Clinical Pharmacy[JOURNAL]
Sun
200 papers
Validation of an updated French national tool for reporting pharmacist interventions for all healthcare products.
Toth R, Martin E, Salomez-Ihl C … +22 more , Bourdelin M, Boyer J, Chasseigne V, Drancourt P, Dupuis A, Figeac C, Fresselinat A, Genay S, Germe AF, Germon L, Gravoulet J, Janoly-Dumenil A, Juste M, Le Du I, Masse M, Mongaret C, Nativel F, Perrey J, Rousseliere C, Schmitt D, Bedouch P, Décaudin B
Int J Clin Pharm · 2026 Jul · PMID 42400770 · Publisher ↗
INTRODUCTION: In France, two validated tools (collectively referred to as "Act-IP©") are commonly used to report pharmacist interventions in both community and hospital pharmacy settings. These tools were designed primar...
INTRODUCTION: In France, two validated tools (collectively referred to as "Act-IP©") are commonly used to report pharmacist interventions in both community and hospital pharmacy settings. These tools were designed primarily for drug-related pharmacist interventions and are less suited to those related to medical devices. To address this limitation, the French Clinical Pharmacy Society and the French Medical Device Pharmacy Society are jointly developing a rating tool that encompasses all healthcare products. AIM: To assess inter-rater agreement for "product-related problem" and "pharmacist intervention" items in a revised version of the Act-IP© during validation by internal and external panels and to evaluate the tool's feasibility and acceptability. METHOD: The revised Act-IP© was based on two previously validated tools; items were revised or added to encompass interventions involving medical devices and drugs. Six expert hospital pharmacists were recruited for the internal validation, and pharmacists attending a national congress were recruited for the external validation. In both validation processes, 60 scenarios had to be rated using the new tool. Each scenario included a case report, a product-related problem, and the corresponding pharmacist interventions. The Clinical, Economic, and Organizational Scale was also used to rate the impacts of each pharmacist intervention. Inter-rater agreement was evaluated using Fleiss's kappa (κ, interpreted according to Landis and Koch's conventions). RESULTS: The revised Act-IP© included 11 product-related problem items (10 revised and one new) and eight pharmacist intervention items (5 revised and one new). In the internal validation, the mean κ values were 0.63 for product-related problems and 0.77 for pharmacist interventions. In the external validation, the mean κ values were lower: 0.42 for product-related problems and 0.52 for pharmacist interventions; this reflecting time constraints, real-world assessment conditions, and greater variability among raters. The level of inter-rater agreement for the Clinical, Economic, and Organizational Scale was low and - despite the tool's usability and applicability - highlighted variability in the raters' judgements. CONCLUSION: The present findings validate the revised Act-IP© for reporting pharmacist interventions. Further work is needed to optimize the tool's implementation and develop specific training programs for hospital pharmacists.
Correction: Anticholinergic burden and health‑related quality of life among adult patients in a resource‑limited setting: a cross‑sectional study.
Gebreyohannes EA, Shibe BS, Taye WA … +7 more , Lee K, Abdela OA, Ayele EM, Belachew EA, Mengistu SB, Myint PK, Soiza RL
Int J Clin Pharm · 2026 Jul · PMID 42397493 · Publisher ↗
Abstract loading — click title to view on PubMed.
Exploring hospital pharmacist perspectives on ethical considerations from automated patient prioritisation: a qualitative study.
Clifford D, Wall A, Kurdi A … +1 more , Bennie M
Int J Clin Pharm · 2026 Jul · PMID 42390696 · Publisher ↗
INTRODUCTION: The use of Hospital Electronic Prescribing and Medicines Administration (HEPMA) data in automated patient prioritisation (APP) tools is an emerging area of interest within pharmacy practice and research. As...
INTRODUCTION: The use of Hospital Electronic Prescribing and Medicines Administration (HEPMA) data in automated patient prioritisation (APP) tools is an emerging area of interest within pharmacy practice and research. As the Scottish Government continues to invest in digital transformation across health and social care, pharmacy professionals are increasingly required to adapt to new technologies whilst maintaining high standards of patient care. APP tools offer the potential to enhance operational efficiency and support clinical decision making. However, despite growing implementation internationally, there is a scarcity of published research exploring the ethical considerations associated with use. AIM: To explore hospital pharmacists' perspectives of ethical considerations from APP tool use prior to adoption in the hospital pharmacy setting. METHOD: Two focus groups were conducted with a total of 12 hospital pharmacists (Pharmacist Team Manager n = 2, Advanced Pharmacist n = 5, Specialist Pharmacist n = 3, Pharmacist n = 2) from a Scottish Health Board prior to the implementation of APP using the 'CoRE-Values' ethical decision-making framework, with the aid of a clinical vignette for context. Focus group transcripts were analysed thematically with the four domains of the framework as mapped themes. RESULTS: Participants considered the use of APP to be a fair and pragmatic approach to managing daily workload, enabling pharmacy teams to focus on patients most at risk of medication related harm. However, professional judgement remains essential when interpreting APP outputs, and caution must be exercised to avoid an overreliance on automation. The clinical rules underpinning APP must be regularly reviewed to ensure alignment with current practice and emerging evidence. While complete visibility of high-risk patients offers significant clinical value, it may also expose limitations in workforce capacity. Participants noted that this visibility could be leveraged to support business case development to secure further staff resource and/or service transformation. CONCLUSION: APP use can support clinical decision making by directing pharmacy staff to patients at risk of medication related harm in hospitals, but ethical concerns can arise if organisations do not give due consideration to these issues prior to adoption.
