International Journal of Clinical Pharmacy最新文献

Introduction: The role of pharmacists in healthcare has evolved, and in several countries, they have prescribing rights. Currently, pharmacists in Sweden do not have the right to prescribe. Exploring their views on pharmacist prescribing may be a critical step toward advancing the profession and improving patient care.

Aim: To explore pharmacists' views on potential pharmacist prescribing in Sweden.

Method: An online questionnaire about pharmacist prescribing was distributed via email to Swedish pharmacists who are members of the Swedish Pharmacists Association (n = 5597). The questionnaire covered demographic information and statements about predefined prescribing models, preconditions, benefits, and risks associated with pharmacist prescribing. Each statement had a 4-point agreement Likert scale response option with additional "Don´t know/no opinion" option. Data were collected in May 2024. Closed-ended questions were analyzed descriptively, while open-ended questions were categorized and summarized.

Results: Of the 395 respondents (7% response rate), 75.2% (n = 297) agreed with introducing at least one model of pharmacist prescribing. The two models that received the most support were "Prescribing based on an agreement or collaboration with one or more independent prescribers" (50.1%; n = 198) and "Independent, but limited prescribing rights" (48.1%; n = 190). All predefined preconditions were important for the respondents; their education (97.2%, n = 384) was identified as the most important factor. Overall, respondents agreed more with the benefits than the risks of introducing pharmacist prescribing. Most frequently (somewhat) agreeing that an enhanced professional position of pharmacists in health care was a key benefit (91.1%; n = 369), and the risks that respondents most (somewhat) agreed with included increased workload (80.8%; n = 319) and the conflict of interest involved in pharmacists acting as both prescribers and dispensers (60.8%; n = 240).

Conclusion: The majority of respondents supported introducing at least one pharmacist prescribing model in Sweden. These findings provide valuable insights for policymakers considering an expanded role for pharmacists in Sweden, which may include a variety of extended professional roles in different settings.

Introduction: Potentially inappropriate medications (PIMs) are medications with an unfavourable risk-benefit profile for patients aged ≥ 65 years. Currently, several screening tools are available and are used in clinical practice to identify PIMs.

Aim: Our objective was to systematically synthesize the available evidence on the association between potentially inappropriate medications (PIMs), as identified by various screening tools including STOPP/START and the Beers Criteria, and the outcomes of rehospitalization and mortality within three months in older patients.

Method: Adhering to Cochrane standards, we conducted a systematic review and meta-analysis to investigate the outcomes of patients aged 65 years and older, comparing those with at least one PIM identified by any explicit screening tool to those without PIMs. Primary outcomes were readmission and/or death within three months. The databases of Embase, MEDLINE, and CENTRAL were searched for retrospective as well as prospective observational studies published between 1991 and May 17 2024. The risk of bias was assessed for all included studies.

Results: In total, 1,642 studies were identified through the systematic search. Nine observational studies were included in this review. Our analysis revealed a statistically significant association between the overall presence of PIMs and rehospitalisation; odds ratio (OR) 1.47 [95% confidence interval (CI) 1.02 to 2.13, p = 0.045]. While stratification according to STOPP/START criteria yielded a statistically significant OR of 1.84 [CI 1.08 to 3.12, p = 0.024; n = 5], no statistically significant difference was seen according to Beers list [OR 1.25, CI 0.86 to 1.81, p = 0.235; n = 5]. Furthermore, no significant association was found between PIMs and mortality in either the overall analysis or the stratification according to the Beers and STOPP/START criteria. The risk of bias in the included studies was moderate to serious, and the certainty of evidence was very low.

Conclusion: The use of PIM screening tools during medication evaluations may reduce the risk of rehospitalisation and potentially lower mortality in older patients. However, further studies are warranted to confirm the association with adverse outcomes.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition, which initially presents in childhood. While prescribing trends for treating ADHD have been previously examined in Ireland's paediatric population, off-label prescribing of ADHD medication has yet to be studied.

Aim: We aimed to describe ADHD medication prescribing and off-label prescribing of ADHD medication in Ireland.

