Search Results (418)

Background/Objective: Polypharmacy, conventionally defined as the concurrent use of five or more medications, has emerged as a critical public health challenge in aging populations worldwide. Polypharmacy in older adults, driven by multimorbidity and age-related physiological changes, increases the risk of adverse drug reactions, drug interactions, falls, cognitive impairment, non-adherence, and preventable hospitalization. This study aims to provide a structured narrative synthesis of the current evidence on the incidence, risk factors, and clinical management of polypharmacy in elderly patients, with particular emphasis on deprescribing strategies, interdisciplinary care models, patient education, and digital clinical decision support technologies. Methods: A structured narrative literature review was conducted across PubMed, Scopus, and Web of Science using Boolean combinations of MeSH and free text terms including ‘polypharmacy,’ ‘elderly,’ ‘deprescribing,’ and ‘medication review.’ Eligible sources were peer-reviewed primary studies published between January 2016 and June 2026 that enrolled adults aged ≥65 years and reported validated prescribing review approaches, such as the STOPP/START criteria. The review drew on 40 primary studies spanning randomized controlled trials (RCTs) and observational, qualitative, and mixed-methods designs, which were interpreted and synthesized narratively across the principal thematic domains of polypharmacy management. Results: Polypharmacy was independently and consistently associated with DDIs, preventable hospitalizations, and functional decline across diverse clinical settings. Pharmacist-led medication reviews and interdisciplinary, team-based interventions produced the most robust improvements in prescribing appropriateness and meaningful reductions in potentially inappropriate medications (PIMs). Electronic clinical decision support systems (CDSSs) have demonstrated measurable benefits for safe deprescribing at scale, although usability limitations, incomplete workflow integration, and clinician resistance are significant implementation obstacles. Conclusions: Effective management of polypharmacy in older adults requires a multicomponent, patient-centered strategy that integrates evidence-based deprescribing algorithms, principally the STOPP/START criteria, sustained interdisciplinary collaboration, structured patient education, and technology-assisted decision support. Full article

Objectives: To estimate the added value of dostarlimab compared to durvalumab and pembrolizumab as first-line treatment for adult patients with primary advanced or recurrent endometrial cancer (EC) in Spain using a Multi-Criteria Decision Analysis (MCDA) framework. Methods: Following the Evidence and Value: Impact on Decision Making (EVIDEM) framework and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations, 25 Spanish experts (12 medical oncologists and 13 hospital pharmacists) weighted and scored 11 quantitative and 5 qualitative criteria based on an evidence matrix from a literature review. Results: Efficacy and safety were weighted as the most important criteria. Dostarlimab showed positive added value in both comparisons with scores of 0.58 versus durvalumab/durvalumab + olaparib and 0.50 versus pembrolizumab. Dostarlimab and pembrolizumab are the only therapies reimbursed in the Spanish public health system; therefore, their comparative assessment is of clinical and strategic relevance. While pembrolizumab may show longer progression-free survival (PFS) and response duration in specific subgroups, the evidence for dostarlimab—including a statistically significant improvement in overall survival (OS) in the overall population as a primary endpoint, more robust data, and favorable long-term quality-of-life outcomes—was considered by the expert panel to support a more favorable assessment. Conclusions: Within the MCDA framework, experts consider dostarlimab an option with a higher value contribution for adult patients with primary advanced or recurrent EC. Its clinical benefits, improved quality-of-life outcomes, and alignment with healthcare priorities promote treatment continuity and adherence in clinical practice. MCDA provided a transparent approach for multidimensional evaluation of these therapies. Full article

Older people are at increased risk of medication-related problems, which may be identified by clinical pharmacists during hospital medication reviews. Some problems are better managed in primary care, where follow-up is possible. Medication-related communication by pharmacists may improve information transfer in care transitions, but this practice remains uncommon in Sweden. This qualitative study explored clinical pharmacists’ experiences and perceptions of writing referrals to primary care. Data were collected through four focus groups and three supplementary interviews with 19 clinical pharmacists from hospitals and primary care, and analysed using qualitative content analysis. Eleven participants had experience writing referrals, although none did so regularly. Four categories emerged: role of the pharmacist, current work procedures, pharmacist–physician relationship and facilitating factors. Pharmacists believe they can contribute to patient safety through involvement in transitions of care. An overall concept of an underused competence permeated the categories. Referrals identifying medication-related problems are hindered by limited pharmacist integration into the healthcare team and limited continuity. Writing referrals was considered a new procedure requiring collaboration with unfamiliar partners. Organisational changes, including increased pharmacist continuity and clearer pharmacist roles, are needed to implement referral practices. Further research is needed to evaluate effects on medication treatment and patient outcomes. Full article