Attitudes of healthcare professionals towards the use of parenteral methotrexate in rheumatoid arthritis patients: a qualitative study.
Tan JM, Chai WC, Ailabouni N … +3 more , Proudman SM, Wiese MD, Reeve E
Int J Clin Pharm · 2026 Jun · PMID 42377857 · Publisher ↗
INTRODUCTION: Methotrexate is a cornerstone disease-modifying antirheumatic drug for rheumatoid arthritis (RA), effectively controlling disease activity and reducing cardiovascular mortality. Despite its efficacy, parent...
INTRODUCTION: Methotrexate is a cornerstone disease-modifying antirheumatic drug for rheumatoid arthritis (RA), effectively controlling disease activity and reducing cardiovascular mortality. Despite its efficacy, parenteral methotrexate, which offers higher bioavailability, faster response, and fewer gastrointestinal side effects compared to oral administration, remains underutilized in clinical practice. Understanding the factors influencing its utilization is critical to improving RA management. AIM: To explore the barriers and enablers towards using parenteral methotrexate in rheumatoid arthritis patients from the perspective of Australian healthcare professionals (HCPs). METHOD: A qualitative study was conducted using semi-structured interviews between May and August 2022. Participants were recruited via advertising and snowballing. The Theoretical Domains Framework was used to guide the development of the interview guide and data analysis (directed content analysis), supplemented by conventional content analysis (inductive content analysis) to identify emergent themes. RESULTS: Nineteen HCPs (57.9% male, 42.1% female, 63.2% with more than 10 years of experience) were interviewed, including 14 rheumatologists, 3 pharmacists and 2 nurses. Findings related to domains "environmental context and resources", "social influences" and "skills" were frequently identified, whereas the domains "intention", "reinforcement" and "emotion" were least reported. The most prominent enablers related to HCPs' knowledge and skills. Necessary skills were grouped into communication, logistical planning, and patient selection. Other enablers included the accessibility of injection support services, availability of prefilled syringes and online resources for patients ("environmental context and resources") and social influences. The most common identified barriers related to the logistics of implementing parenteral methotrexate. Other barriers included issues with the Occupational Health and Safety guidelines, time constraints ("environmental context and resources"), concerns about patients withdrawing methotrexate from the vial ("emotion") and patients' low acceptability or affordability of the injectable medication ("social influences"). CONCLUSION: Our findings suggest that training and guidance on selecting appropriate patients, utilization of systems to support education of patients and to minimize occupational exposure, and availability of patient-friendly devices would support greater implementation of parenteral methotrexate in practice.
Patient perspectives and experiences of collaborative pharmacist prescribing in the hospital inpatient setting: a cross-sectional survey.
Amer H, Marotti S, Johnson J … +6 more , Widagdo I, Burns K, Goldsworthy S, Hossin R, Astley M, Ellett LK
Int J Clin Pharm · 2026 Jun · PMID 42364068 · Publisher ↗
INTRODUCTION: Collaborative pharmacist prescribing in hospitals involves pharmacists, medical doctors, and patients working together to develop medicine plans that support shared decision-making and underpin pharmacist p...
INTRODUCTION: Collaborative pharmacist prescribing in hospitals involves pharmacists, medical doctors, and patients working together to develop medicine plans that support shared decision-making and underpin pharmacist prescriptions. Shared decision-making is a process in which clinicians and patients make treatment decisions together, ensuring they reflect patient preferences and understanding. However, little is known about patient perspectives and experiences with collaborative pharmacist prescribing, particularly related to shared decision-making, in the inpatient hospital setting. AIM: To examine patient perspectives and experiences of collaborative pharmacist prescribing in the hospital inpatient setting. METHOD: A cross-sectional survey was conducted across four hospitals in South Australia. Eligible inpatients were aged ≥ 18 years and provided informed consent. The primary outcome was patient perspectives of collaborative pharmacist prescribing and experiences during medicine prescribing as an inpatient. Results were stratified by the type of prescribing model (collaborative pharmacist prescribing vs. medical prescribing) received by the patient during their admission. Free-text responses were thematically analysed using Braun and Clarke's framework. Likert scale responses were summarised using descriptive statistics, and sub-group analysis compared categorical variables between groups. RESULTS: Responses were received from 200 patients (100 who received collaborative pharmacist prescribing and 100 who received medical doctor prescribing). Overall, patients had a median age of 72 years and just over half were female. Qualitative analysis found that all respondents trust pharmacists' expertise and ability to collaboratively prescribe. Patients in both groups perceived benefits of collaborative pharmacist prescribing including enhanced interprofessional communication, reductions in medication errors, and a better understanding of their medicines. These findings reinforced the quantitative results, with a higher proportion of patients who received collaborative pharmacist prescribing reporting feeling very or extremely involved in medicine decisions compared to patients who received medical prescribing (60% vs. 14%, p < 0.001). CONCLUSION: Collaborative pharmacist prescribing enhances shared decision-making by actively involving patients in discussions about their medicines. It improves patients' understanding of their medicines, which supports safer and more informed treatment decisions. These findings support wider adoption of collaborative pharmacist prescribing to improve patient-centered care in hospitals.
