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Volume 14
Issue 1
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Pharmacy, Volume 14, Issue 1 (February 2026) – 37 articles

Cover Story (view full-size image): The pharmacological management of substance use disorder (SUD) is complex due to extensive polypharmacy and frequent medical and psychiatric comorbidity. More than 80% of patients require pharmacological therapy, including opioid substitution treatments, antipsychotics, antidepressants, and anticonvulsants, increasing the risk of drug–drug interactions, therapeutic duplication, and overdose. Self-medication with benzodiazepines and opioids further amplifies these risks. Structured pharmacotherapy review and individualized deprescribing, conducted by multidisciplinary teams and Pharmaceutical Care Units, are essential to optimize safety, minimize adverse effects, and ensure effective, coordinated treatment. View this paper
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13 pages, 666 KB  
Article
PharmReaDy: A Longitudinal Platform for Industry Career Preparation for Student Pharmacists in the U.S.
by Ashim Malhotra
Pharmacy 2026, 14(1), 37; https://doi.org/10.3390/pharmacy14010037 - 13 Feb 2026
Viewed by 441
Abstract
As pharmacy career pathways diversify, professional doctoral programs such as PharmD face increasing pressure to demonstrate measurable workforce readiness outcomes within accreditation-constrained curricula. This study describes and evaluates PharmReaDy, a longitudinal, theory-informed workforce readiness platform embedded within a U.S. PharmD program. Guided [...] Read more.
As pharmacy career pathways diversify, professional doctoral programs such as PharmD face increasing pressure to demonstrate measurable workforce readiness outcomes within accreditation-constrained curricula. This study describes and evaluates PharmReaDy, a longitudinal, theory-informed workforce readiness platform embedded within a U.S. PharmD program. Guided by Tinto’s student retention framework, the platform integrates curricular, co-curricular, and experiential elements, including an industry-focused elective course, national professional competitions, targeted skills workshops, micro-credentialing opportunities, and experiential placements. Outcomes were assessed using enrollment trends, aggregate course evaluation data, academic performance indicators, and downstream participation in industry-aligned opportunities. Enrollment in the elective increased from 8 to 20 to 30 students across three offerings. Mean course evaluation scores across seven learning domains remained consistently high, ranging from 3.7 to 3.9 on a 4-point scale, with no statistically significant differences between cohorts (Welch’s t-tests, adjusted p > 0.05) and small positive effect sizes observed over time (Hedges’ g ≈ 0.20–0.29). Students demonstrated strong academic performance and increased participation in industry-focused competitions, scholarships, and post-graduate fellowship pathways. Findings from PharmReaDy indicate that workforce readiness can be meaningfully operationalized as a structured educational function embedded within professional curricula rather than being exclusively deferred to post-graduate training. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
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19 pages, 817 KB  
Article
Pharmacist-Led Flu Vaccination Services in Romanian Community Pharmacies: Barriers, Perceptions, and Implementation Challenges
by Marius Calin Chereches, Mihaela Simona Naidin, Alexandra Grosan, Radu Antoniu Patrascu, Anca-Maria Capraru, Marina Daniela Dimulescu and Adina Turcu-Stiolica
Pharmacy 2026, 14(1), 36; https://doi.org/10.3390/pharmacy14010036 - 12 Feb 2026
Viewed by 652
Abstract
Although pharmacist-led vaccination is a global standard for expanding immunization coverage, its adoption in Romania remains at an early stage. While previous studies have focused on early adopters, this research evaluates barriers, perceptions, and readiness among community pharmacies that do not yet provide [...] Read more.
Although pharmacist-led vaccination is a global standard for expanding immunization coverage, its adoption in Romania remains at an early stage. While previous studies have focused on early adopters, this research evaluates barriers, perceptions, and readiness among community pharmacies that do not yet provide this service, thereby addressing a critical knowledge gap regarding the “non-vaccinating” majority. A cross-sectional mixed-methods study was conducted among 208 pharmacists representing national chains, regional networks, and independent pharmacies. Quantitative data were analyzed using Chi-square tests and Spearman correlations to identify structural disparities, while a thematic analysis was employed to explore qualitative insights related to professional identity and operational barriers. We identified a clear mismatch between pharmacies’ willingness to provide vaccination services and their practical ability to implement them. Independent pharmacies demonstrated a strong intention to adopt vaccination services (71.4%) but were limited by financial constraints, with high implementation costs identified as a significant barrier (p = 0.014). In contrast, national pharmacy chains had sufficient resources yet faced marked staff resistance, with 43.9% reporting extreme reluctance (p = 0.038). These chains were concentrated in the capital region (p = 0.002), thereby positioning other pharmacies as key providers in underserved areas. Furthermore, thematic analysis revealed a deep-seated “professional identity” crisis, in which pharmacists struggle with the transition from medication specialists to clinical practitioners. The expansion of vaccination services cannot rely on a “one-size-fits-all” strategy. Successful national implementation requires a segmented policy approach, including financial subsidies to support independent pharmacies, change management strategies to engage the corporate workforce, and targeted regulatory education for regional networks to prevent vaccination deserts. Full article
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10 pages, 223 KB  
Article
Self-Management, Adherence, and the Role of Pharmaceutical Care in Patients with T2DM in Primary Practice: A Cross-Sectional Survey in Bulgaria
by Petya Milushewa, Nataliya Chenesheva and Valentina Petkova
Pharmacy 2026, 14(1), 35; https://doi.org/10.3390/pharmacy14010035 - 12 Feb 2026
Viewed by 510
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease requiring effective pharmacological treatment, sustained self-management, and patient education. Pharmacists are increasingly recognized as key contributors to diabetes care; however, their role remains underutilized in Bulgaria. This study aimed to assess self-management [...] Read more.
Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease requiring effective pharmacological treatment, sustained self-management, and patient education. Pharmacists are increasingly recognized as key contributors to diabetes care; however, their role remains underutilized in Bulgaria. This study aimed to assess self-management behaviors, medication adherence, patient awareness, and the perceived role of pharmacists among patients with T2DM in Bulgarian primary care. Methods: A cross-sectional observational study was conducted among 105 patients with T2DM using an anonymous questionnaire based on the Diabetes Self-Management Questionnaire and supplementary items adapted to the local healthcare context. Data were analyzed using descriptive statistics and non-parametric tests to explore associations between demographic characteristics, treatment patterns, self-management behaviors, and educational needs. Results: Most patients were treated with oral antidiabetic therapy (90.0%), predominantly metformin-based regimens (64.0%). Adherence to prescribed pharmacological treatment was high (93.0%), while adherence to dietary recommendations (70.0%), regular physical activity (60.0%), and blood glucose self-monitoring (63.0%) was less consistent. Although 92.0% of participants reported good or excellent disease awareness, 41.0% expressed a need for additional education, particularly regarding confidence in managing hypoglycemia and the use of digital monitoring tools. More than half of respondents (54.0%) had received diabetes-related information from a pharmacist; however, only 38.0% expressed willingness to participate in pharmacist-led education, while 34.0% were undecided. Female sex was associated with a higher prevalence of comorbidities (p = 0.010), while increasing age was associated with reduced metformin use (p = 0.004). Conclusions: Despite good pharmacological adherence and self-reported awareness, gaps remain in lifestyle-related self-management and patient education. The findings support an expanded role for pharmacists in diabetes care, particularly through structured educational and counseling interventions to enhance self-management and complement physician-led treatment. Full article
(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)
15 pages, 653 KB  
Article
AIM (Analyze–Interpret–Manage): A Novel NAPLEX-Aligned Analytical Assessment Framework for Measuring Individual and Team Critical Thinking Using Generative AI
by Ashim Malhotra
Pharmacy 2026, 14(1), 34; https://doi.org/10.3390/pharmacy14010034 - 12 Feb 2026
Viewed by 410
Abstract
Critical thinking is emphasized across ACPE Standards 2025, the Pharmacist Patient Care Process, interprofessional education (IPE) frameworks, and licensure preparation (NAPLEX). Despite this, pharmacy education lacks a practical, theory-grounded framework that operationalizes critical thinking as an observable, assessable reasoning process, particularly in team-based [...] Read more.