Method: This cross-sectional study used a sample drawn from the population of children and adolescents who were attending mental health services in Ireland as of 31st December 2021. Participants were included based on predefined inclusion and exclusion criteria; those who were aged 17 years or younger and had been prescribed at least one psychotropic medication (n = 3,193). We described the frequency and population of those prescribed an ADHD stimulant or non-stimulant medication and the target condition or target symptom cluster for prescription. We reported the starting and maintenance doses of each medication.

Results: Fifty-three percentage (n = 1,687) of children and adolescents were prescribed an ADHD medication on 31st December 2021, with more boys being prescribed an ADHD medication compared to girls (n = 1,284 vs n = 395). The most common age category prescribed ADHD medication was 11-13 years of age. The most common indication for prescribing ADHD medication was the target condition ADHD (n = 1,661; 98.5%).Twenty-six patients (1.5%) were prescribed ADHD medication for target symptoms, most commonly depressive (n = 8) and behavioural disturbance symptoms (n = 8) (i.e., off-label prescribing of ADHD medication).

Conclusion: More than half of young people attending specialist mental-health services in Ireland were receiving an ADHD-specific medicine, and almost all prescriptions were tied to a confirmed ADHD diagnosis. Off-label use for other symptom clusters was rare (< 2%), indicating strong adherence to licensed indications but also highlighting the importance of continued surveillance to detect emerging off-label trends and to ensure prescribing remains evidence-based and patient-centred.

Artificial intelligence (AI), particularly machine learning (ML), is increasingly influencing pharmacovigilance (PV) by improving case triage and signal detection. Several studies have reported encouraging performance, with high F1 scores and alignment with expert assessments, suggesting that AI tools can help prioritize reports and identify potential safety issues faster than manual review. However, integrating these tools into PV raises concerns. Most models are designed for prediction, not explanation, and operate as "black boxes," offering limited insight into how decisions are made. This lack of transparency may undermine trust and clinical utility, especially in a domain where causality is central. Traditional ML relies on correlational patterns and may amplify biases inherent in spontaneous reporting systems, such as under-reporting, missing data, and confounding. Recent developments in explainable AI (XAI) and causal AI aim to address these issues by offering more interpretable and causally meaningful outputs, but their use in PV remains limited. These methods face challenges, including the need for robust data, the difficulty of defining ground truth for adverse drug reactions (ADRs), and the lack of standard validation frameworks. In this commentary, we explore the promise and pitfalls of AI in PV and argue for a shift toward causally informed, interpretable models grounded in epidemiological reasoning. We identify four priorities: incorporating causal inference into AI workflows; developing benchmark datasets to support transparent evaluation; ensuring model outputs align with clinical and regulatory logic; and upholding rigorous validation standards. The goal is not to replace expert judgment, but to enhance it with tools that are more transparent, reliable, and capable of separating true signals from noise. Moving toward explainable and causally robust AI is essential to ensure that its application in pharmacovigilance is both scientifically credible and ethically sound.

Introduction: Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of management and methotrexate is broadly considered as first-line treatment. Gastrointestinal side effects and variable bioavailability however limit adherence to and effectiveness of oral methotrexate, while parenteral methotrexate remains underutilized.

Aim: To explore RA patients' perspective and their level of acceptance towards parenteral methotrexate and to investigate the barriers and enablers to its use.

Method: A qualitative study was conducted using semi-structured interviews between May and August 2022. Participants were recruited using convenience and purposive sampling strategy. The Theoretical Framework of Acceptability (TFA) was used to guide the development of the interview guide and data analysis (directed content analysis).

Results: Twenty-five participants (68% female, 76% with experience using parenteral methotrexate) were interviewed. All seven TFA constructs were found to influence participants' acceptance of parenteral methotrexate. High acceptance was related to the TFA constructs "perceived effectiveness", "intervention coherence", "self-efficacy" and "ethicality". Experience with disease improvement and gastrointestinal tolerance with parenteral methotrexate was valued by the participants, and understanding these benefits was linked with high acceptability (perceived effectiveness). Participants reported a high level of confidence in using methotrexate injections and adapting to the injection-taking routine (self-efficacy). The user-friendly design of the methotrexate pre-filled syringe, along with the support from healthcare professionals, served as enablers (intervention coherence and ethicality). Minimal opportunity costs (e.g., no major lifestyle sacrifices) further supported acceptability, though some reported initial injection anxiety (affective attitude). Barriers were frequently identified in the "burden" construct, including travel inconvenience and injection-associated cost. Participants without the experience with methotrexate injections expressed the need for further information, particularly regarding the logistical and safety aspects of parenteral methotrexate (intervention coherence).