Factors related to community pharmacists' intention to provide collaborative deprescribing service for fall-risk medications in older adults: a factorial and theory-based cross-sectional study.
Sayın Z, Cebeci IA, Sancar M … +1 more , Okuyan B
Int J Clin Pharm · 2026 Jun · PMID 42334751 · Publisher ↗
INTRODUCTION: Collaborative deprescribing of fall-risk-increasing medication by community pharmacists and family physicians can reduce falls in older adults. No such exists in Türkiye. AIM: To identify factors related to...
INTRODUCTION: Collaborative deprescribing of fall-risk-increasing medication by community pharmacists and family physicians can reduce falls in older adults. No such exists in Türkiye. AIM: To identify factors related to community pharmacists' intention (1) to provide collaborative deprescribing service for fall-risk medications in older adults, and (2) to discuss older adults' potential fall-risk medications with the family physician. METHOD: In this cross-sectional study, a web-based survey was conducted between November 2023 and February 2024 among Turkish community pharmacists recruited using convenience sampling. The questionnaire included items at the respondent level (including a theory of planned behaviour-based questionnaire) and the vignette level (including factorial vignettes). The factors related to their intention to perform two behaviours were evaluated: (1) providing collaborative deprescribing service and (2) discussing older adults' potential fall-risk medications with the family physician. Multilevel linear mixed-effects models were used. RESULTS: Based on responses from 398 community pharmacists (response rate of 93.2%), the intention to provide collaborative deprescribing service was related to their knowledge test score, self-reported rate of older adults served in the community pharmacy (61-80% category), their scores of subjective norm, self-efficacy, and perceived behavioural control (p < 0.05). Community pharmacists' intention to discuss older adults' potential fall-risk medications with the family physician was related to being male, younger age, their experience on patient-centred services, their higher scores of subjective norm, self-efficacy, and perceived behavioural control, and lower scores of attitude (p < 0.05). At vignette level, both intentions were linked to having a history of falls and the number of patients waiting in the community pharmacy (p < 0.05). CONCLUSION: A collaborative deprescribing service for fall-risk-increasing medications in older adults could be implemented by addressing key determinants of community pharmacists' intention at both respondent and vignette levels, including subjective norm, self-efficacy, perceived behavioural control, attitude, workload-related factors, and patient clinical history.
European Society of Clinical Pharmacy: bridging gaps-clinical pharmacy in the digital transition of care.
Pereira Guerreiro M, Paulino E
Int J Clin Pharm · 2026 Jun · PMID 42334750 · Publisher ↗
Abstract loading — click title to view on PubMed.
Development and reliability testing of BRANT-MERQS-2A: A quality assessment tool for medication review type 2a reports.
Tobback E, Peeters A, Basir N … +6 more , Van Haver E, Quayhackx J, Brumer M, Woltersdorf R, De Meyer GRY, De Loof H
Int J Clin Pharm · 2026 Jun · PMID 42334749 · Publisher ↗
INTRODUCTION: Medication reviews (MRs) are increasingly implemented to optimize medication use and address drug-related problems in patients with complex pharmacotherapy, with medication review type 2a (MR2a) representin...
INTRODUCTION: Medication reviews (MRs) are increasingly implemented to optimize medication use and address drug-related problems in patients with complex pharmacotherapy, with medication review type 2a (MR2a) representing an intermediate format involving a pharmacist-led structured assessment with patient interview, based on clinical and medication data, without direct prescriber interaction. Despite their widespread implementation, systematic and operational approaches to evaluate the quality of MRs remain limited. In Belgium, Medication Review type 2a (MR2a) has been implemented in routine practice of community pharmacies since 2023, yet no validated instruments exist to evaluate the quality of written MR2a reports. AIM: This study aimed to adapt the existing BRANT-MERQS framework for the quality evaluation of MR2a reports and to assess the usability, reproducibility and reliability of the resulting tool (BRANT-MERQS-2A). METHOD: Relevant criteria were selected from the original BRANT-MERQS and expanded with criterion-specific instructions to form the BRANT-MERQS-2A. Initial testing involved two student assessors independently evaluating 98 MR2a reports, with interrater agreement (IRA) assessed using weighted Cohen's Kappa. In a subsequent extended testing phase, the same reports were assessed by 61 final-year pharmacy students, with three randomly selected students evaluating each MR2A report. Interrater reliability was evaluated using the Intraclass Correlation Coefficient (ICC) and Gwet's AC1. Assessment duration was recorded to evaluate feasibility. RESULTS: Initial testing demonstrated strong IRA between the two student assessors. In the extended student cohort, agreement at the criterion level ranged from poor to moderate, with an overall ICC of 0.62, indicating moderate reliability. Criteria differed in discriminatory capacity, with some showing high absolute agreement but limited variability. Assessment time decreased over successive rounds, reflecting a learning effect and improved efficiency. CONCLUSION: The BRANT-MERQS-2A provides a feasible and structured approach for assessing the quality of MR2a reports. While variability at criterion level reflects the inherent complexity of MR2a, the tool demonstrates potential for self-and peer-assessment and offers a valuable foundation for further refinement and integration into routine quality monitoring.
Patient health outcomes for evaluation of pharmacist-led primary care: a scoping review.