Critical thinking is emphasized across ACPE Standards 2025, the Pharmacist Patient Care Process, interprofessional education (IPE) frameworks, and licensure preparation (NAPLEX). Despite this, pharmacy education lacks a practical, theory-grounded framework that operationalizes critical thinking as an observable, assessable reasoning process, particularly in team-based and interprofessional contexts. We developed the AIM (Analyze–Interpret–Manage) framework by integrating the Delphi Consensus definition of critical thinking with the AAC&U VALUE framework, translating foundational theory into a concise, measurable, stage-based model applicable to both individual and collective cognition. AIM was tested using qualitative analysis of transcripts of student team discursive narratives of an assigned IPE scenario. Reasoning behaviors were coded by AIM stage and mapped to the 2016 IPEC Core Competencies and the 2025 NAPLEX competencies to ensure professional relevance and external validity. AIM reliably distinguished discrete stages of critical thinking across teams, revealing consistent patterns in how learners analyzed information, interpreted clinical and ethical significance, and managed decisions collaboratively. Mapping demonstrated strong alignment between AIM stages and IPEC and NAPLEX competencies. Our novel AIM framework offers a scalable approach for defining, teaching, and assessing team-based critical thinking in pharmacy education. By operationalizing critical thinking as a staged reasoning process aligned with professional standards, AIM fills a critical gap between educational theory, interprofessional practice, and licensure preparation. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
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11 pages, 426 KB  
Article
Impact of a Pharmacist-Driven Penicillin Allergy De-Labeling Service (PADLS) on Hospitalized Patients
by Parker Kaleo, Natt Patimavirujh, Kristen Greene, Nicholas Piccicacco and Melissa O’Neal
Pharmacy 2026, 14(1), 33; https://doi.org/10.3390/pharmacy14010033 - 11 Feb 2026
Viewed by 716
Abstract
Penicillin (PCN) allergies are frequently reported despite a true prevalence of less than 1%, leading to unnecessary avoidance of beta-lactams, broader antimicrobial use, and increased healthcare costs. Pharmacist-driven de-labeling programs offer a strategy to improve antimicrobial stewardship. This single-center, retrospective study evaluated hospitalized [...] Read more.
Penicillin (PCN) allergies are frequently reported despite a true prevalence of less than 1%, leading to unnecessary avoidance of beta-lactams, broader antimicrobial use, and increased healthcare costs. Pharmacist-driven de-labeling programs offer a strategy to improve antimicrobial stewardship. This single-center, retrospective study evaluated hospitalized adults with a documented PCN allergy and screened by the pharmacist-driven penicillin allergy de-labeling service (PADLS) between 16 January and 26 June 2025. Patients were categorized into a screened cohort and a Full Allergy Reconciliation (FAR) cohort if interviewed using PEN-FAST. Eligible patients underwent direct oral challenge (DOC), penicillin skin testing (PST) plus DOC, or direct de-labeling based on PEN-FAST scoring. Sixty-three patients were screened, and 32 (50.8%) underwent full reconciliation. Among FAR patients, the median PEN-FAST score was 0, and 25 (78.1%) underwent DOC. De-labeling was successful in 28 FAR patients (87.5%). One patient (4%) experienced a mild reaction. Allergy field updates occurred in 69.8% of screened and 96.9% of FAR patients. Antibiotic optimization occurred in 12 FAR patients, saving 78 days of therapy. Estimated cost savings totaled $37,632. PADLS effectively and safely de-labeled PCN allergies, resulting in improved antimicrobial selection, and could generate cost savings, supporting broader implementation of pharmacist-led allergy stewardship programs. Full article
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18 pages, 4633 KB  
Article
Process-Related Incidents in Nuclear Medicine: A Four-Year Single-Center Retrospective Analysis to Support the Implementation of a Scenario-Based Radiopharmacy Training
by Yasmine Soualy, Stéphane C. Renaud, Jade Torchio, Juliette Fouillet, Julie Ensenat, Léa Rubira and Cyril Fersing
Pharmacy 2026, 14(1), 32; https://doi.org/10.3390/pharmacy14010032 - 10 Feb 2026
Viewed by 614
Abstract
Nuclear medicine is a medical specialty combining parenteral radioactive drug handling and complex clinical workflows, making systematic process-related incident (PRI) analysis essential to support healthcare quality improvement. This study reports a four-year single-center retrospective analysis of PRIs in a nuclear medicine department and [...] Read more.
Nuclear medicine is a medical specialty combining parenteral radioactive drug handling and complex clinical workflows, making systematic process-related incident (PRI) analysis essential to support healthcare quality improvement. This study reports a four-year single-center retrospective analysis of PRIs in a nuclear medicine department and describes the development and implementation of a scenario-based radiopharmacy training program for nuclear medicine technologists (NMTs) derived from these findings. PRIs were extracted from the institutional reporting system and categorized according to a structured classification. Training scenarios were designed from recurrent radiopharmacy-related PRIs, and their impact was evaluated using a knowledge questionnaire administered pre and post training. A total of 223 PRIs were analyzed, of which 38.6% (n = 86) were related to the radiopharmaceutical circuit. Among these, 28.3% occurred exclusively within the radiopharmacy cleanroom. Administration (19%), dispensing (15%), delivery and reception (15%), and preparation and quality control (15%) of radiopharmaceuticals were the most frequently involved stages. No PRI exceeded a moderate criticality level. Eight NMTs participated in the training program, consisting of an analysis of videos depicting the developed scenarios. The mean knowledge score increased significantly from 7.51/10 before training to 8.46/10 four weeks after training (p = 0.02), with marked improvements in hygiene- and radioactivity-related topics. These results support the use of retrospective PRI analysis as an operational basis for specific, scenario-based training to strengthen safety practices in radiopharmacy settings. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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16 pages, 252 KB  
Article
From Cosmetic Abuse to Clinical Mismanagement: A National Simulated Patient Study Assessing Community Pharmacists’ Stewardship of Topical Corticosteroids in Jordan
by Derar H. Abdel-Qader, Abdullah Albassam, Esra’ Taybeh, Nadia Al Mazrouei, Rana Ibrahim, Reham Aljalamdeh, Salim Hamadi, Alia Saleh, Sahar Jaradat and Shorouq Al-Omoush
Pharmacy 2026, 14(1), 31; https://doi.org/10.3390/pharmacy14010031 - 9 Feb 2026
Viewed by 646
Abstract
Background: Topical Corticosteroids (TCS) are potent therapeutic agents associated with severe local and systemic adverse effects if misused. In Jordan, the unauthorized supply of TCS for cosmetic purposes and the mismanagement of dermatological conditions remain significant public health concerns. This study utilized a [...] Read more.
Background: Topical Corticosteroids (TCS) are potent therapeutic agents associated with severe local and systemic adverse effects if misused. In Jordan, the unauthorized supply of TCS for cosmetic purposes and the mismanagement of dermatological conditions remain significant public health concerns. This study utilized a repeated-measures simulated patient (SP) methodology to evaluate community pharmacists’ stewardship of TCS across a spectrum of clinical risks. Methods: A national cross-sectional study was conducted across 380 randomly selected community pharmacies in Jordan. Each pharmacy received four covert visits (N = 1520) corresponding to four distinct clinical scenarios representing different risk levels: cosmetic whitening, acne management, fungal infection, and pediatric diaper rash. The primary outcome was appropriate Practice, defined as the refusal to dispense unsafe medication or the provision of evidence-based alternatives. Results: Stewardship behavior varied significantly by clinical context (p < 0.001). Pharmacists demonstrated a hierarchy of safety, adhering to guidelines most strictly in the Pediatric scenario (82.1% appropriate refusal) but frequently abandoning safety standards in the Cosmetic scenario (30.0% appropriate refusal). Notably, 70.0% of pharmacists dispensed potent steroids for facial whitening, and 26.1% voluntarily offered to compound unauthorized steroid mixtures (Khaltat). In the acne scenario, 52.1% dispensed the contraindicated TCS, while only 37.9% appropriately switched the patient to an evidence-based alternative. In the fungal scenario, 60.0% failed to visually inspect the lesion, leading to a 40.0% rate of inappropriate TCS dispensing. Multivariable regression indicated that pharmacists working in chain pharmacies (aOR: 2.15, 95% CI: 1.68–2.75) and those holding advanced degrees (PharmD/MSc) (aOR > 1.38) were significantly more likely to practice appropriate TCS stewardship. High workload (>200 prescriptions/day) was a significant barrier to safety (aOR: 0.55). Conclusions: Community pharmacists in Jordan exhibited selective TCS stewardship, demonstrating high vigilance for pediatric safety, but widespread illegal practice regarding cosmetic misuse and differential diagnosis that may be unethical. The study results warrant the need for further urgent research to understand why these practices are occurring and how best to address them. Full article
11 pages, 226 KB  
Article
Oral Contraceptive Knowledge Among Adolescents and Young Women
by Nga-Weng (Ivy) Leong, Marie Barnard, Meagen Rosenthal and Erin Holmes
Pharmacy 2026, 14(1), 30; https://doi.org/10.3390/pharmacy14010030 - 5 Feb 2026
Viewed by 814
Abstract
This study aims to describe oral contraceptive knowledge among adolescents and young women, and to examine individuals’ characteristics associated with oral contraceptive knowledge. A cross-sectional survey was administered using an online panel. Females aged 16 to 24 were recruited. Oral contraceptive knowledge was [...] Read more.
