BACKGROUND:Research engagement forms a fundamental aspect of clinical practice and hospital pharmacy. Research generates evidence to improve patient care, enhance service delivery, and improve pharmacy workflows. AIM:To identify studies describing interventions and factors that improve research engagement among hospital pharmacists and pharmacy support staff, and to examine the barriers and facilitators to their involvement in research. METHODS:This scoping review systematically searched four databases (PubMed, Embase, Scopus and CiNHAL) from January 2000 to February 2024. Studies included original research focusing on studies describing interventions to improve research engagement in hospital pharmacists and support staff. Factors that improved research engagement or outlined barriers and facilitators to research engagement were also included. Studies were screened by two reviewers using Covidence. Relevant data were extracted into tables and narratively synthesised. Interventions, factors, and barriers/facilitators were mapped to components of the Capability, Opportunity, Motivation - Behaviour (COM-B) Framework and Theoretical Domains Framework using the StrategEase Tool. RESULTS:A total of 2389 studies were screened, with 21 studies included for data extraction. Three studies described interventions to improve research engagement, ten outlined factors associated with research engagement, and fourteen described barriers and/or facilitators to research engagement. The most cited facilitator for research was personal interest, while the most cited barrier was lack of time. Of the three studies that outlined interventions to improve research engagement, all included education and training while only one included the mechanism of protected time to overcome the 'lack of time' barrier. CONCLUSIONS:This review identifies key factors and promising strategies to improve research engagement in hospital pharmacists and support staff, including structured training, protected time, and approaches that foster positive research attitudes. Further evaluation of these interventions and exploration of motivational drivers is needed to inform effective, sustainable research capacity building in hospital pharmacy practice.
Background Coordinated medicine donations improve treatment access, especially in low- and middle-income countries and humanitarian contexts. However, heterogeneous practices raise concerns regarding efficiency, sustainability, and alignment with health priorities. Objective This scoping review mapped evidence on medicine donation programs, focusing on operational mechanisms, public health impacts, and contribution to reducing access inequities. Methods This study followed Joanna Briggs Institute methodology and was reported according to PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Scopus, and Google Scholar (July 11, 2025). Eligible sources included original studies, expert opinions, and grey literature addressing donation programs or solidarity pharmacies. Data were extracted on study characteristics, donated medicines, contexts, involved actors, and responses to guiding questions. Results Forty-one publications were included, most of them published between 1999 and 2020 (n=30; 75%), with over half being observational studies (n=22; 55%). Research mainly focused on Africa (n=9; 22.5%) and Europe (n=7; 17.5%), with pharmacists often playing a central role in donation management (n=12; 29,2%). Three main themes emerged: heterogeneous implementation models, ranging from global partnerships to local reuse initiatives in high-income countries; public health impacts, including disease control and expanded access, as well as logistical, regulatory, and quality challenges; and contributions to reducing inequities, particularly in emergencies, neglected diseases, and high-cost medicines. Conclusion Medicine donation programs are strategic tools but should complement, not replace, sustainable financing and pharmaceutical policies. Their effectiveness depends on governance, alignment with health priorities, and monitoring. Future research should assess long-term outcomes and cost-effectiveness to guide ethical and sustainable global health strategies.
Background and aims To improve medication handling in municipal care facilities, a large-scale project was launched in Denmark providing education on the topic. One of the components of the project was the development of quality indicators concerning instructions on how to handle medications, the residents’ medication lists, medication dispensing, and medication administration to the residents. This study aimed to analyze the validity of the developed indicators focusing on their feasibility, improvement potential, discriminatory capacity, and sensitivity to change. Methods Scoring of the indicators was carried out in a total of 20 municipalities by 21 community pharmacies from November 2022 to April 2023. Each indicator was scored by a pharmacy representative before and after the education as either complied or not. Subsequently, aggregated indicators were generated by calculating individuals with all measured indicators complied or other. Feasibility, improvement potential, and discriminatory capacity were calculated using pre-education data; sensitivity to change assessed the difference between pre- and post-education measurement, where the same residents were not necessarily evaluated at both points. The SQUIRE check list was used to guide the reporting. Results For the Instruction group, nearly all individual indicators (N=11) showed excellent feasibility and improvement potential, and both aggregated indicators were sensitive to change; the discriminatory capacity of all indicators was limited. For the Medication list group, almost 40% of the individual indicators (N=16) showed low feasibility; the aggregated indicator demonstrated the strongest measurement properties. In the Dispensing group, all individual indicators (N=17) had excellent feasibility, and almost 30% of them had good validity across all measured properties. For the Administration group indicators (N=2), one demonstrated good validity in all measured aspects. Conclusion The developed quality indicators can be improved and used to support preparation and assessment of education or other pharmacy services for municipal staff about working safely when handling medications.