Keenan C, Grant A, Bishop A … +10 more , Hancock K, Kennie-Kaulbach N, MacConnell H, Robart A, Guscott N, Cooke C, Giacomantonio R, Tadrous M, Woodill L, Isenor JE
Int J Clin Pharm · 2026 Jun · PMID 42334748 · Publisher ↗
INTRODUCTION: Pharmacists' role in primary care has rapidly evolved in recent years, driven by pressures on primary care and supported by increased government funding, further enabling full scope of practice while reduci...
INTRODUCTION: Pharmacists' role in primary care has rapidly evolved in recent years, driven by pressures on primary care and supported by increased government funding, further enabling full scope of practice while reducing patient costs. To optimize healthcare delivery, the patient outcomes of pharmacist-led primary care in community settings must be evaluated. AIM: This scoping review aimed to identify and explore the breadth of patient health outcomes used to assess the quality, effectiveness, and safety of pharmacist-led primary care. METHOD: A comprehensive search was conducted in four databases and Google for articles published from 1997 to July 2023, updated in February 2025. Database records were screened independently by two reviewers at two stages in Covidence. Google search results were screened by one reviewer, with selections verified by a second reviewer. Studies were included if they involved pharmacist-led primary care and reported patient health outcomes related to quality, effectiveness, and/or safety. Extracted data on study design, disease state, clinical services, and patient outcomes were categorized by two reviewers. Data are reported descriptively (frequencies, percentages) and are displayed using heat maps. Results were reported using PRISMA-ScR guidelines. RESULTS: A total of 299 studies (297 peer-reviewed, 2 grey literature) were included from 10,498 database records and 300 grey literature search results. Experimental study designs were the most common (61%) and increased in prevalence over the study period. Patient populations primarily comprised those with chronic diseases, primarily endocrine (27%) and cardiovascular (26%), with the volume of studies focused on these groups also increasing over time. Studies often evaluated multiple types of clinical service, with more focusing on education or counselling (29%) and chronic disease management (23%). A wide variety of outcomes were measured, with more than 70% being positive. The number of studies reporting outcomes increased markedly after 2002, particularly those examining clinical measures (29%), resource use (19%), and laboratory measures (14%). CONCLUSION: This scoping review identified patient health outcomes used to evaluate pharmacist-led primary care. Although studies on pharmacist-led clinical services have increased, the most assessed services may not reflect current practice. These findings should inform health system metrics grounded in outcomes that matter to patients to ensure safe, effective pharmacist-led care.
Research trends and emerging topics in antifungal therapeutic drug monitoring: a bibliometric analysis with implications for clinical pharmacy practice.
Sun LC, Li JC, Li WS … +6 more , Ren Z, Yang YX, Liu W, Zhai SD, Liang S, Yu ZH
Int J Clin Pharm · 2026 Jun · PMID 42319602 · Publisher ↗
INTRODUCTION: Therapeutic drug monitoring (TDM) plays an important role in optimizing antifungal pharmacotherapy because of the substantial pharmacokinetic variability and narrow therapeutic window of many antifungal age...
INTRODUCTION: Therapeutic drug monitoring (TDM) plays an important role in optimizing antifungal pharmacotherapy because of the substantial pharmacokinetic variability and narrow therapeutic window of many antifungal agents. However, the global research landscape and emerging trends in antifungal TDM have not been systematically evaluated. AIM: This study aimed to analyze global research trends, collaboration networks, and emerging research hotspots in antifungal TDM using bibliometric analyses. METHOD: Relevant publications published between January 2014 and November 14, 2024, were retrieved from the Web of Science Core Collection. Bibliometric analyses were performed using CiteSpace and VOSviewer to evaluate publication trends, countries, institutions, authors, journals, and keyword co-occurrence. RESULTS: A total of 569 publications from 34 countries were included in this review. The United States, China, and Germany were the leading contributors, and the annual publication output increased steadily during the study period. The French National Institute of Health and Medical Research was the most productive institution. The most influential journals were Antimicrobial Agents and Chemotherapy and Clinical Microbiology and Infection. Keyword analysis identified voriconazole TDM, drug-drug interactions, caspofungin, invasive aspergillosis, extracorporeal membrane oxygenation, and immunocompromised pediatric populations as major research hotspots. Machine learning-assisted pharmacokinetic modeling has recently emerged as a research focus. CONCLUSION: Although research on antifungal TDM is increasing globally, high-quality clinical evidence remains limited. Future research should prioritize multicenter clinical studies, optimization of TDM implementation in special populations, and integration of model-informed precision dosing approaches to support individualized antifungal therapy and clinical pharmacy practice.
Evidence on interventions that target prescribing appropriateness in older adults attending the emergency department and other acute care settings: a scoping review.
Fernandes L, McCarthy D, McCormack C … +6 more , Leahy A, Harnett A, Mohamed A, Gabr A, O'Connor M, Galvin R
Int J Clin Pharm · 2026 Jun · PMID 42313336 · Publisher ↗
INTRODUCTION: Potentially inappropriate prescribing (PIP) has been associated with various adverse clinical outcomes, particularly in the context of ageing, multimorbidity and polypharmacy. Despite growing interest in fr...