This study aims to describe oral contraceptive knowledge among adolescents and young women, and to examine individuals’ characteristics associated with oral contraceptive knowledge. A cross-sectional survey was administered using an online panel. Females aged 16 to 24 were recruited. Oral contraceptive knowledge was measured using nine items with six domains, including oral contraceptive use, efficacy, indication, mechanism of action, risks, and side effects. A summated score was created, with a score of 9 indicating highest level of knowledge. Multivariable regression was used to examine significant socio-demographics and clinical characteristics. Among the 700 included responses, largest proportion of respondents were White (45.43%) and were covered by public insurance (43.14%). A total of 446 (63.71%) respondents expressed at least slight interest in using over-the-counter oral contraceptives. Overall, the mean score of knowledge was 4.08 out of 9. Most did not correctly answer questions about side effects, the mechanism of action and appropriate use. Similar patterns were observed among those who were interested in over-the-counter oral contraceptives (mean = 4.11). Adolescents and young women had a low level of oral contraceptive knowledge. With a high proportion of individuals interested in over-the-counter oral contraceptives, additional information support is needed to support informed contraception choice and use. Full article
(This article belongs to the Special Issue Pharmacy Practice for Women’s/Reproductive Health)
12 pages, 319 KB  
Article
Evaluation of Pharmacist-Developed Educational Leaflets for Women’s Health: A Pre–Post Study of Knowledge and Perceived Usefulness
by Weronika Guzenda, Zuzanna Berdzińska, Piotr Przymuszała, Olga Sierpniowska, Magdalena Jasińska-Stroschein and Magdalena Waszyk-Nowaczyk
Pharmacy 2026, 14(1), 29; https://doi.org/10.3390/pharmacy14010029 - 5 Feb 2026
Viewed by 503
Abstract
Background: Written educational materials are widely used in community pharmacies to support patient education, and available evidence suggests their effectiveness in improving short-term knowledge. However, there remains a need for well-documented, practice-oriented evaluations of pharmacist-developed materials in real-world community pharmacy settings. The aim [...] Read more.
Background: Written educational materials are widely used in community pharmacies to support patient education, and available evidence suggests their effectiveness in improving short-term knowledge. However, there remains a need for well-documented, practice-oriented evaluations of pharmacist-developed materials in real-world community pharmacy settings. The aim of this study was to evaluate the immediate impact of a pharmacist-developed educational leaflet on women’s health knowledge and its perceived usefulness, clarity, and acceptability. Methods: This study evaluated pharmacist-developed educational leaflets addressing women’s health topics using a pre–post study design. The study was conducted in Poland and involved 266 adult women. All participants completed a five-question knowledge test before and immediately after reading the educational leaflet, followed by a self-assessment of perceived usefulness, clarity, and visual appeal. Descriptive statistics were performed to summarize the results. Results: A statistically significant increase in knowledge was observed after exposure to the educational material, with mean scores rising from 2.8 ± 1.2 to 4.6 ± 0.7 (out of 5, p < 0.001). The greatest improvements were noted in topics related to sexually transmitted infection self-testing and pregnancy testing. Most participants rated the leaflet as useful, comprehensible, attractive, and engaging, with higher ratings reported among younger and better-educated respondents. Conclusions: Pharmacist-developed educational leaflets can support short-term knowledge acquisition and are perceived positively by women across age groups. These findings highlight the potential role of community pharmacies in delivering accessible written health education, while underscoring the need for future studies to assess long-term knowledge retention, behavioral outcomes, and topic-specific, targeted materials. Full article
(This article belongs to the Special Issue Pharmacy Practice for Women’s/Reproductive Health)
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23 pages, 488 KB  
Article
Role of the Pharmacist in Supporting the Use of Connected Health Devices: Example of Connected Watches
by Cordélia Salomez-Ihl, Léa Liaigre, Wiceme Dala, Ambre Davat, Maud Barbado, Sébastien Chanoine, Philippe Py, Delphine Schmitt, Pascal Defaye and Pierrick Bedouch
Pharmacy 2026, 14(1), 28; https://doi.org/10.3390/pharmacy14010028 - 3 Feb 2026
Viewed by 418
Abstract
The use of Connected Medical Devices (CMDs) is growing significantly throughout the world. Although they are not dispensed in pharmacies and are not part of the pharmacy-only drug dispensing system, clinical pharmacists must be able to support patients in the use of these [...] Read more.
The use of Connected Medical Devices (CMDs) is growing significantly throughout the world. Although they are not dispensed in pharmacies and are not part of the pharmacy-only drug dispensing system, clinical pharmacists must be able to support patients in the use of these new technologies, which are central to their care. The aim of this study is to identify the role of the community pharmacist in supporting patients who use CMDs, using the case of connected watches in electrophysiology. Semi-structured interviews were conducted between 15 February and 20 April 2024 by a pharmacy student. The questionnaires were drafted in collaboration with a pharmacist, a cardiac electrophysiologist, a methodologist specializing in the evaluation of medical devices, and an ethical philosopher specializing in the support and acceptability of new technologies. The aim of these questionnaires was to study the use of connected watches and support for patients who own them. A total of 4 cardiac electrophysiologists and 10 cardiac electrophysiology patients were interviewed, and then 6 pharmacists were also questioned about the roles identified by physicians and patients. This study identified a major need on the part of specialist physicians for clinical pharmacist support in helping patients use connected watches. Patients expressed a high level of confidence in their pharmacists to support them, and in the motivation of pharmacists’ ability to take up these challenges. A number of challenges remain, such as the effective integration of this support into pharmacy practice, remuneration, and the organization of collaboration between clinical pharmacists and hospital electrophysiologists. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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19 pages, 2206 KB  
Review
International Benchmarking of Pharmacology Curricula and Prescribing Related Learning Outcomes, Implications for Australian Health Professional Education: A Systematic Review and Meta-Analysis
by Syed Haris Omar and Anna Barwick
Pharmacy 2026, 14(1), 27; https://doi.org/10.3390/pharmacy14010027 - 3 Feb 2026
Viewed by 715
Abstract
Background: Pharmacology plays a central role in linking biomedical science concepts with their application in clinical practice across medical and healthcare education. Globally, the pharmacological curriculum has evolved, just like other disciplines, through the integration of case-based, problem-based, and hybrid teaching models that [...] Read more.
Background: Pharmacology plays a central role in linking biomedical science concepts with their application in clinical practice across medical and healthcare education. Globally, the pharmacological curriculum has evolved, just like other disciplines, through the integration of case-based, problem-based, and hybrid teaching models that led to firm clinical reasoning and long-term learning. Thus, this study aims to evaluate and compare the learning outcomes of pharmacology curricula across the globe by adopting a systematic review and meta-analysis research approach. Methods: This comprehensive review was conducted with transparency and integrity in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and was registered with PROSPERO (CRD420251207753). Five electronic databases, including MEDLINE (PubMed), EMBASE, CINAHL, PsycINFO, and the Cochrane Library were searched from January 2000 to October 2025. The Cochrane Library tool was used for the risk of bias assessment of randomised controlled trials, while the Joanna Briggs Institute (JBI) checklist was used for mixed-design, quasi-experimental, and cross-sectional cohorts. Review Manager 5.4 was used for statistical analysis. Results: Out of 3300 identified studies, 11 met the inclusion criteria, spanning 11 countries (published between 2007 and 2025). Integrated and case-based curricula significantly improved pharmacology knowledge compared to traditional lecture-based methods (SMD = 0.35; 95% CI: 0.07–0.64; I2 = 75%). Student satisfaction also favours integrated learning (OR = 1.53; 95% CI: 1.16–2.02; I2 = 46%). Most included studies were of moderate-to-high methodological quality. Conclusion: Globally, active and integrated pharmacology curricula foster greater cognitive understanding and learner satisfaction than conventional models. However, significant variability persists in resource-limited settings, leading to unequal competency in prescribing and therapeutic reasoning. Australian pharmacology programmes align broadly with international standards but require greater standardisation in assessment and experiential learning. Full article
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16 pages, 394 KB  
Article
Roles and Responsibilities in Pharmacy Practice as Determinants of Burnout: A Comparative Cross-Sectional Survey of Community Pharmacists and Pharmacy Assistants in the Northeastern Region of Bulgaria
by Mariya Ivanova, Antoaneta Tsvetkova and Anna Todorova
Pharmacy 2026, 14(1), 26; https://doi.org/10.3390/pharmacy14010026 - 3 Feb 2026
Viewed by 402
Abstract
Background: Burnout is a significant occupational risk among healthcare professionals, including community pharmacy staff, whose differing roles and responsibilities may influence burnout determinants. This study aimed to compare burnout levels and associated work characteristics between master pharmacists (MPs) and assistant pharmacists (APs) working [...] Read more.