BACKGROUND:Chronic non-malignant pain (CNMP) is common in low- and middle-income countries (LMICs), yet access to potent opioids is often constrained by fears of misuse and diversion. In Pakistan, community pharmacists (CPs) have no patient-oriented opioid optimisation services despite specialised roles in medicines optimisation in high-income settings. OBJECTIVE:This study aimed to explore and identify barriers, facilitators, and strategies for developing and implementing a novel opioid optimisation service for CNMP in Pakistan. METHODS:A mixed-methods study was conducted in Pakistan from November 2019 to December 2020. Qualitative data were collected through six case studies , semi-structured interviews with pharmacy policymakers (n = 11) and individuals with CNMP (n = 14), and focus groups with doctors (n = 31) and CPs (n = 36). Data were inductively analysed using reflexive thematic analysis supported by NVivo 12, and case study observations in six community pharmacies were examined using cross-case synthesis with an explanation-building approach. Findings were deductively mapped to an adapted implementation science framework (LMIC-CFIR and FISpH), and an implementation research logic model was developed to theorize how implementation strategies might operate through underlying mechanisms to support service delivery and implementation. RESULTS:Barriers and corresponding strategies were identified across five domains (intervention, system, community, organisation, individual). strategies included CP remuneration, regulatory reform and policymaker support, public awareness initiatives, organisational support in community pharmacies, and enhancement of CP knowledge, skills, and motivation. CONCLUSIONS:The study outlines strategies to address multilevel barriers to implementing a novel opioid optimisation service and proposes a pathway for policymakers to mobilise the community pharmacy workforce to optimise opioid use among people with CNMP in Pakistan.
BACKGROUND:Engagement questionnaires have been widely recognized as an indicator of clinician performance, workplace satisfaction, and organizational outcomes. There are several tools that measure engagement among physicians and nurses. However, no validated engagement tools exist for pharmacists, whose work environment and responsibilities differ. This gap highlights the need for a pharmacist-specific engagement tool. This study aimed to assess reliability and factor structure of the POWER Engagement Framework questionnaire. APPROACH:The POWER Engagement Framework was developed to assess the professional and organizational factors that play a role in pharmacist engagement in a pharmacist-led primary care practice environment. It encompasses five core constructs derived and adapted from the literature - Potential, Opportunity, Well-being, Environment, and Resources (POWER). Pharmacists who had worked two or more shifts in the pharmacy primary care clinic in Alberta, Canada completed an online questionnaire administered via the Qualtrics Survey platform between June - September 2024. A comprehensive validation analysis was conducted which included Spearman correlation, internal consistency using Cronbach's alpha and Confirmatory Factor Analysis (CFA). RESULTS:Demographic information was available for 93/113 participants, of whom almost two thirds 61.3% (57/93) were Canadian-trained pharmacists. The overall standardized Cronbach's alpha was 0.82, indicating good internal reliability. Spearman's correlations suggest that pharmacists perceive Well-being, Environment, and Resources as important factors that will enhance their ability to excel and grow in the profession. Validity was assessed using CFA, which tested whether the data fit the hypothesized factor structure of the five constructs. The CFA largely supported the hypothesized factor structure, particularly for Potential and Environment, while Well-being and Resources exhibited weaker model fit. CONCLUSIONS:This study presents the validation of the first pharmacist-specific tool to measure engagement. The POWER Engagement Framework demonstrated good reliability and conceptual coherence to assess pharmacist engagement. Refinement for Well-being and Resources constructs could improve the model.