INTRODUCTION: Potentially inappropriate prescribing (PIP) has been associated with various adverse clinical outcomes, particularly in the context of ageing, multimorbidity and polypharmacy. Despite growing interest in front door frailty initiatives in the emergency department (ED) and acute geriatric units (AGUs), no review has focused specifically on interventions targeting PIP, as defined by validated criteria, across both ED and AGU settings. AIM: This scoping review aimed to map the evidence on interventions addressing PIP in older adults attending EDs or AGUs, identify evidence gaps and highlight areas for future research. METHOD: This scoping review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Medline, Embase, CINAHL Ultimate, Web of Science, Cochrane CENTRAL and grey literature sources were searched from 1991 to 2025 for studies evaluating interventions targeting PIP, defined using validated criteria, in adults aged ≥ 65 years attending the ED or AGUs. RESULTS: Our search returned 8643 results. Twenty-one studies were identified for inclusion, four of which were randomised controlled trials. The 18 interventions identified encompassed pharmacist-led medication reviews, clinical decision support systems (CDSS), educational/academic detailing programmes or combined approaches. While PIP was frequently a primary outcome measure, few studies reported clinical outcomes or explored prescriber adherence and experiences of older adults and prescribers. CONCLUSION: Pharmacist-led medication reviews, CDSS and educational/academic detailing were the main intervention approaches identified. Evidence was heterogeneous and focused mainly on prescribing-related outcomes, with limited assessment of clinical outcomes, prescriber adherence, communication pathways and stakeholder feedback. Future studies should incorporate longer-term follow-up and evaluate patient-centred and implementation outcomes.
A qualitative exploration of healthcare professionals' perspectives on the role of pharmacists in screening older adults for depression during medication reviews.
Gide DN, El-Den S, O'Donnell LK … +1 more , O'Reilly CL
Int J Clin Pharm · 2026 Jun · PMID 42313335 · Publisher ↗
INTRODUCTION: Late-life depression (LLD) (depression occurring in individuals aged ≥ 65 years) often goes underdiagnosed and undertreated. Pharmacists who conduct medication reviews may play a significant role in LLD scr...
INTRODUCTION: Late-life depression (LLD) (depression occurring in individuals aged ≥ 65 years) often goes underdiagnosed and undertreated. Pharmacists who conduct medication reviews may play a significant role in LLD screening. AIM: This study aimed to explore healthcare professionals' (HCPs) perspectives regarding the role of pharmacists in LLD screening for older adults during medication reviews. METHOD: A semi-structured interview guide was developed, guided by the Theoretical Framework of Acceptability (TFA). HCPs across Australia were recruited via purposive sampling through professional organisations' social media and e-newsletters distributed by primary health networks, and via convenience sampling through departmental meetings and emails at Royal North Shore Hospital, New South Wales, Australia. The interviews explored HCPs' acceptability and perspectives regarding the role of pharmacists in LLD screening. Key themes and subthemes were identified using inductive thematic analysis. Each subtheme was then deductively mapped to the TFA constructs. RESULTS: Twenty-eight HCPs participated in the interviews, including 10 credentialed pharmacists (35.7%), nine hospital pharmacists (32.1%), five geriatricians (17.9%) and four general practitioners (14.3%). Most participants were female (n = 22; 78.6%) and practising in New South Wales, Australia (n = 17; 60.7%). The duration of interviews ranged from 21 to 55 min (M = 33 min, SD = 9 min). Five key themes were identified, including Considerations for service delivery, Patients' homes as screening setting, Resource requirements, Timely follow-up, and Benefits of screening. These themes were further divided into eight subthemes. HCPs generally viewed pharmacist-delivered LLD screening as acceptable, provided certain factors were addressed prior to implementation. Facilitators such as increased patient comfort in their homes and the importance of mental health training were noted; however, barriers such as time constraints, lack of remuneration for additional services and the difficulties of timely follow-up may impede the provision of such services. CONCLUSION: HCPs were generally accepting of pharmacist-delivered LLD screening during medication reviews, and perceived pharmacists to have a role in such services. Recommendations for future implementation include targeted mental health training for credentialed pharmacists, appropriate remuneration, and timely follow-up pathways for at-risk patients.
Beyond symptom change: a qualitative descriptive study of reported quality of life experiences among adults prescribed medicinal cannabis for anxiety disorders.
Roberts L, Cumming C, Budgeon CA … +2 more , Preen DB, Lee K
Int J Clin Pharm · 2026 Jun · PMID 42262473 · Publisher ↗
INTRODUCTION: Anxiety disorders are among the most prevalent and disabling mental health conditions and are associated with impairments in quality of life (QoL). Previous studies have examined medicinal cannabis for anxi...
