Global aging makes polypharmacy in older adults a critical concern. Pharmacist-led deprescribing shows promise, but lacks routine implementation. Japan introduced “the Medication Adjustment Support Fee (the Adjustment Fee)” in 2018 for deprescribing medications in patients with polypharmacy based on pharmacists’ recommendations. We aimed to investigate: (1) medication distribution among older patients; (2) medications most frequently deprescribed based on pharmacists’ recommendations; and (3) factors associated with successful deprescribing. This retrospective study analysed patients aged ≥ 65 years who had prescriptions dispensed for ≥ 60 days from 2069 community pharmacies (April 2020–September 2023). Eligibility for the adjustment fee required six or more oral medications for ≥ 4 weeks, with pharmacists receiving remuneration when two or more medications were deprescribed and sustained for ≥ 4 weeks. We examined: (1) medication distribution in older patients; (2) most frequently deprescribed medications based on pharmacists’ recommendations; and (3) factors associated with deprescribing using multi-level logistic regression. Amongst 1,458,323 older patients, 36.9

OBJECTIVE:Psychotropic medicines are widely prescribed to children and adolescents, despite limited regulatory approvals. Off-label use of psychotropic medicines is therefore common in paediatric mental health care. This scoping review aimed to identify and synthesise factors associated with the off-label use of psychotropic medicines among children and adolescents with mental health conditions. METHODS:A systematic scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology. MEDLINE, Embase, APA PsycINFO, International Pharmaceutical Abstracts, and Scopus were searched for English-language studies examining factors associated with off-label psychotropic use in mental health care in individuals aged 18 years or younger (January 2014-April 2025). Data were extracted into a structured form and synthesised inductively. RESULTS:In total, 43 studies across 16 countries were included, most using observational designs. Antipsychotics (n = 28) were the most studied psychotropic drug class. Factors associated with off-label psychotropic use were synthesised across five domains. Diagnosis/indication-level factors were most frequently reported (n = 29), particularly for disruptive behaviour disorders and attention-deficit/hyperactivity disorder, followed by drug- (n = 23), patient- (n = 21), regulatory/system- (n = 13), and prescriber-level (n = 11) factors. Most studies reported combinations of factors across two or more domains (n = 28). Four interrelated themes emerged: regulatory approval frameworks; developmental and diagnostic patterns; symptom-targeted patterns of use; and governance, health system structure, and service availability.Conclusions:Off-label psychotropic use emerges from the interaction of broader regulatory, clinical, and health system contexts. These findings support a more informed interpretation of off-label use patterns across countries and highlight priorities for future research, policy, and governance in paediatric mental health care.

Abstract Background The use of antidepressants is increasing globally. Despite their obvious benefits, ongoing use of these medications is often not properly monitored or deprescribed when a person returns to better mental health. In addition, providing prescriptions to those who do not have clinical depression leads to personal and societal cost burdens. Objective This trial aims to assess the clinical effectiveness and cost-effectiveness of an online support tool designed to help patients with mild to no symptoms of depression and their general practitioners manage the careful and appropriate tapering and cessation of antidepressants at 6 months, and compare the effectiveness to that of usual care. Methods This stratified, single-blind, parallel, 2-arm, superiority randomized controlled trial includes Australian primary care patients (aged 18-75 years) with mild to no symptoms of depression who have been on antidepressant medication for longer than 12 months. After obtaining informed consent, 340 eligible patients will be randomized in a 1:1 ratio to an active intervention arm and an attention control arm, with stratification by general practice or state of residence, if recruited via social media. Those in the active intervention arm will be asked to reduce their antidepressant use with the aid of a clinically guided online support tool (WiserAD), while those in the attention control arm will continue to receive usual care. Participants in both arms will be provided with information about antidepressants through the Beyond Blue website and followed up at 3, 6, 12, and 18 months to record antidepressant use, depression and anxiety symptom severity, quality of life, and health economic data. An intention-to-treat analysis will determine the clinical effectiveness of the online tool compared with usual care. The primary outcome is the between-arm difference in the proportion of participants who successfully cease medication use at 6 months and have mild or absent depressive symptoms. Cost-consequence and cost-utility analyses will be used to determine the cost-effectiveness of the intervention and its impact on quality of life, and comparisons will be made with usual care. Results The study was funded by the National Health and Medical Research Council in 2019. At submission of this manuscript in July 2025, 310 participants have been randomized, and recruitment ongoing. The target number of 340 randomized participants was achieved in January 2026. Trial outcomes will be reported in peer-reviewed journals in Febraury 2027. Conclusions The WiserAD online support tool assists patients and their general practitioners with deprescribing and may lead to successful cessation of antidepressant medication, resulting in enhanced quality of life and cost savings over the longer term.

