Clinical Pharmacy[JOURNAL]
Sun
200 papers
European Society of Clinical Pharmacy: 5 steps of medication safety-medication without harm, where are we now?
Weidmann AE, Lutters M
Int J Clin Pharm · 2025 Dec · PMID 41091409 · Publisher ↗
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Population pharmacokinetics of imipenem and target attainment of pharmacokinetic/pharmacodynamic indices in Chinese adults with febrile neutropenia and hematological malignancies.
Rao Q, Zhu H, Jin L … +6 more , Zhu H, Wu F, Zhou J, Zhang J, Wang S, Liu M
Int J Clin Pharm · 2025 Dec · PMID 41085602 · Publisher ↗
INTRODUCTION: Febrile neutropenia (FN) in patients with hematological malignancies is associated with high morbidity and mortality due to bacterial infections, particularly from Gram-negative pathogens. Imipenem is widel...
INTRODUCTION: Febrile neutropenia (FN) in patients with hematological malignancies is associated with high morbidity and mortality due to bacterial infections, particularly from Gram-negative pathogens. Imipenem is widely used in this setting; however, altered pharmacokinetics in these patients may compromise treatment efficacy, necessitating individualized dosing strategies. AIM: This study aimed to develop a population pharmacokinetic model for imipenem in Chinese adult patients with FN and hematological malignancies and to identify optimal pharmacokinetic/pharmacodynamic (PK/PD) targets to guide dosing and predict antimicrobial efficacy. METHOD: A prospective, single-center, open-label study was conducted involving 121 hospitalized patients who contributed 207 plasma samples. Imipenem concentrations were measured by high-performance liquid chromatography. Pharmacokinetic modeling was performed using NONMEM, incorporating patient-specific covariates. Monte Carlo simulations were used to evaluate dosing regimens, and antimicrobial efficacy was assessed based on clinical and microbiological outcomes. The predictive value of PK/PD indices was analyzed using logistic regression and ROC curve analysis. RESULTS: A two-compartment model best described imipenem pharmacokinetics. Creatinine clearance (CLCR), gamma-glutamyltransferase (GGT), and vancomycin (VAN) co-administration significantly influenced imipenem clearance. The final model was: CL (L·h) = 21.36 × (CLCR/110.39) × (GGT/55.4) + VAN × 3.78; V1 = 42.9 L, Q = 3.7 L·h, and V2 = 59 L. The PK/PD index most strongly associated with efficacy was f%T > MIC, with an optimal threshold of 90.48% (AUC = 0.728, P = 0.024). Simulation results suggested that a 4 g·day regimen (1000 mg q6h, 3-h infusion) is optimal for most patients with MIC ≤ 2 mg·L. However, no standard regimen was effective for Pseudomonas aeruginosa or Acinetobacter baumannii at higher MICs. CONCLUSION: This study highlights the importance of individualized dosing in FN patients with hematological malignancies. CLCR, GGT, and VAN co-administration significantly affect imipenem pharmacokinetics. Achieving f%T > MIC of 90.48% is critical for efficacy. Additional agents may be needed for infections caused by highly resistant organisms such as Pseudomonas aeruginosa and Acinetobacter baumannii.
Effects of County Medical Community Central Pharmacy on antibiotic use in primary care: a multicenter quasi-experiment.
Gao T, Huang S, Shen L … +2 more , Yin J, Sun Q
Int J Clin Pharm · 2025 Dec · PMID 41075025 · Publisher ↗
INTRODUCTION: Antimicrobial resistance poses a growing global health threat and is largely driven by the inappropriate use of antibiotics. Primary healthcare institutions, particularly in low-resource settings, often fac...
INTRODUCTION: Antimicrobial resistance poses a growing global health threat and is largely driven by the inappropriate use of antibiotics. Primary healthcare institutions, particularly in low-resource settings, often face challenges, such as limited oversight and irrational prescribing practices. While progress has been made in improving antibiotic stewardship in higher-level hospitals, efforts to optimize prescription in primary healthcare institutions remain insufficient. The County Medical Community Central Pharmacy (CMCP) program was introduced as an integrated intervention to enhance pharmacy services and promote rational antibiotic use through centralized oversight, training, and pharmacist collaboration. AIM: This multicenter quasi-experimental study aimed to evaluate the effectiveness of the CMCP program in reducing antibiotic misuse and improving prescribing rationality in primary healthcare institutions in Shandong Province, China. METHOD: This multicenter quasi-experimental study was conducted between July and December 2023 in six geographically and economically diverse rural regions of Shandong Province. A total of 37 primary healthcare institutions were included, with 25 voluntarily implementing the CMCP program (intervention group) and 12 continuing routine practices (control group). Data were collected at two time points via structured questionnaires and reviews of 100 randomly selected outpatient prescriptions from each primary healthcare institution. A difference-in-differences (DID) regression model was applied to estimate the impact of the intervention on antibiotic usage and irrational prescribing, controlling for institutional and staffing characteristics. RESULTS: Antibiotic usage rates increased in both groups, but to a lesser extent in the intervention group (from 15.726 to 18.732%; P = 0.006) than in the control group (from 17.682 to 26.582%; P < 0.001). DID analysis showed a mitigating effect on antibiotic use (DID coefficient = - 0.061; P = 0.054). Irrational antibiotic use in the intervention group decreased from 50.660 to 27.655% (P < 0.001), whereas it remained largely unchanged in the control group (36.893% vs. 35.238%). CONCLUSION: The CMCP program was effective in curbing unnecessary antibiotic prescriptions and enhancing prescription quality in primary healthcare institutions. These findings support the continued implementation and scale-up of CMCP as a strategy to strengthen antibiotic stewardship at the primary care level in resource-limited settings.
An evaluation of pre-post antimicrobial stewardship healthcare educational intervention studies utilizing the Kirkpatrick model: a scoping review.