Background: Burnout is a significant occupational risk among healthcare professionals, including community pharmacy staff, whose differing roles and responsibilities may influence burnout determinants. This study aimed to compare burnout levels and associated work characteristics between master pharmacists (MPs) and assistant pharmacists (APs) working in community pharmacies in Northeastern Bulgaria. Methods: A cross-sectional observational survey was conducted between November 2023 and December 2024 using an anonymous, self-administered online questionnaire completed by 221 MPs and 151 APs. Burnout was assessed using the Maslach Burnout Inventory—Human Services Survey for Medical Personnel, measuring emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Work characteristics were evaluated using items adapted from an internationally recognized European Commission guideline on occupational health and safety risks in the healthcare sector. Results: High levels of EE and DP were observed in both groups, with no statistically significant differences in mean burnout scores. Age and years of professional experience were not significantly associated with burnout. However, work environment factors differed: poor team communication and a negative workplace climate affected both groups, whereas lack of recognition and support was more influential for MPs, and physical workload and frequent interruptions were more prominent stressors for APs. Conclusions: Burnout is prevalent among community pharmacy professionals, with role-specific organizational factors shaping its determinants and highlighting the need for targeted preventive strategies. Full article
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29 pages, 596 KB  
Review
Regulation of Food Supplements and Pharmacists’ Responsibility in Professional Practice: A Review
by Cristina Ioana Niculaș, Sonia Bianca Blaj, Marius Călin Cherecheș, Raul Miron, Daniela Cristina Valea and Daniela Lucia Muntean
Pharmacy 2026, 14(1), 25; https://doi.org/10.3390/pharmacy14010025 - 3 Feb 2026
Viewed by 1092
Abstract
(1) Background: Regulations governing food supplements vary considerably across countries, allowing products that are prohibited in one jurisdiction to be legally sold in another. Furthermore, online sales enable and facilitate this practice. Regarding pharmaceutical malpractice, the absence of a standardized European framework complicates [...] Read more.
(1) Background: Regulations governing food supplements vary considerably across countries, allowing products that are prohibited in one jurisdiction to be legally sold in another. Furthermore, online sales enable and facilitate this practice. Regarding pharmaceutical malpractice, the absence of a standardized European framework complicates the evaluation of pharmacist liability. As a result, the specific elements of the liability framework are defined by the national legislation of each Member State. The aim of our review is to map the global regulatory landscape of food supplements and to examine the pharmacist’s professional responsibilities, including instances of malpractice related to this area. (2) Methods: A literature review covering publications from January 2020 to December 2024 was performed using four databases: Scopus, PubMed, Embase, and Web of Science. The search retrieved 8243 records, of which 77 studies fulfilled the eligibility criteria. The extracted data were organized into five main themes: pharmacist responsibility and malpractice, food supplement regulation, consumer safety, health claims, and pharmacist knowledge. (3) Results: The literature reviewed indicated a relatively low number of malpractice cases within the pharmacy profession compared to other professions. A higher incidence of cases is observed among male pharmacists and those practicing in the private sector. Notably, no cases have been identified addressing pharmacists’ responsibilities in the dispensing of food supplements. In the context of food supplement regulation, the reviewed literature highlights a lack of standardized terminology and harmonized legislation across different jurisdictions. Therefore, products may be classified differently across jurisdictions. Another observed barrier is the considerable variation in market access requirements across countries. Regarding consumer safety, several irregularities have been observed. Substantial non-compliance in both product composition and labeling has been observed, reflecting insufficient quality control measures. Concerning health claims, significant regulatory non-compliance with European Union regulations has been documented. In addition, widespread misleading advertising practices have been observed. With respect to pharmacists’ knowledge, the reviewed literature identifies several professional challenges within pharmacy practice, particularly those concerning the dispensing of food supplements. (4) Conclusions: This research offers a comprehensive analysis of the literature published over the past five years concerning pharmaceutical malpractice cases, as well as an examination of food supplement regulation and the professional responsibilities of pharmacists. A recurring barrier identified is the absence of unified regulatory frameworks worldwide. This results in uncertainty concerning the pharmacist’s professional role and responsibilities. Full article
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13 pages, 1007 KB  
Review
Good Practices and Challenges in the Collaboration of Pharmacists with General Practitioners—A Scoping Review
by Evelina Gavazova, Kiril Atliev and Daniela Kafalova
Pharmacy 2026, 14(1), 24; https://doi.org/10.3390/pharmacy14010024 - 3 Feb 2026
Viewed by 602
Abstract
Optimizing medication management and improving patient health outcomes depend primarily on the strength of primary healthcare services, where collaboration between general practitioners (GPs) and pharmacists plays a critical role. This scoping review aimed to identify the main facilitators and barriers influencing pharmacist–GP collaboration. [...] Read more.
Optimizing medication management and improving patient health outcomes depend primarily on the strength of primary healthcare services, where collaboration between general practitioners (GPs) and pharmacists plays a critical role. This scoping review aimed to identify the main facilitators and barriers influencing pharmacist–GP collaboration. The review was conducted in line with PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, and Web of Science identified studies published in English between January 2019 and May 2025, of which twenty met the inclusion criteria. Key facilitators of collaboration included pharmacist co-location within GP practices, clearly defined professional responsibilities, access to shared electronic health records, and supportive government policies. Barriers most frequently reported were limited communication pathways, insufficient interprofessional training, and financial constraints. Overall, the findings suggest that effective pharmacist–GP collaboration relies on structural integration, professional trust, and policy initiatives that enable sustained cooperation. Long-term investment in collaborative infrastructure and workforce development will be essential to strengthen primary care, support patient outcomes, and ensure more efficient use of healthcare resources. Full article
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19 pages, 275 KB  
Article
Healthcare Professionals’ Perspectives on Barriers and Facilitators to Medication Adherence Post Myocardial Infarction: A Qualitative Study Using the Theoretical Domains Framework
by Fatma El-Komy, Michelle O’Driscoll, Stephen Byrne, Margaret Bermingham and Laura J. Sahm
Pharmacy 2026, 14(1), 23; https://doi.org/10.3390/pharmacy14010023 - 2 Feb 2026
Viewed by 769
Abstract
Medication adherence following myocardial infarction (MI) is essential for effective secondary prevention, yet adherence rates remain suboptimal. Healthcare professionals (HCPs) are central to promoting adherence through clinical decision-making, patient education, and ongoing behavioural support. Understanding how HCPs perceive and experience the factors’ influencing [...] Read more.
