BACKGROUND:Limited health literacy (LHL) is associated with poorer health outcomes and presents challenges for chronic disease management. Pharmacy-based interventions may support medication-related outcomes in this population; however, their effectiveness and the extent to which they incorporate co-design elements remain unclear. OBJECTIVES:To evaluate the effectiveness of pharmacy-based interventions for adults with chronic disease and LHL, and to examine the extent to which co-design elements are incorporated in intervention development. METHODS:MEDLINE, CINAHL, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 30 June 2025. Randomised controlled trials evaluating pharmacy-based interventions among adults with chronic disease and LHL were included. Study selection, data extraction, and quality appraisal were conducted independently by two reviewers. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Findings were synthesised narratively due to substantial heterogeneity. RESULTS:A total of 10,029 records were identified, with nine trials (13 publications) included. Intervention effects were heterogeneous across outcomes. Medication understanding improved most consistently, driven primarily by patient-centred medication labels, with more modest gains from universal medication schedules. Care-transition interventions showed reductions in adverse events in some trials, although findings were not consistent across trials. Medication adherence outcomes were inconsistent and not sustained across trials. Clinical outcomes were assessed less frequently and showed mixed effects. Evidence of differential effectiveness by health literacy was limited and inconsistently reported. Co-design elements were largely absent, with only one trial reporting patient and family involvement. All trials were rated as low or moderate risk of bias, with none at high risk. CONCLUSION:Pharmacy-based interventions demonstrate mixed effectiveness in individuals with LHL, with stronger evidence for improving medication understanding and potential benefits in care transitions, but inconsistent effects on adherence and clinical outcomes. Co-design remains under-utilised or under-reported. Future research should prioritise co-designed, theory-informed interventions and improve reporting of health literacy subgroup analyses and participatory development processes.
This commentary follows an insightful paper recently published on the current milieu in academic pharmacy. The paper was unique in that it reported the results of in-depth interviews of persons with previously well-established, successful careers as pharmacy faculty who left the academy for various alternative paths. The commentary reflects on that paper along with other current literatures and trends in academic pharmacy and the broader context of academia, particularly the evolving work environments for faculty. We argue that evolutions in the work of pharmacy academicians have been witness to losses in autonomy, heightened expectations for productivity, greater involvement in administrative bureaucracy, decrements in the teaching environment, and erosion in culture and collegiality vital for their success. Indeed, the results of the aforementioned and other studies present a complex picture of the current environment, yet we cannot let the complexity preclude more immediate actions to address culture, collegiality, autonomy, citizenship, and quality. We must move past lip service and take real actions to address these phenomena. Academic leadership should make examples of the actions of star, or top performing faculty, provide adequate mentorship and development for all faculty, and use clear and specific communication while avoiding general platitudes. They must encourage innovative solutions and reward those who proffer them. Faculty colleagues can take actions, themselves, to yield more collegial environments. Losing faculty talent is problematic not only for the institution, but for the entire academy, for students, the profession, the academic scientific disciplines comprising pharmacy, and for society at large.
BACKGROUND:The transition from paediatric to adult healthcare for Adolescents and Young Adults (AYAs) with chronic conditions is critical, often marked by fragmented care, declining adherence, and worsening disease control. Although structured Transition of Care (TOC) frameworks exist, intervention components remain inconsistently defined, lack explicit theoretical grounding, and inadequately address competencies such as medication management. OBJECTIVES:This review aimed to (1) identify transitional care interventions for AYAs with chronic conditions; (2) classify intervention components using Psychological Empowerment Theory; (3) map components related to medication management; and (4) identify gaps in conceptualisation and implementation. METHODS:A scoping review was conducted following JBI methodology and PRISMA-ScR guidelines. Scopus, Web of Science, and Ovid MEDLINE were searched for English-language studies published between January 2015 and January 2026. Eligible studies evaluated transitional care interventions incorporating medication management or empowerment components. Data were deductively mapped onto the intrapersonal, interactional, and behavioural domains of Psychological Empowerment Theory. RESULTS:Thirty studies, representing a total of 3812 participants, were included. Interventions predominantly targeted interactional components, particularly disease knowledge, alongside behavioural components such as self-management. Intrapersonal constructs, including self-efficacy and psychosocial support, were least addressed and inconsistently operationalised. Pharmacist involvement was reported in only three studies (10%), primarily involving medication education and self-management skills training rather than longitudinal engagement across the transition pathway. CONCLUSION:By applying Psychological Empowerment Theory as an organising lens, this review shows that current TOC interventions prioritise knowledge and skills while underemphasising intrapersonal empowerment, risking the conflation of knowledge with empowerment and highlighting gaps in supporting sustained medication management. Future research should develop theoretically grounded, multidisciplinary models integrating clinical pharmacy expertise across the transition pathway.
