BACKGROUND:Warfarin therapy necessitates precise monitoring using the International Normalized Ratio (INR) owing to its narrow therapeutic index. Patients in remote regions of Pakistan, Afghanistan, and Iran face significant barriers to regular health care access, compounded by language barriers when health care is not provided in their native languages. The objectives of this study are to evaluate pharmacist-led telemedicine delivered in native languages on anticoagulation control, monitoring adherence, and clinical outcomes among warfarin-treated patients from remote, linguistically isolated regions of Pakistan, Afghanistan, and Iran. METHODS:In this retrospective cohort study, 200 adults on warfarin and registered at the National Institute of Cardiovascular Diseases (NICVD) anticoagulation clinic, who spoke Pashto or Persian/Dari and could not attend in person were enrolled. These patients received 6 months of structured telemedicine from bilingual pharmacists comprising educational reminders, biweekly counseling, and remote INR review with protocolized dosing. Time in Therapeutic Range (TTR) was the principal outcome measure. RESULTS:Mean TTR was 62.8% ± 18.1% and medication adherence was 83.5%. Out of 200 patients, 97 patients (48.5%) achieved TTR ≥ 65%. Overall complications occurred in 20 patients (10.0%). All bleeding events (BARC 1-3), the left atrial thrombus, and the stuck prosthetic valve occurred exclusively in the TTR < 65% group. Adequate control was associated with greater on-schedule INR testing (76.3% vs. 57.3%, p = 0.004) and less long-distance laboratory travel (36.1% vs. 63.1%, p < 0.001). CONCLUSION:Native-language, pharmacist-led telemedicine is a feasible model for warfarin management in geographically and linguistically isolated populations and may be scalable to other resource-limited, conflict-affected settings.
BACKGROUND:Board of Pharmacy Specialties board certification has become a common method of distinguishing pharmacists with advanced expertise in various areas of practice. These certifications are an important achievement for the pharmacy workforce, yet the number of new certifications has declined in recent years. Determining if various factors within the education and training pipeline of pharmacists, such as the number of Doctor of Pharmacy (Pharm.D.) graduates and the number of pharmacy residency candidate matches, are involved in this decline has not been previously studied. METHODS:This study was a retrospective database review correlating numbers of Pharm.D. graduates and Postgraduate Year (PGY) 1 and PGY2 residency candidate matches to new board certifications annually. Data from each database was aligned to Pharm.D. year of graduation from 2015-2023 for analysis. Correlation analysis was performed for both Pharm.D. graduates and residency candidate matches with new board certifications, as well as multivariate analysis of both factors with new board certifications. Pharm.D. graduate and PGY2 residency candidate matches were also analyzed for correlations (individually) and multivariate effects (together) with their respective aligned specialty certifications. RESULTS:The number of Pharm.D. graduates declined over the study time period and showed strong correlations between all new board certifications (r = 0.95, p < 0.001) and new Board-Certified Pharmacotherapy Specialist certifications (r = 0.94, p < 0.001). No significant correlations were found for residency candidate matches (PGY1 or PGY2) and new certifications. Correlation analysis between Pharm.D. graduates and PGY2 residency candidate matches with their aligned specialty certifications showed minimal, if any, significant results. CONCLUSION:Number of Pharm.D. graduates, but not residency candidate matches, showed significant correlations with new board certifications annually. Reasons for these correlations should be investigated further to determine how Pharm.D. graduate numbers affect certification patterns, and how this can be utilized to increase board certifications in the future.