Pharmacy practice continues to expand in scope, complexity, and accountability, increasing the need for continuing pharmacy education (CPE) and continuing professional development (CPD) approaches that translate learning into sustained practice improvement while integrating personal and professional growth. Despite widespread adoption of CPD frameworks, evidence across settings indicates variable uptake and inconsistent impact, reflecting a persistent implementation gap between participation and durable practice change. To inform framework development, we conducted a narrative review of CPE/CPD frameworks in pharmacy, with attention to intended outcomes, factors shaping uptake and impact. This synthesis inspired an examination into current gaps in consistent CPE/CPD implementation and thusly a proposal of an equation-based conceptual framework: Personal and Professional Development = (Competence × Commitment) (Behaviour+Attitude). In the framework, competence (knowledge + skills) and commitment (motivation + confidence) form the baseline term; multiplication reflects interdependence such that when either component approaches zero, development correspondingly collapses; addition reflects compensatory strengths within each term; and exponentiation positions behaviour and attitude as scaling forces that can suppress, neutralise, or amplify development. The framework provides a parsimonious diagnostic lens for identifying the dominant constraint (baseline versus scaling term) and prioritising intervention targets across diverse learner profiles. It is advanced as a practical heuristic to structure reflective CPE/CPD and personal development planning, support mentorship and performance-development conversations, and guide prioritisation of development efforts at individual and team levels. The framework focuses on intra-individual determinants offering a clear platform for future context-specific operationalization. By translating common development challenges into an accessible diagnostic structure, the framework provides a shared language for converting reflection into targeted action and sustained practice improvement.
BACKGROUND AND OBJECTIVE:Intermittently scanned continuous glucose monitoring (isCGM) has been shown to improve glycemic control in individuals with type 2 diabetes mellitus (T2DM), yet the optimal frequency of CGM use remains unclear, particularly in community pharmacy settings. This study evaluated the effects of different frequencies of isCGM use within a brief pharmacist-led educational program for adults with T2DM treated without insulin. METHODS:The COMPASS-Libre study was a multicenter, open-label randomized controlled trial conducted in community pharmacies in Japan. Adults with T2DM and glycated hemoglobin (HbA1c) ≥7% were randomized (1:1) to either a single-CGM group (one sensor) or a multiple-CGM group (four sensors) over 12 weeks. The primary outcome was change in time in range (TIR; glucose 70-180 mg/dL). Secondary outcomes included time above range (TAR), time below range (TBR), glucose management indicator (GMI), and coefficient of variation (%CV), along with behavioral and patient-reported outcomes. RESULTS:Seventy-seven participants were randomized (mean age 60.9 ± 10.4 years; mean HbA1c 7.4 ± 0.8%), with a dropout rate of 16.8%. TIR significantly improved in both the single-CGM group (64.6 ± 23.0% to 71.1 ± 17.9%, P = 0.0496) and the multiple-CGM group (62.5 ± 20.8% to 69.6 ± 21.7%, P = 0.002), with no significant between-group difference in change (6.4 ± 17.1% vs 7.3 ± 12.0%, P = 0.808). TAR decreased significantly in both groups, while TBR remained low and unchanged. GMI also improved in both groups, with no significant between-group differences. Improvements in dietary behavior were observed only in the multiple-CGM group (P = 0.032). CONCLUSIONS:A brief pharmacist-led educational program using intermittently scanned CGM improved glycemic metrics in adults with non-insulin-treated T2DM. However, increasing the frequency of CGM use did not provide additional glycemic benefit compared with a single CGM exposure. These findings suggest that even limited CGM use may support behavioral change and glycemic improvement in community pharmacy settings. TRIAL REGISTRATION:UMIN000048893.
Opioid-related stigma within the pharmacy profession can prevent people with substance use disorders receiving necessary care.. Stigmatisation can negatively impact individuals’ interactions with healthcare professionals, reduce engagement with harm reduction services, and deter individuals from seeking treatment. The aim of this study is to identify the educational interventions aimed at addressing opioid-related stigma within pharmacy teams. A scoping review was conducted following the Arksey and O’Malley framework. The search was conducted in October 2024 using MEDLINE, EMBASE, and PSYCINFO. Data from included studies were extracted and categorised into tables for comparison, according to their intervention focus following an analysis of the intervention details. A narrative summary of the included studies, their main characteristics, findings, and reported barriers was conducted. Eleven studies were included, mostly from the USA, encompassing four main intervention types: educational training programmes; toolkit-based interventions; harm reduction training and screening; and brief intervention implementation. Most interventions demonstrated stigma reduction, particularly those incorporating direct patient interactions, stigma-free language training and harm reduction awareness. Barriers to implementation include time constraints, lack of resources and staff hesitancy. Interventions targeting opioid-related stigma show promising results in improving attitudes and reducing discriminatory behaviours in a pharmacy setting. Pharmacists, as accessible healthcare providers, are well-positioned to support harm reduction efforts and foster stigma-free environments. Future research should focus on standardised evaluation methods, research outside of the USA, and long-term stigma reduction strategies.