Drug-drug interactions (DDIs) are an important source of preventable adverse drug events and remain challenging to address in clinical practice. Conventional rule-based clinical decision support systems are frequently associated with high false-positive rates and alert override exceeding 90%, contributing to alert fatigue. Artificial intelligence (AI) approaches are increasingly applied to DDI prediction; however, their methodological robustness and clinical readiness remain unclear. This scoping review mapped AI-based DDI prediction studies, examining input features, training strategies, validation approaches, performance metrics, and clinical applicability. Of 963 records screened across five databases, 131 studies met the inclusion criteria. Deep learning models predominated (82, 62%), with supervised learning (118, 90%) and internal validation (108, 82%) most common. Most studies relied on chemical structure-based features and curated knowledge bases (notably DrugBank), whereas only 18 (13.7%) studies incorporated patient-level variables. Although 25 (19%) studies reported AUROC, AUPR, and F1-score ≥ 0.90, these findings were largely derived from internally validated datasets, with limited external or clinical validation. AI-based DDI prediction research demonstrates substantial methodological sophistication but remains constrained by limited patient contextualization, interpretability challenges, and insufficient external validation, highlighting a translational gap between algorithmic performance and clinical applicability.
OBJECTIVES:To map international evidence on non-medical prescribers' (NMPs) antimicrobial stewardship (AMS) knowledge, competencies, and prescribing behaviours, and to examine how these are assessed across professional groups and healthcare settings. METHODS:A scoping review was conducted following Arksey and O'Malley framework and PRISMA-ScR guidelines. Six databases and grey literature were searched using a Population-Concept-Context strategy. Eligible studies addressed independent non-medical antimicrobial prescribing in high-income countries (2016-2026). Records were screened and data charted using a piloted standardised form. Findings were synthesised using framework analysis. RESULTS:Twenty papers from 19 studies across five countries (USA, UK, Canada, New Zealand, the Netherlands) were included. In one Canadian community-pharmacy sub-study, pharmacist prescribers achieved 95% concordance with provincial guidelines for uncomplicated UTI - a single-setting figure not generalisable beyond it. Pharmacist-led interventions reduced inappropriate prescribing. Nurse prescribers showed greater variability by experience and patient expectations. Cross-country differences in prescribing authority followed a consistent classification structure. In UK dispensing data, NMP antibiotic prescribing fell 12% in 2020 while the high-risk share rose modestly (5.3% to 6.4%; descriptive only). CONCLUSIONS:Antimicrobial stewardship knowledge among NMPs is generally high, but its application varies across settings and professional groups. This variability is one of capability, not competence: adaptive stewardship in ambiguous presentations, not the bounded knowledge that frameworks already articulate. NMPs should adopt validated antimicrobial prescribing and stewardship competency (NMP-APSC) assessment tools, and capability development in early-career prescribers warrants further empirical study. The Ahmed classification offers a workable shared vocabulary for regulatory comparison, pending empirical test of its discriminative validity beyond pharmacist prescribing.
