Chronic kidney disease (CKD) affects more than 10% of the global population and represents one of the leading causes of mortality. This study aimed to assess the pharmacotherapy of hospitalized patients aged ≥ 65 years with CKD, focusing on the prevalence of polypharmacy, potentially inappropriate medications (PIMs), potentially clinically significant drug–drug interactions (DDIs), the use of renal-risk drugs (RRDs). A prospective observational study was conducted at the Department of Nephrology and Dialysis of University Hospital Dubrava, including 100 participants. A clinical pharmacist obtained the Best Possible Medication History (BPMH) within 24 h of hospital admission. A total of 1324 comorbidities were recorded (median 12 per patient), along with 985 prescribed medications. Polypharmacy (5–9 drugs) was observed in 43% of patients, while excessive polypharmacy (≥10 drugs) was present in 48%. A total of 258 PIMs were identified, with 89% of patients having at least one PIM (mean 2.6 per patient). Nearly 94% of patients had significantly impaired renal function (G3–G5), and 82% were exposed to inappropriately prescribed RRDs. Contraindicated medications based on renal function were identified in 62% of patients, while 52% had at least one medication prescribed at an unadjusted dose. A total of 1097 potentially clinically significant DDIs were identified, with a mean of 10.9 interactions per patient. The results indicate a high prevalence of polypharmacy, PIMs, potentially clinically significant DDIs and inappropriately prescribed RRDs among older hospitalized patients with CKD, increasing the risk of adverse events and unfavorable treatment outcomes. The findings highlight the importance of the 24 h period following hospital admission as an early opportunity for identifying medication-related problems and optimizing pharmacotherapy in highly vulnerable patients, such as elderly patients with CKD. The study also emphasizes the importance of early involvement of a clinical pharmacist in the pharmacotherapy review and obtaining the BPMH.
Introduction: The development of technology to support medication management and adherence among older adults is rising. Many of these technologies offer diverse features, which add complexity when making a choice. Evidence-based decision aids can inform decision-making in such situations. To inform the development of such a decision aid, it is necessary to review the literature on the development and validation of decision aids that impact medication adherence. Therefore, this study aims to review the available literature on digital decision aids that examine the impact on medication adherence and investigate their features, development, and validation processes. Methods: Adopting the Arksey and O’Malley scoping review framework, a comprehensive search was conducted using PubMed, Embase, CINAHL, IPA and Scopus, using four key concepts: medication adherence, decision aids/tools, older adults, and software/technology. Eligibility criteria included studies that enrolled older adults with a mean/median age of 65 years, published protocols for studies that supported decision-making, published in the English language, and examined and reported the development and/or validation and/or evaluation of digital decision aids. Results: Our search identified 3526 records. After removing 947 duplicates, 2579 records underwent title and abstract screening, of which 726 proceeded to full-text screening. Following full-text screening, one research protocol met all eligibility criteria and was included in the review. An additional 16 systematic reviews were examined to identify potentially relevant studies from their reference lists; however, none of the studies identified through this supplementary screening met the eligibility criteria. Conclusion: The limited number of eligible studies shows a substantial gap in the literature on the development and validation of digital decision aids that support medication adherence among older adults. Further research in this field is needed to develop and validate evidence-based and user-centered digital decision aids for this population.