Nasr ZG, Said HM, Barakat KR … +3 more , Elwan RM, Maklad A, Nazar ZJ
Int J Clin Pharm · 2025 Dec · PMID 41066036 · Publisher ↗
INTRODUCTION: Antimicrobial stewardship (AMS) education plays a vital role in addressing antimicrobial resistance (AMR), yet its long-term impact on behavior and clinical outcomes remains underexplored. Educational inter...
INTRODUCTION: Antimicrobial stewardship (AMS) education plays a vital role in addressing antimicrobial resistance (AMR), yet its long-term impact on behavior and clinical outcomes remains underexplored. Educational interventions are often assessed through knowledge-based outcomes, with limited evaluation of sustained practice changes or patient-level results, and standardized higher-level outcome measures across diverse healthcare settings. AIM: This scoping review aimed to map pre-post AMS healthcare educational interventions using the Kirkpatrick Model, evaluating their effectiveness across its four levels: reaction, learning, behavior, and results. The goal was to identify trends, highlight gaps, and provide insight into reported outcomes, delivery methods, and evaluation tools, supporting future research and strengthening the evidence base for AMS education. METHOD: This review followed the Joanna Briggs Institute framework. A literature search of nine databases identified studies from 2010 to 2024. Eligible studies included pre-post AMS educational interventions targeting undergraduate students and healthcare professionals (HCPs) and reporting outcomes which were subsequently mapped by the reviewers to the Kirkpatrick Model. Data were categorized by target population, delivery format, and evaluation tools. Narrative synthesis was used to describe trends and relationships. RESULTS: Studies targeted HCPs such as physicians, pharmacists, nurses, and dental professionals, and undergraduate students in pharmacy, medicine, nursing, and dentistry. Sixty-three studies were included. Outcomes were distributed across Level 1 (Reaction) (n = 46, 24%), Level 2 (Learning) (n = 51, 27%), Level 3 (Behavior) (n = 50, 26%), and Level 4 (Results) (n = 45, 23%). While n = 24 (38%) assessed all four levels, another n = 24 (38%) reported mixed or partial levels. Face-to-face or online-only formats achieved Levels 1 and 2. Whereas blended or workplace-integrated interventions more often demonstrated behavior change and clinical outcomes (Levels 3 and 4). Longitudinal follow-up and mixed evaluation tools (e.g., surveys, chart reviews, interviews) supported higher-level impacts. Pharmacy-led, interdisciplinary, and contextually tailored interventions mapped to all levels. CONCLUSION: AMS education often leads to short-term learning gains, but fewer interventions achieve sustained behavior change or measurable clinical outcomes. Blended and practice-integrated formats, paired with long-term evaluation, are key to realizing the full potential of AMS education. Embedding such approaches in undergraduate and professional programs can better prepare the future HCPs to address AMR effectively.
Prevalence and factors associated with anticholinergic medication use in community-dwelling older adults: a systematic review.
Pelen K, Hagenimana WB, Baroud ML … +5 more , Chiu YM, Chebbihi H, Lebel K, Boissy P, Cossette B
Int J Clin Pharm · 2025 Dec · PMID 41066035 · Publisher ↗
INTRODUCTION: Medications with anticholinergic effects are widely used despite the mounting evidence of physical and cognitive impairment associated with their use among older adults. AIM: A systematic review was conduct...
INTRODUCTION: Medications with anticholinergic effects are widely used despite the mounting evidence of physical and cognitive impairment associated with their use among older adults. AIM: A systematic review was conducted to describe the prevalence of anticholinergic medication use in community-dwelling older adults, document the factors associated with their use and describe the most frequently used medication classes. METHOD: MEDLINE, Embase and CINAHL were searched from inception to May 2024. All study designs except case reports and case studies were eligible if they included community-dwelling older adults aged 65 and older and assessed the factors associated with anticholinergic medication use. An open-source artificial intelligence screening tool was used to optimise title and abstract screening. The subsequent review of the full texts of potentially eligible studies and data extraction were conducted in the Covidence systematic review tool using standardised data collection forms. Study quality was assessed with the Newcastle-Ottawa scale. The study selection, data extraction and quality assessment were conducted independently by two reviewers. RESULTS: From 4139 records of interest, the seven selected studies included five cross-sectional and two retrospective studies, published between 2014 and 2021. The risk of bias was assessed to be low in five studies and high in two studies. Greater anticholinergic burden was associated with female sex, lower socioeconomic status, higher co-morbidity score, higher frailty probability, specific diseases, polypharmacy and greater use of healthcare, while increasing age was associated with both increased and decreased anticholinergic burden. Anticholinergic exposure, varied from a low of 6.2% of medical visits in the United States between 2006 and 2015, assessed with the 2015 Beers Criteria and the Anticholinergic Risk Scale, to a high of 72.8% of medication claims (dispensed medications) in South Korea, over the year 2012, assessed with the 2015 Beers Criteria and the Anticholinergic Burden Scale. The use of six different anticholinergic scales and different evaluation periods did not allow a meaningful comparison of the prevalence of anticholinergic exposure across studies. Antidepressants, antihistamines and antimuscarinics were the most common medication classes in the two studies using this classification. CONCLUSION: This systematic review documented key socioeconomic and health status factors to be targeted by interventions aimed at limiting the use of anticholinergic medications in community-dwelling older adults.
Pharmacists' views on barriers and enablers to the implementation of advanced pharmacist prescribing in Scotland: a qualitative study using normalisation process theory.
McLean MA, Forsyth P, Boyter AC
Int J Clin Pharm · 2026 Apr · PMID 41051718 · Full text
INTRODUCTION: Healthcare systems need more professionals able to deliver autonomous holistic advanced care. Exploring pharmacists' views on the implementation of advanced pharmacist prescribing (i.e. prescribing autonomo...