BACKGROUND:Poor adherence to self-administered antibiotics in community and ambulatory care may compromise outcomes and contribute to inappropriate antibiotic use. Pharmacist-led adherence interventions are plausible, but evidence is heterogeneous and adherence is difficult to measure consistently. OBJECTIVE:To evaluate the published literature on whether pharmacist-led interventions in community and ambulatory care improve adherence to self-administered antibiotic therapy compared with usual care or less intensive support. METHODS:This PRISMA 2020 systematic review and meta-analysis was registered in PROSPERO (CRD420261329577). PubMed, Embase, Web of Science Core Collection, Scopus, and CENTRAL were searched from inception to 22 January 2026, with backward citation tracking. Eligible studies enrolled outpatients or ambulatory patients prescribed self-administered antibiotics. Randomized and cluster-randomized studies were pooled using random-effects models with Hartung-Knapp adjustment. Certainty was assessed with GRADE. RESULTS:Eighteen studies met the inclusion criteria; 10 randomized or cluster-randomized studies contributed to the primary meta-analysis. Certainty was very low because of risk of bias, inconsistency, and possible small-study effects. The pooled estimate favored pharmacist-led interventions (RR 1.42, 95% CI 1.04-1.93), but heterogeneity was considerable (I2 = 83.4%). Egger regression suggested possible small-study effects (p = 0.009) but not definitive publication bias. CONCLUSIONS:It remains uncertain whether pharmacist-led interventions improve adherence to self-administered antibiotics in community and ambulatory care. The pooled estimate suggests a possible benefit, but confidence in the magnitude and consistency of this effect is very limited. Future studies should use standardized adherence outcomes, transparent cluster-design methods, and downstream stewardship-relevant outcomes.
BACKGROUND:Over the past several decades, the pharmacist's role in healthcare has undergone a substantial transformation. The public's relationship with this professional shift remains largely uninvestigated. METHODS:Through this single site study conducted at a science museum located in a metropolitan area, 405 consented adults completed a 40-item survey to capture the public's understanding of the pharmacist's role in healthcare, trust in pharmacists to provide healthcare, and support for scope of practice expansion. Surveys were administered in-person, with all responses captured electronically. The dataset was examined using descriptive statistical procedures and association analyses. RESULTS:93% of respondents reported having a preferred pharmacy and 79% routinely picking up at least one prescription. For common health services, 53.5% had spoken to a pharmacist about a medication in the past year, while 48.4% had received a vaccination at a pharmacy. However, 20.3% of respondents indicated having a preferred pharmacist with whom they have an established patient-provider relationship. Additionally, utilization of pharmacist-provided health care services outside of vaccination and medication dispensing was uncommon among respondents at 12.2%. Lastly, comfort with pharmacist prescribing was high for seasonal illnesses (91.2%) and more moderate for chronic health conditions (52.5%). Only 5.8% of respondents reported they were not comfortable with pharmacists prescribing any medications. CONCLUSIONS:The public relies on pharmacists as medication experts, with most viewing them as trustworthy healthcare professionals capable of independently providing a range of services, although trust varies by service, including prescribing. Increasing awareness of pharmacist-provided care, alongside expanding access to and the scope of these services, presents an opportunity to improve patient outcomes.
INTRODUCTION:Healthcare workforce pressures are driving task shifting to optimize care delivery. Expanding the role of pharmacy technicians with a new service to support nurses with medication administration may reduce nursing workload while advancing pharmacy technician practice. AIMS:The study aimed to evaluate service effectiveness in terms of nursing time saved and safety profile, alongside implementation factors using the Consolidated Framework for Implementation Research (CFIR). METHODS:A mixed-methods study was conducted, including a descriptive analysis of activity by two pharmacy technicians, qualitative interviews, and confirmatory surveys. Effectiveness was evaluated using an observational study of patients receiving intravenous (IV) medicines within the new service and a pre/post implementation review of medication incident reports. Ten semi-structured interviews on implementation were analyzed using CFIR. An anonymous survey triangulated the interview data and allowed opinions from the wider nursing team. RESULTS:Pharmacy technicians assisted with the preparation and administration of 920 of a possible 4447 IV medicines (20%), saving approximately 1 h of nursing time per day. Medication safety analysis showed increased reporting of near misses and risk issues identified before reaching patients. Qualitative themes included adaptability, training and education, positive impacts on work culture and medication safety, interprofessional relationships, and future utilization of pharmacy technicians. Survey respondents strongly supported the service: 100% (n = 22) agreed pharmacy technicians can perform the role, and 95% (n = 21) felt their involvement improved IV medication rounds. CONCLUSION:Integrating pharmacy technicians into IV medication administration is acceptable, safe, and enhances nursing capacity by freeing time for direct patient care.
