROR 3.84; 95% CI 2.89-5.12) and suicide attempt (ROR 4.11; 95% CI 1.62-10.45. CONCLUSION: GLP-1 and dual-incretin agents did not show disproportionality signals for suicidal ideation or suicide attempt. A statistically significant disproportionality signal for completed suicide was observed for liraglutide; however, this estimate was based on few cases and displayed wide confidence intervals, warranting cautious interpretation. These findings support an overall neutral psychiatric safety profile for incretin-based therapies while underscoring the need for continued monitoring of rare events such as completed suicide.
Scoping review of apixaban and rivaroxaban dosing for atrial fibrillation and venous thromboembolism in advanced chronic kidney disease.
Gillis S, Phelan E, Pitman J … +7 more , Trenaman S, Battistella M, Sanyal C, Daley C, Tennankore K, Gillis L, Wilson JA
Int J Clin Pharm · 2026 Jun · PMID 41733864 · Full text
INTRODUCTION: Individuals with advanced chronic kidney disease (CKD) have elevated risks for stroke, venous thromboembolism (VTE), and bleeding, yet their exclusion from major trials leaves uncertainty about dosing of ap...
INTRODUCTION: Individuals with advanced chronic kidney disease (CKD) have elevated risks for stroke, venous thromboembolism (VTE), and bleeding, yet their exclusion from major trials leaves uncertainty about dosing of apixaban and rivaroxaban. AIM: To map existing evidence on apixaban and rivaroxaban dosing practices and associated clinical outcomes in patients with advanced CKD, predominantly not receiving dialysis, treated for atrial fibrillation (AF) and/or venous thromboembolism (VTE), and to identify knowledge gaps in this area. METHOD: A scoping review was conducted following the Arksey and O'Malley framework and reported per PRISMA-ScR guidelines. The search, developed with a medical librarian, was conducted in MEDLINE, Embase, Cochrane, and CINAHL through May 7, 2025. Duplicates were removed, and records managed in Covidence. Two reviewers independently screened titles, abstracts, and full texts. We included studies of apixaban or rivaroxaban dosing in adults with advanced CKD (mostly non-dialysis) with AF or VTE reporting thromboembolic or major bleeding outcomes. Non-English articles and publication types (e.g., abstracts, case series, editorials) were excluded. Data was extracted using a structured form and summarized to address the study aim. RESULTS: Thirty-four studies were identified: seven VTE, six combined AF/VTE, and 21 AF. Standard-dose apixaban and rivaroxaban were more commonly used and associated with lower, though non-significant, rates of recurrent VTE and major bleeding compared to warfarin. In apixaban groups, standard-dose 5 mg BID had fewer VTE events than the 2.5 mg BID dose but more major bleeding events which were also not statistically significant. In AF studies, both standard and reduced-dose apixaban (5 mg BID and 2.5 mg BID), and reduced-dose rivaroxaban (15 mg daily), significantly reduced major bleeding risk versus warfarin. Stroke reductions were not consistently significant but trended lower with apixaban and rivaroxaban compared to warfarin. In the only AF study comparing apixaban and rivaroxaban, both doses of rivaroxaban (20 mg or 15 mg daily) had higher bleeding rates than apixaban. One of four AF studies showed higher bleeding with standard versus reduced-dose apixaban. CONCLUSION: This review summarizes apixaban and rivaroxaban dosing for AF/VTE in advanced CKD, revealing gaps such as limited dose-comparison studies, heterogeneous outcomes and sparse data in non-dialysis. Robust trials are urgently needed.
Long-acting reversible contraception and medication abortion: a national descriptive survey of Australian community pharmacist knowledge, attitudes and practices.
Assifi AR, James S, Melwani S … +5 more , Black KI, Taft A, Bateson D, Norman WV, Mazza D
Int J Clin Pharm · 2026 Jun · PMID 41733863 · Full text
INTRODUCTION: Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA...