Background: Therapeutic drug monitoring (TDM) for piperacillin/tazobactam has become established in intensive care. TDM should be used in a structured approach to optimize dosing. We evaluated a newly designed TDM- and algorithm-based clinical-pharmacy-service to determine whether it is appropriate for optimization. Methods: We developed a clinical pharmacy service providing algorithmic recommendations for optimizing piperacillin/tazobactam dosing based on piperacillin TDM. After implementing the clinical pharmacy service, we evaluated the treatment of intensive-care patients with piperacillin/tazobactam in terms of achieving the minimum-inhibitory-concentration-(MIC)-related target concentration at the following four time points: t1, t2, t3, and t4 (1–4 working days after piperacillin/tazobactam therapy was started). Results: A total of 132 patients (including 36% women), median age 78 years, received piperacillin/tazobactam therapy. Sepsis or septic shock was the most common indication (43%), while a pulmonary focus was most frequent (40%). From 132 patients (t1), 19% had “too low piperacillin concentrations”, 20% “appropriate concentrations”, and 61% “too high concentrations”. After recommendations were given (acceptance rate 100%) the corresponding numbers from 93 remaining patients (t2) were 16%, 35%, and 48%, from 49 patients (t3) 8%, 53%, and 39% and from 29 patients (t4) 38%, 45%, and 17%. In (t1), dose reduction was the main recommendation (49%). The number of patients with “appropriate concentrations” increased in one comparison (t1–t2: n.s.; t1–t3: p = 0.0013; t1–t4: n.s.; Bonferroni-corrected McNemar test), while “too high concentrations” decreased (t1–t2: p = 0.0080; t1–t3: p = 0.0056; t1–t4: p = 0.0095). “too low concentrations” were not influenced (t1–t2: n.s.; t1–t3: n.s.; t1–t4: n.s.). Conclusions: Inappropriate piperacillin plasma concentrations were common. A TDM- and algorithm-based clinical-pharmacy-service especially decreased the number of overdosed patients in routine practice.
The optimal fixed-dose strategy for managing warfarin-associated hemorrhages remains unknown and few studies have evaluated the use of Factor VIII Inhibitor Bypass Activity (FEIBA). This retrospective cohort study’s primary efficacy outcome was the percentage of patients who achieved a post-FEIBA INR ≤ 1.5 following receipt of the old and new dosing regimens. In the old group patients received 500 or 1000 units for an INR < 5 or ≥5, respectively. In the new group patients received 1000, 1500, or 2000 units for an INR < 5, 5–9.9, or ≥10, respectively. Eighteen patients were included in each group. The median (IQR) pre-FEIBA INR in the old and new groups was 6.1 (3.1–12.9) and 5.3 (3.4–13.0), respectively [difference: −0.8 (95 CI%, −7.2 to 6.5)]. The median (IQR) post-FEIBA INR in the old and new groups was 1.6 (1.4–2.1) and 1.4 (1.2–1.5), respectively [difference: −0.2 (95% CI: −0.6 to 0.0)]. A post-FEIBA INR ≤ 1.5 was achieved in 14 (78%) patients in the new group and 9 (50%) patients in the old group (relative risk: 1.56; 95% CI, 0.91 to 2.7; p = 0.16). The post-FEIBA INR values in the patients who did not achieve a post-FEIBA INR ≤ 1.5 in the new group were 1.6, 1.6, 1.8, and 2.4. Among patients with a baseline INR ≥ 10, significantly more patients in the new group achieved a post-FEIBA INR ≤ 1.5 compared to the old group (86% vs. 17%, respectively). These findings suggest that the new FEIBA dosing regimen may improve INR reversal compared with the previous regimen, particularly among patients with a baseline INR ≥ 10, but larger studies are needed to confirm this observation.
(1) Objective: This study aims to evaluate the pre-admission clinic (PAC) pharmacist for high-risk obstetric patients’ admissions on medication management processes, workflow efficiency, and staff satisfaction. (2) Methods: Data collected over a 12-month period, from March 2025 to February 2026, were analysed. Data collected included clinic type, patient attendance, mode of pharmacist review, and follow-up requirements. Multidisciplinary healthcare professionals were invited to complete a satisfaction survey to identify themes relating to service value, workflow impact, and opportunities for improvement. (3) Results: A total of 1039 interviews with obstetric patients, equating to an average of 19.98 interviews per week. A total of 999 patients were involved in the 1039 interviews held, 40/999 (4%) patients required additional follow-up telephone interview and 14 patients (14/999, 1.4%) required in-person interview for interpreter services, detailed discussion or hearing impairment. Thirty-two staff responded to a survey and demonstrated a consistent trend across anaesthetists, nursing and midwifery staff, and pharmacists. All respondents either agreed or strongly agreed that a PAC pharmacist in the obstetric setting was valuable and beneficial to clinical workflow and medication management processes, and that they were satisfied with the PAC pharmacy service. (4) Conclusions: The PAC pharmacist demonstrated a positive impact on medication management for obstetric patients within the pre-admission setting.
Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings.
“Triple whammy” prescriptions, combining non-steroidal anti-inflammatory drugs (NSAIDs), renin–angiotensin system (RAS) inhibitors, and diuretics, increase acute kidney injury (AKI) risk. To clarify the frequency and profiles of these prescriptions and identify vulnerable populations, we analyzed the AHI partners database to estimate the number of individuals prescribed these three drug classes. In the single-agent analysis, loxoprofen was the most commonly prescribed NSAID (66.3%), olmesartan (19.4%) and telmisartan (15.9%) were the predominant RAS inhibitors, and furosemide (19.6%) and spironolactone (16.0%) were the most frequently used diuretics. Dual-drug combinations showed patterns consistent with the single-agent results for NSAIDs and diuretics. By contrast, sacubitril/valsartan was the most common RAS inhibitor when combined with diuretics, frequently utilized for heart failure management. In triple whammy prescriptions, NSAIDs and diuretics patterns mirrored those of single-agents. The annual number of triple whammy prescriptions showed a statistically significant downward trend over the study period by the Mann–Kendall trend test (p = 0.048). Notably, sacubitril/valsartan was the leading RAS inhibitor (46/199 patients, 23%), showing a higher proportion than its single-agent use (7.4%). Heart failure patients prescribed these two causative drugs are highly vulnerable to “triple whammy” prescriptions. Awareness of inadvertent NSAID additions is warranted to mitigate potential AKI risks.
Background/Objectives: Self-medication and keeping medicine inventory in households are common practices, even among healthcare professionals and healthcare professions students. Despite their knowledge of appropriate medicine use and storage, these practices are not always responsible and may pose health risks. This study aimed to describe self-medication practices, contents of home pharmacies, and habits of keeping medicine inventories in households of medical and pharmacy students at the Faculty of Medicine, University of Rijeka. Methods: In this cross-sectional study conducted in 2025, 60 third-year medical and pharmacy students interviewed members of their households regarding contents of home pharmacies and self-medication practices and compiled inventories of medicines kept at home. Results: Of the participating students, 70.0% were female. Healthcare professionals (physicians or pharmacists) were present in 23.3% of households. Medicines were stored in a designated location (“home pharmacy”) in 65.0% of households, whereas only one household reported having no medicines. Expired medicines and/or medicines with an unknown purpose were found in 41.6% of households. No household reported that medicines were accessible to children younger than 14 years. Inventories of stored medicines were obtained from 54 households (90.0%). Analgesics and antipyretics were present in 92.6% of households and were used for self-medication in 96.0% of them. Cough and cold preparations were found in 35.2% of households and used for self-medication in 94.7%. Antibiotics were present in 31.5% of households and used for self-medication in 52.9%, while anxiolytics were found in 16.7% of households and used for self-medication in 33.3%. Conclusions: Stocking medicine supplies and practicing self-medication are common among households of third-year medical and pharmacy students at the Faculty of Medicine, University of Rijeka. Analgesics and antipyretics were the most frequently stored medicines used for self-medication. The presence of expired medicines and the self-medication of prescription-only medicines highlight the need for greater emphasis on responsible self-medication, safe medicine storage, and rational medicine use within healthcare professions education.
Resilience, the capacity to recover from adversity, manage stress, and maintain well-being, is vital for pharmacy students to manage academic stress, clinical challenges, and future professional demands. Despite its recognised importance, pharmacy curricula often lack structured resilience education. This pilot study aimed to design, implement, and evaluate resilience-focused activities within Monash University’s Bachelor of Pharmacy (Hons)/Master of Pharmacy program. This study employed a descriptive cross-sectional educational evaluation design using a single post-intervention survey to explore student perceptions following participation in curriculum-integrated resilience activities within the Skills Coaching program. Sessions used reflective frameworks and interactive small-group activities facilitated by staff and pharmacists across the Australian and Malaysian campuses. In 2022, 1061 students participated, with feedback response rates between 26 and 40%. Students reported perceived improvements in their understanding of resilience following participation in the sessions. Likert-scale responses indicated improved understanding of resilience and highlighted strong engagement with case discussions and reflective exercises. Findings from this pilot inform curriculum refinement, assessment design, and faculty development to support sustainable integration of resilience education in pharmacy programs. This work also supports the lead author’s doctoral research to develop a comprehensive resilience curriculum for undergraduate pharmacy education.