Background/Objectives: Clinical pharmacists contribute pharmacotherapy expertise to antimicrobial stewardship (AMS), but antimicrobial prescribing remains a multidisciplinary process led by treating clinicians. In physician-centered hospital systems, pharmacists’ contributions may be integrated into prescribing decisions to varying degrees depending on the organizational structures, interprofessional relationships, workflow integration, and prescribing cultures. This study aimed to explore how contextual and interprofessional factors shape the integration of clinical pharmacists’ antimicrobial stewardship contributions within multidisciplinary prescribing decisions in Jordanian hospitals. Methods: A multi-site qualitative study was conducted across nine Jordanian hospitals. Semi-structured interviews were conducted with 26 clinical pharmacists involved in antimicrobial reviews in intensive care and general medical units. Interviews incorporated the critical incident technique to elicit examples of accepted and rejected stewardship recommendations. Data were analyzed using a realist-informed approach to develop context–mechanism–outcome configurations explaining variations in pharmacists’ reported AMS contribution. Results: Pharmacotherapy expertise was necessary but not sufficient for pharmacists’ recommendations to shape antimicrobial prescribing. Leadership endorsement, structured multidisciplinary rounds, and formal documentation pathways activated mechanisms of legitimacy, credibility, and workflow visibility, supporting reported uptake of dose optimization, therapeutic drug monitoring, and selected de-escalation recommendations. In contrast, prescriber-led hierarchies, limited documentation pathways, workload pressures, and defensive prescribing cultures activated mechanisms of self-limitation, risk aversion, and limited recommendation uptake, particularly for discontinuation, duration control, and narrowing of broad-spectrum therapy. Conclusions: Strengthening AMS requires not only formal committees and guidelines but also team-based structures that integrate pharmacists’ pharmacotherapy expertise into antimicrobial review while preserving clinicians’ ultimate prescribing responsibility. Full article

Background: Pharmacist-led interventions in Gulf Cooperation Council (GCC) countries have been increasingly studied, yet their overall effectiveness across clinical and healthcare outcomes remains incompletely defined. To address this gap, a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies published between 2000 and 2025 was conducted, following PRISMA 2020 and Cochrane standards. Methods: Searches of PubMed/MEDLINE, Scopus, Web of Science, and CENTRAL identified 437 records, of which 20 studies met the inclusion criteria; 13 contributed meta-analyzable data as randomized controlled trials and seven as quasi-experimental studies. Results: Pooled random-effects estimates favored pharmacist-led care for HbA1c, fasting glucose, low-density lipoprotein cholesterol, diastolic blood pressure, and medication knowledge, although these estimates carried substantial, largely unexplained heterogeneity and were rated as low to very low certainty under GRADE. The effects on systolic blood pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, unplanned healthcare use, and antimicrobial utilization were favorable but not statistically significant. Quasi-experimental studies consistently demonstrated reductions in mortality and readmissions, though hospital and ICU length of stay remained variable. Risk of bias was judged as some concerns for randomized trials and moderate to serious for quasi-experimental studies, with substantial heterogeneity observed across blood pressure and lipid outcomes. Conclusions: Overall, pharmacist-led interventions in GCC settings were associated with improvements in glycemic control and LDL cholesterol, with additional benefits in mortality and readmissions, although the certainty of evidence was low to very low, owing to substantial heterogeneity and the predominance of non-randomized designs for the inpatient outcomes. These findings underscore the need for standardized intervention models and outcome measures. Full article

The Canadian cancer care landscape faces rising cancer incidence, persistent inequities, and increasing system pressures. Led by the Canadian Association of Provincial Cancer Agencies (CAPCA), this scoping review applied an implementation science lens to evaluate the scalability of innovative cancer care models across Canada. Using a mixed-methods design, innovations were identified through a scoping review (n = 42), grey literature analysis (>50), a pan-Canadian survey (n = 72), and key informant interviews (n = 24). Guided by the Consolidated Framework for Implementation Research (CFIR), this review assessed feasibility, barriers, and facilitators influencing adoption and scale-up of identified innovations. Results revealed widespread adoption across various domains including virtual oncology, artificial intelligence (AI)-driven tools, and expansion of team-based care. At-home models, including home infusion, palliative care, and pharmacist-led chronic disease clinics, demonstrated improved access, patient satisfaction, and reduced hospital burden. CFIR mapping revealed cross-cutting facilitators including strong stakeholder engagement, structured training, and demonstrated patient benefits. However, persistent barriers include regulatory variability, funding instability, digital infrastructure gaps, and workforce capacity constraints. This paper highlights implemented innovations in cancer care and identifies strategic scaling opportunities needed to ensure all people living in Canada benefit from high-quality, person-centred equitable cancer care. Full article