INTRODUCTION: Healthcare systems need more professionals able to deliver autonomous holistic advanced care. Exploring pharmacists' views on the implementation of advanced pharmacist prescribing (i.e. prescribing autonomously in complex, uncertain, or higher-risk situations) will allow stakeholders to reflect on possible changes that may embed and sustain this work. AIM: To explore pharmacists' views on barriers and enablers to the implementation of advanced pharmacist prescribing in Scotland. METHOD: Semi-structured one-to-one interviews were conducted with National Health Service employed pharmacists from across Scotland, recruited via professional networks using purposive sampling to ensure a range of professional backgrounds, geography and prescribing activity. Interviews were developed and analysed using Normalisation Process Theory (NPT), a sociological framework for understanding how new practices become embedded in routine healthcare and analysed using a hybrid deductive/inductive thematic framework analysis approach. RESULTS: Thirteen pharmacists from across Scotland participated in the study. Barriers and enablers to advanced pharmacist prescribing were identified in all NPT constructs (Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring). In responses relating to the Coherence construct, enablers included individual understanding of how advanced pharmacist prescribing differs from other advanced pharmacist tasks, as well as the role of an advanced pharmacist prescriber. Lack of shared understanding emerged as a barrier. Cognitive Participation identified barriers including lack of appropriate roles and training as well as a lack of infrastructure to support advanced pharmacist prescribing. In Collective Action, barriers included lack of confidence in consistent delivery of advanced pharmacist prescribing and resource constraints. Reflexive Monitoring revealed strong individual belief in advanced pharmacist prescribing, but barriers included a lack of multidisciplinary evaluation and a need for service reconfiguration. CONCLUSION: While individual pharmacists were found to be committed to advanced pharmacist prescribing, widespread implementation is hindered by a lack of shared understanding, inconsistent role structures, and limited strategic alignment. These findings offer valuable insight for those with an interest in embedding and sustaining advanced pharmacist prescribing.
Disparities associated with race and ethnicity in pain management: a scoping review.
Patterson D, McGuinness C, Dunne S … +4 more , Kane CI, Wogu LR, Hayden J, Strawbridge J
Int J Clin Pharm · 2026 Apr · PMID 41051717 · Full text
INTRODUCTION: Health inequalities can occur where there are differences in how people are treated with respect to their race and ethnicity. Disparities and systemic inequities in healthcare have led to negative outcomes....
INTRODUCTION: Health inequalities can occur where there are differences in how people are treated with respect to their race and ethnicity. Disparities and systemic inequities in healthcare have led to negative outcomes. Pain management is an area where there are perceived health inequalities. Medicines optimisation is a framework for healthcare provider interventions under four principles to ensure that medicines are used safely and effectively, producing the best possible outcomes for patients. Using this framework allows a systematic and theory-informed identification of areas of care at risk of disparities. AIM: The aim was to assess disparities associated with race and ethnicity in pain management, mapped to the medicines optimisation framework. METHOD: Electronic databases CINAHL, Ovid and Medline were searched from 2012 to 2025. Studies involving pain management, medicine optimisation, ethnicity, ethnic minorities and race were included. Two reviewers independently screened titles, abstracts and full texts. Data were extracted on evidence relating to the application of the four principles of medicines optimisation, and for the presence or absence of disparities in pain management overall. RESULTS: One hundred and eighteen studies were identified that met the inclusion criteria. Eighty-nine (75%) identified pain management disparities in respect to race and ethnicity, with the majority of disparities related to medicine optimisation principle 2 (evidenced based medicine). Disparities identified were discrepancies in the reporting of pain scores, time to pain and pain assessment and discrepancies in the receipt of opioids across all races. Other disparities were, inconsistencies with prescriptions issued at discharge or outpatients, patients' dissatisfaction with pain management. There were less disparities observed in studies that involved children, when managing surgical pain and pain in palliative care and when protocols were used in the management of pain. CONCLUSION: Disparities in pain management associated with patient race and ethnicity are prevalent have decreased over the past decade. Healthcare professionals should seek to understand the patient experience and incorporate protocols/guidelines into their care to promote evidence-based medicine. Further research in wider geographies is required, particularly in medication safety and incorporating medicines optimisation into routine care.
The prevalence of medication-related hospital readmissions after bariatric surgery: a retrospective observational study.
Kingma JS, Loh C, Eland IA … +6 more , van den Broek MPH, Derksen WJM, Knibbe CAJ, Karapinar-Çarkit F, van den Bemt PMLA, Burgers DMT
Int J Clin Pharm · 2026 Apr · PMID 41051716 · Full text
INTRODUCTION: Bariatric surgery may induce changes in the effects of oral medication, which may result in medication related problems. Therefore, tailored pharmacotherapy is necessary for individual patients following su...