Conclusion: Our findings highlighted that patients' comprehension of the benefits of using parenteral methotrexate, confidence in self-administration, healthcare professionals' support, and the ease of using injections may help optimize treatment acceptability, underscoring the importance of patient's education from healthcare professionals and the availability of patient-friendly devices.

Prehabilitation has emerged as a proactive, multimodal strategy in perioperative care, aiming to enhance functional capacity and resilience before surgery through medical optimization, exercise, nutrition, and psychological support. Despite their multidisciplinary nature, pharmacists are underutilized in this evolving field. Pharmacists are uniquely positioned to advance prehabilitation by applying Medication Therapy Management (MTM) and Collaborative Drug Therapy Management (CDTM) models to identify medication-related risks, manage comorbidities, and optimize perioperative outcomes. China's experience provides a compelling demonstration of this potential. Since 2015, Zhihua Zheng and colleagues at the Guangdong Pharmaceutical Association have pioneered surgical pharmacy, integrating MTM into pharmacist-managed clinics and employing CDTM frameworks to extend pharmacists' clinical authority in China. These innovations empower pharmacists to perform key prehabilitation functions, such as optimizing complex medication regimens, mitigating polypharmacy, stabilizing cardiovascular and metabolic parameters, managing nutrition and anemia, and supporting pain control. Internationally, prehabilitation has gained traction through initiatives such as Enhanced Recovery After Surgery programs and perioperative surgical home models. However, the pharmacist's contribution remains insufficiently defined. This commentary aims to highlight strategic opportunities for strengthening pharmacist involvement in prehabilitation rather than prescribing detailed operational protocols. Integrating MTM and CDTM conceptually within prehabilitation teams offers a scalable, evidence-informed direction that can guide health systems to enhance perioperative safety and readiness. Pharmacist-led interventions not only reduce medication errors and adverse events but also complement the work of surgeons, anesthesiologists, nutritionists, and rehabilitation specialists. Global collaboration is essential for standardizing competencies, developing training frameworks, and strengthening the evidence for pharmacist-led prehabilitation. The International Pharmaceutical Federation (FIP), the American Society of Health-System Pharmacists (ASHP), and the European Society of Clinical Pharmacy can catalyze this progress by promoting education, guidelines, and policy integration. By embedding MTM/CDTM into surgical prehabilitation, health systems can empower pharmacists to enhance patient safety, improve surgical outcomes, and advance the global standards of perioperative care.

Introduction: The renal effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors in diverse populations remain under investigation. While randomized controlled trials have shown renoprotective effects of SGLT2 inhibitors, their impact in routine clinical settings and specific populations such as Koreans requires further evaluation.

Aim: This study aimed to evaluate the impact of empagliflozin compared to sitagliptin on renal function and related clinical outcomes in patients with type 2 diabetes (T2D) using a target trial emulation approach.

Method: We conducted a retrospective cohort study using electronic medical records from a Korean tertiary care hospital between 2018 and 2019. New users of empagliflozin or sitagliptin were identified and matched using propensity scores to control for confounding factors. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and other renal function markers over time. Secondary outcomes included acute kidney injury, albuminuria, and composite renal events, as well as other clinical parameters. A modified intention-to-treat analysis was performed, with follow-up up to 13 months.

Results: After matching, 219 T2D patients were identified in each group. Empagliflozin was associated with a slower decline in eGFR compared to sitagliptin (p < 0.05). Serum phosphorus levels increased more with empagliflozin (p < 0.05). Empagliflozin showed a non-significant trend toward lower risk of composite renal outcomes (hazard ratio [HR] 0.78; 95% confidence interval [CI], 0.50-1.22). Significant increases in weight loss (HR 2.95; 95% CI, 2.01-4.33) and urination frequency (HR 4.05; 95% CI, 1.14-14.34) were observed with empagliflozin. Serum uric acid levels decreased more in the empagliflozin group (p < 0.05).