Background Increasing attention has been given to the role of organizational culture in influencing medication safety practices across healthcare settings. The lack of widely accepted standardized instrumentation makes operational measurement of organizational culture and medication safety challenging. The purpose of this systematic review was to examine the impact of organizational culture on medication safety within community healthcare settings. Methods MEDLINE, CINAHL, Scopus, and Nursing & Allied Health were searched in August 2025 using keywords, subject terms, field codes, and Boolean operators to identify papers relevant to the review question; bibliographies of included studies were also reviewed. Screening and full-text review were completed independently by two reviewers with a third to adjudicate conflicts. The Critical Appraisal Skills Programme was used for quality assessment. The PRISMA statement guided the development and implementation of the review. Results Thirteen articles were included representing various community settings. Most studies reported on untoward medication events, but few measured systematically collected safety data before and after an intervention. Organizational culture was seldom defined or operationalized. Most studies were methodologically sound, but the overall level of evidence was weak to moderate. Conclusion Organizational culture influences medication safety through aspects such as communication channels, teamwork, training, and an environment that allows error and near-miss reporting. Few studies explicitly evaluate the causal impact of culture interventions on measurable medication safety outcomes in community healthcare settings. Further research should incorporate standardized measurement tools and intervention-based, pre-post designs to better understand how organizational culture influences medication safety in community healthcare settings.
Generative artificial intelligence (AI) moved from novelty to clinical infrastructure within a single Doctor of Pharmacy program, yet pharmacy curricula and the accreditation standards that govern them have not uniformly caught up. Written from a Canadian vantage point, this narrative review synthesizes international peer-reviewed literature and grey-literature guidance from the International Pharmaceutical Federation, World Health Organization, UNESCO, and national accreditors in Canada, the United States, the United Kingdom, Australia, and New Zealand. Rather than presenting a flat catalogue of competencies, we propose a four-tier hierarchy that makes explicit which AI competencies pharmacy owns and which it shares: general competencies (foundational AI literacy and the applied skills that follow from it, which in steady state belong upstream of pharmacy education); interprofessional competencies (AI governance, ethics, equity, and regulatory awareness, shared across the health professions); pharmacy-specific competencies (clinical AI applications in pharmacy workflows, pharmaceutical sciences AI, and AI-augmented pharmacokinetics and model-informed precision dosing); and role-specific specialization. Because current students entered pharmacy programmes without K-12 or undergraduate AI preparation, faculties must carry the general and interprofessional layers transitionally, a five to ten year window in which faculty development, not curriculum design, is the binding constraint. Six pedagogical principles and five accreditation levers are synthesized, with CCAPP Standard 20 and its international counterparts named as the single highest-leverage accreditation instrument. Whether pharmacy remains the medication-therapy expert profession depends on whether graduates are the clinicians most literate in AI assisted pharmacotherapy and, most distinctively, in model-informed precision dosing, where the profession's claim is strongest.
BACKGROUND:Implementation science recognises that health innovations must be adapted to local contexts. Context analysis is a critical foundational phase for tailoring interventions and implementation strategies, yet remains underutilised in pharmaceutical sciences, limiting successful translation and scale-up of proven services in interprofessional settings. AIM:This paper provides a methodological roadmap highlighting the foundational role of context analysis in guiding real-world adaptation of a known service - the New Medicine Service - to form the myCare Start service in Switzerland. METHODS:Guided by the Basel Approach for coNtextual ANAlysis (BANANA), a mixed-methods context analysis was enacted including individual interviews and online quantitative surveys to understand the current patient journey, interprofessional practice patterns, and readiness of pharmacists and physicians to deliver enhanced medication adherence services. RESULTS:Between September 2023 and February 2024, individual interviews were conducted with 16 patients, 22 physicians, 11 pharmacists and 11 pharmacy technicians from French and German speaking regions of Switzerland. In addition, online surveys were completed by 48 pharmacists and 49 pharmacy technicians. Outputs includes a context report presenting the current state of long-term medication initiation in Swiss community pharmacies and other ambulatory care settings, a comprehensive list of multi-level contextual factors (barriers/facilitators) affecting implementation of myCare Start and stakeholder preferences relating to intervention design and delivery which will inform the adaptation of myCare Start and the selection of multilevel implementation strategies to facilitate implementation in Switzerland. DISCUSSION AND CONCLUSION:This study offers a replicable methodology prioritising contextual understanding as a basis for optimising care processes and real world translation. TRIAL REGISTRATION:ClinicalTrials.gov, Implementation of a New Model of Care for Supporting Long-term Medication Adherence (myCareStart-I) - NCT06191835.