BACKGROUND:Organisational culture, defined as the shared values, assumptions, and norms that influence behaviour within organisations, is widely recognised as a key determinant of patient safety in healthcare systems. Within acute care settings, medication safety represents a critical component of patient safety and depends on the ability of healthcare professionals to recognise risks, communicate openly, and intervene before errors result in patient harm. However, medication use is inherently interdisciplinary and requires effective coordination between multiple professional groups. Understanding how organisational culture influences medication safety practices across healthcare professions is therefore essential to inform governance, policy, and improvement strategies. This study aimed to achieve expert consensus on the organisational cultural factors influencing medication safety practices, barriers to medication error reporting, and strategies to strengthen medication safety in acute healthcare settings. METHODS:A modified electronic Delphi method was used to synthesise expert perspectives. A multidisciplinary panel of 41 healthcare professionals practising in Malta's acute care system were invited to participate, including nurses, midwives, medical doctors, and pharmacists. In Round 1, participants completed an exploratory qualitative questionnaire consisting of three open-ended questions addressing cultural influences on medication safety, barriers to error reporting, and potential improvement strategies. Responses were analysed using inductive content analysis, generating thematic categories that informed the development of 20 structured statements grouped into four domains: organisational safety culture and psychological safety; workforce and operational pressures; reporting culture and barriers; and strategies to strengthen medication safety. In Round 2, participants rated the importance of each statement using a five-point Likert scale. Consensus was predefined as ≥ 70% agreement. RESULTS:A total of 28 out of 41 healthcare professionals participated in Round 1 (68.3% response rate), including nurses (n = 15), midwives (n = 5), medical doctors (n = 5), and pharmacists (n = 3). Round 1 identified seven categories grouped into four domains, with blame culture emerging as a key barrier to medication error reporting. In Round 2 (n = 25/41; 61.0% response rate), consensus (≥70%) was reached for all but one statement. The strongest consensus centred on psychological safety, open communication, and adequate staffing. CONCLUSION:Findings indicate that medication safety is shaped primarily by organisational culture and systemic conditions rather than technical safeguards alone. Establishing a psychologically safe, non-punitive environment supported by engaged leadership and appropriate workforce conditions is fundamental for encouraging transparent reporting, organisational learning, and safer medication practices. These insights can inform policy development, organisational governance, and future research aimed at strengthening medication safety cultures in healthcare systems.

BACKGROUND:Minor ailments contribute significantly to the burden on healthcare systems. The introduction of a Minor Ailment Service (MAS) may alleviate pressure from hospital Accident & Emergency departments by directing patients suffering from minor ailments to be managed within the community. Although MAS has demonstrated positive results internationally, its effectiveness and acceptability in Hong Kong have not been evaluated. This prospective observational study aims to evaluate the clinical and humanistic impacts of a MAS delivered by pharmacists at community pharmacies operated by non-governmental organisations (NGOs) in Hong Kong. METHODS:Subjects were recruited using convenience sampling at eight NGO-operated community pharmacies. Patient-reported outcomes, including symptom resolution, satisfaction, and enablement, were collected using a follow-up questionnaire one week after MAS. Additionally, consultation records were matched and extracted from the Community Pharmacy Services System. Descriptive data analyses were conducted to evaluate the patient-reported outcomes after using MAS. Factors influencing the primary outcomes were assessed using mixed-effects linear and logistic regression models. RESULTS:This study demonstrates that most subjects (95.1%) report improvement in their symptoms. The mean scores for the Pharmacy Services Questionnaire and Patient Enablement Instrument are 4.0 ± 0.8 out of 5 and 6.8 ± 3.2 out of 12, respectively. Minor ailments relating to the respiratory system are most frequently reported. Significant negative associations in symptom resolution, satisfaction, and enablement are mainly observed in patients suffering from central nervous system-related symptoms. CONCLUSIONS:Patients receiving MAS provided by community pharmacists in community pharmacies report high levels of symptom resolution, satisfaction and enablement.