Medication adherence following myocardial infarction (MI) is essential for effective secondary prevention, yet adherence rates remain suboptimal. Healthcare professionals (HCPs) are central to promoting adherence through clinical decision-making, patient education, and ongoing behavioural support. Understanding how HCPs perceive and experience the factors’ influencing adherence is key to developing effective, context-specific interventions. This study explored HCPs’ perspectives on medication adherence post-MI and identified behavioural determinants influencing medication management across the care pathway. A qualitative descriptive study was conducted using semi-structured interviews with HCPs in the southwest of Ireland. Participants included hospital pharmacists, community pharmacists, general practitioners (GPs), cardiologists, and nurses, recruited through purposive, convenience, and snowball sampling. Interviews were recorded, transcribed verbatim, and analysed using directed content analysis guided by the Theoretical Domains Framework (TDF). Twelve HCPs (eight female) were interviewed between December 2024 and May 2025, including four pharmacists, two GPs, three cardiologists and three nurses. Interviews lasted 30–50 min (mean 41 min). Analysis identified 15 facilitators, 13 barriers, and 7 dual-role determinants across 10 TDF domains. Novel contributions include demonstrating how HCPs’ real-world experiences contextualise adherence issues in the distinct post-MI setting characterised by abrupt care transitions, polypharmacy, and emotional vulnerability and identifying where HCPs feel most constrained and where their expertise could directly inform targeted intervention design. HCPs’ insights reveal complex, context-specific behavioural determinants influencing post-MI medication adherence and highlight the need for multidisciplinary, tailored, and system-level solutions. Enhancing collaboration, supporting patient-centred communication, and addressing resource barriers could empower HCPs to deliver more effective, personalised adherence support and inform the development of targeted intervention strategies. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
9 pages, 339 KB  
Article
ACE Inhibitor/ARB Therapy and Other Risk Factors for COVID-19 Infection in Elderly Hypertensive Patients: Sub-Group Analysis Based on a Single-Center, Retrospective, Observational Study in Japan
by Kazuhiro Furumachi, Akari Higuchi, Tatsuki Kagatsume, Mariko Kozaru, Tsutomu Nakamura, Etsuko Kumagai and Keiko Hosohata
Pharmacy 2026, 14(1), 22; https://doi.org/10.3390/pharmacy14010022 - 2 Feb 2026
Viewed by 478
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are often used in hypertensive patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, binds the ACE2 receptor on the cell surface. This [...] Read more.
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are often used in hypertensive patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, binds the ACE2 receptor on the cell surface. This study aimed to identify the risk factors influencing COVID-19 infection in hypertensive patients. Methods: This is a part of a single-center, retrospective, observational study investigating patients ≥ 20 years old at Kenwakai Hospital (Nagano, Japan). COVID-19 was diagnosed by polymerase chain reaction. All patients received antihypertensive drugs. Results: Among 316 patients (mean age, 75.0 ± 13.4 years; men, 55.1%), COVID-19 was diagnosed in 39 (12.3%). Multiple logistic regression analysis after adjustment for age, sex, and smoking status identified increased serum creatinine (Scr) as a significant risk factor for COVID-19 (odds ratio [OR] 1.10; 95% confidence interval [CI] 1.00–1.20; p = 0.046). Conversely, lower serum chloride was associated with COVID-19 (OR 0.92; 95% CI 0.85–0.99; p = 0.047). There was no significant association between COVID-19 and the use of ACEIs and ARBs. Conclusions: Scr was independently associated with COVID-19 risk, whereas ACEI/ARB use was not associated with COVID-19 risk in Japanese hypertensive patients, suggesting that these users need not discontinue or change their treatment. The study population included a very high proportion of patients with advanced chronic kidney disease, which makes the cohort substantially different from the general hypertensive population. However, our results can help guide targeted treatment strategies, improving patient outcomes in healthcare settings. Full article
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13 pages, 369 KB  
Article
Perspectives and Experiences of Doctors and Pharmacists on the Clinical Use of Direct Oral Anticoagulants in Saudi Arabia
by Dalal Salem Aldossari, Komal Latif, Amjad Nasser Alsadoni, Orjuwan Hasan Alshehri, Rakan Ibrahim Binjathlan, Monirah Mutlaq Alenezy, Taif Farhan Alshahrani, Hana Ahmed Lubbad, Rana Saeed Alshamasi, Abdulmajead Khaled Alanazi, Raed Ghazi Alotaibi, Ghazi Ibrahim Arishi and Sheraz Ali
Pharmacy 2026, 14(1), 21; https://doi.org/10.3390/pharmacy14010021 - 2 Feb 2026
Viewed by 623
Abstract
Background and objectives: Research into clinicians’ and pharmacists’ experiences and perspectives on direct oral anticoagulant (DOAC) use in Saudi Arabia and the broader Middle Eastern area is limited. Therefore, we aimed to evaluate the perspectives and experiences of physicians and pharmacists practicing in [...] Read more.
Background and objectives: Research into clinicians’ and pharmacists’ experiences and perspectives on direct oral anticoagulant (DOAC) use in Saudi Arabia and the broader Middle Eastern area is limited. Therefore, we aimed to evaluate the perspectives and experiences of physicians and pharmacists practicing in Saudi Arabia who prescribe DOACs and dispense DOAC therapy, respectively. Methods: A cross-sectional study was undertaken utilizing an online survey instrument. We collected data via Google Forms. Between June and July 2024, the study questionnaire was distributed to community pharmacists, general practitioners [GPs], cardiologists, residents in internal medicine, and hospital pharmacists (primary and secondary healthcare professionals) working in Saudi Arabia. Results: Comprising 146 doctors and 167 pharmacists, 313 total healthcare professionals participated in the study. Of the weekly DOAC prescriptions, cardiologists had the most at 35%; internal medicine residents came next at 16.3% and general practitioners at 17.5%. Among pharmacists, 16.7% of community pharmacists and 23.9% of hospital pharmacists dispensed DOACs weekly. The most often prescribed and dispensed medications were rivaroxaban, edoxaban, and apixaban. Across all categories, Lexicomp was the most often used tool. Most physicians (98%) said they lowered the DOAC dose when necessary. Especially in dosing, preoperative care, patient education, and medication interaction identification, internal medicine residents and hospital pharmacists expressed more confidence in managing DOACs. In these domains, community pharmacists expressed less trust. Conclusions: This study revealed that most participants preferred newer oral anticoagulants over warfarin and demonstrated a fairly good level of self-perceived knowledge regarding various aspects of the clinical use of DOACs. The study findings highlight the importance of focused training initiatives to standardize the use of DOACs, boost trust among community pharmacists and GPs, and ensure safe and effective patient care. Full article
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11 pages, 196 KB  
Article
An Exploratory Study of Over-the-Counter Medication Counseling Topics in Community Pharmacies and Alignment with Counseling Frameworks
by Jason S. Chladek, Leena Jaiswal, Jamie A. Stone, Aaron M. Gilson, Taylor L. Watterson, Elin C. Lehnbom, Jukrin Moon, Emily L. Hoffins, Maria E. Berbakov and Michelle A. Chui
Pharmacy 2026, 14(1), 20; https://doi.org/10.3390/pharmacy14010020 - 2 Feb 2026
Viewed by 581
Abstract
Community pharmacists can play an important role in patient safety by consulting patients on over-the-counter (OTC) medications. Several OTC counseling frameworks have been integrated into pharmacy education to guide pharmacists through these consultations, but limited work has been performed to examine how these [...] Read more.
Community pharmacists can play an important role in patient safety by consulting patients on over-the-counter (OTC) medications. Several OTC counseling frameworks have been integrated into pharmacy education to guide pharmacists through these consultations, but limited work has been performed to examine how these frameworks are applied in real-world settings. The objective of this study was to identify the topics discussed during over-the-counter medication consultations and explore how they align with existing counseling frameworks. Participants were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select OTCs for self-treatment. The selection process and potential interactions with pharmacy staff were recorded via Tobii Pro Glasses 2. Deductive and inductive content analysis of the recordings were used to compare participant–pharmacist consultations to existing OTC counseling frameworks. In total, 144 participants completed the study, with 32 (22%) having an OTC consultation with the pharmacist. Across all consultations, eight topic categories were identified. The consultations most frequently focused on discussions of product details and did not closely align with the OTC counseling frameworks. Future work should examine if and how this discordance contributes to OTC misuse among those interacting with pharmacists and potentially adapt or develop new frameworks to further support consultations and OTC safety. Full article
12 pages, 436 KB  
Review
Direct Oral Anti-Xa Anticoagulants and the Future of Factor XI/FXIa Inhibition: A New Paradigm in Thrombosis Prevention
by Francesca Futura Bernardi, Dario Bianco, Rosaria Lanzillo, Natalia Diana, Mario Scarpato, Antonio Lalli, Aniello Corallo, Consiglia Riccardi, Ugo Trama, Alessandro Perrella, Manuela Basaglia, Ada Maffettone, Pierpaolo Di Micco and Carmine Siniscalchi
Pharmacy 2026, 14(1), 19; https://doi.org/10.3390/pharmacy14010019 - 27 Jan 2026
Viewed by 878
Abstract
The introduction of direct oral anticoagulants (DOACs), particularly factor Xa (FXa) inhibitors, has transformed the prevention and treatment of thromboembolic events. These agents have largely replaced vitamin K antagonists across most indications due to their predictable pharmacokinetics, reduced rates of intracranial bleeding, and [...] Read more.