Background/Objectives: Initiation of empiric antibiotic therapy for neonatal early-onset sepsis (EOS) is prudent to prevent morbidity and mortality, particularly in low- and middle-income countries (LMICs). Inappropriate or prolonged antibiotic exposure in neonates is associated with poor clinical outcomes. Antimicrobial stewardship programs (ASPs) have been shown to optimize antibiotic use, but data from LMICs are limited. In this study, we aimed to evaluate adherence to a locally developed and adopted guideline for antibiotic use in EOS. Methods: We conducted a retrospective before-and-after study during the pre- (June 2024–January 2025) and post-implementation (May–December 2025) of ASP guideline for EOS. The intervention involved consolidating best practices—previously shared verbally and applied variably into a locally united written guideline, then provide training to neonatologists, pharmacists, and nurses. Adherence to best practices was evaluated by indication, dosing, timing, and duration of antibiotic therapy. Results: In a cohort of 388 neonates with EOS (i.e., 205 pre- and 183 post-implementation), the median gestational age was 38 (IQR: [37–39]) weeks, with the median birthweight of 3000 (IQR: [2800–3400]) grams, and 63% were male. The total adherence improved from 2.0% to 65.6% (p < 0.001) from pre- to post-implementation of ASP. In the post period, adherence rates were 96.7% for empiric antibiotics indication, 95.6% for antibiotics indication after culture results are obtained, 88.5% for antibiotic dosing, 83.1% for timely antibiotic initiation, and 89.1% for appropriate discontinuation of antibiotics. The median days of therapy and length of therapy significantly decreased by 139 per 1000 patient-days, from 1806 (IQR: [1556–2083] to 1667 (IQR: [1400–2000]; p < 0.001)] patient-days; and from 1000 (IQR: [875–1000]) to 875 (IQR: [769–1000]; p < 0.001) patient-days in the pre- versus the post-implementation, respectively. Median length of hospitalization of 8 [7–12] days and recovery (~93%) from EOS were similar pre- and post-implementation. Conclusions: The results support the effectiveness of ASP implementation in improving guideline adherence and reducing antibiotic exposure among neonates with EOS in low-resource settings. In-hospital clinical outcomes, including mortality at discharge, were similar between periods; however, further studies with longer follow-up are needed to better evaluate clinical outcomes. Full article

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article

Background: Pharmacy students in France complete an equivalent six-month full-time hospital placement during the fifth year of their university curriculum. At our school, it includes a clinical pharmacy within a medical ward, with daily supervision by a clinical pharmacist and a pharmacy resident. This training has been strengthened by the introduction of a workplace-based formative assessment conducted at the end of the clinical pharmacy rotation, alongside weekly clinical case discussions at the school, culminating in an end-of-year oral assessment. Objective: To assess the performance, determinants, and acceptability of this assessment model. Methods: We conducted a retrospective, single-center study over ten academic years (2013–2023). The evaluation combined three complementary components: the workplace-based clinical assessment based on real patient interactions, the case-based oral assessment, and students’ satisfaction. Results: Nearly one thousand students were included. Students’ performances remained stable over time. Higher scores were observed among students with prior clinical experience and those enrolled in hospital-focused training pathways. Student satisfaction was high, particularly in settings with direct pharmaceutical supervision, which was strongly associated with improved perceived learning, engagement, and supervision quality. Conclusions: Beyond performance measurement, this model appears to foster clinical reasoning, professional development, and student engagement, suggesting its relevance for competency-based pharmacy education. Full article