INTRODUCTION: Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA). However, Australian pharmacists' practice and knowledge of effective contraceptive methods, including long-acting reversible contraception (LARC), is unknown, and few were registered to dispense MA at the time of the study. AIM: Our aim was to understand the knowledge, attitudes and practices of Australian community pharmacists in LARC and MA care. METHOD: We conducted a cross-sectional national online survey of community pharmacists from July until October 2021. Participants were recruited through convenience sampling via mail and partner organisations' emails, newsletters, and mailing lists. We used descriptive statistical analysis, including counts, proportions, Pearson's chi-squared tests and Poisson regression for data analysis. Our descriptive survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) mixed-methods project (ACTRN12622000655741). RESULTS: There were 533 eligible responses; 72% (n = 385) self-identified as women, and 71% (n = 378) were from metropolitan areas. Respondents' correct LARC knowledge varied, with 88% understanding LARC effectiveness, 67.7% understanding return to fertility, and 65.9% understanding LARC suitability for nulliparous women. Most pharmacists were registered to dispense MA (70%; n = 373), although fewer than half discussed LARC at the time of dispensing MA. Those working outside metropolitan areas were more likely to be registered to dispense MA and feel that they had the knowledge and confidence to dispense MA. CONCLUSION: With community pharmacists increasing scope of service in relation to contraception and MA, ongoing education and support will ensure they have accurate information for the provision of LARC and MA.
Lived experiences of shared decision-making in young adults prescribed antipsychotics: a qualitative interview study.
Grey H, Lindsey L
Int J Clin Pharm · 2026 Jun · PMID 41733862 · Full text
INTRODUCTION: Serious mental illnesses, such as schizophrenia, schizoaffective or bipolar disorder, often starts in late teens or twenties. Adherence to antipsychotic treatment for serious mental illness is often poor. I...
INTRODUCTION: Serious mental illnesses, such as schizophrenia, schizoaffective or bipolar disorder, often starts in late teens or twenties. Adherence to antipsychotic treatment for serious mental illness is often poor. Involving service users in decisions about their treatment leads to improved clinical outcomes and adherence. Shared decision-making is bilateral information sharing between clinician and service user where decision-making is shared between both parties. This study aimed to evaluate the lived experiences of young adults on how healthcare professionals involve them in decisions about antipsychotic medication. METHOD: Fifteen semi-structured interviews were conducted online using Zoom. Participants were selected using purposive sampling via patient recruitment platform, support groups relevant to psychosis and social media. Those included in the study were diagnosed with schizophrenia, schizoaffective or bipolar disorder and treated with antipsychotics between the ages of 18-30. Data was coded inductively and thematic analysis was used to analyse the data. RESULTS: Four themes were identified. These were living with antipsychotics, influence of family and friends, gaining autonomy and consequences of young adulthood. Findings highlighted the range of side effects from antipsychotic medication and their impact on young adults, and how the choices made by health care professionals influenced the quality of shared decision-making. Health care professionals' decisions directly influence the quality of life for service users. Young adults with psychosis acknowledge the effectiveness of antipsychotics but see the side effects as significant obstacles in their lives. CONCLUSION: The study found that health care professionals provided limited acknowledgement and support for antipsychotic side effects, which significantly impacted the young adults' lives. Young adults want to be fully informed of their medication and potential side effects but support from friends and family was a potential barrier. Changes in practice are needed including an adjustment in clinical language used by health care professionals, giving information to service users' post-psychosis and ensuring health care professionals are trained in shared decision-making.
Drug class duplication patterns among South African middle-aged adults: findings from a medicine claims database.
Fourie DH, Burger JR, du Plessis JM … +1 more , Lubbe MS
Int J Clin Pharm · 2026 Jun · PMID 41733861 · Full text
INTRODUCTION: Middle-aged adults (45-64 years), who constitute a large proportion of the population, are at risk of potentially inappropriate medicine (PIM) prescribing due to their high prevalence of multimorbidity. Dru...