Community pharmacies are increasingly providing health care services like tobacco treatment and disease-related management but need sustainable models for implementation. As several state Medicaid programs reimburse for community health worker (CHW) services, one promising model is to have pharmacy technicians engage with patients as designated CHWs. This qualitative study interviewed staff in seven California pharmacies about their experience with and perspectives on implementing community pharmacy technicians as CHWs. Guided by implementation science frameworks, data were hand-coded and analyzed iteratively using thematic analysis. Relative advantage and compatibility of CHWs was high across all pharmacies. Pharmacy culture aligned with CHW values, and CHW integration helped formalize the work that pharmacy staff were already doing. Challenges included the complexity of billing and obtaining payment for services provided. Despite these barriers, pharmacies successfully integrated and expanded their CHW services, ranging from social service connections to tobacco treatment or disease-related management education. Pharmacy peer networks, health plan champions and patient outcome improvements accelerated diffusion. Community pharmacies provide a trusted setting for delivering both CHW education and extending health care services, but broad implementation will need health plans to improve policy and procedure with guidance specifically for the pharmacy context that helps overcome administrative barriers.
The NHS-funded Common Ailments Service (CAS) in Wales enables community pharmacists to manage 28 common ailments by providing advice and/or medication free of charge without the need for patients to book an appointment. The aim of this study was to evaluate the patient experience of the CAS using patient reported experience measures (PREMs) and determine the feasibility of digital data capture collected directly from patients through a pharmacist-led manual recruitment model. The study used prospective, primary data collected through an online survey accessible via a Quick Response code and census recruitment. A total of 3660 surveys were included in the analysis, completed between 27 October 2025 and 31 March 2026. Overall experience was rated as excellent by 95.1% of participants. A theory-based framework analysis of 1499 free-text comments across the six domains of healthcare quality confirmed the high standard of care provision, primarily influenced by consultation quality, convenience, accessibility, and short waiting times. It also identified targeted areas for improvement, such as the need for seamless referrals from other areas of primary care and consistent availability of the service across all pharmacies. While digital PREMs captured high-quality insights, the pharmacist-led recruitment model reached a “feasibility ceiling”, with an overall response rate of 3.2%.
Misuse of over-the-counter (OTC) and prescription-only medicines (POMs) is increasingly recognised as a public health and medicine-safety concern. Although specialist substance misuse services (SMS) increasingly support people affected by OTC/POM misuse, little is known about how SMS staff perceive the characteristics, challenges, and treatment needs of this population. This study explored the experiences of SMS staff to address this evidence gap and inform pharmacy practice and service development. Confidential semi-structured interviews were conducted with staff across five community adult English SMS. Audio recordings were transcribed verbatim and analysed thematically using NVivo®. Twenty interviews with varied professionals achieved data saturation. Three overarching themes emerged: (1) characteristics of OTC/POM misuse; (2) staff-perceived patterns among people who misuse OTC/POM; and (3) negative experiences and concerns. Dependence on orally administered opioids (particularly codeine-containing products), benzodiazepines and gabapentinoids predominated. Polypharmacy including illicit substance use was also reported. Withdrawal symptoms frequently perpetuated misuse, and abrupt supply cessation created additional risks. Routine enquiry about OTC/POM misuse and provision of tailored harm-reduction interventions are essential. The findings suggest that pharmacists may have an important role in early identification of problematic OTC/POM use, harm-reduction interventions, medicine review and facilitating referral into appropriate treatment pathways. Further research should examine whether dedicated OTC/POM pathways are required and explore differences in demographic and treatment needs across medicine types.
