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.
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.
Independent community pharmacies serve as critical healthcare access points in rural areas, yet they consistently underperform chain pharmacies on contraceptive access measures. This narrative commentary draws on mystery caller studies, implementation research, and policy analyses to examine pharmacy-based contraceptive access in the United States (US). Using emergency contraception (EC) as a case study, we show that independent pharmacies stock EC at dramatically lower rates than chains (e.g., 14.6% vs. 76.3% in West Virginia), provide less accurate information about purchase requirements and timing, and impose more barriers to access. Because independent pharmacies account for 76.5% of pharmacies in rural areas, this disparity concentrates contraceptive inaccessibility in communities already facing the highest rates of unintended pregnancy, maternal mortality, and maternity care deserts. This pattern extends beyond EC to pharmacist-prescribed contraception and over-the-counter daily oral contraceptives. These disparities reflect systemic barriers, such as inadequate reimbursement, limited training infrastructure, and absence of corporate support, rather than failures of individual pharmacies. Drawing on implementation research and the success of West Virginia’s COVID-19 vaccination model, this paper proposes coordinated, sector-specific strategies to transform independent pharmacies from barriers into bridges for rural women’s contraceptive access.