Dose administration aids (DAAs) support medication taking, yet little is known about how pharmacists perceive DAA benefits and challenges. This study aimed to explore community pharmacists’ preferences for attributes of a DAA service and how these influence their decision to provide this service. A discrete choice experiment (DCE) was conducted to elicit pharmacists’ preferences. Participants completed 12 choice questions, each presenting three alternatives: two DAA services and no DAA service. The questions included seven attributes: patient type, patient control over their medicines, impact on patient medication adherence, staff time, patient co-payment, government reimbursement fee and presence of a cap on government funded DAA services per pharmacy. A total of 615 community pharmacists completed the DCE survey. All attributes, except patient type and co-payment, significantly influenced preferences. Pharmacists were more likely to provide a DAA service (compared with no DAA service) when it was associated with higher government funding (pharmacy owners: OR 1.054, 95

Introduction Access to safe, high quality, acceptable and sustainable general practice (GP) and primary care services is essential to improved health outcomes and quality of life for people living in residential aged care homes (RACH). There are, however, critically low levels of service availability and a decline in GPs providing RACH services globally, suggesting there is an urgent need for safe and effective models of care. Telehealth, delivered as part of a holistic model of care, offers a solution to address this gap but comprehensive, person-centred research is needed to directly assess its effect on safety and quality of care in RACH settings.Objectives This collaborative 4-year project (General practice and Residential Aged CarE: GRACE video-telehealth) will (1) scope current telehealth models of care and their acceptability and person-centredness, including identifying the barriers and enablers experienced by RACH residents, carers, staff, GPs and practice managers; (2) co-design a best-practice model of care with an accompanying suite of digital resources and education materials to improve the uptake of video-telehealth; and (3) implement and evaluate this best-practice model of care.Methods and analysis This is a mixed-methods study of residents, carers, RACH staff, GPs and their practice teams that will be conducted across New South Wales, Australia. This protocol describes a staged approach across three phases. In Phase 1, we will collect baseline measures of the frequency of telehealth use in GP practices and RACHs, clinical outcomes (eg, hospitalisations), questionnaires to measure person-centred care, satisfaction and usability of telehealth and qualitative observations and semi-structured interviews. In Phase 2, we will conduct workshops to co-design an intervention that will include developing a model of care to support person-centred video-telehealth, with an accompanying online hub of resources and educational materials to facilitate and support its utilisation. In Phase 3, we will implement and evaluate the intervention. Data will be analysed statistically and thematically and synthesised.Ethics and dissemination Ethics approval has been obtained from the University of Sydney Human Research Ethics Committee (2025/000340) (human.ethics@sydney.edu.au). Prior informed written consent will be obtained from all research participants. Findings from each phase of the study will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales and Australia.