BACKGROUND:Medication adherence is a primary determinant of treatment success in the management of coexisting diabetes and hypertension. Most existing literature focuses on disease-specific medication adherence, neglecting factors arising from managing coexisting chronic conditions. Pinpointing factors influencing medication adherence in people with coexisting diabetes and hypertension is crucial for developing multimorbidity focused interventions. METHODS:This study aimed to explore factors influencing medication adherence in people with coexisting diabetes and hypertension. A qualitative study was conducted with adults on medications for coexisting diabetes and hypertension, residing in Australia. In-depth interviews were conducted using a semi-structured guide to explore factors influencing medication adherence. NVivo software was used to organise and code transcripts. Thematic analysis was used to analyze the data and identify key factors influencing medication adherence. RESULTS:Thirty participants were interviewed. The factors influencing medication adherence fell into five themes, which aligned with the WHO dimensions of adherence, with most comments highlighting patient and therapy-related themes. Adherence was reported to be lower when medications were taken at times that did not align with individual preferences. Intentional non-adherence was mainly driven by the burden of managing long-term medications for two chronic conditions, which resulted in frustration and emotional fatigue. CONCLUSIONS:Medication non-adherence in people with coexisting hypertension and diabetes is driven by diverse and interrelated factors, reflecting its complexity. Addressing these multifaceted factors requires a holistic approach that actively engages all key stakeholders (patients, healthcare providers, policy makers) to design sustainable medication adherence interventions tailored for people managing coexisting chronic conditions.
Pharmacist prescribing has expanded rapidly across many health systems as governments seek to improve access to care and optimise medicines use. However, policy development and evaluation of these initiatives are impeded by inconsistent and ambiguous use of terminology describing prescribing, scope of practice, and models of pharmacist involvement. This commentary discusses the concept of prescribing as a regulated act constituted by four interdependent elements: the medicine, the condition, the prescriber, and the regulatory authority that authorizes practice. Terms such as minor ailments, common conditions, independent prescribing, autonomous prescribing, and collaborative or supplementary prescribing are variably applied across jurisdictions, often conflating prescribing with broader clinical management activities. It is argued that such imprecision obscures professional accountability, complicates interprofessional boundary setting, and undermines coherent regulatory governance. The paper discusses the need for a standardised terminology that is applicable across health professions and prescribing models, rather than pharmacy-specific labels. Clarifying the conceptual and regulatory meaning of prescribing is positioned as a prerequisite for effective policy design, implementation, and evaluation of expanded community pharmacy services. Establishing a shared language will support transparent allocation of clinical responsibility, improve system integration, and enable robust assessment of safety, and equity.
Systematic approaches to studying pharmacist-patient communication are relevant to support the development of communication practices to improve identification and resolvement of patient medication-related problems. However, there is currently no established gold standard for systematically coding pharmacist-patient communication, making it relevant to explore whether existing Systematic Coding of Observed Human Behavior (SCOBe) systems from other healthcare professions could be transferable to pharmacy practice. Therefore, this commentary explores the opportunities and challenges of applying existing SCOBe systems, originally developed in other healthcare professions, to pharmacist-patient communication research, education, and practice. A group of pharmacy researchers carried out a screening and assessment process of already validated SCOBe systems, developed for other health settings, with regard to degree of need for adaptation to a pharmacy practice context. While many SCOBe systems appear potentially transferable to pharmacy practice, it is currently unclear what degree of adaptation is required. Some tools may need only limited revisions, whereas others would require major structural changes or complete re-validation to fit the pharmacist-patient context, a process that is both important and resource-intensive. The outcomes were discussed according to the need for pharmacy researchers to strategically select communication domains and prioritize validated instruments that can enhance comparability and strengthen collective knowledge. Collaborative efforts within international pharmacy networks may support the development of a recommended core set of coding tools. Moreover, SCOBe systems hold value not only for research but also for pharmacist education, contributing to a more humanistic and person-centered professional identity.