INTRODUCTION: Anxiety disorders are among the most prevalent and disabling mental health conditions and are associated with impairments in quality of life (QoL). Previous studies have examined medicinal cannabis for anxiety and QoL using short-term follow-up or cross-sectional surveys. However, there is little longitudinal qualitative research examining how patients experience QoL changes. AIM: To explore the perceived impacts on QoL for people with diagnosed anxiety disorders over the first six to twelve months after commencement of medicinal cannabis treatment. METHOD: A qualitative descriptive study was conducted using semi-structured interviews and participant diary entries. Adults with an anxiety disorder who had initiated medicinal cannabis within the previous six months were purposively recruited from clinics across Australia. Diary entries were completed at three and six months to capture evolving treatment experiences, with semi-structured interviews conducted within 12 months of treatment commencement. Data were analysed inductively using reflexive thematic analysis following Braun and Clarke's methodology. RESULTS: Nine participants (median age 36 years) were included, eight completed diary entries and interviews, and one completed interview only. Participants described improvements across QoL domains following initiation of medicinal cannabis. Themes reflected benefits and challenges, including reclaiming agency over anxiety, QoL changes, social and legal concerns, barriers to treatment initiation, and future treatment intentions. Participants reported perceived improvements in sleep, emotional regulation, relationships, motivation, daily functioning, and overall wellbeing. Several participants also described greater engagement with coping strategies and increased participation in social and daily activities. These benefits occurred alongside challenges, including stigma surrounding disclosure of medicinal cannabis treatment and concerns about cannabis driving legislation and roadside drug testing. CONCLUSION: Participants perceived medicinal cannabis as a tool for managing anxiety rather than eliminating symptoms, contributing to improved QoL across domains. Findings highlight the importance of considering QoL alongside symptom management and the role of pharmacists and other healthcare professionals in supporting patients through counselling, treatment monitoring, and stigma reduction. There is a need for evidence-informed policy that balances road safety measures while minimising unintended social and legal harms for patients prescribed medicinal cannabis.
Correction: A consolidated framework for implementation research (CFIR) informed exploration of a primary care intervention to support deprescribing for problematic polypharmacy in older adults living with frailty (DEPPLOY) in England: a qualitative study.
Breen L, Daffu-O'Reilly A, Darr A … +11 more , Benn J, Fylan B, Silcock J, Peat G, Raynor DKT, Petty DR, Zaidi ST, Bravington A, Butt N, Hartley H, Alldred DP
Int J Clin Pharm · 2026 Jun · PMID 42258008 · Publisher ↗
Abstract loading — click title to view on PubMed.
Beyond scope of practice: a prescribing autonomy framework to support early-career prescribers.
Swain W, Styles M, Schafheutle E
Int J Clin Pharm · 2026 Jun · PMID 42247041 · Publisher ↗
The introduction of pharmacist independent prescribing at the point of registration represents a profound shift in UK pharmacy practice. From 2026, newly qualified pharmacist independent prescribers will begin their care...
The introduction of pharmacist independent prescribing at the point of registration represents a profound shift in UK pharmacy practice. From 2026, newly qualified pharmacist independent prescribers will begin their careers with prescribing responsibilities but without the experiential consolidation or structured supervision pathways that underpin early prescribing in other professions. Existing governance mechanisms-particularly the concept of scope of practice-were designed for experienced, often specialist, prescribers and therefore fail to capture the dynamic decision-support needs of novice practitioners working across varied clinical contexts. Competency frameworks also provide limited insight into how prescribers negotiate uncertainty, collaborate with colleagues or calibrate clinical oversight in day-to-day practice. This commentary argues that these developments in the UK require an alternative approach to describing, governing and supporting prescribing practice, particularly at transition points. The Prescribing Autonomy Framework (PAF) proposes a context-sensitive framework that categorises prescribing decision-making into three levels of autonomy-low, medium and high-based on the degree of collaboration, protocol use, clinical oversight and digital decision-support required. By focusing on how prescribing decisions are reached rather than solely on what prescribers are authorised to prescribe, the framework offers a structured vocabulary for framing competence, informing support needs and surfacing risks. It also intersects with concepts of clinical complexity, accountability and risk, with the potential to support richer reflection and governance than existing approaches in the UK. While developed in response to changes in UK pharmacy training, the framework may have broader applicability. It offers a mechanism for supporting early-career prescribers across professions, guiding transitions into new areas of practice and strengthening healthcare governance. As prescribing roles expand internationally, the PAF aims to provide a scalable and adaptable approach to supporting safe, contextualised development of prescribing practice. The framework is presented as a theoretical governance lens and has not yet undergone empirical testing or formal validation.
The association between age and medication-related hospital admission in adults: a systematic review and meta-analysis.
Munshi RM, Ni Sheachnasaigh E, Strugaru M … +3 more , Olawoye F, Comiskey C, Grimes T
Int J Clin Pharm · 2026 Jun · PMID 42240819 · Publisher ↗
INTRODUCTION: Medication-related hospital admission is a major contributor to preventable patient harm and healthcare burden worldwide. The relationship between age and medication-related hospital admission has not been...
