In the United Kingdom (UK), the vision is to further develop the pharmacy workforce through career development pathways aligning to the Royal Pharmaceutical Society's post-registration foundation, advanced, and consultant practice curricula, which align with the four pillars of advanced practice recognized across multiple healthcare professionals-clinical practice, leadership and management, education, and research. However, it has been recognized that research capacity, competency, and confidence within the pharmacy profession require development. It has been noted that it is this 'pillar' that most frequently impedes successful credentialing at both 'Core advanced' and 'Consultant levels'. A report presenting the findings of a UK-wide call for evidence on clinical academic careers in pharmacy outlines recommendations to embed a research culture in pharmacy careers, develop a clinical academic pathway for pharmacy, and provide a pipeline of pharmacy research leaders. The establishment of such pathways would provide opportunities for building capacity within the profession. The Scottish Pharmacist Clinical Academic Fellowship (SPCAF) programme was created to develop a network of Clinical Academic Pharmacist posts; a collaborative initiative between National Health Service Education for Scotland and the two Pharmacy Higher Education Institutions in Scotland is aimed at developing pharmacists as researchers to advance pharmaceutical care within the National Health Service in Scotland. This commentary presents a summary of an archival review completed as part of a wider research programme that adopted a case study approach with the purpose of evaluating the SPCAF programme cohort 1 (2021-23). The scope is to support others looking to develop similar practice-based research programmes aiming to build research capacity, competence, and confidence in the pharmacy workforce.

Background:Integrating social media into healthcare practice presents opportunities and poses key challenges for health professionals. While multiple reviews have been published, Western contexts receive the most attention, despite the distinct cultural and regulatory contexts that may shape social media use in other regions. The aim of this review was to scope the views and experiences of health professionals in the Middle East and North Africa region regarding social media use. Methods:Six databases were systematically searched from inception to November 2022 (updated search in March 2025). Studies published in English reporting the views and experiences of health professionals regarding social media use in 24 MENA countries were included. Two reviewers independently screened articles for selection, followed by data extraction and synthesis. Results:Thirty-eight studies were included; the majority adopted cross-sectional methodology (n = 36), with physicians the most studied group (n = 18) and mostly from Saudi Arabia (n = 22). Only two studies included theory in the development of data collection tools. Positive and negative views and experiences were reported along with the need for education and policies and guidance. Positive themes related to aspects of knowledge and skills, networking, patient communication, marketing, and perceptions of improved practice and enhanced patient care. Negative themes were less well reported and focused on data protection, social media being a distraction, and the perceived impact on well-being. Conclusions:Despite the substantial volume of existing studies, the evidence remains largely descriptive and lacking in theoretical grounding. More rigorous, in-depth research encompassing all health professional groups is needed to clarify the mechanisms through which social media influences practice. Such work is essential for informing robust policies, practical guidelines, and targeted educational strategies that can mitigate risks while maximising the professional and clinical benefits of social media use.

IntroductionEvidence shows that non-medical prescribing is as effective as medical prescribing in a range of acute and chronic conditions and is well accepted by a diverse range of key stakeholders. Pharmacists in the UK are set to acquire prescribing skills at an earlier stage in their training, with prescribing integrated into the first five years of training and the ability to prescribe from the point of registration from August 2026. Therefore, reliable and reproducible methods of assessing their ability to prescribe safely need to be in place. The UK Prescribing Safety Assessment (PSA) could be a standard method to assess prescribing skills across professions.AimTo examine the performance of post-registration Foundation pharmacists in the PSA and to explore their views on its suitability as a development tool before enrolling on an independent prescribing (IP) course.MethodPharmacists in Scotland 12 months into the post-registration Foundation programme were invited to sit a 30-question, blueprint-aligned online PSA in September 2024. Mean scores and facility scores were determined. (Facility is a measurement of how easy a question is: higher facility index = question is considered easier; lower facility index = question is considered more difficult). An online evaluation questionnaire gathered feedback on content and appropriateness, analysed using thematic analysis.ResultsSeventy-one of 128 (55.5%) eligible pharmacists sat the PSA; mean total score was 72.5% (SD 10.2). Domain-level mean scores (facility) were: Prescription Review 13.51/16 (0.84); Providing Information 4.96/6 (0.83); Dose Calculations 6.85/8 (0.86); Adverse Drug Reactions 6.51/8 (0.81); Drug Monitoring 5.61/8 (0.70); Planning Management 5.01/8 (0.63); Data Interpretation 3.41/6 (0.57); Prescription Writing 26.62/40 (0.67). The questionnaire was completed by 16/71 (22.5%) PSA sitters: most agreed the assessment was appropriate for their stage and helpful preparation for an IP course; some community pharmacists considered hospital-based content less relevant.ConclusionFormative participation in the UK PSA by post-registration Foundation pharmacists provided domain-level performance data and was regarded by respondents as useful preparation for an IP course. Findings suggest potential value in situating the PSA during the Foundation Training Year, with consideration of sector relevance and targeted support for domains such as prescription writing and data interpretation.