INTRODUCTION: Middle-aged adults (45-64 years), who constitute a large proportion of the population, are at risk of potentially inappropriate medicine (PIM) prescribing due to their high prevalence of multimorbidity. Drug class duplication, the concurrent prescription of two or more medicines from the same pharmacological class, is a commonly reported PIM criterion in studies using the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria. AIM: To determine the prevalence of drug class duplication, stratified by sex and age group, and its associated factors among middle-aged adults using a South African pharmaceutical benefit management (PBM) company's medicine claims database. METHOD: A cross-sectional study was conducted using data from 1 January 2023-31 December 2023. Drug class duplication was assessed across 14 pharmacological drug classes. Prevalence of drug class duplications was analysed by sex and age group, with associations tested using Pearson's chi-square test. Spearman's correlation coefficient (r) was used to assess the correlation between drug class duplication and potential associated factors. RESULTS: Of the 195,446 patients analysed (51.9% female; mean age 53.69 years [standard deviation (SD) 5.41, 95% confidence interval (CI) 53.665-53.713]), 48.8% experienced one or more drug class duplication. Duplication was similar between sexes (p = 0.1685) and higher in older age groups (p < 0.0001, Cramér's V = 0.2). The most prevalent drug class duplications were 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) (n = 36,887, 18.9%); non-steroidal anti-inflammatory drugs (NSAIDs) (n = 30,829, 15.8%); angiotensin-converting enzyme (ACE) inhibitors (n = 25,646, 13.1%); angiotensin II receptor blockers (ARBs) (n = 22,411, 11.5%); calcium-channel blockers (CCBs) (n = 15,716, 8.0%); selective serotonin reuptake inhibitors (SSRIs) (n = 12,139, 6.2%); and beta-receptor blockers (β-blockers) (n = 11,577, 5.9%). Strong correlations were observed between drug class duplication and the number of Chronic Disease List (CDL) conditions per patient (r = 0.680, 95% CI 0.678-0.683), and number of prescriptions per patient (r = 0.638, 95% CI 0.636-0.641). Correlation with the number of medicine items per prescription per patient was moderate (r = 0.391, 95% CI 0.388-0.400), and weak with age (r = 0.232, 95% CI 0.227-0.236) (all p < 0.0001). CONCLUSION: Drug class duplication was common, highlighting that targeted interventions may be useful to improve patient safety.
Integrating sports pharmacy into pharmacy education: a qualitative study of pharmacy students' perceptions, barriers, and educational priorities.
Rajiah K, Kirwan E
Int J Clin Pharm · 2026 Jun · PMID 41733860 · Full text
INTRODUCTION: Sports pharmacy is a developing field in which pharmacists support athlete health, promote safe medication use, and contribute to anti-doping efforts. Despite international recognition of pharmacists' poten...
INTRODUCTION: Sports pharmacy is a developing field in which pharmacists support athlete health, promote safe medication use, and contribute to anti-doping efforts. Despite international recognition of pharmacists' potential roles, limited evidence exists on pharmacy students' knowledge and perceptions of this area, particularly in Northern Ireland. AIM: To explore pharmacy students' perceptions and experiences of sports pharmacy, with a particular focus on its relevance to pharmacy education, professional roles, and career aspirations. METHOD: An exploratory qualitative design was employed, using Braun and Clarke's inductive thematic analysis. Sixteen MPharm students (Years 1-4) from a university in Northern Ireland participated in semi-structured interviews conducted online between January and May 2025. Data were coded independently by two researchers, with themes developed through consensus. RESULTS: A total of sixteen students were interviewed. Data saturation was reached at the fourteenth interview, when no new codes or themes were identified, and this was confirmed through researcher consensus following review of coded transcripts. Six key themes were developed from analysis of the full dataset. Interviews lasted between 30 and 45 min (mean length = 37 ± 5 min): (1) Lack of curricular embedding, (2) Latent recognition of professional relevance, (3) Constraints in curriculum integration, (4) Feasible ways for embedding sports pharmacy, (5) Envisioned professional evolution, and (6) Motivation shaped by exposure and identity. Awareness was consistently low across all years. Students recognised sports pharmacy's value for athlete safety and career development, but expressed concerns about curriculum overload, limited expertise, and variable relevance. Practical solutions included guest lectures, interdisciplinary workshops, and optional or elective modules to provide exposure without adding to the curriculum burden. Sports pharmacy was perceived as an expanding niche with potential to shape future roles for pharmacists. CONCLUSION: Pharmacy students valued the potential of sports pharmacy but highlighted challenges in embedding it within an already overloaded curriculum. Flexible and targeted approaches, such as electives and guest lectures, may enhance awareness while accommodating diverse student interests. Future research should evaluate such strategies and their impact on preparing pharmacists for roles in sports pharmacy and anti-doping.