Background Depression affects over 280 million people worldwide and is a leading contributor to disease burden in Australia, where most patients are managed in primary care. Although antidepressants are recommended for moderate-to-severe depression, up to half of patients do not respond to their first medication. Pharmacogenomic testing of CYP2C19 and CYP2D6 genotypes has been proposed to guide antidepressant prescribing, but evidence of their effectiveness from primary care settings is scarce. The aim of this trial was to test the effect of a pharmacogenomic-informed antidepressant-prescribing report on depressive symptoms at 12 weeks in primary care. Methods This double-blind, two-arm, stratified, randomised controlled trial was conducted in 19 general practices in Victoria, Australia. Adults aged 18–65 years with moderate-to-severe depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) and an upcoming appointment with a participating general practitioner (GP) within 2 days of being approached for participation in the trial were eligible. Participants were randomly assigned (1:1) to have their GP receive a prescribing report with four to six recommended antidepressants and respective dosage based either on the Australian Therapeutic Guidelines (control intervention) or CYP2C19 and CYP2D6 genotype-predicted phenotypes (experimental intervention). In the intervention reports, if there were no pharmacogenomic-specific recommendations for a patient, guidance was also based on Australian Therapeutic Guidelines. The primary outcome was the between-group difference in mean change in PHQ-9 score from baseline to 12 weeks. Analyses were conducted by intention-to-treat. This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12621000181808) and is completed. Findings Between May 26, 2021, and Sept 28, 2023, 552 participants were randomly assigned. Two participants withdrew after randomisation (one in each group), leaving a final intention-to-treat cohort of 550 participants (275 in each group); 168 men, 368 women, and 14 non-binary or gender diverse participants who were predominantly of European (n=452; 82%) or Asian ethnicity (n=56; 10%). At 12 weeks, 479 (87%; n=235 intervention, n=244 control) reported their PHQ-9 for the primary outcome. Both groups improved compared with baseline, but the control group showed a slightly greater reduction in PHQ-9 scores (mean change from baseline: intervention group –3·45, control group –4·63; between-group difference 0·90, 95% CI 0·06–1·75; standardised mean between-group difference 0·23, 0·02–0·45; p=0·036). There were no serious adverse events or deaths, and one grade 1 adverse event related to mishandling of a prescribing report by a general practice. Interpretation Pharmacogenomic-guided antidepressant prescribing did not improve depression severity compared with prescribing reports based on national clinical guidelines in Australian primary care, and cannot be recommended for implementation. Better approaches are needed to ensure pharmacogenomic results are accessible at the point of prescribing, and to identify if particular subgroups of patients with depression treated in primary care could benefit. Funding Australian Medical Research Futures Fund.

BackgroundInappropriate prescribing in Sri Lankan older adults, contributes to adverse drug events, hospital admissions and increased healthcare expenditure. Although international tools exist to assess prescribing appropriateness in older adults, their direct application in Sri Lanka is limited by differences in clinical practices, resource constraints and variability in medicine availability.ObjectiveWe aimed to develop and validate country-specific prescription appropriateness criteria for Sri Lankan older adults, focusing on prevalent diseases.MethodsA literature review was conducted to develop a preliminary list of criteria, which was scrutinised by three internal reviewers. The criteria were then validated using the RAND/UCLA Appropriateness Method (RAM). A multidisciplinary Sri Lankan panel (medical specialists, hospital pharmacists and pharmacy academics) completed three rounds of ratings involving 15, 11 and 7 panellists, respectively.ResultsThe preliminary list contained 38 criteria; all were rated appropriate in round one, with clarity amendments suggested for seven criteria. Two additional criteria were proposed and accepted, producing a final set of 40 criteria. The criteria most frequently addressed medicines used for cardiovascular disease and diabetes mellitus, with additional focus on pain, musculoskeletal and bone health, asthma and neuropsychiatric disorders. Criteria not commonly included in international tools covered gabapentinoid prescribing for pain with renal dose adjustment, corticosteroid-associated glycaemic monitoring with antihyperglycaemic dose adjustment and blood monitoring requirements for methotrexate therapy.ConclusionsThese criteria provide a context-specific framework to support safer prescribing for older adults in Sri Lanka. Their integration into clinical practice and pharmacist-led medication reviews could reduce medication-related problems and improve outcomes.