Background: Hyperkalemia (HK) is a common complication of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and the risk is often increased by concomitant use of a mineralocorticoid receptor antagonist (MRA). The effect of SGLT2i co-prescription on this risk in routine clinical practice remains incompletely understood. Methods: This is a secondary analysis of a published retrospective cohort of 905 adult RAASi users attending outpatient clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia (IRB: NRJ22J/279/11), followed for a median of 28 months. Patients were classified as RAASi alone (n = 723) or RAASi plus MRA (n = 182). Beta-blockers and digoxin were excluded from the exposure definition. Effect modification by SGLT2i was assessed using logistic regression with a multiplicative interaction term. Results: MRA addition was associated with significantly higher rates of any HK (48.4% vs. 28.9%; RR 1.67, 95% CI 1.38–2.02, p < 0.001) and moderate-to-severe HK (13.7% vs. 6.9%; RR 1.99, 95% CI 1.26–3.12, p = 0.003). Overall, RAASi discontinuation rates were similar between groups. SGLT2i co-prescription significantly modified the association between MRA use and HK-driven RAASi discontinuation (interaction p = 0.004): among patients without SGLT2i, MRA addition was associated with a more than 5-fold increase in HK-driven discontinuation (21.1% vs. 4.1%; RR 5.11, p = 0.001), whereas no significant excess risk was observed among SGLT2i users (1.8% vs. 4.2%; RR 0.44, 95% CI 0.12–1.57, p = 0.190), although this subgroup estimate was imprecise. CKD (aOR 2.16, 95% CI 1.56–2.99) and age ≥ 75 years (aOR 1.64, 95% CI 1.04–2.58) were the strongest independent predictors of HK. Conclusions: MRA addition to RAASi substantially increases HK burden, and SGLT2i co-prescription appears to protect against HK-driven RAASi discontinuation in combined RAASi–MRA-treated patients. In patients with established indications for SGLT2i, co-prescription may confer the additional benefit of preserving RAASi continuity in the setting of MRA combination therapy.
Oncology conditions are increasingly defined by their molecular profiles, and drug repurposing exploits this new evidence to identify new therapeutic uses of authorized/investigational medicinal products outside their original indication(s). This scoping review mapped original research published between January 2022 and December 2024 to determine the impact of automated processes and artificial intelligence in generating oncology candidates for drug repositioning, and 42 individual projects met the eligibility criteria and were analyzed. The included studies demonstrate extensive use of computational approaches for candidate prioritization, large-scale data integration, and hypothesis generation in oncology drug repurposing, creating opportunities for positive impact on efficiency. The included projects most commonly were target-oriented and disease-oriented and used multiple databases and computational validation procedures, while experimental and clinical validation were less frequently reported. The available open-access literature suggests substantial activity in China and India, which can support the notion that digitalization represents an important instrument in healthcare systems of low- and middle-income countries but should be interpreted cautiously. While the search was limited to PubMed and open-access English-language publications, we identified a relatively small number of drug-oriented projects, the importance of providing publicly accessible source code to reduce development costs, and the predominant role of academic institutions.
Science communication is increasingly recognized as a key component of higher education; however, its integration into disciplinary training remains limited, particularly in pharmaceutical sciences. This study analyzes the Panamacani initiative as an institutional science communication initiative embedded within pharmacy education, based on editorial practice within the Pharmaceutical Chemist Biologist program at the Universidad de Colima, Mexico. A descriptive institutional case study was conducted using data from the first five issues (2023–2025), comprising 58 published contributions. Institutional participation, authorship profiles, and audience engagement were evaluated through descriptive statistics and editorial records. Results showed that 70.7% of contributions originated from the host institution, while 29.3% involved external institutions, indicating progressive expansion. Undergraduate students accounted for 44.8% of authorship, with a gradual increase in participation from postgraduate students and researchers. External contributions reached up to 50% in one issue, suggesting increased visibility beyond the host institution. Article visibility totaled approximately 1500 views, with applied health topics receiving the highest level of audience attention. These findings suggest that editorial-based initiatives may provide opportunities for student participation in science communication, peer review, and knowledge dissemination. However, the present study did not directly evaluate educational outcomes or competency development. This model may represent a scalable framework for integrating science communication activities into pharmacy education while fostering public engagement with science.
