Background Pharmacist-delivered pharmaceutical care improves medication outcomes, but the evidence derives mainly from published trials; the registered landscape, including unpublished studies, is undescribed. Objectives To describe design, temporal and geographic characteristics of pharmacist-delivered pharmaceutical care studies registered on ClinicalTrials.gov, to distinguish pharmacist-led (PL) from collaborative-practice (CP) arrangements as recorded at registration, and to classify primary intervention categories. Methods Records first posted 1 January 2003–30 June 2026 were retrieved with “pharmacist-led”, “pharmaceutical care” and “medication therapy management”. Eligibility, pharmacist role and one of eight prespecified intervention categories were assigned from registered text by a rule-based algorithm with stratified verification by a single investigator, with a large language model as an assistive reading tool only. Results Of 464 records, 422 were included (414 PL, 98.1%; eight CP, 1.9%). Most were interventional (87.0%), randomised (79.8% of interventional studies), open-label (63.5%) and sponsored by hospitals, universities or other non-industry, non-governmental organisations (92.4%). Registrations rose from one (2004) to 36 (2023), 44.5% since 2021, across 45 countries (30.8% United States). Chronic disease management (21.1%), education/counseling (17.3%), medication therapy management (17.3%) and prescription review (16.1%) predominated. Post hoc, 22 of 150 randomly re-screened unverified records (14.7%) were ineligible and 19 of 128 eligible (14.8%) described collaborative rather than pharmacist-led practice; the CP count is therefore a lower bound. Conclusions Registered pharmacist-service research is growing but is recorded overwhelmingly as pharmacist-led, open-label and geographically concentrated, and post-hoc validation indicates that collaborative arrangements are under-recognised in registration text. Explicit registration of pharmacist authority and care model is needed.
Background Antibiotic prescribing in pediatric emergency care represents an important clinical and economic challenge, particularly for antimicrobial stewardship and resource allocation. Evidence from pediatric emergency settings in low- and middle-income countries remains limited. Approach This retrospective study evaluated antibiotic prescribing patterns, direct antibiotic acquisition costs, and hospital-transfer status in a pediatric emergency care unit in Northeastern Brazil from 2019 to 2021. The full prescription dataset was used for descriptive analyses and cumulative acquisition cost estimation, whereas complete-case subsets were used for antibiotic unit-cost comparisons and hospital-transfer analyses. Direct costs were estimated using institutional acquisition prices. Statistical analyses included group comparisons, principal component analysis (PCA), and hierarchical cluster analysis (HCA). Results The descriptive sample comprised 10,489 antibiotic prescription records, with 324 treatment episodes included in the unit-cost analysis and 302 in the hospital-transfer analysis. The estimated minimum cumulative direct antibiotic acquisition cost for the overall prescription dataset was USD 13,044.67, with benzathine benzylpenicillin, ceftriaxone, amoxicillin, and azithromycin accounting for the highest cumulative costs. Antibiotic unit costs differed significantly across diagnostic groups (p = 0.022). Among treatment episodes included in the unit-cost analysis, 78.1% of antibiotics were classified as Access and 21.9% as Watch according to the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification, with no Reserve antibiotics identified. Exploratory PCA and HCA showed differences in therapeutic profiles across diagnostic groups. Higher antibiotic unit costs were observed among transferred episodes, although only seven episodes involved transfer, limiting the interpretation of this exploratory comparison. Conclusions Antibiotic utilization and direct antibiotic acquisition costs varied across pediatric diagnoses, highlighting opportunities for antimicrobial stewardship and pharmaceutical resource optimization in pediatric emergency care.
Background Medication-related anticholinergic burden (AB) has been studied mainly in older adults and selected patient populations, whereas population-based evidence across adulthood remains limited, particularly regarding over-the-counter (OTC) drug use and utilization patterns. Objective To characterize the frequency, distribution, and pharmacological drivers of AB in the German National Cohort (NAKO). Methods We conducted a cross-sectional analysis of NAKO baseline data collected in 2014–2019 from participants aged 19–75 years recruited through age- and sex-stratified random sampling from population registries. AB was quantified from participant-reported seven-day medication use using the German Anticholinergic Burden Scale; cumulative scores ≥ 1 and ≥ 3 defined any and high burden, respectively. Descriptive analyses characterized AB by age, sex, drug class, prescription status, and utilization pattern; logistic regression assessed associations of AB with age, sex, and polypharmacy. Results Among 199,813 participants (median age 51 years; 50.4% women), 17.4% had any and 3.0% had high AB, with exposure in all analyzed age groups. Any and high AB were associated with female sex (aOR = 1.09, 95% CI 1.06–1.12 and aOR = 1.44, 95% CI 1.37–1.53, respectively), most older age groups, and polypharmacy. Nervous system drugs contributed most to aggregate AB. Medications obtained OTC accounted for over one tenth of the sample's burden, with a greater relative contribution in younger age groups. Most anticholinergic drugs were used on a scheduled basis, with daily and long-term use predominating. Conclusion In this large population-based cohort, anticholinergic exposure was observed across all examined age groups, and OTC medications made a non-negligible contribution to the overall burden. These findings suggest that age range and non-prescription medication use may be important considerations when assessing AB.
Background Underreporting of adverse drug reactions (ADRs) remains a major challenge in pharmacovigilance despite established reporting systems in Saudi Arabia. Limited healthcare professional (HCP) engagement, inadequate awareness, and low patient participation contribute to low reporting rates, while evidence on integrated real-world interventions remains scarce. Objective To evaluate the feasibility and real-world impact of a pragmatic, multi-component intervention combining HCP education, community engagement, and a QR code–based digital ADR reporting system. Methods A quasi-experimental pre–post study was conducted at Turaif General Hospital, Saudi Arabia. Seventy-eight matched HCPs completed validated questionnaires before and after the intervention to assess ADR reporting knowledge, perceptions, barriers, and facilitators. The intervention included implementation of a QR code–based reporting system in the outpatient pharmacy, targeted HCP education, and community awareness activities. ADR reports during a 4-month baseline period were compared with those from a 4-month post-intervention period. Results HCP knowledge (mean difference = 0.311; p = 0.0092) and perceptions (mean difference = 0.354; p = 0.0037) improved significantly after the intervention, whereas perceived barriers and facilitators did not change significantly. ADR reports increased from 11 at baseline to 156 post-intervention, representing a 14.2-fold increase. Patients and the public submitted 33% of all reports. Conclusion This pragmatic, pharmacy-led intervention was feasible and substantially improved HCP knowledge, perceptions, and ADR reporting. Integrating digital reporting with professional education and community engagement may strengthen patient-centered pharmacovigilance and medication safety.