INTRODUCTION: Bariatric surgery may induce changes in the effects of oral medication, which may result in medication related problems. Therefore, tailored pharmacotherapy is necessary for individual patients following surgery. In case pharmacotherapy is not adjusted, adverse drug events and even unplanned hospital readmissions may occur. The prevalence of these medication-related readmissions is not known. AIM: The primary objective of this study was to determine the prevalence of medication-related readmissions within two years after bariatric surgery. Secondary objectives were to determine the percentage of potentially preventable medication-related readmissions. The reasons for readmission, the associated medication, and medication errors involved in the potentially preventable readmissions were also determined. METHOD: A retrospective, observational study in a large Dutch teaching hospital was performed. Unplanned readmissions of patients who underwent primary bariatric surgery between January 1, 2018 and August 31, 2020 were included with a follow-up of two years. Records were screened to identify potential medication-related reasons for readmissions. Identified records were independently assessed using adjusted versions of the algorithms of Kramer, Schumock & Thornton for causality and preventability by a doctor and pharmacist. All readmissions assessed as possibly (Kamer scores 0 through 3) or probably (Kramer score 4) related to medication were included. In addition, reasons for readmission, associated medication and medication errors were recorded. Descriptive statistics were used to analyze the data. RESULTS: In total, 606 unplanned readmissions of 356 individual patients were included. Eighty-three of 606 (13.7%, 95% CI 11.1-16.7%) readmissions were identified as medication-related with a median time between index hospitalization and readmission of 152 days (IQR 16-438). Of these readmissions 36 (43.3%) from 32 unique patients were potentially preventable. The most frequently occurring reasons for readmissions were abdominal pain and infections. Medication most frequently associated with readmissions were Proton Pump Inhibitors, opioids and antibiotics. Medication errors involved in the preventable readmissions were most often prescribing errors followed by non-adherence. CONCLUSION: Medication-related readmissions frequently occur after bariatric surgery. More attention is needed for correct pharmacotherapy and patient education in this population.
ESCP Best Practice: Development, implementation and evaluation of a practical risk assessment process for the introduction of new medicines to clinical practice at an Acute Hospital.
Lewis C, Weerasooriya D, Cheng C … +1 more , Dalby M
Int J Clin Pharm · 2025 Dec · PMID 41028659 · Publisher ↗
INTRODUCTION: Incorporating new medications into clinical practice can present potential risks to staff and patients. Risk assessment of new medicines procured into acute hospitals in the United Kingdom varies between or...
INTRODUCTION: Incorporating new medications into clinical practice can present potential risks to staff and patients. Risk assessment of new medicines procured into acute hospitals in the United Kingdom varies between organisations and national guidance is lacking. Existing processes required risk assessment of all new medicines, consuming considerable pharmacist resource. AIM: To rationalise the risk assessment of new medicines at an acute hospital. SETTING: A 1300 bed, multi-site tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: A pharmacy working group, including formulary, governance, medication safety, and clinical leads, developed a rationalised risk assessment process. An initial triage was proposed to evaluate whether a risk assessment was required. Existing risk assessment tools were combined and adapted for use. A New Drug Panel (NDP) of pharmacy leaders was formed to review risk assessments. IMPLEMENTATION: The process was piloted for 6 months; minor modifications were made and it was fully introduced in May 2022. Implementation included governance sign off and training of members of the NDP on utilisation of the tools. EVALUATION: Two years after introduction, 646 requests for new medicines were triaged and 196 (30%) required risk assessment. Fourteen requests were cancelled, so 182 risk assessments were reviewed by the NDP. The NDP recommended an additional 46 mitigations. Trends identified issues with unlicensed medicines, safe administration practices, communication and electronic prescribing. CONCLUSION: A practical risk assessment process reduced risk assessments by 70%, releasing clinical pharmacist time. An expert NDP identified additional mitigations, reducing patient harm and ensuring safe incorporation of medicines into clinical practice.
Impact of Australian home medicines reviews on continuous polypharmacy and associated costs among older women: a cohort study.
Thiruchelvam K, Egan N, Hasan SS … +1 more , Byles J
Int J Clin Pharm · 2025 Dec · PMID 41028658 · Publisher ↗
INTRODUCTION: Medication misadventure is associated with the use of polypharmacy and is highly prevalent in the older population living in the community, especially among women. AIM: This study aimed to determine the imp...
INTRODUCTION: Medication misadventure is associated with the use of polypharmacy and is highly prevalent in the older population living in the community, especially among women. AIM: This study aimed to determine the impact of Home Medicines Reviews (HMRs) on continuous polypharmacy, the prevalence of continuous polypharmacy, and inflation-adjusted differences in costs among women who did and did not receive HMRs. METHOD: The study included 9347 participants from the Australian Longitudinal Study on Women's Health who fulfilled the eligibility criteria from 77-82 years in 2003 to 91-96 years in 2017. Generalised estimating equations were used to estimate the association between HMRs and continuous polypharmacy. Out-of-pocket costs and benefits paid to government were presented as median costs for each participant from 2003 to 2017, alongside interquartile ranges. RESULTS: Only a small percentage of women received HMRs in 2003 (1.14%) but this percentage increased over time to 2017 (3.95%). The prevalence of continuous polypharmacy in 2017 was 39.06% amongst women who received an HMR and 28.05% amongst women who did not receive an HMR. There was evidence for an association between the use of HMRs and continuous polypharmacy in the following calendar year (OR 1.12; 95% CI 1.03, 1.21). There was an increase in out-of-pocket (OOP) medication costs in both women with and without HMRs, with the HMR group demonstrating higher OOP medication costs (AUD$26 to AUD$57) than the non-HMR group (AUD$22 to AUD$50). CONCLUSION: HMRs were associated with a modest increase in the odds of continuous polypharmacy in the subsequent year. Increase in OOP medication costs over time highlights the need to further optimise cost-effective medications for individuals.
ESCP best practice: development of the national methodology for the provision of clinical-pharmaceutical care and its implementation in the healthcare system of the Czech Republic.
Hartinger JM, Tašková I, Gregorová J … +2 more , Slanař O, Fialová D
Int J Clin Pharm · 2025 Dec · PMID 41026336 · Full text
INTRODUCTION: In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important...