INTRODUCTION: Medication-related hospital admission is a major contributor to preventable patient harm and healthcare burden worldwide. The relationship between age and medication-related hospital admission has not been comprehensively synthesised. AIM: To evaluate the association between age and medication-related admission in adults and to provide research recommendations. METHOD: MEDLINE (Ovid), EMBASE, Scopus, Web of Science, PsycINFO, CINAHL, Cochrane Library, and Global Health databases were searched from January 2000 to March 2025. Studies of adults reporting medication-related admission, providing data on participant age for an exposed and comparator group, published in English were included. Studies restricted to children were excluded. Selection through dual, independent title/abstract screening and full-text assessment using predefined eligibility criteria. Disagreements resolved by third reviewer or consensus. Study quality assessed using Joanna Briggs Institute tool for systematic reviews addressing questions of prevalence. Findings were reported descriptively and two meta-analyses were performed. Risk ratios of experiencing medication-related admission by age group (16-64 years-old, 65+years-old) were pooled. Mean ages of those experiencing medication-related admission compared to another cause of admission were pooled. Prediction intervals and sub-group analyses were used to explain heterogeneity. RESULTS: Fifty studies, recruiting 210,514 participants, were included, with the majority judged as good quality. Thirteen studies exclusively recruited an older cohort, 30 studies were undertaken in Europe. Age data were variably described. The pooled risk ratio 1.64, (95% CI 1.15-2.35, K = 12, I = 96%, n = 56,101) suggested adults ≥ 65 years had a higher risk of experiencing medication-related admission than younger adults (16-64 years). Studies undertaken in Africa had a higher effect size. The pooled mean difference (2.86 years, 95% CI - 1.63-7.36; p = 0.21, K = 10, I = 93%, n = 12,440) indicated no statistically significant difference in age between groups. Risk of bias judgement was a statistically significant contributor to heterogeneity. Prediction intervals for both meta-analyses were wide, suggesting that findings of future studies could differ significantly. The certainty of evidence, GRADE approach, was very low. CONCLUSION: Age is an unreliable predictor for medication-related admission without accounting for confounding and context. Future research should consistently define age categories and better explore other risk factors for medication-related admission.
Development and validation of a machine learning-based clinical decision support tool for stratifying intravenous medication risk in hospitalized patients with heart failure.
Yang Y, Xu Z, Peilin Y … +3 more , Li H, Wang H, Shan X
Int J Clin Pharm · 2026 Jun · PMID 42234370 · Publisher ↗
INTRODUCTION: Hospitalized patients with heart failure (HF) frequently receive multiple high-risk intravenous (IV) medications, placing them at a substantial risk of clinically significant drug-related problems (DRPs). T...
INTRODUCTION: Hospitalized patients with heart failure (HF) frequently receive multiple high-risk intravenous (IV) medications, placing them at a substantial risk of clinically significant drug-related problems (DRPs). Timely severity-based stratification of IV medication-related risks remains challenging, particularly in the context of complex regimens and organ dysfunction. AIM: To develop and externally validate a clinically applicable machine learning-based stratification tool for classifying IV medication-related risk severity in hospitalized patients with HF and to support pharmacist-led medication safety management through a web-based clinical decision support tool. METHOD: This multicenter retrospective study included 1,884 adult patients hospitalized with HF from seven tertiary hospitals, with an independent external validation cohort of 100 patients. IV medication-related DRPs were identified and classified by senior clinical pharmacists using the Pharmaceutical Care Network Europe (PCNE) DRP classification (version 9.1) and stratified by severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index. Medication risk severity (levels C-F) was used as a multiclass stratification outcome. Candidate clinical and medication-related variables reflecting patient characteristics, organ function, and medication burden were selected using least absolute shrinkage and selection operator (LASSO) regression, and six machine learning algorithms for multiclass risk stratification were developed and compared. RESULTS: Overall, 1405 patients (74.6%) experienced at least one IV medication-related DRP, with treatment safety problems predominating. Eleven clinically interpretable predictors, including neutrophil percentage, fibrinogen, serum albumin, and creatinine clearance were retained in the final models. In internal validation, the random forest (RF) model achieved the highest discriminative performance (AUC = 0.934), whereas in external validation, the artificial neural network (ANN) demonstrated the best performance (AUC = 0.921). Considering its consistent performance across datasets, ANN was selected as the final model, achieving AUC of 0.889 and 0.921 in the internal and external validation, respectively. Based on this model, a web-based clinical decision support tool was developed to provide individualized IV medication risk stratification at the point-of-care. CONCLUSION: A machine learning-based clinical decision support tool that incorporates routinely available clinical and medication-related variables can accurately stratify IV medication-related risk severity in hospitalized patients with HF.
Fenofibrate discontinuation and the association with clinical outcomes in primary biliary cholangitis patients receiving combination therapy.
Su S, Yang J, Luo J … +5 more , Yang C, Li C, Liu X, Guo G, Han Y
Int J Clin Pharm · 2026 May · PMID 42213371 · Publisher ↗
INTRODUCTION: Fenofibrate serves as a second-line therapy in combination with ursodeoxycholic acid (UDCA) for patients with primary biliary cholangitis (PBC). However, a substantial proportion of patients discontinue tre...
INTRODUCTION: Fenofibrate serves as a second-line therapy in combination with ursodeoxycholic acid (UDCA) for patients with primary biliary cholangitis (PBC). However, a substantial proportion of patients discontinue treatment in clinical practice. AIM: To characterize the biochemical and clinical associations of fenofibrate discontinuation and the changes observed upon re-initiation in PBC patients. METHOD: Patients receiving combination therapy with UDCA and fenofibrate were consecutively enrolled between January 2011 and March 2025. Fenofibrate discontinuation was treated as a time-dependent covariate: patients were classified as being in the continuation group from fenofibrate initiation until the date of first discontinuation. Treatment adherence was quantified using the medication possession ratio (MPR). The composite endpoint included decompensated cirrhosis, liver transplantation, and death. RESULTS: Among 161 patients analyzed, 46 (28.6%) discontinued fenofibrate, and 31 of these later re-initiated treatment during follow-up. Patients were stratified into continuation and discontinuation groups, and no significant difference in the incidence of adverse events was observed. Discontinuation was associated with rapid biochemical relapse, with alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels significantly increasing within one month and the biochemical response rates declining from 59 to 25% at 12 months. Re-initiation of fenofibrate effectively reversed this deterioration. Time-dependent Cox analysis showed fenofibrate discontinuation was associated with a higher risk of clinical endpoint events (HR 2.57, 95% CI 1.12-5.91, P = 0.026). MPR showed an independent association with the risk of endpoint events and can be used to monitor patient medication adherence. CONCLUSION: Discontinuation of fenofibrate in patients with PBC is associated with rapid biochemical relapse and a trend toward unfavorable long-term outcomes. Maintaining treatment adherence is crucial, whereas timely re-initiation of therapy can effectively restore biochemical control.