BACKGROUND:Inappropriate antimicrobial use in emergency departments (EDs) contributes significantly to antimicrobial resistance (AMR). Pharmacist-led antimicrobial stewardship programs (ASPs) can potentially optimize antimicrobial prescribing and improve patient outcomes; however, their specific impact in the ED setting warrants further evaluation. METHODS:This retrospective cohort study evaluated adult patients receiving empiric antimicrobial therapy in the ED of a large, tertiary-care, community teaching hospital in South Florida before (pre-ASP) and after (post-ASP) the implementation of a pharmacist-led ASP. The primary outcome was the appropriateness of empiric antimicrobial therapy based on societal guidelines and local resistance patterns. Secondary outcomes included the use and appropriateness of antipseudomonal and anti-Methicillin-resistant Staph Aureus (MRSA) agents, as well as the appropriateness of vancomycin dosing. Logistic regression analyses identified predictors of inappropriate prescribing. RESULTS:A total of 324 patients (median age, 65 years; 53.4% female) were included, with 162 patients in both the pre-ASP and post-ASP groups. Appropriate empiric regimens did not differ significantly (49.4% vs. 53.7%, p = 0.44). There were significant reductions in unnecessary pseudomonal (54.9% vs. 35.2%; p < 0.001) and MRSA coverage (23.5% vs. 13.6%; p = 0.02), and vancomycin dosing appropriateness trended upward post-ASP (52.6% vs. 77.3%; p = 0.06). The post-ASP group demonstrated significant reductions in aztreonam (5.2% vs. 0.5%; p < 0.01), piperacillin/tazobactam (22.3% vs. 14.5%; p = 0.02), and vancomycin use (18.0% vs. 11.0%; p = 0.02), with increased ceftriaxone (17.5% vs. 33.0%; p < 0.001) and metronidazole prescribing (1.4% vs. 7.0%; p = 0.01). Independent predictors of inappropriate prescribing included home wound care (Adjusted odds ratio [aOR], 5.36; CI, 1.3-36.2), male sex (aOR, 1.72; CI, 1.1-2.8), and gastrointestinal infection (aOR, 2.67; CI, 1.1-6.7). CONCLUSION:Although the overall rate of appropriate empiric therapy remained unchanged, the pharmacist-led ASP was associated with reduced broad-spectrum antimicrobial usage and enhanced vancomycin dosing accuracy. These findings suggest that pharmacists can help optimize ED antimicrobial use, although additional strategies are needed to improve overall appropriateness.
BACKGROUND:Suboptimal antibiotic prescribing for pediatric community-acquired pneumonia (CAP) contributes to avoidable harm and antimicrobial resistance, yet evidence on pharmacist-led stewardship in low- and middle-income countries remains limited. The objective of this study is to evaluate the impact of a pharmacist-led antimicrobial stewardship intervention on antibiotic prescribing appropriateness for pediatric CAP in Vietnam. METHODS:We conducted a quasi-experimental before-and-after study at a provincial maternal and pediatric referral hospital. Using monthly stratified systematic sampling, we reviewed 560 unique paper-based medical records of children aged 2 months to 5 years who were hospitalized with a primary diagnosis of CAP and received systemic antibiotics (280 records in January-June 2024 and 280 in January-June 2025). The intervention comprised locally adapted prescribing guidance, two in-person educational seminars, printed and digital prescribing tools, and case-triggered face-to-face audit and feedback. Appropriateness was evaluated against the hospital protocol, Vietnamese national guidance, the Vietnam National Drug Formulary, and manufacturer information. Proportions were compared between periods; exploratory univariable logistic regression examined factors associated with inappropriate prescribing before the intervention. RESULTS:Overall appropriateness increased from 60.36% (169/280) to 86.79% (243/280; p < 0.001). Dose appropriateness increased from 67.14% to 90.71% (p < 0.001), and dosing-interval appropriateness increased from 90.36% to 98.57% (p < 0.001). Before the intervention, age < 12 months (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3-3.5; p = 0.003) and combination therapy (OR 4.6, 95% CI 1.75-12.1; p = 0.001) were associated with inappropriate prescribing. CONCLUSION:A structured pharmacist-led stewardship intervention was associated with substantial improvement in antibiotic prescribing appropriateness for pediatric CAP, driven mainly by better dosing and dosing intervals. These findings support sustained pharmacist participation in pediatric antimicrobial stewardship in provincial Vietnamese hospitals.