Despite high disease burden and heightened suicide risk associated with psychosis, psychosis education is lacking in healthcare curricula, potentially hindering students’ willingness, and confidence to provide psychosis care as future healthcare professionals. This study aimed to co-design and content validate psychosis care assessment material for medical, pharmacy, nursing, and occupational therapy curricula. A nominal group technique (NGT) meeting was conducted to generate and rank ideas among people with lived/living experience of mental illness. Prioritised ideas were used to create simulated role-play scenarios for each discipline, by discipline experts. The developed scenarios underwent content validation by content experts, whereby the content validity index was computed for relevance and clarity. The four highest ranked ideas based on rank scores and accumulated rank score sums were selected during the NGT meeting and used to guide the development of four role-play scenarios focusing on antipsychotic medication side effects, suicide risk, paranoia and delusions, and visual hallucinations. Discipline experts created scenario outlines and rubrics for each selected idea. Content validity indices of all items were deemed satisfactory, ranging from 0.8 to 1. Written feedback for each role-play scenario was considered and scenarios/rubrics were modified accordingly. Overall, this study provides a framework for partnering with mental health stakeholders to co-design and validate psychosis care assessment material for healthcare curricula. Through the integral contribution of people with lived/living experience and clinicians, authentic scenarios which reflect real-life practice have been developed. Future research is required to evaluate the newly developed materials in educational setting.

BACKGROUND:The Medication-Related Burden Quality of Life (MRB-QoL) is a patient-reported measure of medicines burden on functioning and well-being in people with long-term conditions (LTCs). The Arabic version has demonstrated good content validity; however, no data is available on its other psychometric properties. OBJECTIVES:To evaluate the reliability and validity of the Arabic MRB-QoL tool. METHODS:Four hundred patients (≥18 years) with LTCs were recruited from a tertiary hospital in the United Arab Emirates. Exploratory factor analysis (EFA) was performed using Principal Axis Factoring for extraction and Oblimin rotation. Cronbach's alpha, intraclass correlation coefficient (ICC), and minimum detectable change (MDC) assessed internal consistency, test-retest reliability, and measurement error, respectively. Structural, Known-group, convergent, and discriminant validity were evaluated using EFA, Mann Whitney U test, and Spearman's rank correlations tests, respectively. Convergent validity (r > 0.3, moderate to high correlations) and discriminant validity (r < 0.3, weak correlations) were examined through correlation with the Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and 12-item Short Form Health Survey (SF-12) measures. Known-group validity was assessed by comparing MRB-QoL scores across clinically diverse groups. RESULTS:EFA revealed a 31-item, four-factor structure accounting for 78.5 % of the variance. Reliability results showed good internal consistency (Cronbach's α = 0.973) and test-retest reliability (ICC = 0.994). The MDC for the total MRB-QoL was 3.89, indicating that a change of more than 4 points between 2 measurements reflects a true difference with 95 % confidence. There were weak correlations between domains of MRB-QoL and MRCI (r 0.120 to 0.152) indicating discriminant validity. Correlations between the mental component summary of the SF-12 and MRB-QoL (r = -0.387) and its domains (r -0.357 to -0.374) suggested convergent validity. Patients with polypharmacy and multimorbidity had higher median MRB-QoL scores, showing known-group validity. CONCLUSION:This study demonstrated that the Arabic MRB-QoL is a valid and reliable medication-related burden (MRB) measure with good construct validity, including structural, known-group, convergent, and discriminant validity. It also shows excellent reliability, with high internal consistency, low measurement error, and good test-retest reliability. These findings support its use as a psychometrically robust measure for assessing MRB and facilitating person-centred medicines optimisation services in Arabic-speaking populations.

Background:The Medication-Related Burden Quality of Life (MRB-QoL) Arabic version is a 31-item valid and reliable measure of medication burden on functioning and well-being in people with long-term conditions. Aim:To evaluate the feasibility of using the Arabic MRB-QoL tool in clinical pharmacist-led medicines optimisation services in United Arab Emirates (UAE) hospitals. Method:This non-randomised, non-controlled, feasibility study was conducted in 4 UAE hospitals, utilising a mixed-methods approach. The clinical utility of the MRB-QoL Arabic was evaluated, covering various aspects of feasibility, including acceptability, usability, benefits, facilitators, and barriers to its implementation in practice. The study comprised 3 stages: providing training for clinical pharmacists (CPs) and nurses, implementing the Arabic MRB-QoL tool, and the System Usability Scale (SUS) survey and semi-structured interviews with CPs. The usability and perceived benefits were evaluated using qualitative interviews and a Qualtrics survey. The perceived acceptability, barriers, and facilitators were explored through analysis of the interviews. Results:Ten CPs implemented the Arabic MRB-QoL tool during routine medication reviews for 227 admitted patients. Thematic analysis of the interview transcripts identified key themes that highlighted the acceptability, usability, benefits, as well as facilitators, and barriers the CPs faced in implementing the tool in their routine clinical practice. In addition, the SUS survey showed an average score of 82.2, indicating excellent usability of the tool in facilitating medicines optimisation services. Conclusions:This study confirmed the clinical utility of the MRB-QoL Arabic in pharmacist-led medicines optimisation services in UAE hospitals, highlighting preliminary evidence of its acceptability, usability, and benefits, as well as facilitators and barriers to implementation. By promoting patient-centred medicines optimisation, the Arabic MRB-QoL tool has the potential to help healthcare providers gain insights into patients' experiences with medicines and the key dimensions of medication burden patients encounter, optimise medicines regimens, and improve patients' quality of life.