INTRODUCTION: In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important which led to extension of pharmacy practice beyond merely drug-oriented pharmacy-based services. AIM: To outline the development, implementation and outcomes of the methodology that established standards for CP practice in the Czech Republic and which contributed to establishing CP as an independent postgraduate specialization with its own workplaces and full-time employment positions. SETTING: Inpatient and outpatient healthcare settings in the Czech Republic. DEVELOPMENT: Legislative changes in 2011 incorporated CP care into the healthcare system and the national CP methodology was published in 2014. Proactive screening of the medication lists and patient healthcare documentation was introduced. Results of CMRs are discussed with attending physicians and the plans for drug therapy adjustment are added to patient documentation. Clinical pharmacists have become standard partners for physicians on medical wards and outpatient facilities. A comprehensive clinical postgraduate training program (fully interlinked with accredited CP wards) has been established to maintain high standards of CP care. IMPLEMENTATION: Based on the CP care methodology approved by professional medical and pharmaceutical societies and accepted by the Ministry of Health and health insurance companies, three inpatient procedures and one outpatient procedure became eligible for reimbursement thus facilitating the further development of CP practice and independent CP departments. Currently, the Czech Republic has 58 CP facilities and nearly 200 specialized clinical pharmacists. EVALUATION: The provision of CP care according to current national guidelines was shown to provide an effective and cost-effective approach by the results of two extensive studies; the calculated economic cost-benefit ratio was determined at 1:3-4.2. The number of clinical pharmacy specialists and facilities is steadily increasing. CONCLUSION: The development of methodological approach accompanied by changes concerning reimbursement in the Czech Republic have led to the establishment of a stable and well-defined environment for clinical pharmacists to become full-time experts in both inpatient and outpatient settings. Clinical pharmacists are now recognized as skilled experts who are respected for their valuable contribution to inter-professional cooperation within medical teams.
Impact of a pharmacist-led elective caesarean section pre-admission clinic on efficiency of pharmacist workflow and patient preparedness for post-operative discharge medication supply: a retrospective observational study.
Lau C, Wardan R
Int J Clin Pharm · 2025 Dec · PMID 41021110 · Publisher ↗
INTRODUCTION: Rapid patient throughput on maternity wards results in pharmacist resources being directed towards discharge processes, primarily focused on patients who have undergone caesarean section (CS) due to their d...
INTRODUCTION: Rapid patient throughput on maternity wards results in pharmacist resources being directed towards discharge processes, primarily focused on patients who have undergone caesarean section (CS) due to their discharge medication requirements. This occurs at the expense of admission processes, including best possible medication history (BPMH) documentation. AIM: To evaluate the impact of a pharmacist-led elective caesarean section (ELCS) pre-admission clinic (PAC) on efficiency of pharmacist workflows, BPMH documentation, and patient preparedness for analgesic supply on discharge. METHOD: A retrospective observational study was undertaken at an Australian tertiary obstetric public hospital where an ELCS PAC was introduced through reallocation of clinical pharmacist resources. The PAC pharmacist attempted telephone contact with all patients scheduled for ELCS, within 1 week before surgery. The pharmacist obtained and documented a BPMH, and where appropriate, encouraged patients to purchase paracetamol and ibuprofen pre-operatively. Data were collected from electronic medical records and dispensing records for 1 month pre- and 2 months post-implementation, including: CS classification (elective or emergency); whether PAC was completed and timing of completion before CS; number of BPMH documented per day; timing of BPMH completion after CS; pharmacist staffing levels; and whether paracetamol and ibuprofen were dispensed on discharge. RESULTS: During the 3-month study period, 1863 patients were admitted to the maternity wards, with 654 patients birthing via CS. Elective CS accounted for 43.3% (283/654) of CS deliveries, with 57.2% (162/283) of these patients reviewed in ELCS PAC. Post-implementation, workflow efficiency increased, with 19.9% more BPMH documented per pharmacist per day (3.87 vs 4.64, p = 0.012). Overall BPMH completion increased for all patients who underwent CS (83.7% vs 93.3%, p < 0.001). Timeliness of BPMH documentation improved for ELCS patients, with higher BPMH completion on the day of surgery (19.8% vs 34.5%, p = 0.019). Patients reviewed in PAC were less likely to require discharge supply of paracetamol (52% vs 37.1%, p = 0.031) and ibuprofen (80% vs 56.4%, p < 0.001). CONCLUSION: Reallocation of resources to introduce the ELCS PAC enhanced workflow efficiency and BPMH completion. Patient preparedness improved, with reduced reliance on hospital supply of simple analgesics on discharge.
Pharmacovigilance assessment of drug-induced aplastic anemia: analysis of the FDA adverse event reporting system.
Zhang F, Wang P, Liu X … +2 more , Chen Y, Yang J
Int J Clin Pharm · 2025 Dec · PMID 41021109 · Publisher ↗
INTRODUCTION: Aplastic anemia is a rare but life-threatening disorder often triggered by drug exposure. Given its low incidence, identifying drug-associated risks requires large-scale real-world data. The FDA Adverse Eve...
INTRODUCTION: Aplastic anemia is a rare but life-threatening disorder often triggered by drug exposure. Given its low incidence, identifying drug-associated risks requires large-scale real-world data. The FDA Adverse Event Reporting System (FAERS) is a valuable pharmacovigilance resource for detecting rare and serious drug reactions. AIM: This study aimed to evaluate the association between a broad range of medications and the risk of drug-induced aplastic anemia using FAERS data obtained through disproportionality analysis, regression modeling, time-to-onset analysis, and predictive modeling. METHOD: A retrospective pharmacovigilance study was conducted using FAERS reports from January 1, 2004, to December 31, 2024. Aplastic anemia cases were identified using five Preferred Terms from the Medical Dictionary for Regulatory Activities. Signal detection was performed using ROR, PRR, BCPNN, and MGPS. Logistic regression analyses with weighted LASSO variable selection identified the independent risk factors. A predictive model was developed and validated using receiver operating characteristic (ROC) curve analysis. Time-to-onset (TTO) and pharmacological classification were also conducted. RESULTS: A total of 4493 drug-related aplastic anemia cases were identified. Disproportionality analysis revealed 593 significant drugs, of which 16 met stringent inclusion criteria for multivariate analysis. Temozolomide was most frequent (n = 148), followed by methotrexate (n = 126), busulfan (n = 100), and linezolid (n = 90). Other common drugs included ribavirin, nivolumab, pembrolizumab, fludarabine, carboplatin, etoposide, and cyclophosphamide. Male sex was a significant risk factor (OR = 1.63), while older age (> 42 years) and higher weight (> 60 kg) were protective. The predictive model showed good discrimination (AUC = 0.777). Median TTO was 299 days, with most cases occurring within six months. The 16 implicated drugs fell into categories including antineoplastics, antibacterials, antivirals, antiepileptics, and antigout agents. CONCLUSION: This study identified key drugs and patient factors associated with aplastic anemia, providing a data-driven framework for pharmacovigilance. These findings support early detection and informed clinical and regulatory decision making, but prospective studies are required to confirm causality and refine individualized risk predictions.