The introduction of direct oral anticoagulants (DOACs), particularly factor Xa (FXa) inhibitors, has transformed the prevention and treatment of thromboembolic events. These agents have largely replaced vitamin K antagonists across most indications due to their predictable pharmacokinetics, reduced rates of intracranial bleeding, and overall ease of use. Nevertheless, a substantial residual bleeding risk remains, particularly gastrointestinal bleeding and clinically relevant non-major bleeding in elderly, frail, or polymedicated patients. Furthermore, the management of patients with severe renal dysfunction, active cancer, especially gastrointestinal or genitourinary malignancies and those requiring complex pharmacological regimens, continues to pose significant challenges. These limitations have intensified interest in targeting earlier steps of the coagulation cascade, specifically factor XI (FXI) and its activated form (FXIa). FXI occupies a unique mechanistic position: it contributes substantially to pathological thrombosis while playing only a limited role in physiological hemostasis. Genetic, observational, and mechanistic evidence consistently demonstrates that FXI deficiency confers protection against venous thromboembolism and cardiovascular events while causing minimal spontaneous bleeding. This biological paradigm has catalyzed the development of novel FXI/FXIa inhibitors, including small-molecule agents (asundexian, milvexian) and biological therapies (abelacimab). Clinical trials such as AXIOMATIC-TKR, PACIFIC-AF, and OCEANIC-AF, and ongoing programmes including ASTER and MAGNOLIA suggest that FXI inhibition may preserve antithrombotic efficacy while substantially reducing bleeding risk. This review summarizes the current landscape of oral FXa inhibitors, outlines the biological rationale for FXI/FXIa inhibition, and discusses the evolving clinical evidence supporting what may represent the next major advance in anticoagulant therapy. Full article
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17 pages, 245 KB  
Article
Pharmacists’ Work Experiences and Career Dynamics in Saudi Arabia: A Cross-Sector Study
by Mohammed Alnuhait, Ayidh Alqarni, Leena Alsharafi, Arjwan Alshreef, Renad Althebaiti, Alaa Shahbar, Foud Bahamdain, Abdulhamid Althagafi, Mohamed A. Albekery, Abdullah F. Alharthi and Abdulmalik S. Alotaibi
Pharmacy 2026, 14(1), 18; https://doi.org/10.3390/pharmacy14010018 - 27 Jan 2026
Viewed by 1014
Abstract
Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions [...] Read more.
Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions among pharmacists across multiple practice sectors in Saudi Arabia. Method: A nationwide cross-sectional survey was conducted between December 2024 and January 2025 using an electronic questionnaire distributed to licensed pharmacists. The instrument assessed mental well-being, job satisfaction, burnout, workplace environment, and career mobility. Descriptive and inferential analyses were performed using SPSS version 20.0. Results: A total of 531 pharmacists completed the survey; 65% were male, and 89.3% were Saudi nationals. Sector distribution differed significantly by gender (p < 0.001): females were more represented in clinical and hospital pharmacy, while males predominated in the pharmaceutical industry–related roles. Male pharmacists reported higher work environment scores (p = 0.028) and greater sector mobility (34.2% vs. 23.7%, p = 0.012). Approximately 30.5% of participants had changed their employment sector at least once. Community pharmacists reported the highest burnout levels, whereas those in regulatory and administrative roles demonstrated the greatest job satisfaction (both p < 0.001). Participation in professional development showed strong positive associations with job satisfaction and intention to remain in the current role. Conclusions: Marked variations exist in pharmacists’ well-being, satisfaction, and career mobility across sectors in Saudi Arabia, with notable gender differences. Enhancing professional development, ensuring equitable work environments, and promoting sector-specific support strategies may help inform discussions on pharmacist engagement and retention within the evolving national healthcare system. Full article
(This article belongs to the Special Issue Pharmacist Workforce Challenges and Solutions: Perspectives from Research and Practice)
11 pages, 213 KB  
Article
The Prevalence and Impact of Bacteremia Among Neonates Receiving Parenteral Nutrition: A Multicenter Retrospective Study from Saudi Arabia
by Shaker Althobaiti, Aisha H. Alshehri, Abeer K. Alorabi, Alhussain Alzahrani, Lama Marwan Fetyani, Ebtihal Mohsin Fairaq, Enas Ahmed Abukwaik, Njood Abdulsalam Alharbi, Abrar A. Alotaibi, Safia Ghali Alotibi, Shaimaa Alsulami, Abdullah Althomali and Ahmed Ibrahim Fathelrahman
Pharmacy 2026, 14(1), 17; https://doi.org/10.3390/pharmacy14010017 - 26 Jan 2026
Viewed by 534
Abstract
(1) Background: We aimed to determine rates of bacteremia and multidrug resistance (MDR) bacteremia and associated risk factors among neonates receiving parenteral nutrition (PN). (2) Methods: This is a multicenter study conducted in three neonatal intensive care units in Saudi Arabia, including 414 [...] Read more.
(1) Background: We aimed to determine rates of bacteremia and multidrug resistance (MDR) bacteremia and associated risk factors among neonates receiving parenteral nutrition (PN). (2) Methods: This is a multicenter study conducted in three neonatal intensive care units in Saudi Arabia, including 414 neonates who received PN. Associations were assessed using Chi-square or Fisher’s Exact tests when applicable and logistic regression analyses were conducted to determine factors predicting outcomes. Odds ratios with their 95% confidence intervals were computed, and a p value < 0.05 was considered statistically significant. (3) Results: PN was started within the first 10 days of life in 74.4% of cases. Fat emulsion was administered to 38.9% of the newborns. Blood cultures were positive in 24.9% of patients. Among the positive cultures, 4.9% were confirmed to have MDR bacteria. The mortality rate following bacteremia was 7.8%. The use of fat emulsion (p = 0.003), birth weight < 700 g (p < 0.001), and a gestational age within 27 weeks (p < 0.001) predicted bacteremia. (4) Conclusions: There was an association between the PN and bacteremia. Significant predictors of bacteremia were the use of fat emulsion, birth weight < 700 g, and a gestational age within 27 weeks. Full article
8 pages, 185 KB  
Opinion
Parenteral Nutrition Management from the Clinical Pharmacy Perspective: Insights and Recommendations from the Saudi Society of Clinical Pharmacy
by Nora Albanyan, Dana Altannir, Osama Tabbara, Abdullah M. Alrajhi, Ahmed Aldemerdash, Razan Orfali and Ahmed Aljedai
Pharmacy 2026, 14(1), 16; https://doi.org/10.3390/pharmacy14010016 - 26 Jan 2026
Viewed by 528
Abstract
Parenteral nutrition (PN) is essential for patients who are unable to tolerate oral or enteral feeding, providing them with necessary nutrients intravenously, including dextrose, amino acids, electrolytes, vitamins, trace elements, and lipid emulsions. Clinical pharmacists (CPs) play a critical role in PN management [...] Read more.
Parenteral nutrition (PN) is essential for patients who are unable to tolerate oral or enteral feeding, providing them with necessary nutrients intravenously, including dextrose, amino acids, electrolytes, vitamins, trace elements, and lipid emulsions. Clinical pharmacists (CPs) play a critical role in PN management by ensuring proper formulation, monitoring therapy, preventing complications, and optimizing patient outcomes. In Saudi Arabia, limited literature exists on CPs’ involvement in total parenteral nutrition (TPN) administration, health information management (HIM) systems, and pharmacist staffing ratios. This paper examines the evolving role of CPs in PN management, addressing key challenges such as the optimal patient-to-CP ratio, the impact of HIM systems on PN prescribing, and the advantages and limitations of centralized versus decentralized PN prescription models. It highlights the need for standardized staffing levels, structured pharmacist training, and improved HIM integration to enhance workflow efficiency and prescribing accuracy. Additionally, the study examines how the adoption of advanced HIM systems can streamline documentation, reduce prescribing errors, and enhance interdisciplinary collaboration. This paper provides a framework for optimizing PN delivery, enhancing healthcare quality, and strengthening CPs’ contributions to nutrition support by addressing these factors. Implementing these recommendations will improve patient outcomes and establish a more efficient PN management system in Saudi Arabia, reinforcing the vital role of CPs in multidisciplinary care. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
13 pages, 706 KB  
Article
Addressing Pharmacy Admissions Declines Through a Student-Led Pre-Health Advising and Leadership System (PAALS): An Implementation Evaluation
by Ashim Malhotra
Pharmacy 2026, 14(1), 15; https://doi.org/10.3390/pharmacy14010015 - 25 Jan 2026
Viewed by 412
Abstract
To enhance PharmD student leadership and advocacy skills, combat the paucity of trained pre-health advisors for pharmacy admissions, augment community relationships, and increase pharmacy admissions volume, we designed, implemented, and assessed PAALS, a Pre-health Academic Advising and Leadership System. PAALS was grounded in [...] Read more.