Syphilis, a sexually transmitted infection that can lead to serious health complications, was almost eliminated in the United States by 2000. But since then, its incidence began to increase, recently reaching a 60-year peak. We suggest that the introduction of the highly active antiretroviral therapy (HAART) drug regimen, which transformed HIV from a terminal condition into a manageable chronic disease, is partly responsible, as people living with and without HIV altered their sexual behavior after the introduction of HAART. To test this empirically, we exploit variation in HAART takeup based on spatial variation in pre-HAART AIDS prevalence, sex, and time in a triple differences framework. We find that a one standard deviation increase in the pre-HAART AIDS prevalence rate led to a 17.8 percent increase in the syphilis incidence rate, and that in the absence of HAART, there would have been 81 percent fewer syphilis cases between 1996 and 2008. These results highlight the need to consider unintended consequences that could stem from behavioral changes following the introduction of life-saving medical innovations.

BACKGROUND:The MyWay Diabetes (MWD) digital platform aims to improve diabetes management through personalised access to health records, structured education, and other self-management features. PURPOSE:We aimed to assess health outcomes in MWD users with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) over 6 years of use. METHODS:An interrupted time-series analysis in MWD users with T1DM or T2DM in Somerset, UK, compared pre- and post-MWD registration trends to estimate differences in health outcomes (HbA1c, blood pressure, lipids, BMI, weight). Generalised estimating equations modelling adjusted for participant baseline characteristics and identified significant predictors. RESULTS:A total of 7207 people (T1DM: n = 750 (52.3 % female, mean age 51.2 (SD15.8)), T2DM: n = 6457 (58.1 % male, mean age 64.7 (SD12.0))) were included in the analysis. The study showed some health outcomes improved significantly for T2DM between pre- and post-MWD registration. HbA1c reduced by 8.6 mmol/mol at 24 months post-MWD registration, with greatest improvements observed in users who were younger, had shorter diabetes durations and who were frequent MWD users. All health outcomes for T1DM were unchanged. CONCLUSION:The large HbA1c reduction for T2DM is notable for a scalable digitally-enabled self-management intervention and adds to the evidence base for digital interventions for diabetes self-management.

OBJECTIVE:To determine consensus among key stakeholders on statements to design a framework supporting practice-based interprofessional education (IPE) initiatives for student pharmacists. METHODS:The study used a 2-round modified Delphi technique. Statements were developed from published literature, a document analysis of international IPE frameworks, and findings from empirical studies completed as part of a wider program of research. This study was underpinned by the 3P (Presage-Process-Product) Model of Classroom Learning. A 4-point Likert scale was used. Data were analyzed using descriptive statistics. Consensus was preset at ≥70% agreement for individual statements. Panelists could provide comments at the end of each section; these were analyzed thematically. The Robert Gordon University School Ethics Review Committee granted ethical approval. RESULTS:Forty-five panelists consented to participate; a response rate of 82.2% (37/45) was achieved in round 1 and 71.1% (32/45) in round 2. In round 1, consensus was reached on 70/75 (93.3%) statements/substatements. In round 2, consensus was reached on 9/11 (81.8%) statements; 5 statements that did not achieve consensus in round 1, and 6 new statements based on panel members' comments. The 2 statements that did not reach consensus related to summative assessment. Two themes were identified: "Realistic versus idealistic approach?" and "Looking at the bigger picture." CONCLUSION:Key stakeholders agree on the majority of presage, process, and product factors that must be considered during the development of practice-based IPE initiatives. Further investigation is needed to clarify any factors potentially contributing to a lack of agreement on statements relating to assessment.

Economics has long studied how consumers respond to the disclosure of information about firms. We study a case in which the disclosed information is unrelated to the firm's products or leadership, but which could still potentially affect consumer patronage through the mechanism of repugnance, as described in Roth (2007). The information in this case concerns the arrest of Jared Fogle, the well-known spokesman and advertising pitchman for the Subway sandwich franchise, who was arrested in 2015 on charges of sex with a minor and child pornography. We study how the disclosure of this information, which was widely covered in the media, affected patronage of Subway. We estimate synthetic control models using data from a large nationwide survey of consumers regarding the restaurants they patronize. Despite the close and long-standing association of Jared Fogle with Subway, and heavy publicity of his crimes, we consistently fail to detect any effect of the Jared Fogle scandal on the probability of visiting a Subway restaurant. These results contrast with predictions made at the time by industry observers as well as by the public in an original survey and are in contrast to several previous studies of the impact of negative information disclosure on firms. The absence of an effect in this case suggests that repugnance did not drive demand, and that consumers largely separated the offenses of a symbol of the firm from the products of the firm.