Pharmacists' views on potential non-medical prescribing for pharmacists in Sweden: a nationwide survey study.
Ljungdahl N, Kälvemark-Sporrong S, Tranberg A … +1 more , Kempen T
Int J Clin Pharm · 2026 Apr · PMID 41014469 · Full text
INTRODUCTION: The role of pharmacists in healthcare has evolved, and in several countries, they have prescribing rights. Currently, pharmacists in Sweden do not have the right to prescribe. Exploring their views on pharm...
INTRODUCTION: The role of pharmacists in healthcare has evolved, and in several countries, they have prescribing rights. Currently, pharmacists in Sweden do not have the right to prescribe. Exploring their views on pharmacist prescribing may be a critical step toward advancing the profession and improving patient care. AIM: To explore pharmacists' views on potential pharmacist prescribing in Sweden. METHOD: An online questionnaire about pharmacist prescribing was distributed via email to Swedish pharmacists who are members of the Swedish Pharmacists Association (n = 5597). The questionnaire covered demographic information and statements about predefined prescribing models, preconditions, benefits, and risks associated with pharmacist prescribing. Each statement had a 4-point agreement Likert scale response option with additional "Don´t know/no opinion" option. Data were collected in May 2024. Closed-ended questions were analyzed descriptively, while open-ended questions were categorized and summarized. RESULTS: Of the 395 respondents (7% response rate), 75.2% (n = 297) agreed with introducing at least one model of pharmacist prescribing. The two models that received the most support were "Prescribing based on an agreement or collaboration with one or more independent prescribers" (50.1%; n = 198) and "Independent, but limited prescribing rights" (48.1%; n = 190). All predefined preconditions were important for the respondents; their education (97.2%, n = 384) was identified as the most important factor. Overall, respondents agreed more with the benefits than the risks of introducing pharmacist prescribing. Most frequently (somewhat) agreeing that an enhanced professional position of pharmacists in health care was a key benefit (91.1%; n = 369), and the risks that respondents most (somewhat) agreed with included increased workload (80.8%; n = 319) and the conflict of interest involved in pharmacists acting as both prescribers and dispensers (60.8%; n = 240). CONCLUSION: The majority of respondents supported introducing at least one pharmacist prescribing model in Sweden. These findings provide valuable insights for policymakers considering an expanded role for pharmacists in Sweden, which may include a variety of extended professional roles in different settings.
Implementation fidelity of a pharmacist-led intervention program to improve a high serum phosphate concentration in haemodialysis patients: a mixed-methods study.
van den Oever FJ, Vasbinder EC, Schrama YC … +3 more , van Gelder T, van den Bemt PMLA, Hugtenburg JG
Int J Clin Pharm · 2026 Apr · PMID 41003963 · Full text
INTRODUCTION: The PIDO-P (Pharmacist Intervention and Dose Optimization of Phosphate-binding medication) was designed to improve high serum phosphate concentration (SPC) in haemodialysis patients with a high pill burden...
INTRODUCTION: The PIDO-P (Pharmacist Intervention and Dose Optimization of Phosphate-binding medication) was designed to improve high serum phosphate concentration (SPC) in haemodialysis patients with a high pill burden of phosphate-binding medication (PBM). This intervention consisted of three pharmacist-patient consultations, in which barriers to adherence to PBM were addressed and PBM dose was reduced. Although this intervention improved PBM adherence, SPC remained high. AIM: To determine the implementation fidelity (IF) of the PIDO-P intervention. METHOD: This mixed-methods implementation study had a convergent design using the intervention mixed-methods framework. Data from all patients included in the PIDO-P study (n = 75) were used to assess IF using Carroll's Framework for IF. Six key components were identified [A: identifying barriers, B: assessing medication-related health literacy; C: providing information and advice, D: discussing patient preferences, E: providing a summary/dose reduction advice, F: performing a follow-up consultation]. Two researchers independently rated the extent to which the different aspects of the key intervention components were carried out as planned. Data sources were research administration (quantitative and qualitative), oral surveys from patients (quantitative and qualitative) and pharmacists (quantitative), semi-structured interviews with six patients, two pharmacists, and three prescribers (qualitative), and electronic medical records (quantitative). Data from semi-structured interviews were thematically analysed according to Braun and Clarke with Atlas.ti, quantitative data were analysed using descriptive statistics in SPSS. Where possible, data integration was performed. RESULTS: The adherence to the intervention was moderate to high, except for the screening process. The written summary was delivered to a moderate degree (65.3%). Facilitation strategies were helpful, and pharmacists considered the intervention not too complex. The quality of delivery and participant responsiveness were good. Four IF themes could be identified: (1) patient knowledge and understanding, (2) correct use of PBM, (3) PBM treatment individualisation, (4) relationship between pharmacist and patient. To increase its feasibility, the intervention should be targeted at patients with SPC > 2.0 mmol/L, and patient selection should be improved. CONCLUSION: The lack of effect of the PIDO-P intervention on SPC cannot be explained by low IF. Targeting patients with higher SPC and improving patient selection may increase its effectiveness.