Community pharmacies provide vaccinations through nationally commissioned or private services. In Great Britain, pharmacies are regulated by the General Pharmaceutical Council (GPhC) and inspected for compliance against the 26 Standards for registered pharmacies. GPhC inspection outcomes between 2022 and 2024 were examined for differences between pharmacies offering vaccination services and those who did not. Inspection data from 2197 pharmacies, consisting of 1918 (87.3%) ‘brick-and-mortar’ pharmacies and 279 (12.7%) ‘other’ types (predominantly online pharmacies) were analysed. In total, 1922 (87.5%) pharmacies met all 26 Standards. Pharmacies providing vaccinations demonstrated higher compliance with Standards relating to governance, service delivery, and suitability of premises. Independent single-owner pharmacies and independent pharmacy chains were more likely to not meet standards. A gradient effect was observed across pharmacy-ownership categories, with progressively higher odds of inspection failure as the ownership model size decreased. Analysis of inspector comments identified three key factors influencing inspection performance: governance and organisational oversight; suitability of the physical environment; and staff competence and training. Strengthening governance structures, workforce development and infrastructure support, particularly in smaller independent pharmacies, may improve consistency in regulatory compliance, and support safe, high-quality delivery of vaccination services from community pharmacies.
Delirium is a transient neuropsychiatric condition that is a severe and prevalent condition affecting 2.6 million older adults each year. Alzheimer’s disease (AD) and anticholinergic medication use are risk factors for delirium. This study evaluated the association between cumulative anticholinergic burden (CAB) and risk of delirium among older adults with AD initiating cholinesterase inhibitors (ChEIs). This retrospective cohort study used 2013–2017 Medicare claims data, and included adults 65 years and older with AD who initiated any of the ChEIs (donepezil, rivastigmine, and galantamine) after a 12-month washout period. CAB, as the primary exposure, was measured on the index date and calculated as the monthly total standardized daily dose of anticholinergic medications. A multivariable Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) generated using generalized boosted models was used to evaluate the risk of delirium associated with the CAB. This study identified 143,320 older adults with AD who initiated ChEIs. Most patients were in the low/no burden (62.73%) group, followed by high burden (21.12%) and moderate burden (16.14%). Overall, delirium diagnosis was observed in 19.11% of the cohort. The Cox regression model with IPTW found that moderate (aHR, 1.56; 95% CI, 1.52–1.61; p < 0.0001) and high CAB (aHR, 1.45; 95% CI, 1.42–1.49; p < 0.0001) were associated with an increased risk of delirium compared to low/no burden. Among older adults with AD initiating ChEIs, moderate and high CAB were associated with an increased risk of delirium compared with low/no CAB. These findings highlight the need to carefully reduce the CAB, especially dose and duration, along with utilizing anticholinergic alternatives in older adults with AD.
Thirty-one U.S. states and the District of Columbia currently authorize pharmacists to prescribe hormonal contraception. Expansion of pharmacist scope of practice into areas such as contraceptive prescribing represents an extension beyond traditional baseline licensure authority. As a result, jurisdictions frequently require additional training to address competency, patient safety, and liability considerations. Because regulation of pharmacy practice occurs at the state level, training requirements vary across jurisdictions. State boards of pharmacy websites and publicly available regulatory materials were reviewed to identify training requirements for pharmacists authorized to prescribe hormonal contraception. Relevant statutes, regulations, and prescribing protocols were examined. Identified requirements were extracted and categorized into thematic groupings based on the level and type of training specified. Most jurisdictions require pharmacists to complete training beyond standard pharmacy education prior to prescribing hormonal contraception. Such requirements are characteristic of newly expanded scope-of-practice authorities, where regulators seek to verify competency and mitigate liability risk. As prescribing activities become more fully incorporated into pharmacy practice acts and professional education, separate training requirements may diminish over time.