To enhance PharmD student leadership and advocacy skills, combat the paucity of trained pre-health advisors for pharmacy admissions, augment community relationships, and increase pharmacy admissions volume, we designed, implemented, and assessed PAALS, a Pre-health Academic Advising and Leadership System. PAALS was grounded in Astin’s Theory of Student Involvement and evaluated using the RE-AIM implementation science framework. RE-AIM measured outcomes across Reach, Effectiveness, Adoption, Implementation, and Maintenance as indicators of PAALS’s scale, fidelity, sustainability, and institutional embedding. Analysis of PAALS using the RE-AIM framework demonstrated the following outcomes: (1) Reach: 42 P1-P3 PharmD students participated as mentors; external partnerships expanded from 2 to 8 regional high schools and community programs; and more than 25 mentored learners successfully matriculated into the PharmD program. (2) Effectiveness: students enacted sustained leadership, advocacy, and mentoring roles. (3) Adoption: voluntary uptake of mentoring and governance roles by PharmD students occurred with repeated engagement by external partner institutions. (4) Implementation: Core program components were delivered consistently using existing institutional resources. (5) Maintenance: PAALS remained operational across five academic years despite student turnover, with leadership succession and institutional embedding sustained across cohorts. Our findings demonstrate that student-led advising and advocacy ecosystems address critical gaps in pharmacy-specific pre-health advising models. Full article
(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)
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13 pages, 811 KB  
Article
Trends in Antipsychotic Drug Use in the United States, 2000–2016
by Nisrine Haddad, Nawal Farhat, Jennifer Go, Yue Chen, Christopher A. Gravel, Franco Momoli, Donald R. Mattison, Douglas McNair, Abdallah Alami and Daniel Krewski
Pharmacy 2026, 14(1), 14; https://doi.org/10.3390/pharmacy14010014 - 24 Jan 2026
Viewed by 916
Abstract
This study evaluated long-term trends in the prevalence of use of atypical and typical antipsychotic drugs (APDs), both as classes of drugs and as individual drugs, among adult inpatients in the United States (US). The Health Facts® database developed by Cerner Corporation [...] Read more.
This study evaluated long-term trends in the prevalence of use of atypical and typical antipsychotic drugs (APDs), both as classes of drugs and as individual drugs, among adult inpatients in the United States (US). The Health Facts® database developed by Cerner Corporation was used to analyze the prevalence of APD use among adult inpatients aged 18 years or older who were administered at least one antipsychotic medication order during hospitalization between 1 January 2000 and 31 December 2016. The prevalence of APD use was standardized by age, sex, race, and census region. Typical and atypical antipsychotic treatment patterns in the US differed over this period. While the use of atypical APDs increased overall, the use of typical antipsychotic medications decreased, but remained more prevalent. Overall, haloperidol and prochlorperazine were the two most administered antipsychotic medications throughout the study period. From 2000 to 2011, prochlorperazine and haloperidol were the first- and second-most prescribed typical APDs, respectively; haloperidol became the most administered antipsychotic of this class as of 2012. Quetiapine was the most administered atypical antipsychotic medication, followed by risperidone and olanzapine until 2014, after which olanzapine was the second-most administered atypical APD. There was a notable decline in the use of atypical antipsychotics medications between 2005 and 2008, which may reflect the impact of the Food and Drug Administration’s warnings and the American Diabetes Association’s consensus position, but only for a short time. The usage patterns observed in this study support existing evidence of substantial off-label use of antipsychotic drugs in the US. Full article
(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)
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10 pages, 227 KB  
Article
Comparison of Subcutaneous Versus Intramuscular Estradiol Administration for Feminizing Gender-Affirming Hormone Therapy
by Abby C. Poage, Jordan M. Rowe, Mary Beth A. Dameron, Abigail M. Bavuso and Andrew J. Smith
Pharmacy 2026, 14(1), 13; https://doi.org/10.3390/pharmacy14010013 - 23 Jan 2026
Viewed by 1022
Abstract
This single health system, retrospective cohort study compared subcutaneous (SC) versus intramuscular (IM) estradiol administration in 70 adult patients with a diagnosis of gender incongruence or gender dysphoria seen in an LGBTQ Specialty Clinic within a safety-net institution between October 2018 and December [...] Read more.
This single health system, retrospective cohort study compared subcutaneous (SC) versus intramuscular (IM) estradiol administration in 70 adult patients with a diagnosis of gender incongruence or gender dysphoria seen in an LGBTQ Specialty Clinic within a safety-net institution between October 2018 and December 2024. The primary endpoint was patients who reached therapeutic estradiol levels at 6 months. Secondary endpoints included the incidence of sub- and supra-therapeutic and actual estradiol levels at months 3, 6, 9, and 12 and patients who received pharmacist-led injection technique education. At 6 months, the proportion of patients achieving therapeutic estradiol levels did not differ between IM and SC administration. In exploratory analyses of continuous estradiol concentrations, IM administration was associated with higher measured estradiol levels. Full article
(This article belongs to the Special Issue Pharmacy Practice for Women’s/Reproductive Health)
15 pages, 247 KB  
Article
Drug-Drug Interaction Knowledge, Practices, and Barriers in Community Pharmacies: A Cross-Sectional Study from Jazan Region, Saudi Arabia
by Moaddey Alfarhan, Muath F. Haqwi, Abdulrahman H. Musayyikh, Jala Ashqar, Lama Y. Suwidi, Amal H. Fageh, Enas A. Alajam, Hadi Almansour, Thamir M. Alshammari and Saeed Al-Qahtani
Pharmacy 2026, 14(1), 12; https://doi.org/10.3390/pharmacy14010012 - 23 Jan 2026
Viewed by 645
Abstract
(1) Background: Drug–drug interactions (DDIs) are a frequent cause of medication-related harm, particularly in ambulatory care. Community pharmacists are uniquely positioned to identify and manage these risks. This study assessed DDI knowledge, practices, and barriers among community pharmacists in the Jazan Region, Saudi [...] Read more.
(1) Background: Drug–drug interactions (DDIs) are a frequent cause of medication-related harm, particularly in ambulatory care. Community pharmacists are uniquely positioned to identify and manage these risks. This study assessed DDI knowledge, practices, and barriers among community pharmacists in the Jazan Region, Saudi Arabia. (2) Methods: A structured, self-administered questionnaire was distributed to community pharmacists. The survey assessed DDI knowledge using 26 clinically relevant drug pairings and included questions on professional behavior, training exposure, software use, and educational needs. Descriptive and inferential statistics were applied to identify associations between knowledge scores and demographic or practice-related variables. (3) Results: A total of 219 pharmacists participated in the study. The mean knowledge score was (9.63 ± 4.58) out of 26, reflecting suboptimal to moderate awareness. Female pharmacists demonstrated significantly higher DDI knowledge scores than males (10.74 ± 5.4 vs. 9.08 ± 4.2; p = 0.016). Knowledge scores also differed significantly by academic qualification (p < 0.001), with PharmD holders scoring higher than B. Pharm and postgraduate degree holders. Pharmacists with less than 10 years of experience had significantly higher scores compared with those with longer practice duration (p = 0.002). Additionally, pharmacists who graduated from Saudi institutions scored higher than those trained outside Saudi Arabia (10.22 ± 4.7 vs. 8.44 ± 4.2; p = 0.005). Pharmacists who had received professional development training and those who attended workshops regularly also scored significantly higher. Familiarity with guidelines showed a positive trend. Reported barriers to effective DDI counseling included time constraints, limited patient understanding, and poor collaboration with prescribers. Self-rated awareness of DDIs was positively associated with actual knowledge scores. Pharmacists expressed strong preferences for workshops, online courses, and webinars as future training formats. (4) Conclusions: Pharmacists in the Jazan Region demonstrate moderate awareness of DDIs, with variation influenced by training, experience, and qualifications. Enhancing access to structured professional development and integrating clinical decision support tools could strengthen pharmacists’ role in preventing DDIs in community practice. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
10 pages, 233 KB  
Article
Medication Regimen Complexity and Patient-Reported Adverse Drug Events in Korean Community Pharmacies: A Cross-Sectional Study
by Sunmin Lee and Kyung sun Oh
Pharmacy 2026, 14(1), 11; https://doi.org/10.3390/pharmacy14010011 - 22 Jan 2026
Viewed by 478
Abstract
Evidence linking medication regimen complexity to patient-reported adverse drug events (ADEs) is limited. This study examined the association between regimen complexity and patient-reported ADEs among adults using community pharmacy services. A cross-sectional survey was conducted among adults with prescription experience at community pharmacies [...] Read more.