Dose-dependent relationships in potential prescribing cascades: a cohort study using community pharmacy dispensing data.
Gündogan-Yilmaz R, Wahedi S, Driessen JHM … +3 more , Mohammad A, Denig P, Karapinar-Carkit F
Int J Clin Pharm · 2026 Jun · PMID 41701303 · Full text
INTRODUCTION: Prescribing cascades occur when new medications are initiated to treat adverse drug reactions (ADRs) caused by an initial medication (index). Although using lower dose of the index medication is often recom...
INTRODUCTION: Prescribing cascades occur when new medications are initiated to treat adverse drug reactions (ADRs) caused by an initial medication (index). Although using lower dose of the index medication is often recommended as a general strategy to address adverse drug reactions that may trigger potential prescribing cascades, evidence supporting a dose-dependent relationship for many prescribing cascades is limited. AIM: The aim was to examine the dose-dependent relationship across a range of index medications related to various potential prescribing cascades, for which the dose-dependent relationship between the index medication and the ADR was not yet known. METHOD: A cohort study was conducted using prescription sequence symmetry analysis with data from over 600 Dutch community pharmacies (2015-2020). We assessed 18 potential prescribing cascades involving ACE inhibitors (ACEIs), statins, antidepressants, dihydropyridine calcium channel blockers (DCCBs), and other drug classes. Index medication doses were categorized based on the World Health Organization (WHO) Defined Daily Dose (DDD) into low (< 0.50 DDD), medium (0.50-1.50 DDD), and high (> 1.50 DDD). The adjusted sequence ratio (aSR) quantified the likelihood of marker drug initiation after vs. before the index drug, corrected for prescribing trends; aSR > 1 indicated a potential prescribing cascade. RESULTS: Twelve of the 18 potential prescribing cascades showed a dose-dependent relationship. All angiotensin converting enzyme inhibitor (ACEI) related cascades demonstrated increasing aSRs with higher doses. ACEIs associated with cough showed increasing aSRs, from 0.86 to 2.09 at low dose to 1.29 to 2.78 at high dose across four cascades. Dose-dependent relationships were also found for statins, antidepressants, and DCCBs. No such relationship was observed for cascades involving proton pump inhibitors, diuretics, and non-steroidal anti-inflammatory drugs. CONCLUSION: Medication dose can play a significant role in potential prescribing cascades. Healthcare professionals should be aware of the potential contribution of dose to prescribing cascade development. The study design precludes causal inference, and confirmation is needed to support further clinical recommendations.
Exploring the applicability of the UK Prescribing Safety Assessment with early career pharmacists as preparation before formal prescribing training.
McMillan F, Wakeling J, Inch J … +5 more , Zlotos L, Maxwell S, Cunningham S, Boyter A, Power A
Int J Clin Pharm · 2026 Jun · PMID 41701302 · Full text
INTRODUCTION: Evidence shows that non-medical prescribing is as effective as medical prescribing in a range of acute and chronic conditions and is well accepted by a diverse range of key stakeholders. Pharmacists in the...