BackgroundComparing health indicators across the European Union (EU) is a challenging endeavour. A feasibility study was conducted to explore opportunities for improvement through the contextualisation of indicators for major non-communicable diseases (NCDs). We aimed to improve the usability and transparency of indicators in the domain of NCDs by describing the contextual information about the data from which they draw and the related data processes. In particular, we sought to illustrate how semantic linkage could be achieved to facilitate interoperability with other metadata models using FAIR data principles. Finally, we aimed to provide recommendations for the implementation of the proposed metadata model at the EU level.MethodsA number of expert group meetings were held between March 2023 and October 2024 to agree on the approach and related technologies to meet the standard requirements for the meaningful comparison of indicators across countries and regions of Europe in the domain of NCDs.ResultsThe Semantic Ontology-Labelled Indicator Contextualisation Integrative Taxonomy (SOLICIT) was selected as a suitable generic metadata model for contextualising indicators. In this work, we adapted the SOLICIT generic framework to the diabetes sub-domain and extended its applicability more generally across all NCDs. As a proof of concept, we present an example of how to adapt a diabetes indicator and its related contextualisation within SOLICIT.ConclusionThe accurate contextualisation of NCD indicators can substantially improve their use and comparability across national and regional boundaries. This study delivered a set of seven recommendations for implementation in three different areas: (a) contextualisation of common data elements and indicators (use of contextual information; common schema for semantic linkage), (b) generic contextualisation framework (adoption of the framework; use of SOLICIT), and (c) implementation at EU level (pilot test of the model on federated networks; development of European portals; implementation of a user-friendly interface for SOLICIT). The proposed concepts provide a way of validating indicator values and their comparisons, as well as their provision, including all relevant details, encouraging secondary use and potential integration with additional indicator sets. Further studies are needed to test and refine the proposed model.

OBJECTIVES:Pharmacist independent prescribers (PIPs) enhance patient care but there is variability in their integration in community pharmacy (CP). The objective was to collate and characterize literature on the integration of 'standard of care' model PIPs in CP for acute common clinical conditions (CCCs). METHODS:This review followed the Arksey and O'Malley framework. Eligibility criteria, search databases, and terms were defined. Information sources were searched from January 2006 to October 2023. Following screening, full text review, and data extraction a narrative synthesis approach was used to address the review objectives. All steps were independently checked by two of the review team. Barriers and facilitators for integration used the Consolidated Framework for Implementation Research as a theoretical lens. KEY FINDINGS:Ten papers remained for full text review from 1075 records. Most studies were from Canada and focused on pharmacist views, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antimicrobial prescribing. A wide range of barriers and facilitators influencing implementation were identified including; 'regulatory constraints' and 'fiscal challenges' at a macro socio-organizational level and several challenges within organizations; lack of clarity on the pharmacists' scopes of practice and linked consumer confusion, staffing levels, and workload with specific mention of paperwork and access to patient records. CONCLUSIONS:Most evidence for CCC management by PIPs relates to antimicrobials, originates in Canada and identifies multiple challenges. Given this there is a need to consider this topic further to identify ways to address the challenges and facilitate integration of PIPs in CP.

BackgroundThe Collaborative Health Information European Framework (CHIEF) is an initiative led by the Joint Research Centre (JRC) of the European Commission to enable a sustainable data collection and production of indicators to monitor and evaluate best practices for people with NCDs.ObjectivesWe aimed to support international assessment and comparability of NCD indicators through a taxonomy of NCD indicators, a core set of measurable diabetes indicators and high-level policy recommendations.Materials and methodsThe study is an expert review run by the multidisciplinary expert group “CHIEF-diabetes.dwg” between 2022 and 2024. The group convened on several remote and in-presence meetings. A common set of key references were identified to underpin collective discussions and agree on the fundamental criteria for the selection of indicators. An iterative process was followed to reach agreement and release final recommendations.ResultsA taxonomy of NCD indicators and relevant stakeholders was identified to guide the selection process. A core set of diabetes indicators was agreed, including: diabetes incidence and prevalence rate, retinopathy prevalence rate, major lower extremity amputation incidence rate, blindness rate and rate of end stage renal disease. Measurement issues across chronic diseases and data collection were included in recommendations to the EU.DiscussionThe taxonomies and core set of diabetes indicators identified by the expert group may be used as a proof of concept of a collaborative European framework. The expert group recommended: (a) to determine the purpose of NCD indicators in advance; (b) to prioritise actionable indicators for the high-level governance of chronic diseases; (c) to align with existing standardisation processes; (d) to build on the experience of existing registries; and (e) to align with current efforts to strengthen the EU data infrastructure.ConclusionThe expert group delivered general guidance on criteria and principles for the selection of NCD indicators, using diabetes as a case study. The core set of six diabetes indicators can be used as a field-test for future reporting initiatives. In this context, disease registries can provide the high-quality data needed to compute reliable indicators. Targeted projects are needed to design a cohesive health information system of NCD indicators.