Effective implementation of pharmacist-delivered patient care interventions requires systematic, careful pre-launch planning, which includes assessing and building readiness of the health care setting embracing this change. A health care team needs to be both willing and able to deliver the selected service. Despite its recognized importance, implementation readiness has rarely been operationalized into a usable system for pharmacy practice. The present article introduces the "POWERS" heuristic, which outlines the six elements of implementation readiness to consider in preparation for service implementation: Ready patient (Patient), Ready priorities (Organizational Priorities), Ready workflow (Workflow), Ready workforce (Engaged Workforce), Ready Operations (Resources and Operations), and Ready Supports (Supports). These domains represent the readiness content components of a broader readiness formula that, when paired with a systematic readiness assessment and building (RAB) process, provides a structured approach to strengthening implementation readiness. Application of the heuristic within the RAB process is illustrated through a case study involving delivery of three community pharmacist-delivered patient care services (for diabetes, cardiovascular disease, and anxiety/depression) in 22 national/regional, grocery store, and independently owned pharmacies. This heuristic not only expands on current conceptualizations of readiness, but also provides a practical and actionable set of readiness domains to support systematic readiness assessment and building efforts in pharmacy practice and beyond.
BACKGROUND:Drug-related problems (DRPs) are common in ambulatory prescribing and can cause preventable harm, yet evidence that pharmacist-led interventions reduce clinically meaningful DRPs in Vietnam remains limited. This study evaluated a multifaceted clinical pharmacist intervention to reduce the prevalence and potential clinical harm of DRPs in adult outpatient prescriptions. METHODS:We conducted a quasi-experimental pre-post study of electronic adult outpatient prescription records at a tertiary hospital in Ho Chi Minh City, Vietnam. Adult outpatient encounters in which patients were prescribed at least two medicines were consecutively sampled during two 14-day observation periods before and after a 4-week intervention. The intervention combined prospective prescription review with prescriber feedback, targeted education, and reminders. DRPs were classified using the Pharmaceutical Care Network Europe classification. The primary outcome was the prevalence of prescription records with at least one DRP. Secondary outcomes were DRP density and potentially harmful DRPs assessed by expert-panel consensus using the Doerper method. Multivariable logistic regression adjusted for prespecified potential confounders. RESULTS:A total of 8832 prescription records were analyzed (pre-intervention, 4586; post-intervention, 4246). Prescriptions with at least one DRP decreased from 65.7% to 37.3% (p < 0.001), and mean DRPs per prescription decreased from 1.22 ± 1.24 to 0.55 ± 0.83 (p < 0.001). Prescriptions with potentially harmful DRPs decreased from 2.4% to 1.7% (p = 0.04). Reductions occurred across all evaluated DRP subtypes, especially dose selection and administration-timing problems. After adjustment, the post-intervention phase remained associated with lower DRP occurrence (adjusted odds ratio, 0.29; 95% confidence interval, 0.26-0.32; the estimated prevalence ratio was 0.57). CONCLUSION:A structured, multifaceted clinical pharmacist intervention was associated with substantial reductions in DRP burden and potentially harmful DRPs in outpatient prescribing. These findings support integrating clinical pharmacists into ambulatory care teams as a scalable medication-safety strategy in Vietnam and similar resource-limited health systems.
BACKGROUND:Large language models (LLMs) are increasingly explored for drug information support, yet their reliability and clinical applicability remain uncertain. This study evaluated multiple LLMs in responding to real-world drug information questions retrieved from a university hospital in Thailand, focusing on clarity in Thai, concordance with pharmacist responses, relevance, context awareness, and citation credibility. METHODS:A total of 102 drug information questions were submitted to seven LLMs, generating 714 responses. In the inter-rater reliability phase, 10 pilot questions were submitted to all seven LLMs, and the resulting 70 responses were evaluated by three assessors, yielding 210 rating instances. Agreement was measured using intra-class correlation coefficient and Fleiss' kappa. Following satisfactory agreement, the 102 questions were divided into three subsets, each assessed by one assessor using a predefined rubric. Binary outcomes were coded to calculate sensitivity and domain fulfillment rates, with pharmacist-provided answers serving as the reference standard for concordance. Model performance was compared using Cochran's Q test, and citation-related issues were identified from qualitative comments. RESULTS:Inter-rater reliability demonstrated substantial to almost perfect agreement, with coefficients ranging from 0.79-0.86. Overall, most LLMs performed well in clarity, relevance, and context awareness. Clarity scores ranged from 85.25%-92.75%, while fulfillment rates ranged from 0.97-1.00 for relevance and 0.90-0.99 for context awareness. Concordance was more variable, ranging from 0.70-0.86, whereas citation credibility was consistently weak, ranging from 0.03-0.36. A significant difference between LLMs was observed only in the concordance, with post hoc analyses identifying a significant difference between ChatGPT-5.2 Thinking (OpenAI, San Francisco, CA, USA) and Copilot Think Deeper (Microsoft, Redmond, WA, USA). (McNemar test, adjusted p = 0.0178). CONCLUSIONS:LLMs show potential as tools for preliminary drug information retrieval and rapid responses generation in drug information services. However, variable concordance and persistent limitations in citation credibility indicate the need for continued pharmacist oversight.