INTRODUCTION: Evidence shows that non-medical prescribing is as effective as medical prescribing in a range of acute and chronic conditions and is well accepted by a diverse range of key stakeholders. Pharmacists in the UK are set to acquire prescribing skills at an earlier stage in their training, with prescribing integrated into the first five years of training and the ability to prescribe from the point of registration from August 2026. Therefore, reliable and reproducible methods of assessing their ability to prescribe safely need to be in place. The UK Prescribing Safety Assessment (PSA) could be a standard method to assess prescribing skills across professions. AIM: To examine the performance of post-registration Foundation pharmacists in the PSA and to explore their views on its suitability as a development tool before enrolling on an independent prescribing (IP) course. METHOD: Pharmacists in Scotland 12 months into the post-registration Foundation programme were invited to sit a 30-question, blueprint-aligned online PSA in September 2024. Mean scores and facility scores were determined. (Facility is a measurement of how easy a question is: higher facility index = question is considered easier; lower facility index = question is considered more difficult). An online evaluation questionnaire gathered feedback on content and appropriateness, analysed using thematic analysis. RESULTS: Seventy-one of 128 (55.5%) eligible pharmacists sat the PSA; mean total score was 72.5% (SD 10.2). Domain-level mean scores (facility) were: Prescription Review 13.51/16 (0.84); Providing Information 4.96/6 (0.83); Dose Calculations 6.85/8 (0.86); Adverse Drug Reactions 6.51/8 (0.81); Drug Monitoring 5.61/8 (0.70); Planning Management 5.01/8 (0.63); Data Interpretation 3.41/6 (0.57); Prescription Writing 26.62/40 (0.67). The questionnaire was completed by 16/71 (22.5%) PSA sitters: most agreed the assessment was appropriate for their stage and helpful preparation for an IP course; some community pharmacists considered hospital-based content less relevant. CONCLUSION: Formative participation in the UK PSA by post-registration Foundation pharmacists provided domain-level performance data and was regarded by respondents as useful preparation for an IP course. Findings suggest potential value in situating the PSA during the Foundation Training Year, with consideration of sector relevance and targeted support for domains such as prescription writing and data interpretation.
Nationwide validation of the CLEO tool to evaluate the relevance of pharmacists' interventions in German hospitals.
Berger V, van der Linde A, Cuba L … +7 more , Horn C, Köster D, Lanzinger H, Wien K, Vo HT, Bedouch P, Langebrake C
Int J Clin Pharm · 2026 Jun · PMID 41701301 · Full text
INTRODUCTION: The clinical relevance of pharmacists' interventions (PIs) is complex to determine. The CLEO tool is a multidimensional scoring system to assess the relevance of PIs across three dimensions: clinical, econo...
INTRODUCTION: The clinical relevance of pharmacists' interventions (PIs) is complex to determine. The CLEO tool is a multidimensional scoring system to assess the relevance of PIs across three dimensions: clinical, economic, and organisational impact. AIM: This study aimed to nationwide validate the CLEO tool by clinical pharmacists in German hospitals using structured and representative clinical cases. METHOD: The German CLEO version was adapted to the German hospital setting and supplemented with practical examples. Fifty up-to-date cases from the inpatient setting were developed in a multistage process following the Identification, Situation, Background, Assessment, Recommendation structure. In the first round, each rater was randomly assigned 20 from the pool of 50 clinical cases, ensuring that all cases were evaluated by multiple raters. After a 14-day washout period, the same 20 cases were reassessed by the same raters. In the second round, all raters from the first round were invited again, and a subset who volunteered assessed another 20 cases after intensified training. Inter- and intra-rater reliability were calculated using Krippendorff's α and the intraclass correlation coefficient (ICC). User feedback was collected through a 16-item questionnaire. RESULTS: A total of 79 pharmacists from 56 hospitals participated in the first round; 27 completed the second round as well. Inter-rater reliability was poor across all three CLEO dimensions (Krippendorff's α < 0.67), both overall and among experienced clinical pharmacists. Intra-rater reliability was good for all dimensions (ICC 0.63-0.74), highest for the clinical dimension (0.74). Most raters (77%) needed less than one minute per case. Overall, the CLEO tool was perceived by users as appropriate, precise, acceptable and feasible (mean score 5.36; 7-point Likert scale; 1 = strongly disagree, 7 = strongly agree). CONCLUSION: Since clinical pharmacy is still a developing discipline in German hospitals, differences in clinical practice and professional expertise complicate the evaluation of PIs. While intra-rater reliability was good, the validation of the CLEO tool in Germany did not achieve satisfactory inter-rater reliability. The CLEO tool may be useful within institutions with shared standards, but broader application across diverse settings in Germany requires additional training, further research and standardisation of clinical pharmacy services.