Introduction Pharmacy practice is becoming increasingly patient-centric with the development of community pharmacy services. Their implementation appears to be affected by causal relationships and interdependencies of determinants. To address these determinants, change agents need to select, operationalise strategies, and measure their impact. However, there is little real-world guidance on efficiently selecting strategies tailored to determinants. Objectives The aims of this study were to (1) explore the relationships between determinants and implementation strategies identified during the implementation of a Minor Ailment Service in Spanish community pharmacies and (2) develop a visual tool that links implementation strategies tailored to specific determinants for change agents to use during the facilitation process. Methods The study employed a mixed methods approach within a three-year pragmatic type 3 hybrid effectiveness-implementation design. Data collection was facilitated by change agents, who utilised on-site and remote communication methods. The objectives of the change agents were to identify determinants, design and operationalise tailored implementation strategies. These data were documented and transformed into Sankey diagrams. Results Ten change agents systematically documented 4236 determinant-strategy relationships in 92 pharmacies. The most common primary determinant domain they identified was “intervention characteristics” (n=1843, 43.5%). The most common secondary determinant domain was “characteristics of the individuals involved” (n=3069, 72.5%). The most common strategy category was “other” (n=1808, 42.7%). A Sankey diagram tool was developed to allow change agents to receive feedback on the effect of their strategies and select appropriate future implementation strategies. Conclusions The findings of this study inform the development of future visual tools for assisting change agents during the facilitation process. Sankey diagrams act as a generic and real-time tool, which will reduce the complexity inherent to the facilitation activity. This will facilitate prospective implementation researchers to plan implementation interventions and train change agents more efficiently, thereby optimising the change management process.

Background:The importance of involvement of community pharmacy (CP) teams in antimicrobial stewardship (AMS)-related interventions is justified by the high prevalence of antimicrobial prescribing in primary care. Yet, CP teams are rarely considered as part of AMS activities. Aim:To synthesize the available evidence in relation to the current involvement of community pharmacists in AMS-related interventions involving CP team members. Methods:To ensure rigour, the search followed the recommendations of the PRISMA-ScR and the protocol registered with the Open Science Framework. The search was conducted in MEDLINE, International Pharmaceutical Abstracts and CINAHL, identifying studies published between 1999 and 2023 and in English. Studies reporting AMS-related interventions, including at least one CP team member and conducted in a CP setting were included. Study selection and data extraction were performed by two independent reviewers. Results:Thirty-eight reports were included with pharmacists mainly using patient interviews (n = 26) and point-of-care testing (n = 15) as information sources to support patient assessment. Pharmacist interventions included providing patient counselling (n = 30) and referring to other healthcare professionals (n = 17). The main barrier for intervention implementation was the lack of or inadequate remuneration (n = 10); the easy accessibility of CPs was the predominant facilitator (n = 12). Only three of the included reports were underpinned by implementation theory. Conclusions:The review is significant since it highlights CP interventions in an area where there is not much evidence. It emphasizes the need to remunerate CPs for their involvement in AMS while highlighting the potential for expansion of easily accessible CP services.

Background: Flourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave. Objectives: To systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals. Methods: We identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science - Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility. Results: Searches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie. Conclusion: Alienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady.