OBJECTIVES:Community pharmacies in Norway offer accessible healthcare services that require monitoring. Relevant and realistic quality indicators (QIs) must be developed to establish standards. This study aimed to establish consensus on healthcare quality measures in a community pharmacy setting by implementing two distinct approaches. METHODS:A comprehensive multi-phase research design was implemented to identify, define, and select potential QIs for community pharmacies. Potential QIs were identified and nominated from workshops, focus groups, and literature. Thirteen panellists were recruited for a modified Delphi study over two rounds. We used the RAND/UCLA Appropriateness Method (RAM) panel median ratings and disagreement index (DI) to assess appropriateness and disagreement and define consensus. KEY FINDINGS:We identified 192 QIs from workshops, focus groups and literature searches. After duplicates were removed and QIs with similar wording were merged, 137 QIs were nominated for the first Delphi round. The panellists deemed 61 appropriate, two inappropriate and excluded six QIs in the first round. The remaining 68 QIs were assessed in Round 2, where 23 achieved consensus as appropriate without disagreement. After DI was calculated, the number of QIs categorized as appropriate without disagreement after Round 1 and 2 was 34 and 10, respectively. CONCLUSION:This study demonstrates the use of the RAM combined with the DI to establish consensus on healthcare quality measures, i.e. QIs for community pharmacy services. Our findings indicate that the number of QIs considered acceptable is strongly impacted by the method chosen to handle disagreement in the ratings. Incorporating DI and conventional RAM disagreement calculations reduced the number of QIs deemed acceptable by half.

INTRODUCTION:People with dementia and carers face challenges in understanding and managing medications at discharge. This study aimed to develop user-centered, co-designed medication management guidance tools to enhance medication management literacy post-hospitalization for these populations. METHODS:A four-phase, multi-methods study integrating experience-based co-design: (1) literature review, qualitative study, and survey; (2) expert advisory panels involving people with dementia; (3) focus groups with people with dementia, carers, and healthcare professionals; and (4) quantitative readability and suitability analysis. RESULTS:Two tools were developed: a simplified medication management guide for people with dementia and a carer-focused guide. Topics included shared decision-making, informed consent, and medications that can affect cognition. Participants valued the use of simple and active language, goal-of-care discussions, and the right to second opinion. Tools were acceptable for use from admission and during hospitalization. DISCUSSION:This study addresses gaps in medication related health literacy tools for dementia care, offering a framework for developing similar resources. HIGHLIGHTS:Medication management guidance tools have not included people living with dementia or their carers in their development. This study is the first to describe the co-design of medication management guidance tools for people with dementia. Two tools were generated, one for people with dementia and one for carers to extend their agency. This co-design study can serve as a framework to inform the development of future tools for people with dementia and carers.