ABSTRACT Background Pharmacist board certification through the Board of Pharmacy Specialties (BPS) is expanding in many developed countries; however, research on this topic in the Middle East remains limited. This study aimed to assess the perceptions, motivations, barriers, and factors associated with pharmacists pursuing BPS board certification in Middle Eastern countries. Methods A cross‐sectional online questionnaire consisting of multiple sections assessing demographics, knowledge, attitudes, motivations, barriers, and job satisfaction was distributed to licensed pharmacists across Middle East countries between October 2024 and January 2025 via professional and social media platforms using a snowball sampling approach. Results A total of 1631 pharmacists participated in the study, of whom 512 (31.4%) were board certified. Board‐certified pharmacists reported higher levels of pride and self‐confidence related to their certification status ( p < 0.001). Multivariable logistic regression showed that lower‐income pharmacists were more likely to seek board certification (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.4–3.4; p < 0.001). Conversely, lack of guidance regarding BPS certification (OR = 0.55; 95% CI: 0.40–0.76; p < 0.001) and insufficient financial support (OR = 0.59; 95% CI: 0.40–0.84; p = 0.003) were associated with lower odds of certification. Pharmacists who learned about certification through an instructor (OR = 1.9; 95% CI: 1.4–2.57; p < 0.001) or through journal articles (OR = 1.36; 95% CI: 1.01–1.8; p = 0.045) were more likely to pursue a certification. Conclusion This study identifies key regional barriers toward pursuing board certification particularly limited guidance and financial constraints which highlights the need for targeted strategies such as mentorship, employer support, and educational outreach to enhance certification uptake and strengthen the pharmacy workforce in the Middle East.
BACKGROUND:Generative artificial intelligence (AI) tools are increasingly used in health professional education, including for automated writing evaluation (AWE). While AI-based grading may reduce faculty workload and variability, its alignment with human grading remains unclear. This study compared rubric-based grading of pharmacy student drug information papers by faculty and ChatGPT (Open AI, San Francisco, CA). METHODS:We conducted a retrospective comparative analysis of 159 de-identified assignments from a required evidence-based medicine course. Faculty-assigned grades were paired with scores generated by a custom generative pretrained transformer (GPT) configured with the assignment rubric. The primary outcome was the difference in mean total scores; secondary outcomes included rubric section-level scores, variability, and agreement metrics. Paired t-tests, Lin's concordance correlation coefficient, and Cohen's weighted kappa were used for analysis. RESULTS:Aggregate mean total scores were higher for ChatGPT versus faculty (51.3 vs. 49; p = 0.0004, mean difference, 2.3; 95% confidence interval, 1.015-3.595), with differences in five of seven rubric sections. Faculty scores exhibited greater variability than ChatGPT scores (standard deviation, 7.4 vs. 3.7). Concordance between faculty and AI grading at the individual student level was poor (Lin's coefficient for total score = 0.06; kappa for overall grade = 0.03). ChatGPT also assigned more "B" grades and fewer failing grades compared with faculty. CONCLUSION:AI-based grading produced similar aggregate letter grades and reduced variability but demonstrated poor agreement with faculty scores at the individual level. AI grading may complement, not replace, faculty evaluation for assignments requiring critical appraisal, but further studies are needed.