Background/Objectives: Health promotion (HPr) is increasingly recognized as an essential component of modern pharmacy practice. In developing countries like Pakistan, pharmacists’ roles are evolving from traditional dispensing toward extended pharmacy services (EPS). This study evaluated the willingness, knowledge, attitudes, and perceived barriers of pharmacists in Karachi, Pakistan, regarding the provision of HPr-focused EPS. Methods: An online, cross-sectional, observational study was conducted between October 2024 and April 2025, using a 32-item questionnaire. Purposive and snowball sampling were employed to recruit pharmacists, including interns and fresh graduates. Descriptive and inferential statistics (χ2, Fisher’s exact and Welch’s t-tests) were used for data analysis. Results: Of N = 389 respondents (mean age 29.8 ± 4.8 years), 85.1% expressed willingness to provide HPr services. A majority of respondents (72.7% and 70.4%, respectively) felt they possessed sufficient knowledge for HPr and for identifying lifestyle-related risks, while more experienced pharmacists (>1 year) reported higher confidence (p < 0.001 and p = 0.043). Positive attitudes toward public health involvement were high (82.3%), particularly among females (p < 0.001), younger pharmacists and fresh graduates (p = 0.019 and p = 0.010). However, only 39.1% believed they had sufficient time for patient education. Practicing pharmacists (n = 114) were most frequently involved in dietary advice (4.38 ± 0.89) and medication safety education (4.36 ± 0.97), while family planning counseling (2.92 ± 1.36) was the least commonly reported activity. Leading barriers identified via word cloud analysis included lack of time (n = 101), perceived lack of necessary skills (n = 96), insufficient resources (n = 91), limited technology access (n = 89), and lack of specific protocols (n = 84). Conclusions: Pakistani pharmacists demonstrate high professional willingness to engage in HPr-focused EPS. However, systemic barriers—primarily time constraints and a lack of supportive infrastructure—impede the full integration of these services into routine practice. Policy interventions, standardized protocols, and reimbursement models are necessary to leverage pharmacists’ potential in primary healthcare.
Opioid misuse continues to be a major public health issue in the United States. Older adults (≥65) are at particular risk of harm from opioids due to changes in opioid pharmacokinetics with age; however, healthcare professionals lack training and confidence in addressing opioid harm reduction strategies in this population. Therefore, the purpose of this study was to improve healthcare professional knowledge and beliefs regarding opioid harm reduction strategies amongst older adults. An 8 h interprofessional conference was conducted 1 May 2025 to educate healthcare providers about opioid misuse prevention strategies for older adults. This study utilized a quasi-experimental one-group pretest–posttest design to assess changes in healthcare professional knowledge and beliefs before and after the conference. Healthcare professionals in the U.S. were recruited to participate in the conference via email listservs with national reach, predominantly concentrated in Alabama. Data were collected at pre- and post-conference via an anonymous online survey informed by the Theory of Planned Behavior and Health Belief Model. Primary outcome measures included: (1) knowledge of opioid use and misuse in older adults (5 items); (2) prescribing and dispensing attitudes surrounding opioids and medications for opioid use disorder (MOUD) (5 items); (3) perceived susceptibility to harm from opioids (4 items); and (4) perceived barriers to opioid harm reduction in older adults (17-items). Constructs were measured using multiple-choice questions (knowledge) and Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, intention to join a Microsoft Teams working group for ongoing collaboration was assessed through a single categorical (Yes/No/Unsure) multiple-choice question at post-conference. Data were analyzed using descriptive statistics, and differences in mean knowledge, attitudes, susceptibility, and barriers scale scores from pre- to post-conference were analyzed using Wilcoxon signed-rank tests (alpha = 0.05). Of N = 75 survey respondents, the majority were White (86.7%), female (74.7%), 50 years of age on average, and employed as pharmacists (68%). Overall, mean (SD) knowledge (83.73% [19.92] versus 90.67% [12.45]; p = 0.011) and perceived susceptibility (3.82 [0.63] versus 4.03 [0.63]; p = 0.002) increased from pre- to post-conference, while perceived barriers decreased (2.71 [0.54] versus 2.54 [0.58]; p = 0.001). Despite an upward trend, there was no statistically significant change in the mean prescribing and dispensing attitudes from baseline to post-conference. Additionally, 34.7% intended to join the Microsoft Teams working group at post-conference. Findings support the utility of interprofessional educational interventions to increase healthcare provider knowledge and beliefs regarding opioid harm reduction strategies amongst older adults.