Evidence linking medication regimen complexity to patient-reported adverse drug events (ADEs) is limited. This study examined the association between regimen complexity and patient-reported ADEs among adults using community pharmacy services. A cross-sectional survey was conducted among adults with prescription experience at community pharmacies in Korea (14 January–24 February 2025). Data included MRCI-K scores, medication adherence, ADE reports, comorbidities, polypharmacy status, and demographics. Prescription records verified medication counts and drug-related risks. Determinants of regimen complexity were assessed using multivariable linear regression, and predictors of ADE reporting were examined using multivariable logistic regression. Among 201 participants, 101 (50.2%) reported at least one ADE in the past month. Polypharmacy, comorbidities, and multidose dispensing service use were independently associated with higher regimen complexity, whereas higher income, college education, and older age were associated with lower complexity. Higher MRCI-K scores (OR = 0.95, 95% CI 0.91–0.99) and older age (OR = 0.98, 95% CI 0.96–0.99) were associated with lower odds of ADE reporting. Higher medication regimen complexity and older age were associated with reduced reporting of ADEs, suggesting possible under-recognition among these populations. Patient-centered strategies are needed to enhance ADE identification in individuals with complex medication regimens. Full article
(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)
12 pages, 1248 KB  
Article
AI-Enabled Sacramento Public Health (SACPH) App: A Reproducible AI-Based Method for Population-to-Practice Reasoning in Foundational Sciences in Pharmacy Education
by Ashim Malhotra
Pharmacy 2026, 14(1), 10; https://doi.org/10.3390/pharmacy14010010 - 16 Jan 2026
Viewed by 405
Abstract
Foundational biomedical sciences are commonly taught without routine integration of local population health contexts, limiting students’ ability to connect mechanisms to community disease burden and practice responsibilities. In this method paper, we developed and piloted an AI-enabled “Sacramento County Public Health (SACPH)” AI [...] Read more.
Foundational biomedical sciences are commonly taught without routine integration of local population health contexts, limiting students’ ability to connect mechanisms to community disease burden and practice responsibilities. In this method paper, we developed and piloted an AI-enabled “Sacramento County Public Health (SACPH)” AI workflow and app prototype, a structured, faculty-authored prompt sequence designed to guide population-to-practice reasoning using publicly available data. The workflow was implemented during a TBL session with first-year PharmD students in an immunology course. Using splenectomy and risk of overwhelming post-splenectomy infection (OPSI) as an illustrative use case, students executed a standardized prompt sequence addressing data source identification, coding logic (diagnosis vs. procedure codes), population-level estimation with uncertainty framing, and translation to pharmacist-relevant prevention and counseling implications. Feasibility was defined by conceptual convergence. The validated reasoning workflow was subsequently translated into a prototype, app-style interface using generative design prompts. Across student teams, outputs converged on similar categories, consistent recognition of coding frameworks and verification steps, and directionally similar interpretations of local burden and pharmacist responsibilities. The prototype demonstrated successful externalization of the reasoning workflow into a modular, reproducible artifact. SACPH demonstrates a feasible, reproducible method for using generative AI to integrate foundational science instruction with local population health context and pharmacist practice reasoning, while supporting AI literacy competencies. Full article
(This article belongs to the Special Issue AI Use in Pharmacy and Pharmacy Education)
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11 pages, 454 KB  
Review
Irisin as a Neuroprotective Agent in Parkinson’s Disease: The Role of Physical Exercise in Modulating Dopaminergic Neurons
by José Garcia de Brito-Neto, Paulo Leonardo de Góis Morais, José Rodolfo Lopes de Paiva Cavalcanti, Francisco Irochima Pinheiro, Fausto Pierdoná Guzen and Ricardo Ney Cobucci
Pharmacy 2026, 14(1), 9; https://doi.org/10.3390/pharmacy14010009 - 13 Jan 2026
Viewed by 592
Abstract
Exercise-induced myokines have emerged as crucial mediators of the beneficial effects of physical activity on neurodegenerative diseases through complex molecular mechanisms involving oxidative stress reduction, neuroinflammation suppression, and synaptic plasticity enhancement. Among these myokines, irisin, encoded by the FNDC5 gene, has gained significant [...] Read more.
Exercise-induced myokines have emerged as crucial mediators of the beneficial effects of physical activity on neurodegenerative diseases through complex molecular mechanisms involving oxidative stress reduction, neuroinflammation suppression, and synaptic plasticity enhancement. Among these myokines, irisin, encoded by the FNDC5 gene, has gained significant attention as a potential therapeutic target in neurodegenerative conditions due to its ability to cross the blood–brain barrier and exert pleiotropic neuroprotective effects. This review synthesizes current evidence from both preclinical and clinical studies examining the role of exercise-induced irisin in neurodegeneration, with particular emphasis on translational potential and therapeutic applications. A comprehensive search was conducted across PubMed, Web of Science, Scopus, and EMBASE databases (spanning January 2015 to December 2024) to identify peer-reviewed articles investigating irisin’s neuroprotective mechanisms in neurodegenerative diseases. Ten studies met the inclusion criteria (five rodent/primate model studies and five human clinical investigations), which were analyzed for methodological rigor, intervention protocols, biomarker quantification methods, and reported outcomes. Reviewed studies consistently demonstrated that exercise-induced endogenous irisin elevation correlates with improved cognitive function, reduced neuroinflammatory markers, enhanced synaptic plasticity, and modulation of neurodegenerative pathways, with exogenous irisin administration reproducing several neuroprotective benefits observed with exercise training in animal models. However, substantial heterogeneity exists regarding exercise prescription parameters (intensity, duration, frequency, modality), training-induced irisin quantification methodologies (ELISA versus mass spectrometry), and study designs (ranging from uncontrolled human observations to randomized controlled trials in animal models). Critical appraisal reveals that human studies lack adequate control for confounding variables including baseline physical fitness, comorbidities, concurrent medications, and potential sources of bias, while biochemical studies indicate distinct pharmacokinetics between endogenous training-induced irisin and exogenous bolus dosing, necessitating careful interpretation of therapeutic applicability. The translational potential of irisin as a therapeutic agent or drug target depends on resolving methodological standardization in biomarker measurement, conducting well-designed clinical trials with rigorous control for confounders, and integrating findings from molecular/biochemical studies to elucidate mechanisms linking irisin to disease modification. Future research should prioritize establishing clinical trial frameworks that harmonize exercise prescriptions, employ robust biomarker quantification (mass spectrometry), and stratify participants based on disease stage, comorbidities, and genetic predisposition to clarify irisin’s role as a potential therapeutic intervention in neurodegenerative disease management. Full article
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Article
Patient and Physician Perspectives on Pharmacotherapy in Parkinson’s Disease Psychosis: A Mixed-Methods Exploratory Study
by Olaf Rose, Tobias Hinteregger, Eugen Trinka, Bernhard Iglseder, Johanna Pachmayr and Stephanie Clemens
Pharmacy 2026, 14(1), 8; https://doi.org/10.3390/pharmacy14010008 - 13 Jan 2026
Viewed by 495
Abstract
Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized [...] Read more.
Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized at a university center completed semi-structured interviews on perceived efficacy, adverse effects, and daily functioning. Neurologists and geriatricians attending training sessions completed a structured questionnaire on prescribing patterns, attitudes toward clozapine, and perceived treatment burden. Data were analyzed thematically and triangulated across cohorts. Eleven patients (mean age 81 years; nine treated with quetiapine, two with clozapine) were included. Most quetiapine-treated patients reported persistent hallucinations, sedation, dizziness, and reduced autonomy. Fourteen physicians completed the survey and most preferred quetiapine, citing monitoring logistics and agranulocytosis risk as barriers to clozapine. Overall, patient priorities centered on symptom control and independence, whereas physician decisions emphasized feasibility and safety. Facilitating clozapine monitoring and incorporating patient-reported outcomes into routine care may improve patient-centered PDP management. Full article
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