BACKGROUND:Integrating patient-reported experience measures (PREMs) into medication management could strengthen patient-centred care. However, few tools capture patients' experiences with medications (PREM-Rx) in primary care, including community pharmacy. This study examined factors impacting the implementation of PREM-Rx from key interest-holders' perspectives. METHODS:We conducted a three-phase sequential mixed methods study in Ontario, Canada. Phase 1 involved semi-structured interviews with key interest-holders, including persons with lived experience (PWLE) of medication use (n = 21), medication prescribers (n = 20), and health system decision-makers (n = 9). Phase 2 comprised a cross-sectional survey of PWLE (n = 197) and prescribers/decision-makers (n = 200). In Phase 3, we used a triangulation protocol to integrate qualitative and quantitative findings using the Theoretical Domains Framework (TDF). RESULTS:Integration identified convergence across seven TDF domains: Knowledge, Skills, Beliefs about capabilities, Beliefs about consequences, Behavioural regulation, Goals, and Environmental context and resources, with additional alignment in PREM-Rx delivery preferences. Key interest-holders agreed that PREM-Rx could promote safer medication use, but identified gaps in awareness, confidence, and system-level supports. PWLE prioritized shared decision-making and medication safety during conversations about medications, while prescribers emphasized potential workflow and resource constraints of implementing PREM-Rx without additional supports alongside. Delivery preferences of PREM-Rx included short completion time, accessible formats, and flexible delivery, with most PWLE preferring primary care and most prescribers favoring community pharmacy. CONCLUSIONS:PREM-Rx are promising tools for eliciting medication-related experiences in routine care. Implementation efforts should focus on building user confidence, integrating PREM-Rx into existing workflows, and tailoring delivery to patient and prescribers needs to inform targeted implementation strategies.
Purpose As the United States (U.S.) population continues to age, innovative approaches are needed to address gaps in age-friendly care. This paper highlights the utility and application of geographic information systems (GIS) to expand age-friendly care within nursing homes (NHs). Objective To create a geographic visualization to aid pharmacists, referred to as regional champions, in their efforts to identify and enhance adoption and implementation of Age-Friendly NH care. Methods This study uses a cross-sectional, descriptive, geospatial approach using ArcGIS Online Creator 11.3 joining datasets of CMS-certified and IHI recognized NHs in March 2025. Results A total of approximately 790 NHs with Age-Friendly recognition were identified. Among 14,800 NHs in the U.S., roughly 14,670 number have not achieved Age-Friendly recognition and were identified as targets for intervention by regional champions. On average, 1,850 NHs were identified for each regional champion as potential targets. Regional champions engaged 67 NHs through August 31st, 2025. Conclusion The geographic visualization highlights significant regions in the U.S. where CMS-certified NHs have not yet achieved Age-Friendly Health Systems (AFHS) recognition. This serves as a practical opportunity for strategic mobilization of regional champions to identify, plan, and track efforts aimed at supporting NH’s adoption and implementation of age-friendly care.
BACKGROUND:Over-the-counter (OTC) medication misuse among older adults is a patient safety concern, exacerbated by limited patient engagement about potential risks. Senior Safe™, a pharmacy-based intervention using human-factors engineering and participatory design,specifically, shelf signage, product repositioning, and patient engagement to nudge safer choices. Despite its safety intent, and demonstrated effectiveness, it was important to determine the intervention's impact on its financial sustainability. METHODS:This study evaluated Senior Safe's effect on daily unit sales of OTC analgesic, sleep, and cough/cold/allergy products across 65 community pharmacies in a Midwestern health system. Using Generalized Linear Mixed Model regressions with Poisson distribution, the analyses compared daily unit sales pre- and post-intervention trends for products marked with Green Banners (safer), Red Stop Signs (high-risk), or Behind-the-Counter (BTC) signage (very high-risk), controlling for pharmacy type, size, location, open hours, and staff hours. RESULTS:Senior Safe was associated with increased sales of safer analgesics and cough/cold/allergy medications (IRR = 1.064 and 1.106), along with significant decreases in unit sales of BTC and Red Stop Sign products (IRR = 0.424-0.869). These findings suggest a substitution effect, where patients chose safer alternatives rather than forgoing OTC purchases. Operational factors, such as longer open hours and higher staffing levels, were positively associated with safer product unit sales. CONCLUSIONS:Senior Safe successfully shifted consumer behavior toward safer OTC medication use without reducing overall sales volume, suggesting patient safety interventions can be financially sustainable in retail pharmacy settings. These results support broader implementation of low-cost, system-level interventions that align safety with business operations.