Association of potentially inappropriate medications with rehospitalisation and death within three months in older patients: a systematic review and meta-analysis.
Muzzarelli I, Neumeier VI, Gagesch M … +2 more , Rösler W, Burch AR
Int J Clin Pharm · 2026 Apr · PMID 40996586 · Full text
INTRODUCTION: Potentially inappropriate medications (PIMs) are medications with an unfavourable risk-benefit profile for patients aged ≥ 65 years. Currently, several screening tools are available and are used in clinical...
INTRODUCTION: Potentially inappropriate medications (PIMs) are medications with an unfavourable risk-benefit profile for patients aged ≥ 65 years. Currently, several screening tools are available and are used in clinical practice to identify PIMs. AIM: Our objective was to systematically synthesize the available evidence on the association between potentially inappropriate medications (PIMs), as identified by various screening tools including STOPP/START and the Beers Criteria, and the outcomes of rehospitalization and mortality within three months in older patients. METHOD: Adhering to Cochrane standards, we conducted a systematic review and meta-analysis to investigate the outcomes of patients aged 65 years and older, comparing those with at least one PIM identified by any explicit screening tool to those without PIMs. Primary outcomes were readmission and/or death within three months. The databases of Embase, MEDLINE, and CENTRAL were searched for retrospective as well as prospective observational studies published between 1991 and May 17 2024. The risk of bias was assessed for all included studies. RESULTS: In total, 1,642 studies were identified through the systematic search. Nine observational studies were included in this review. Our analysis revealed a statistically significant association between the overall presence of PIMs and rehospitalisation; odds ratio (OR) 1.47 [95% confidence interval (CI) 1.02 to 2.13, p = 0.045]. While stratification according to STOPP/START criteria yielded a statistically significant OR of 1.84 [CI 1.08 to 3.12, p = 0.024; n = 5], no statistically significant difference was seen according to Beers list [OR 1.25, CI 0.86 to 1.81, p = 0.235; n = 5]. Furthermore, no significant association was found between PIMs and mortality in either the overall analysis or the stratification according to the Beers and STOPP/START criteria. The risk of bias in the included studies was moderate to serious, and the certainty of evidence was very low. CONCLUSION: The use of PIM screening tools during medication evaluations may reduce the risk of rehospitalisation and potentially lower mortality in older patients. However, further studies are warranted to confirm the association with adverse outcomes.
Development of an interpretable machine learning model to predict short-term bleeding risk in patients receiving dual antithrombotic therapy following cardiac surgery.
Han H, Zhang J, Wang X … +2 more , Ge W, Qu JZ
Int J Clin Pharm · 2026 Apr · PMID 40991170 · Full text
INTRODUCTION: Bleeding is a serious complication in cardiac surgery, especially among patients receiving combined anticoagulant and antiplatelet therapy. Current prediction models rarely include those undergoing both val...
INTRODUCTION: Bleeding is a serious complication in cardiac surgery, especially among patients receiving combined anticoagulant and antiplatelet therapy. Current prediction models rarely include those undergoing both valve surgery and coronary artery bypass grafting (CABG) or account for postoperative factors and dual antithrombotic therapy, limiting their clinical utility. AIM: This study aimed to develop and validate machine learning models for the individualized prediction of bleeding events within three months after discharge in patients receiving warfarin plus aspirin following combined CABG and valve surgery. METHOD: Data from 499 adult patients who underwent cardiac surgery and received combined anticoagulant and antiplatelet therapy between June 2019 and December 2023 were retrospectively analyzed. Patients were randomly assigned to training (70%) and internal validation (30%) cohorts. Eleven key bleeding predictors were selected using the least absolute shrinkage and selection operator (LASSO) method. Seven machine learning algorithms, logistic regression, decision tree, random forest (RF), support vector machine, eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM) and k-nearest neighbors, were subsequently trained using these predictors. The model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and Brier score. External validation was performed in a temporally independent cohort of 93 patients. Model interpretability was assessed through Shapley Additive Explanations (SHAP), which were used to visualize both global and individual risk contributions. RESULTS: Eleven clinical variables, including anemia, diabetes, heart failure, atrial fibrillation, age, postoperative drainage, previous bleeding, stroke, body mass index, estimated glomerular filtration rates and intraoperative bleeding, were identified as predictors. Among the models, the RF algorithm demonstrated the best performance (internal validation: AUC = 0.85, accuracy = 0.80, sensitivity = 0.75, specificity = 0.82, PPV = 0.64, NPV = 0.89 and F1-score = 0.69). In the external validation, the RF model maintained strong performance (AUC = 0.82, accuracy = 0.73, sensitivity = 0.76, specificity = 0.72, PPV = 0.44, NPV = 0.92 and F1-score = 0.56). Decision curve analysis confirmed the clinical utility of the model, and SHAP visualizations provided a transparent interpretation of individualized bleeding risks. CONCLUSION: This study demonstrates the feasibility and clinical utility of ML-based prediction of short-term bleeding risk in cardiac surgery patients on dual antithrombotic therapy. The RF model enables individualized risk assessment, with SHAP interpretation supporting clinical applicability.
Climate conscious pharmacy practice: a qualitative interview study with pharmacists in the context of respiratory health care.
Cameron R, Alhazmi Y, Kwok PCL … +1 more , Saini B
Int J Clin Pharm · 2026 Apr · PMID 40986129 · Full text
INTRODUCTION: Climate change negatively impacts millions of people with respiratory conditions. On the other hand, respiratory health care negatively impacts climate change given that mainstay inhaler treatment poses its...