PURPOSE:With little known about medication adherence for non-HIV chronic conditions in people living with HIV (PLHIV), this research evaluated antiretroviral (ART) adherence and non-ART composite medication adherence patterns among PLHIV and non-HIV chronic conditions (i.e., type 2 diabetes, hypertension, and hyperlipidemia) and their association with corresponding treatment goals. METHODS:Group-based multi-trajectory modeling of ART and non-ART adherence was used to identify medication adherence trajectories (MATs) over a 37-month observation period (9/2018-9/2021) in 525 continuously-enrolled PLHIV with multiple chronic conditions. ART and non-ART adherence were estimated using monthly proportion of days covered for diabetes, renin-angiotensin system antagonist, and statin medications. Relationships between MAT group membership and viral load, and a composite endpoint reflecting hemoglobin A1c, blood pressure, and/or total cholesterol control were evaluated using multivariable logistic regression. RESULTS:A six MAT model was identified: MAT-1 had inadequate, decreasing ART and non-ART adherence (6.3%); MAT-2 had inadequate, increasing ART and non-ART adherence (6.0%); MAT-3 had inadequate, divergent ART and non-ART adherence (11.5%); MAT-4 had inadequate, stable ART and non-ART adherence (17.6%); MAT-5 had low adequate ART and non-ART adherence (32.6%); and MAT-6 had high adequate ART and non-ART adherence (25.9%). Compared to MAT-6, MAT-1 (aOR = 0.24, p = 0.004) and MAT-2 (aOR = 0.24, p = 0.004) had decreased odds of achieving a viral load <20 copies/mL. Additionally, MAT-1 (aOR = 0.31, p = 0.038) and MAT-4 (aOR = 0.49, p = 0.033) had decreased odds of achieving the composite endpoint compared to MAT-6. CONCLUSIONS:Varying patterns of ART and non-ART adherence are differentially associated with achieving intermediate clinical endpoints suggesting tailored intervention to address unique medication adherence needs.
Background Community pharmacists are an accessible yet underutilized workforce for colorectal cancer (CRC) screening, but global evidence on their impact and the optimal implementation models remains fragmented. Objective To synthesize global evidence on the effectiveness, implementation contexts, and key motivators and barriers of pharmacy-based CRC screening initiatives to inform scalable healthcare integration. Methods This scoping review was conducted searching PubMed, Scopus, Embase, and CINAHL for studies published from inception to October 2025, guided by the Population-Concept-Context (PCC) framework. Eligible studies included pharmacist-led or pharmacy-based CRC screening interventions (e.g., kit distribution, education, referral) as well as observational studies assessing implementation determinants, including pharmacist knowledge, patient attitudes, and system-level motivators and barriers. Data were extracted, then synthesised thematically and presented narratively. Results A total of 27 articles representing 24 unique studies from 13 countries were included. Interventions featuring direct provision of faecal immunochemical tests (FIT) consistently demonstrated superior uptake (e.g., 93.5% kit return rate in Spain; 59.3% completion in US bundled vaccination models). In contrast, models relying solely on education or physician referral demonstrated lower uptake (e.g., 17%). Regarding implementation determinants, motivators included high patient trust, service accessibility, and pharmacist willingness to expand their professional role. However, critical barriers undermined scalability, specifically the lack of reimbursement mechanisms, knowledge gaps regarding screening guidelines, and fragmented communication pathways with primary care providers for positive-result follow-up. Conclusions Pharmacy-based CRC screening initiatives were effective and achieved high adherence when delivered through direct-provision models integrated into national or regional health frameworks. However, the current reliance on ad-hoc, non-reimbursed pilot programs limits sustainability. Policy efforts must focus on formalizing reimbursement mechanisms and establishing closed-loop communication with primary care to transform this opportunistic service into a scalable public health strategy.