BACKGROUND:Advances in antiretroviral therapy have extended the lifespan of people living with HIV, increasing age-related comorbidities and polypharmacy. This study aimed to examine how frailty is associated with co-medication network structure and anticholinergic burden in adults living with HIV. METHODS:This cross-sectional study analysed co-medication networks across robust, prefrail, and frail states using data from the Positive Brain Health Now cohort of adults aged ≥35 years. Frailty was assessed using a modified Fried Frailty Phenotype. Network metrics such as density (proportion of observed to possible medication-medication connections), clustering coefficient, and assortativity were calculated to characterize structural differences. Exponential Random Graph Models (ERGMs) assessed the relationship between anticholinergic burden and co-medication patterns, and permutation tests evaluated differences in network metrics between frailty states. RESULTS:Network density was very similar across frailty groups (0.148 in the robust group vs 0.160 in the prefrail and frail groups). The clustering coefficient increased slightly from robust (0.42) to frail (0.44) states (p < 0.001), indicating somewhat tighter connectivity among medications in frail individuals. ERGM analyses showed that a one-unit increase in anticholinergic burden reduced the likelihood of co-medication by 43.8% in robust individuals, 44.3% in prefrail individuals, and 47.7% in frail individuals, with significant differences between robust and frail groups (p < 0.001). CONCLUSION:Frailty is associated with modest but distinct differences in co-medication network structure and the influence of anticholinergic burden. Early interventions in robust and prefrail states, along with tailored strategies for frail individuals, might help mitigate medication-related risks.
BACKGROUND:Existing medication counselling frameworks often compartmentalize communication, behavioural science, and pharmacy practice as distinct domains, limiting their real-world effectiveness. This study aimed to develop and validate a structured, theory-informed medication counselling framework that operationalizes Motivational Interviewing principles together with complementary behavioural models. METHODS:A mixed-methods validation study was conducted with 27 pharmacists from hospitals and health clinics in Selangor, Malaysia. Participants completed pre- and post-intervention self-assessment surveys and structured roleplay evaluations following a 60-min training on CONNECT-6. Performance was assessed using validated checklists measuring motivational interviewing principles and patient-centred counselling behaviours. A qualitative hot wash session captured experiential feedback. RESULTS:Significant improvements were observed across all competency domains. Mean total roleplay scores increased from 9.71 (SD = 3.75) to 17.00 (SD = 4.90) post-intervention (p = 0.002). Self-assessed understanding and confidence improved significantly across all 13 survey items (p ≤ 0.003), with largest gains in assessing patient motivation, collaborative education techniques, and uncovering non-adherence reasons. Thematic analysis revealed a shift from directive monologue to collaborative dialogue and deepened therapeutic connections, though concerns regarding time constraints and practical implementation emerged. CONCLUSION:CONNECT-6 demonstrates significant effectiveness in enhancing pharmacist competency and patient-centred communication skills. By integrating behavioural science theory with practical application, this framework addresses critical gaps in medication counselling practice and shows promise for broader implementation across diverse healthcare settings.
Background Generative AI (GenAI) has increasingly been used in ways to support health professions education but the utility of it to support research skill development for pharmacy residents is not well established. Objectives We examined perceptions of GenAI for supporting the development of research and evaluation skills among dual master’s/resident students in a health system administration and leadership degree program. Methods This was a convergent parallel mixed-methods design study situated within a two-year dual masters/residency Master in Pharmaceutical Sciences program with a specialization in Health System Pharmacy Administration. Students completed Part 1 and Part 2 of an activity involving GenAI feedback on research design and were asked to complete a survey involving Likert-type questions and open-ended questions. Results Nearly all students (n=46) completed Part 1 (96% response rate) and Part 2 (n=46, 100% response rate). Qualitative analysis of responses from Parts 1 and 2 produced four themes that aligned the quantitative findings from Part 1: helpful and informative feedback, skepticism around GenAI feedback, reflection on work and course learnings, and desire to learn more and use GenAI in the future. Conclusion Residency students found GenAI to be supportive for developing research plans situated within their healthcare institutions and in future contexts. But they also expressed a need for critical review of GenAI’s suggestions. GenAI presents a possible avenue for support in research skill development with appropriate guidance and mentorship.