INTRODUCTION: Climate change negatively impacts millions of people with respiratory conditions. On the other hand, respiratory health care negatively impacts climate change given that mainstay inhaler treatment poses its own environmental risk. Pharmacists are frequently involved in managing chronic respiratory conditions including counselling on inhaler use, thus they are well-positioned to reduce associated environmental impacts, however this role is unexplored. AIM: This study aimed to investigate Australian pharmacists' perceptions on the impact of climate change on respiratory health and the impact of respiratory health care provision or treatment use on the environment. We also aimed to explore pharmacists' views about their potential roles in promoting sustainable respiratory health care. METHOD: Following approval from an institutional ethics review committee, qualitative semi-structured interviews were conducted with consenting pharmacists who had at least one year of post-registration experience and were currently working in any clinical setting. The interviews explored pharmacists' general perspectives on climate change before delving specifically into respiratory health care. Interviews were recorded, transcribed verbatim and subjected to an inductive thematic analysis within a constructivist paradigm. RESULTS: Thirty-two participants (72% female, 28% male) were interviewed. Three key themes were derived from the analysis: (1) environment considerations as an afterthought, (2) linking environment to respiratory care, and (3) working towards sustainable practice. Patient health was expressed as the main concern in clinical practice, with environmental considerations reported as lower priority. Most participants saw their role as being the management of patients 'respiratory symptom control'. Barriers to climate action described by participants included prescriber and patient acceptance of recommendations and concerns about counselling patients on switching to low carbon footprint inhalers being beyond their current scope of practice. Participants recommended multi-stakeholder collaboration and inclusion of this topic in pharmacy curricula as key factors to address to build sustainable respiratory health care provision. CONCLUSION: Pharmacists' main focus in respiratory health care provision is on clinical rather than environmental change issues. Many barriers such as concerns about patients' acceptance of sustainability related advice or counselling, and limited training on the topic were cited. Further research should explore best ways to address these issues, preferably in co-design practices with stakeholders.
Economic evaluation of hepatitis B screening in low- and middle-income countries: a systematic review.
Nguyen HT, Nguyen PTL, Ngo TV … +2 more , Dang AHC, Nguyen HT
Int J Clin Pharm · 2025 Dec · PMID 40982118 · Publisher ↗
INTRODUCTION: Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essen...
INTRODUCTION: Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essential for reducing infection rates. AIM: To synthesize economic evaluation evidence of hepatitis B (HBV) screening strategies in LMICs. METHOD: A comprehensive search of PubMed, Embase, and Scopus was conducted up to August 08, 2024. All types of economic evaluations comparing HBV screening strategies in LMICs were included. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and the Consensus Health Economic Criteria (CHEC) extended checklists. The protocol was registered in PROSPERO (CRD42023472855). RESULTS: Twenty-four studies were included, with 11 focusing on pregnant women, 7 on adults, and others on children or infants. Most studies were from Asia, primarily China, using model-based analyses and a provider cost perspective. Regarding antenatal screening, adding tenofovir prophylaxis for HBsAg-positive pregnant women was more cost-effective than intervention solely targeting infants. In adults, a combination of screening and treating eligible cases or immunizing non-infected individuals was more cost-effective than no screening, particularly among young adults aged 21 to 39. Notably, expanding HBV screening to the general population was more cost-effective than limiting screening to high-risk groups. In children, screening plus re-vaccination of infants or 10-year-olds born to HBV-infected mothers was cost-effective compared to no re-vaccination. CONCLUSION: Overall, more comprehensive interventions were generally cost-effective across all populations. The most cost-effective strategies included tenofovir prophylaxis for HBV-infected pregnant women, screening with treatment and/or vaccination in adults, and screening combined with re-vaccination in children.
Tele-triaging: a qualitative study exploring pharmacists' clinical decision-making in a Poisons Information Centre using interviews and a clinical vignette.
Koh QX, Wise S, Debono D … +2 more , Roberts DM, Carland JE
Int J Clin Pharm · 2026 Apr · PMID 40974516 · Full text
INTRODUCTION: Specialists in Poisons Information (SPIs), most of whom are pharmacists, work in Australian Poisons Information Centres (PICs) and provide telephone-based triage (tele-triage) and management advice for pois...
INTRODUCTION: Specialists in Poisons Information (SPIs), most of whom are pharmacists, work in Australian Poisons Information Centres (PICs) and provide telephone-based triage (tele-triage) and management advice for poison exposures. Australian PICs answer calls from the public and healthcare practitioners and are considered an emergency telephone service. While tele-triaging and clinical decision-making have been explored in other health professions, limited studies are available exploring how pharmacists apply their knowledge to make clinical decisions in a busy tele-triage emergency setting. AIM: To explore how SPIs apply clinical judgement in tele-triage and to understand the factors that shape their decision-making. METHOD: This study represents the second, qualitative phase of an exploratory sequential mixed-methods design examining calls related to unintentional poisoning exposures in older adults (≥ 75 years) to the New South Wales PIC. Semi-structured interviews with 12 SPIs were conducted, supported by clinical vignettes and analysed using an inductive approach. Thematic analysis was combined with process mapping to describe the decision-making process. RESULTS: SPIs followed a flexible, three-phase process of information gathering, risk stratification, and management decision-making. This process was iterative, shaped by experience, clinical knowledge, and the urgency of the call. Decision-making relied on the ability to balance known and uncertain risks, interpret caller information, and assess social and clinical context. While structured guidelines supported consistency, SPIs emphasised the importance of clinical autonomy, particularly in complex cases. A strong collegial culture and peer learning were central to developing decision-making skills. Time pressure and documentation requirements created tensions, highlighting the need to align workflows with clinical priorities. CONCLUSION: SPI decision-making is a dynamic, context-dependent process that combines clinical expertise, guideline use, and real-time judgement. Findings have implications for SPI training, documentation systems, and the design of telehealth services involving complex risk assessment.
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