BACKGROUND:During their lifetime, more than half of all women will have a urinary tract infection. In many countries, due to difficulty accessing a general practitioner, community pharmacists can prescribe drugs for uncomplicated cystitis. OBJECTIVE:This study evaluated the effectiveness of a pharmacist-led protocol compared to usual care (over-the-counter drugs, lifestyle, referral to a physician) for managing uncomplicated cystitis in women presenting to community pharmacies. METHODS:The PharmaCyst' open-label, multicenter, controlled, cluster-randomized study was conducted in 24 community pharmacies in the Loire region, France. Women aged 18 to 65 years presenting to a pharmacy with at least one symptom of uncomplicated cystitis were considered for inclusion. They were assigned to the intervention arm or the control arm depending on their pharmacy (i.e. clusters). The primary endpoint was the score change in the 'typical symptoms' section of the Acute Cystitis Symptom Score (ACSS), between day 0 (intervention) and day 3. Patients were contacted by telephone at day 3, day 10, and month 3 post-intervention. RESULTS:144 patients were included: 24 in the control arm and 120 in the intervention arm. The ACSS 'typical symptoms' score reduction at day 3 was greater in the intervention than control arm (-8.21 vs -5.84 points, p = 0.035). No difference in the occurrence of adverse events or complications was observed between arms. Patient overall satisfaction with the care provided by community pharmacists was excellent (mean score: 9.66 of 10). CONCLUSION:Pharmacists' management of cystitis in women leads to a greater reduction in symptoms at day 3.
Background Australia's Aged Care Onsite Pharmacist program aims to support quality use of medicines in residential aged care homes. This is a novel role introduced into existing teams in a complex environment. Factors associated with successful integration since implementation are currently unknown. Aim This study aims to explore the perspectives of pharmacists and other stakeholders within aged care homes regarding successful integration of the novel aged care pharmacist service into healthcare teams. Methods A qualitative approach, using interpretive descriptive methodology, was used to explore perspectives. Semi-structured focus groups and interviews with pharmacists, nursing and care staff, allied health professionals, general practitioners, residents, and family members were undertaken. Data were collected via Zoom™, audio- and video-recorded, and transcribed verbatim. Two researchers undertook inductive thematic analysis to identify key themes. Results 30 participants across focus groups, focus-group interviews, interviews, and member-checking processes contributed. An overarching theme of proactivity and showing a genuine interest in others underpinned three key themes. Theme 1: Pharmacists needed to be seen, through physical presence and availability, as well as developing a distinct identity. Theme 2: Pharmacists needed to build trust, through collaboration in real time and demonstrating value. Theme 3: Pharmacists needed to develop an understanding of the aged care home environment, including social and contextual norms, as well as procedures, routines and roles. Discussion This research complements existing understandings of interprofessional collaboration and teamwork amongst healthcare professionals. Themes were interlinked; we used a sensitising framework, social cognitive theory, to present and explain the findings and interactions that can support pharmacist integration into existing teams.Aged care services should structure onboarding to prioritise early visibility, clarify roles and organisational needs, and foster in-person collaboration. Pharmacists should demonstrate proactivity and an authentic interest in all staff, residents and families.
Background The Roter Interaction Analysis System (RIAS) is the gold standard for medical communication analysis, but its automated coding remains underexplored due to imbalanced code distributions. This study developed an automated RIAS classification system using Japanese transformer-based models and evaluated AI-based data augmentation to mitigate class imbalance. Methods Five transformer models were fine-tuned for 44-class RIAS classification using medication counseling dialogues. To enhance generalizability, we employed AI-based data augmentation and evaluated performance using both AI-augmented and real-data-only test sets. Assessment metrics included accuracy, macro F1, and weighted F1. Findings The dataset comprised 17,391 utterances (39.4% AI-generated). In the real-data-only (primary) test set, ELECTRA achieved the highest accuracy (0.7875), macro F1 (0.6561), and weighted F1 (0.7835). All models performed worse under the real-data-only condition than under the AI-augmented condition, mainly for minority-class categories. Error analysis showed semantically ambiguous and context-dependent categories, including domain-adjacent counseling topics and affective expressions, remained challenging, indicating linguistic transparency and definitional distinctiveness influence classification beyond training frequency. Conclusion This proof of concept shows that AI-based augmentation can mitigate class imbalance in automated RIAS classification of medication counseling dialogues. While robust for prototypical expressions, nuanced affective categories remain challenging for text-only approaches. These findings support the feasibility of automated RIAS analysis for pharmacy education while suggesting that multimodal approaches are needed to capture subtle emotional dynamics. By complementing manual coding with quantitative insights, this system may support timelier and objective feedback and ultimately contribute to patient-centered care.