An online machine learning model for predicting medication adherence in hypertensive patients: data from the China health and retirement longitudinal study (CHARLS).
Zhang H, Sun M, Hou X … +4 more , Zhang J, Zhang J, Ye Y, Yuan H
Int J Clin Pharm · 2026 Jun · PMID 41701300 · Full text
INTRODUCTION: Hypertension, a leading global cause of death with high prevalence and poor control, faces a critical issue of poor medication adherence. Existing predictive models for medication adherence suffer from limi...
INTRODUCTION: Hypertension, a leading global cause of death with high prevalence and poor control, faces a critical issue of poor medication adherence. Existing predictive models for medication adherence suffer from limitations such as small sample sizes, insufficient inclusion of multiple factors, and a lack of nationally representative longitudinal data on the Chinese population. AIM: This study aimed to develop an interpretable machine learning model for predicting medication adherence among Chinese hypertensive patients. METHOD: Using data from the China Health and Retirement Longitudinal Study, we categorized medication adherence as "high" or "low" based on consistency across two survey waves. Predictors included demographics, physical/psychological capability, motivation, and social-environmental factors. After missing data imputation via random forest, feature selection was performed using least absolute shrinkage and selection operator regression. Seven machine learning algorithms were trained and evaluated, with interpretability provided by Shapley additive explanations (SHAP) analysis. A Shiny-based web application was developed for model visualization and functions. RESULTS: Among 2773 hypertensive patients aged ≥ 45 years, 53.2% had low medication adherence. XGBoost performed best (area under the receiver operating characteristic curve = 0.828, accuracy = 0.726, F1-score = 0.713) in the test set. SHAP analysis indicated that better adherence was associated with the presence of multiple chronic conditions, overweight or obesity, cardiometabolic multimorbidity, older age, depression, residence in an urban area, sleep duration exceeding 8 h, a lack of bidirectional financial support, and disability in instrumental activities of daily living. In contrast, residence in the western region, smoking, and being employed were associated with non-adherence. The developed online tool provided real-time, personalized risk assessments, with predictions made interpretable via the SHAP framework to quantify key factors' contributions and offer transparent decision support. CONCLUSION: This study developed an XGBoost machine learning model and online tool to predict medication adherence in Chinese hypertensive patients. The tool provided immediately actionable and transparent risk stratification, enabling targeted intervention. Future research should perform external validation of the model using electronic medical records or objective adherence data, thereby enhancing its generalizability and practical utility.
Correction: Behavioural theories, models and frameworks to underpin clinical pharmacy and pharmacy practice research: guidance from the European Society of Clinical Pharmacy.
Weidmann AE, Cadogan C, Fialová D … +7 more , Hazen A, Henman MC, Okuyan B, Wirth F, Abdi A, Urru SAM, Nørgaard LS
Int J Clin Pharm · 2026 Apr · PMID 41649691 · Full text
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