OBJECTIVE:This study investigates the association between socioeconomic status (SES) and opioid utilization behaviors among U.S. adults experiencing chronic or recurrent pain. METHODS:Using data from the 2011-2018 NHANES, we carried out a cross-sectional assessment. A cohort of 978 adults aged 18 and above who reported pain lasting at least one month were included. The primary outcome was the self-reported number of days on which prescription opioid medications were used across the preceding 30-day period, which reflects the frequency, not the dose or intensity, of opioid use. The main predictors were SES indicators, comprising poverty-income ratio (PIR), employment status and retirement status. Negative binomial regression models were used, adjusting for demographic and clinical covariates. RESULTS:Unemployed and low-income individuals demonstrated significantly longer durations of opioid use than their employed and higher-income counterparts. Patients with health insurance coverage also reported more opioid use days than uninsured patients. The interaction between SES and pain type revealed that unemployed individuals with oral or chest pain had notably higher opioid use durations. Stratified analyses showed that the effects of SES on opioid use varied across subgroups defined by age, gender, race, and comorbidity profiles. CONCLUSION:Socioeconomic disparities are key determinants of shaping opioid consumption behaviors among chronic pain patients. Findings underscore the need for personalized pain management strategies and policy interventions that account for patients' socioeconomic conditions to mitigate the risk of opioid overuse.
Pharmaceutical care in public health services is often hindered by the need for pharmacists to balance clinical, technical, and managerial tasks, limiting their ability to focus on patient care. The high prevalence of systemic arterial hypertension (SAH) combined with increased demand for healthcare and limited resources, further strains these services, making it difficult to meet the needs of the entire population. To address this, tools that help identify high-priority cases are essential for effective healthcare delivery. This study aimed to develop and validate a screening tool to identify patients with SAH who require pharmacotherapy follow-up in Primary Health Care settings.The study followed a four-step validation process: evaluation by experts, semantic analysis, application of the tool to SAH patients, and score determination. The initial instrument contained 36 items across four categories: Lifestyle, Comorbidities, Use of Health Services, and Use of Medications. Fleiss' Kappa coefficient of 0.66 indicated good agreement among the evaluators. After semantic analysis, ten items were rewritten, and additional information was included in eight items for clarity. The final version of the tool, applied to 828 patients, identified the most relevant items through composite reliability (rho) analysis.The validated instrument, ISPHAF-APS, contains 14 items across three dimensions: Comorbidities, Use of Health Services, and Use of Medications. A score of three or less indicates low priority, while a score above five suggests a higher need for pharmacotherapy follow-up. The ISPHAF-APS demonstrated adequate psychometric properties and can effectively identify SAH patients who would benefit most from pharmaceutical care.
BACKGROUND:Over two-thirds of gastrointestinal (GI) malignancies occur in adults aged 65 and older, yet limited evidence exists on the associated economic burden. This study aimed to assess healthcare costs among U.S. Medicare beneficiaries diagnosed with GI malignancies. METHODS:Using 2015-2019 Medicare Current Beneficiary Survey (MCBS) data, we conducted a pooled cross-sectional analysis of Medicare beneficiaries aged ≥65. We identified patients with GI malignancies via International Classification of Diseases (ICD) codes and compared their annual medical costs with those without GI malignancies. A two-part model adjusting for demographic, socioeconomic, and health-related factors estimated the incremental cost associated with GI malignancies. RESULTS:Among 51,827 beneficiaries, 567 (1.1%) had GI malignancies. Unadjusted annual medical costs were significantly higher for those with GI malignancies ($19,582.0 vs. $7,962.4, p < 0.001). After adjustment, GI malignancies were associated with an incremental annual cost of $5,008.3 (95% CI: $2,864.7-$7,151.9) per person. Medicare covered the majority of this increase, while cost differences by gender and race/ethnicity were observed particularly in out-of-pocket, outpatient, and institutional spending. CONCLUSIONS:GI malignancies place a significant economic burden on Medicare beneficiaries, driven mainly by outpatient and inpatient costs. Policy and care delivery reforms are needed to reduce costs and improve equitable access.