Psychotropic medicine use in paediatric patients is increasing across many countries, despite limited regulatory approvals and evidence for safety and efficacy. This study investigated the extent of off-label use (OLU) of psychotropic medicines in paediatric patients in Australian primary care, using data from the Bettering the Evaluation and Care of Health (BEACH) program. We retrospectively analysed data collected from 15,276 general practitioners between 2000 and 2016, encompassing 144,397 encounters with children and adolescents aged 3-17 years. Psychotropic medicines were defined by the Anatomical Therapeutic Chemical Classification codes N05 (Psycholeptics) and N06 (Psychoanaleptics), except for prochlorperazine. OLU was defined as use outside of the approved age or indication as specified in the Australian Product Information. A total of 1650 psychotropic medicines were prescribed, with sertraline (14.55 %), fluoxetine (12.48 %), methylphenidate (9.27 %), diazepam (5.52 %), and citalopram (5.27 %) being the most common. Of these, 75.03 % (95 % CI: 71.98, 78.08) were off-label, predominantly due to age (51.74 %, 95 % CI: 48.22, 55.26), followed by indication (23.29 %, 95 % CI: 20.32, 26.27). Off-label rates were highest for citalopram and fluoxetine (both 100 %), followed by sertraline (97.08 %, 95 % CI: 94.94, 99.23), diazepam (41.76 %, 95 % CI: 31.43, 52.09), and methylphenidate (12.42 %, 95 % CI: 7.13, 17.70). Off-label psychotropic medicine use in paediatric patients is common in Australian primary care, with most OLU classified as age-based rather than indication-based. These findings demonstrate high off-label rates and, given limited paediatric evidence, underscore the need for targeted guidelines, enhanced prescriber education, and further research to improve safe and effective use in this population.

Background:Community pharmacists (CPs) play a valuable role in the provision of mental healthcare in primary care settings; however, CPs may not be comfortable or confident doing so. Mental health literacy (MHL) of CPs and consumers, alongside factors in community pharmacies may contribute to this. Objective:The aims of this study were to explore how MHL may affect the provision and receipt of mental healthcare in community pharmacies, and the perceived barriers and facilitators for CPs in providing mental healthcare. Methods:Participants were recruited from a sample of respondents to a prior national survey of MHL in CPs. Thirteen CPs with a mean age of 40 years, comprising participants from both independent and chain pharmacies were recruited. Individual, semi-structured interviews were conducted, followed by professional transcription and thematic analysis. Results:Analysis revealed five main themes describing factors related to MHL and also the provision of mental healthcare services in community pharmacies: 1) Complexities in the understanding of and recognition and management of mental illness; 2) Attitudes and experiences of CPs in supporting mental health needs; 3) Prevention and management of mental illness needing a collaborative approach; 4) Opportunities and challenges within community pharmacies to support mental healthcare needs; and 5) Preparedness and willingness of CPs to provide mental healthcare. Conclusions:CPs identified several MHL-related factors that could affect mental healthcare delivery by CPs and consumers receiving care. CPs also described several ways to enhance preparedness to deliver mental healthcare in community pharmacies including working collaboratively with other healthcare providers.

Background: The Medication-Related Burden Quality of Life (MRB-QoL) Arabic version is a 31-item valid and reliable measure of medication burden on functioning and well-being. Objective: To examine the factor structure of the MRB-QoL Arabic in a sample of adults living with long-term conditions (LTC). Methods: Three hundred forty-three patients (≥ 18 years old) living with at least one LTC were recruited from 4 tertiary hospitals in the United Arab Emirates. Confirmatory factor analysis (CFA) was performed using Maximum likelihood estimation with bootstrap. Two models (first order and second order) were examined. Model fit indices, composite reliability (CR), and average variance extracted (AVE) were used to assess the model's goodness of fit, reliability, and convergent/discriminant validity, respectively. The model's fit was evaluated using absolute fit, comparative fit, and parsimony-adjusted indices. The RMSEA and SRMR ≤0.08, χ2/df < 5, and CFI, IFI, and TLI ≥ 0.90 were considered indicators of good model fit. PNFI and PCFI >0.5 were also considered as indicators of good fit. CR ≥ 0.7, AVE ≥ 0.5, and AVE greater than squared factors correlation were considered as evidence indicating reliability, convergent validity, and discriminant validity, respectively. Results: The first-order model showed an excellent fit (χ2/df = 3.262, RMSEA = 0.08, SRMR = 0.05, CFI = 0.913, TLI = 0.914, IFI = 0.914, PNFI = 0.810, PCFI = 0.841) as did the second-order model (χ2/df = 2.845, RMSEA = 0.073, SRMR = 0.072, CFI = 0.934, TLI = 0.923, IFI = 0.915, PNFI = 0.820, PCFI = 0.851). All domains of the MRB-QoL met the convergent/discriminant validity and reliability criteria. Conclusions: The study supports the factor structure from previous research and confirms the MRB-QoL Arabic as a valid and reliable measure. This tool can be used to assess medicines burden from patient perspectives and facilitate person-centred care in medicines optimisation services across Arabic-speaking countries.