Clinical pharmacy in Syria at a crossroads: challenges, opportunities, and pathways for post-conflict reform.
Al-Diery T, Al-Abdullah A, Zidan A … +4 more , Jafar MM, Hameed A, Al-Safadi SA, Mahli A
Int J Clin Pharm · 2026 May · PMID 42213370 · Publisher ↗
Following more than a decade of conflict and humanitarian crises, Syria's health and higher education systems have experienced profound disruption, with lasting consequences for the pharmacy profession. Clinical pharmacy...
Following more than a decade of conflict and humanitarian crises, Syria's health and higher education systems have experienced profound disruption, with lasting consequences for the pharmacy profession. Clinical pharmacy, in particular, remains underdeveloped despite its well-established potential to improve patient outcomes and support an overstretched healthcare system. This commentary critically examines the current landscape of clinical pharmacy education, training, and practice in Syria, highlighting the structural, regulatory, and cultural barriers that have constrained its advancement. Drawing on available evidence and the authors' professional expertise in clinical pharmacy education and workforce development, the commentary examines the persistent theory-practice gap across undergraduate and postgraduate training and identifies key areas for reform. Building on this analysis, the commentary proposes context-sensitive future directions to strengthen clinical pharmacy in Syria. These include reforming competency-based curricula at the undergraduate and postgraduate levels, establishing hospital pharmacy residency programs accredited by pharmacy specific hospital organisations, investing in clinical pharmacy units within governmental hospitals, developing and supporting pharmacy preceptors and mentors, and fostering a culture of clinical and practice-based research. The role of professional pharmacy bodies and the Syrian diaspora in capacity building and mentorship is also emphasised as a bridge to achieving such desired outcomes. Ultimately, transforming clinical pharmacy in Syria will require coordinated leadership and sustained commitment from both the Ministry of Health and the Ministry of Higher Education. If aligned reform is pursued, clinical pharmacy can evolve from a marginalised practice into an essential pillar of Syria's post-conflict health system, contributing to improved patient outcomes and long-term system resilience.
Healthcare professionals' perspectives of pharmacist roles in residential aged care: a qualitative systematic review and meta-synthesis.
McDonough T, Griffin E, Page A … +3 more , Kalisch Ellett L, Etherton-Beer C, Johnson J
Int J Clin Pharm · 2026 May · PMID 42207476 · Publisher ↗
INTRODUCTION: Aged care systems are under increasing pressures, demanding optimised interdisciplinary teams. Pharmacist roles are expanding into these teams, and successful integration requires an understanding of team m...
INTRODUCTION: Aged care systems are under increasing pressures, demanding optimised interdisciplinary teams. Pharmacist roles are expanding into these teams, and successful integration requires an understanding of team member perspectives. AIM: This systematic review and meta-synthesis aimed to identify, analyse and present the published literature pertaining to healthcare professional perspectives of the roles of pharmacists working in residential aged care settings. METHOD: A systematic search of literature published between 2000 and 2025, in English language only, was undertaken across Embase, Medline, CINAHL and Web of Science. Primary studies addressing the research aim were eligible for inclusion. The Mixed Methods Appraisal Tool was used to assess methodological quality of each paper; no papers were excluded based on quality. Two researchers independently reviewed and reached consensus agreement for all studies to include. Both researchers undertook a thematic synthesis of qualitative data to identify analytic themes. RESULTS: After removing duplicates, 1874 unique papers were identified through database searching and an additional two papers identified through citation searching. After screening, we included 39 papers for data extraction and analysis. Three overarching themes were identified. Theme 1: 'Supporting the role' describes how pharmacist roles in aged care are supported through building trust with the team, education and experience, access to information, specific attributes, organisational buy-in, favourable models of care, and role clarity. Theme 2: 'Medicines expertise activities' describes how pharmacists perform three key roles valued by healthcare staff: knowledge and communication brokers, filling existing gaps in care, and optimising quality use of medicines. Theme 3: 'Helping the team' illustrates health professionals' perception of three distinct outcomes of pharmacist input (ie enhanced confidence, improved workforce capacity and capability, and improved person-centred care). CONCLUSION: This meta-synthesis of the evidence regarding the perceptions of healthcare professionals on the role of pharmacists in aged care provides contextual information for individuals, organisations and policy-makers for future implementation. Pharmacists are perceived to improve stakeholder confidence, staff capacity and capability, and overall person-centred care. Embedded roles that foster interdisciplinary collaboration are preferred to irregular visiting roles. These embedded roles are enabled through a range of mechanisms that policymakers, organisations and individuals may leverage for successful implementation in future iterations.
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