BACKGROUNDS:Drug-related problems (DRPs) remain a critical concern in perioperative management. Improper perioperative medication decision-making will significantly increase patients' perioperative medical risks, increase medical expenses, and cause a great waste of medical resources. OBJECTS:To enhance clinical pharmacists' perioperative medication management abilities and improve patient adherence, this study analyzes the current status of competency research to propose appropriate indicators. Using expert consultation, a suitable indicator system was selected. Based on survey data, a competency model for clinical pharmacists in perioperative medication management was constructed. The model was empirically tested to evaluate its effectiveness and aims to contribute to the development of a training and accreditation system for clinical pharmacists in China. METHODS:Through literature review and expert consultation, a national survey was developed on perioperative medication management practices via a national-level working committee focused on perioperative medication (organization name blinded). A competency theoretical model was constructed using Delphi method and validated through confirmatory factor analysis. A six-month empirical study was conducted in the spinal surgery department of a tertiary hospital in Eastern China (institution name blinded) to evaluate model effectiveness. RESULTS:The finalized model comprised four dimensions: pharmacist qualification, perioperative medication therapy management, teamwork, and academic involvement. The most influential factor was perioperative medication therapy management (path coefficient: 0.904), followed by qualification (0.857), teamwork (0.797), and teaching and research (0.669). Model-guided pharmacist training significantly improved clinical outcomes, including a 55.6% reduction in postoperative infection rate, a 0.61-day decrease in antimicrobial therapy duration (p = 0.007), a 51.4% reduction in respiratory symptoms, a 0.8-point reduction in pain scores (p < 0.05), and a 2-day reduction in incision healing time for diabetic patients (p = 0.01). Economic benefits included a 25.8% decrease in total treatment cost and a 97.5% reduction in proton pump inhibitor expenditure. CONCLUSION:This study preliminarily developed a competency indicator system for Chinese clinical pharmacists in perioperative medication management, thereby enhancing the overall standard of clinical pharmacist practice in this domain.
BACKGROUND:The potential mediating effects of work fatigue and well-being on the relationship between personal abilities and inclusive healthcare practices among community pharmacists remain an understudied area in Lebanon. The aim is to examine the factors associated with community pharmacists' professional inclusivity and their moral/ethical attitudes. It also investigates how pharmacists' well-being and work fatigue mediate the relationship between personal abilities, specifically empathy and emotional intelligence, and the expected outcomes. METHODS:Online cross-sectional study, conducted in 2023 among 430 Lebanese community pharmacies. Inclusivity, equity, and professional integrity were evaluated using the Pharmacy Inclusivity and Accessibility Scale (PIAS-13), the Population Prioritization and Equity Index (PPEI-24), and the Professional Commitment and Integrity Scale (PCIS-15). Moral and ethical perceptions were assessed using the Ethical Pharmacy Practice Scale (EPPS-16), the Moral Exception and Blame-Avoidance Scale (MEBAS), and the short form of the Moral Expansiveness Scale (MESx). Emotional Intelligence was measured using the Wong and Law Emotional Intelligence Scale (WLEIS), empathy using the Toronto Empathy Questionnaire (TEQ), and work fatigue using the Three-Dimensional Work Fatigue Inventory (3D-WFI). Multivariable and mediation analyses were conducted to examine relationships among variables. RESULTS:Among graduate pharmacists, well-being mediated the associations between empathy, emotional intelligence, and priority assessment-a measure of inclusive practice-with β = -.02, 95% CI [-.11, -.04], P = 0.058, and β = -.03, 95% CI [-.07, .001], P = 0.013, respectively. Well-being also mediated the association between empathy and moral expansiveness (an indicator of inclusive attitudes) (β = -.02, 95% CI [.006, .079], P = 0.044). In contrast, work fatigue did not mediate any of the examined associations in this group. Among undergraduate pharmacists, work fatigue partially and negatively mediated the relationships between empathy and emotional intelligence with professional commitment and integrity, whereas well-being showed no mediating effects. CONCLUSION:This study highlights the complex interplay of factors influencing community pharmacists' professional inclusivity and moral/ethical attitudes. Both concepts were associated with emotional intelligence, empathy, and moral expansiveness. Additional research is necessary to validate these findings, investigating targeted educational interventions, in particular, to enhance inclusivity in pharmacy practice.