Background: Chronic obstructive pulmonary disease (COPD) is commonly managed alongside multimorbidity, polypharmacy, recurrent treatment escalation, and older age, all of which increase vulnerability to drug–drug interactions (DDIs). We aimed to synthesize the main DDI domains relevant to COPD pharmacotherapy and to distinguish harmful DDIs from beneficial combination therapy and formal compatibility findings. Methods: We performed a narrative review using structured literature searches and citation tracking to evaluate COPD-related studies. We prioritized direct COPD-specific DDI evidence, while also including mechanistic, class-specific, and contextual studies when direct evidence was lacking. Retained evidence included observational cohorts, prescribing studies, pharmacokinetic trials, case reports, and systematic reviews. Results: The reviewed literature indicates that DDI vulnerability in COPD is driven less by isolated drug pairs than by overall regimen complexity, multimorbidity, aging, fragmented prescribing, and high-intensity treatment periods such as exacerbations, hospitalization, and discharge. Key DDI domains included cardiopulmonary co-treatment, QT-related vulnerability, and potential or clinically relevant interactions amplified during exacerbations. Inhaled therapies are not universally interaction-free, particularly with strong metabolic inhibitors. Psychotropics, frailty, dementia, and palliative care further increase clinical complexity. However, beneficial bronchodilator combinations and formal compatibility studies demonstrate that not all multidrug COPD regimens are harmful. Conclusions: In COPD, DDI assessment should focus on the full treatment regimen and not be limited to a set of iconic drug pairs. Clinicians must focus on exacerbation-related prescribing, QT-active drugs, theophylline exposure, psychotropic co-medication, and vulnerable subgroups such as older, frail, and palliative patients. Pharmacist-supported drug review, drug reconciliation, and selective deprescribing are key strategies for reducing clinically relevant DDI burden in COPD. Full article

Background/Objectives: Pharmacists play an essential role in healthcare delivery across Europe, yet growing professional demands, organisational constraints, and evolving practice models may negatively affect job satisfaction and professional fulfilment. This study aimed to evaluate job satisfaction and professional perception among pharmacists across multiple European countries and to identify sociodemographic and workplace-related factors associated with these outcomes. Methods: A cross-sectional, web-based survey was conducted between October 2023 and January 2024 among licensed pharmacists from 17 European countries. Eligible participants were pharmacists employed in community pharmacies, hospitals, clinical pharmacy services, or the pharmaceutical industry. The questionnaire, developed and administered in English, collected sociodemographic and professional data and included two composite measures: the Job Satisfaction Scale (12 items) and the Pharmacist Professional Perception Scale (6 items). Responses were recorded using 5-point Likert scales. Descriptive statistics and inferential analyses were performed using SPSS version 27.0. Results: A total of 789 pharmacists participated (median age 40 years; 80.1% female). The mean job satisfaction score was 3.26 (SD 0.88), with the lowest scores related to staffing adequacy and salary, and the highest to collegial relationships. The mean professional perception score was 3.08 (SD 0.81), indicating moderate perceived professional recognition. Significant associations were identified between both scales and workplace setting, income level, employment status, geographical region, education, and professional experience (p < 0.05). Conclusions: In this multi-country convenience sample, pharmacists reported moderate levels of job satisfaction and professional perception, with variation across workplace and sociodemographic factors. These findings should be interpreted cautiously, as the sample is not representative of all European pharmacists; however, they suggest that staffing conditions, remuneration, professional recognition, and career development opportunities may be relevant areas for further investigation and policy attention. Full article

This pilot study (NCT05743686) evaluated the feasibility of a web-based application enabling patients with breast cancer (BC) receiving oral therapy to self-report and manage treatment-related adverse effects (AEs). Patients were enrolled between January and August 2023. Historical controls were used for comparison. Participants used the web-app to self-report AEs daily for 13 weeks, completed the PRO-CTCAE weekly, and completed a questionnaire assessing psychosocial precursor factors associated with treatment adherence. Some patients and healthcare professionals participated in semi-structured interviews. The study included 28 participants and 185 historical controls. Compared with controls, participants had fewer interactions with hospital pharmacists (0 [0–1] vs. 0 [0–7], p = 0.04), with no significant differences in the number of visits, hospitalizations, or modifications to treatment. Concordance between AEs reported via the web-app and PRO-CTCAE was 66.2%. No statistically significant changes were observed in psychosocial precursor factors of treatment adherence following the intervention (all p > 0.05). The qualitative data underscored the generally positive reception of the web-based application among both patients and healthcare professionals. In conclusion, in this small mixed-methods pilot study, monitoring oral cancer therapy-related adverse effects using the web-app was feasible and acceptable, and was associated with a lower frequency of telephone contacts with hospital pharmacists compared with historical usual care. These preliminary findings are exploratory and warrant confirmation in larger, prospectively designed studies. Full article