Conclusion: This real-world study suggests that empagliflozin may offer renoprotective benefits compared to sitagliptin in T2D patients. However, the increased serum phosphorus levels warrant careful monitoring. These findings provide valuable insights for clinical decision-making in managing T2D patients at risk of renal complications.

Introduction: Chronic non-cancer pain (CNCP) affects 22-88% of older adults and is associated with a lower quality of life and polypharmacy. It thus puts these already very vulnerable patients at a greater risk of medication-related harm.

Aim: This feasibility study aimed to implement a multimodal clinical pharmacy intervention to improve CNCP-related care for older adult inpatients on hospital geriatrics wards.

Method: We conducted a single-arm feasibility study from January to May 2025, including patients aged 65 or older, hospitalised on the geriatrics ward of a tertiary hospital in Switzerland and previously diagnosed with CNCP. Feasibility was defined as the ability to perform the intervention as planned and approximated by recruitment and dropout rates. The intervention included semi-structured interviews about patients' pain histories, collected patient-reported outcome measures (PROMs) and recorded therapy goals. Pharmacists then conducted medication reviews using a previously developed and validated trigger tool. The trigger tool was used as a standardised approach for identifying medication-related issues, comprising a set of previously validated quality indicators. Findings were discussed during interprofessional ward rounds. Final treatment decisions were made jointly with patients. We followed up with patients by telephone one month after hospital discharge.

Results: Of 253 screened patients, we included 48 patients: 28 (58%) were interviewed, and 18 (38%) had a follow-up telephone call. Pharmacists suggested 56 therapy changes, with 29 identified by the trigger tool and 27 identified by regular medication review. Therapy change acceptance rates by the care team were 78% and 41%, respectively. Pain frequency and the highest and lowest pain levels over the last seven days all decreased after hospital discharge, although these changes cannot be causally attributed to the intervention. Other pain-related PROMs showed no change or just a slight improvement or deterioration.

Conclusion: The present feasibility study showed that implementing a clinical pharmacy intervention for older adult inpatients was indeed feasible. However, the recruitment rates were relatively low, and dropout rates were relatively high. Using a standardised approach involving a trigger tool showed promising results for detecting medication-related problems. These are important first indicators that including pharmacists more closely in standard care could be beneficial to CNCP patients.

Introduction: Drug-related hospitalisations are common and approximately 50% are preventable. They can be caused by adverse drug reactions, therapeutic failures, and Adverse Drug Withdrawal Events (ADWEs). ADWEs include any clinically significant set of symptoms caused by the cessation or dose reduction of a medication, including physiological withdrawal reactions or return of the underlying medical condition; few studies have examined the prevalence and characteristics of ADWEs.

Aim: To conduct a pilot study to determine the proportion of hospital readmissions caused or contributed to by ADWEs in older adults, explore the characteristics of these events, and test the method of assessment of ADWEs.

Method: A retrospective case note review included patients that were admitted to geriatric units with two hospital admissions within a three month period. Participants were screened for deprescribing events, defined as medication cessation, dose reduction, or substitution. Two assessors then independently reviewed the data to determine if an ADWE had occurred and assessed its contribution to a readmission.

Results: Ten participants experienced 33 deprescribing events during their first hospital admission, or between admissions. A total of seven out of the 33 deprescribing events (affecting six participants) were assessed to have likely led to an ADWE (21%). Of these, six were assessed as likely contributing to the readmission. Of the total 12 readmissions examined (across 10 participants), five readmissions (five participants) were assessed as likely being contributed to by an ADWE (41.6%). The most common medications that were assessed as likely to have contributed to an ADWE-related hospital admission were cardiac medications, particularly diuretics, which were implicated in four out of six ADWEs assessed as likely to have contributed to hospital readmission.

Conclusion: ADWEs are potentially common in complex older adults and their potential contribution to hospital readmissions highlights the need for further research on how to identify and ultimately prevent them.