Background:The Pharmacy Services Questionnaire (PSQ) was developed to measure patient satisfaction with pharmaceutical care. However, it has not been translated into Cantonese-Chinese and validated in the Hong Kong population. To develop and validate a Cantonese-Chinese-translated PSQ among native Chinese patients who have used pharmacy services at community pharmacies in Hong Kong. Methods:The PSQ was developed and translated into Cantonese-Chinese using iterative forward-backwards translation. Subjects were recruited by convenience sampling at three community pharmacies. Internal consistency, construct validity, discriminant validity, known-group comparison and Confirmatory Factor Analysis (CFA) were performed to confirm that the Cantonese-Chinese-translated PSQ is a valid measure of its intended constructs. Qualitative think-aloud interviews were carried out to test for comprehension and content validity. The subjects' views and interpretation of each questionnaire item were also explored to determine the relevance, comprehensiveness, and adequacy of the response options. Results:A total of 236 adult subjects were recruited to complete the Cantonese-Chinese PSQ and the Chinese 5-Level EuroQol 5-Dimension (EQ-5D-5L HK) questionnaire. Additionally, think-aloud interviews were carried out with 15 subjects. Most subjects were able to understand and interpret the Cantonese-Chinese PSQ with relative ease. The internal consistency of Cantonese-Chinese PSQ was excellent (Cronbach's α > 0.96) for the full-scale, Friendly explanation (FE) subscale and Managing therapy (MT) subscale. CFA confirmed the hypothesised two-factor structure of the Cantonese-Chinese PSQ. Individuals with higher education levels showed statistically significantly higher satisfaction levels in the overall PSQ score and MT scale score compared to those with lower levels of education. Additionally, there was no statistically significant correlation between the Cantonese-Chinese PSQ and EQ-5D-5L HK scores, demonstrating discriminant validity. Conclusion:The Cantonese-Chinese translation of the PSQ is a validated, reliable, and semantically equivalent instrument used to assess satisfaction towards services provided by community pharmacies.

Background: While pharmacists' roles in mental healthcare are expanding, research exploring pharmacists' acceptability and willingness to provide mental health services is limited. This study developed and validated theory-driven measures of pharmacists' acceptability and willingness to screen for perinatal depression in community pharmacy settings. Materials/Methods: Items were developed using published literature and the Theoretical Framework of Acceptability (TFA), then content validated using consensus methods with experts who completed the content validity index (CVI). The revised items were disseminated to pharmacists in Australia. Responses were analysed descriptively. Exploratory factor analyses (EFA) were used to explore the factorial structure and generate scales. Multivariate regression analysis was conducted to explore predictors of willingness. Results: A 58-item questionnaire was developed, encompassing the 7 domains of the TFA and an eighth domain (willingness). The average CVI was 0.92, domain range (0.88-0.96). The universal CVI was 56/58. Expert feedback informed item revision, creation and deletion. Pharmacists' responses (n = 157) to the final 42- item questionnaire indicated overall acceptance and willingness to conduct PND screening. However, perceived knowledge was lacking. The EFA resulted a two- factor solution (1 = acceptance; 2 = self-efficacy). The measurement scales created had good internal consistency. In multivariate regression analysis, 'Acceptance' (Beta = 0.949 (0.760-1.103)) and 'Self-Efficacy' (Beta = 0.107 (0.036-0.174)) were significant predictors of 'Willingness' and the model predicted 77 % of the variation in 'Willingness'. Conclusions: Psychometrically-sound measures of pharmacists' acceptability and willingness to screen for PND have been developed with stakeholder input. The questionnaire can be used for standardised measurement of these constructs across studies.