Background/objectives: Chronic kidney disease (CKD) affects approximately 800 million individuals worldwide and poses a growing health challenge. To support safer prescribing practices, our research group developed a renal risk medication quick guide (RRMQG), which provides recommendations for the 50 most prevalent renal risk medications (RRMs). This study explored the usefulness of implementing the RRMQG in Danish hospital settings. Methods: In this multicenter pilot study conducted across six Danish hospitals, 28 clinical pharmacists applied the RRMQG during medication reviews of frail, geriatric patients with renal impairment from May to October 2023. Useability was explored through structured surveys completed by the pharmacists. Results: Among 182 patients, 378 RRMs were detected, and 14% of these were associated with potential drug-related problems (DRPs). The RRMs were distributed across 35 of the 50 from the RRMQG, and patients received an average of two RRMs each. Most pharmacists found the RRMQG manageable for implementation in practice. Conclusions: The RRMQG was useful and manageable for implementation in practice in Danish hospitals, particularly due to its medication-specific recommendations. However, adjustments to the RRMQG may be beneficial by, for example, adding opioids or context-relevant medications to meet individual needs. Full article

Background: Treatment-related problems (TRPs), including patient adherence, knowledge, and medication errors, affect hospitalized patients’ outcomes worldwide. Effective clinical pharmacist communication is essential for proper patient counselling and medication safety. However, the effect of clinical pharmacist communication skills on TRPs has not been adequately studied. Objective: This study aimed to assess patients’ satisfaction with clinical pharmacists’ communication components (appropriate timing, language, and empathy) and examine their association with TRPs, including patient adherence, knowledge, and medication errors. Method: A cross-sectional study was conducted in two Jordanian public hospitals between October 2023 and April 2024 through a structured questionnaire to assess patients’ satisfaction, adherence, and knowledge. Medication errors were detected in collaboration with other healthcare providers through reviewing medical records and direct patient assessment based on the American Society of Health-System Pharmacists classification. Data analysis was conducted using SPSS version 27. Results: A total of 613 adult inpatients were included. Overall, 82.1% (n = 503) of patients were satisfied with the clinical pharmacist communication, 75.5% (n = 463) showed good adherence, and 76% (n = 466) showed good knowledge. A total of 42.4% of medication errors (n = 260) were identified. Errors with harm or fatalities were not observed. The regression results showed that the overall satisfaction level was positively associated with patients’ adherence rate (B = 0.59; p < 0.001) and patients’ knowledge (B = 0.978; p < 0.001) and negatively associated with the number of medication errors (B = −0.024; p < 0.001). Conclusions: Clear, timely, and empathetic communication by clinical pharmacists was associated with patient satisfaction and was linked to better patient adherence and knowledge and fewer medication errors. Improving communication skills among clinical pharmacists could be a practical way to reduce TRPs. Full article

Background: Access to reliable medicines information is essential to support safe medicine use during pregnancy and breastfeeding, where concerns regarding fetal and neonatal safety complicate clinical decision-making. Analgesics are widely used during these periods, yet uncertainty regarding safety persists due to evolving evidence, regulatory changes, and inconsistent information sources. Obstetric medicines information services play a critical role in addressing these information needs. This study aimed to evaluate patterns of analgesic-related enquiries to a pharmacist-led specialist obstetric medicines information service over a 20-year period. Methods: A retrospective observational study was conducted using enquiry data from the King Edward Memorial Hospital Obstetric Medicines Information Service (KEMH OMIS), Western Australia. All enquiries recorded between 1 January 2001 and 31 December 2020 were extracted from the Microsoft Access^® database. Records with incomplete data were excluded. Data were standardised, coded, and analysed using Microsoft Excel^® and SPSS^® Version 25. Descriptive statistics were used to summarise enquiry characteristics, caller type, the timing of exposure, and analgesic medicines involved. Trends over time were analysed. Results: A total of 48,458 enquiries were analysed, of which 4,978 (10.3%) related to analgesics, making this the third most common medicine class. Most enquiries related to breastfeeding (62.1%), followed by pregnancy (32.7%). The public accounted for 60.9% of calls, while health professionals contributed 39.1%. The highest frequency of breastfeeding enquiries occurred within the first four weeks postpartum, and pregnancy enquiries were most common in the second trimester. Paracetamol was the most frequently enquired analgesic (24.5%), followed by codeine (19.8%), ibuprofen (14.4%), diclofenac (7.2%), and tramadol (9.3%). Analgesic-related enquiries declined significantly over time (p < 0.001), particularly codeine-related enquiries following regulatory safety warnings. Conclusions: Analgesics represent a substantial proportion of medicines information enquiries in pregnancy and breastfeeding, reflecting widespread use and ongoing safety concerns. Pharmacist-led medicines information services play a critical role in supporting safe analgesic use. Full article