BACKGROUND:Pharmacist intervention (PI) is an important strategy for reducing drug-related problems (DRP; events or circumstances related to drug therapy that actually or potentially interfere with desired health outcomes) and improving efficiency, quality, and clinical outcomes, thereby avoiding unnecessary health care costs. This systematic review aims to identify and analyze studies that have validated PI and/or DRP classification systems within inpatient hospital settings, and to assess the validity and quality of the methodological procedures adopted in these systems. METHODS:This research followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. We searched MEDLINE, Embase, LILACS, Web of Science, Scopus, and the gray literature databases without restrictions on publication date or language. Two authors independently carried out study selection, data extraction, quality assessment, and analysis. A narrative synthesis was conducted, and the results were tabulated and synthesized descriptively in tables and in the text. RESULTS:Seventeen articles were included, in which 14 distinct classification systems for PI and/or DRP were identified. Most studies (13/17) were conducted in Europe, did not conceptualize the construct of interest (12/17), failed to disclose the undertaking of a literature review to support the generation of items for the classification system (13/17), and did not assess the content validity evidence (13/17). Also, the majority of studies (15/17) demonstrated the reliability of the classification instrument, but did not report whether the sample used was representative of the population, information on controlling confounding variables, or on evaluator blinding. CONCLUSION:Most instruments demonstrated acceptable reliability. However, few studies assessed sources of validity evidence, often with methodological limitations. Further studies employing rigorous methods for assessing validity evidence are needed to develop an instrument that is both valid and reliable for use in hospital pharmacy clinical practice.
BACKGROUND:Under-reporting of adverse drug reactions (ADRs) limits medication-safety learning in provincial hospitals, where dedicated pharmacovigilance infrastructure and personnel are often constrained. The objective of this study was to evaluate a clinical pharmacy-led multifaceted intervention to improve healthcare professionals' knowledge, attitudes, and reporting practices and to strengthen hospital pharmacovigilance performance. METHODS:We conducted a multicenter pre-post evaluation in three provincial hospitals in Ca Mau province, Vietnam (January 1, 2022-June 30, 2025). Repeated cross-sectional surveys were administered before and after a 6-month intervention (July-December 2023) (n = 372 each round). All spontaneous ADR reports submitted to the national pharmacovigilance center and archived at hospital pharmacies were retrospectively reviewed. Report completeness was assessed using VigiGrade (well documented ≥ 0.8), and organizational capacity was assessed using the Indicator-based Pharmacovigilance Assessment Tool (IPAT). RESULTS:Adequate knowledge increased from 2.7% (10/372) preintervention to 29.8% (111/372) postintervention. Adequate attitudes increased from 57.5% to 64.2%, and adequate self-reported practices from 47.8% to 55.6%. Among professionals who had encountered suspected ADRs, ever-reporting increased from 46/308 (14.9%) to 75/334 (22.5%) (p = 0.015). Spontaneous ADR reports increased from 26 preintervention to 144 postintervention while maintaining high completeness (VigiGrade ≥ 0.8: 96.2% vs. 97.9%; p = 0.419). IPAT performance improved across domains, with the largest gains in monitoring and reporting activities. CONCLUSIONS:A pragmatic, pharmacy-coordinated multifaceted intervention was associated with increased ADR reporting participation and volume without compromising documentation completeness and with strengthened organizational pharmacovigilance performance. This model appears feasible for resource-limited provincial hospitals, but the outcomes should be interpreted as improvements in reporting processes rather than direct evidence of reduced patient harm.