OBJECTIVE:This study aimed to explore student pharmacists' experiences of interprofessional education (IPE) during experiential learning (EL) placements. METHOD:A paper questionnaire was used to collect data and was distributed to all penultimate/final-year student pharmacists enrolled in the Master of Pharmacy programs at Robert Gordon University or the University of Strathclyde (n = 485). Data collection took place between January and March 2023, shortly after student pharmacists attended EL placements in various practice settings. Participation in the research was voluntary, and questionnaires were completed anonymously. Thematic analysis was used to identify themes from responses to open-ended questions, aligning with the research aim. Ethical approval was granted by the Robert Gordon University School Ethics Research Committee. RESULTS:The questionnaire was completed by 328 (67.6%) student pharmacists. Themes identified included: (1) Nature of IPE experiences: mostly unplanned or informally planned, with few examples of formally planned IPE; opportunities varied across areas of practice; professional groups varied, with medicine and nursing most represented. (2) Factors influencing interprofessional learning: related to EL facilitator (preceptor), student pharmacist, placement, and cultural factors. Facilitators included prioritization of IPE and positive role modeling by mentors; barriers included student pharmacists' perceived lack of preparedness for IPE, lack of specific IPE learning outcomes, and sector-specific limitations. (3) Student pharmacists' perceived value of IPE: experiences supported the development of collaborative competencies, as well as personal, professional, and interprofessional identity development. CONCLUSION:Greater emphasis on the relevance of IPE in the EL curriculum and the wider Master of Pharmacy curriculum could enhance learning from opportunistic IPE. The lack of formally planned IPE opportunities requires further attention.

Introduction Antimicrobial stewardship (AMS) is defined by the World Health Organization as "a coherent set of actions which promotes the responsible use of antimicrobials" [1]. The involvement of community pharmacy (CP) teams in AMS-related interventions is justified by high usage of antimicrobials in primary care. Yet, CP teams are rarely considered as part of AMS activities [2].Aim The aim of this scoping review is to synthesise the available evidence in relation to AMS-related interventions delivered in CP settings and involving CP team members.Methodology To ensure rigour, the search followed the recommendations of the PRISMA-ScR and the protocol registered with the Open Science Framework. The search was conducted in MEDLINE, IPA and CINAHL, identifying studies published 1999-2023 in English, with no geographical restrictions. Studies reporting AMS-related interventions, including at least one CP team member and conducted in a CP setting were included. Study selection and data extraction were performed by two independent reviewers. To describe intervention components, the Descriptive Elements of Pharmacist Intervention Characterisation Tool - version 2 (DEPICT-2) was adopted [3]; barriers and facilitators for intervention implementation were identified and mapped to the Consolidated Framework for Implementation Research (CFIR) [4]. While conducting the review, as no human participants were involved, an ethical approval was not required.Results Thirty-eight reports met the inclusion criteria. All the interventions were delivered by community pharmacists. According to the DEPICT-2, pharmacists mainly obtained information for patient's assessment from patient interviews (n = 26) and point-of-care-testing (n = 15), providing patient counselling in 30 reports and referring to other healthcare professionals in 17. Most of the interventions provided service outcomes (n = 30), which were generally positive and led to medication and healthcare optimisation. Only three interventions were underpinned by theory. The most common identified barrier for intervention implementation was linked to the CFIR construct "Financing", particularly the lack of and adequate remuneration (n = 10). The easy accessibility of CPs represented the most frequently detected facilitator (n = 12), linked to the CFIR construct "Local conditions".Discussion The findings from this review show how community pharmacists and their teams can contribute to AMS through a variety of interventions that provide positive service outcomes including the potential for reduction of antimicrobial resistance. The review emphasises the need to consider models of remuneration of CPs to facilitate the expansion of AMS services in a setting that has potential to offer more accessible antimicrobial treatment for common clinical conditions, particularly in areas of high deprivation. The lack of geographical restrictions of reports included reflects the global potential of AMS-related initiatives within CP and this has been emphasised by the International Pharmaceutical Federation [5]. However, challenges may exist through differences in legal, regulatory and contractual frameworks for CPs and scopes of practice. The focus of some AMS interventions may be based on infection epidemiology which may also vary from country to country. Findings need to be considered in these contexts. Future research should be underpinned by implementation science theory to ensure intervention success of clinical practice. Discussion The findings from this review show how community pharmacists and their teams can contribute to AMS through a variety of interventions that provide positive service outcomes including the potential for reduction of antimicrobial resistance. The review emphasises the need to consider models of remuneration of CPs to facilitate the expansion of AMS services in a setting that has potential to offer more accessible antimicrobial treatment for common clinical conditions, particularly in areas of high deprivation. The lack of geographical restrictions of reports included reflects the global potential of AMS-related initiatives within CP and this has been emphasised by the International Pharmaceutical Federation [5]. However, challenges may exist through differences in legal, regulatory and contractual frameworks for CPs and scopes of practice. The focus of some AMS interventions may be based on infection epidemiology which may also vary from country to country. Findings need to be considered in these contexts. Future research should be underpinned by implementation science theory to ensure intervention success of clinical practice.