BACKGROUND:Obesity, diabetes, and cardiovascular disease often co-exist in people with chronic kidney disease, placing them at high risk for adverse health outcomes. Availability of highly effective medications that span cardiovascular-kidney-metabolic (CKM) conditions, but limited uptake in real world settings, calls for a new transformative practice paradigm. We sought to identify key gaps, barriers, and facilitators to implementing a standardized CKM-focused comprehensive medication management (CMM) intervention, including needs/solutions among various care team members involved in CKM care in diverse health systems across the United States. METHODS:This was a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) deployed in five health care systems across the United States. Clinical pharmacists, pharmacist administrators, primary care and specialty (nephrology, cardiology, endocrinology) physicians, and advanced practice professionals were interviewed using open-ended questions that were informed by results from three mainly quantitative online surveys. RESULTS:A total of 26 interviews were conducted with 42 participants. Practitioners and administrators reported many similar challenges to successfully implement CMM for people with CKM including lack of standardized CMM practice and workflow across the health system, electronic medical record integrated tools to identify and track patients with CKM, automatic pharmacist referrals, broad clinical practice agreements, and holistic CKM performance metrics, as well as pharmacist time constraints and limited reimbursement. Participants also highlighted CMM-CKM practice facilitators including recognition across most health care professionals that CKM should be a system priority, requiring strong supportive professional relationships among physician and/or administrator champions, and tools, knowledge, and resources that could be shared with others. CONCLUSION:Successful implementation of a transformative, holistic CMM-CKM interprofessional team-practice will require a tailored implementation strategy for each health system including consolidated tools such as a CMM-CKM Change Package, integrated with coaching, field experts, and peer-to-peer learning.
BACKGROUND:This study aimed to describe the development of pharmacist-led clinical services in primary health care (PHC) in a region of São Paulo, Brazil, comparing the profile of patients served, the types of care provided, and the clinical outcomes achieved in the provision of these services in two distinct periods. METHODS:This quantitative, descriptive, retrospective, observational study analyzed data from pharmaceutical consultations conducted in 12 PHC units in São Paulo, Brazil. Data were extracted from the service database and included patient characteristics and lifestyle habits, control of prevalent chronic conditions based on clinical and laboratory parameters, medication use history, identified drug-related problems, and pharmaceutical interventions. RESULTS:A total of 3626 pharmacist-led clinical appointments were analyzed, involving 2442 patients, conducted between May and November 2016 and 2022 in Community Health Centers and patients' homes. Most patients were referred by other health care professionals and were predominantly women aged ≥ 60 years using five or more medicines. Overall, 7849 drug-related problems were identified, with a mean of 2.9 problems per patient in 2016 and 3.5 in 2022, mainly related to treatment adherence and clinical monitoring. A total of 17 304 pharmaceutical interventions were performed, with a mean of 7.0 per patient, predominantly involving pharmacotherapeutic counseling. An increase in the number of consultations was associated with higher rates of resolved drug-related problems and improved control of chronic conditions. CONCLUSION:These findings demonstrate the sustainability of pharmacist-led clinical services in a large Brazilian municipality, with measurable benefits for medication management and chronic disease control, supporting the expansion of integrated clinical pharmacy services in PHC.
BACKGROUND:Documentation burden in the electronic health record (EHR), including clinical note writing, inbox management, and order entry, contributes to clinician inefficiency and burnout. Ambient artificial intelligence (AI) documentation tools can generate draft clinical notes for clinician review and have been shown to reduce documentation burden among physicians and advanced practice providers; however, their impact on clinical pharmacists has not been described. METHODS:This retrospective, observational study evaluated changes in EHR efficiency and clinical productivity metrics among ambulatory care clinical pharmacists at a federally qualified health center during the 2 months before and after implementation of an ambient AI documentation tool. Outcomes included time in notes per day, time in notes per appointment, time in clinical review, number of clinical encounters per month, number of clinical interventions per month, and inbasket tasks completed per month. descriptive statistics characterized the cohorts. Wilcoxon signed-rank tests were used to compare EHR efficiency metrics, and paired t-tests were used to compare clinical productivity data between pre and postimplementation periods. RESULTS:Nine ambient AI documentation tool users demonstrated a 31.17% reduction in median time spent documenting notes per day (38.5 vs. 26.5 min, p = 0.04). Ambient AI users showed an average increase of approximately 33 visits per 1.0 full-time equivalent (FTE) per month, whereas nonusers saw an increase of about 17 visits per 1.0 FTE per month during the same period, though neither of these changes were statistically significant. CONCLUSION:Ambient AI documentation tools were associated with reduced documentation time among ambulatory care clinical pharmacists and may enable increased clinical capacity. These findings provide early implementation evidence supporting the use of ambient AI documentation tools in pharmacy practice, demonstrating feasibility and measurable workflow impact in the ambulatory care setting.
