International Journal of Clinical Pharmacy最新文献

Introduction: Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA). However, Australian pharmacists' practice and knowledge of effective contraceptive methods, including long-acting reversible contraception (LARC), is unknown, and few were registered to dispense MA at the time of the study.

Aim: Our aim was to understand the knowledge, attitudes and practices of Australian community pharmacists in LARC and MA care.

Method: We conducted a cross-sectional national online survey of community pharmacists from July until October 2021. Participants were recruited through convenience sampling via mail and partner organisations' emails, newsletters, and mailing lists. We used descriptive statistical analysis, including counts, proportions, Pearson's chi-squared tests and Poisson regression for data analysis. Our descriptive survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) mixed-methods project (ACTRN12622000655741).

Results: There were 533 eligible responses; 72% (n = 385) self-identified as women, and 71% (n = 378) were from metropolitan areas. Respondents' correct LARC knowledge varied, with 88% understanding LARC effectiveness, 67.7% understanding return to fertility, and 65.9% understanding LARC suitability for nulliparous women. Most pharmacists were registered to dispense MA (70%; n = 373), although fewer than half discussed LARC at the time of dispensing MA. Those working outside metropolitan areas were more likely to be registered to dispense MA and feel that they had the knowledge and confidence to dispense MA.

Conclusion: With community pharmacists increasing scope of service in relation to contraception and MA, ongoing education and support will ensure they have accurate information for the provision of LARC and MA.

Introduction: Serious mental illnesses, such as schizophrenia, schizoaffective or bipolar disorder, often starts in late teens or twenties. Adherence to antipsychotic treatment for serious mental illness is often poor. Involving service users in decisions about their treatment leads to improved clinical outcomes and adherence. Shared decision-making is bilateral information sharing between clinician and service user where decision-making is shared between both parties. This study aimed to evaluate the lived experiences of young adults on how healthcare professionals involve them in decisions about antipsychotic medication.

Method: Fifteen semi-structured interviews were conducted online using Zoom. Participants were selected using purposive sampling via patient recruitment platform, support groups relevant to psychosis and social media. Those included in the study were diagnosed with schizophrenia, schizoaffective or bipolar disorder and treated with antipsychotics between the ages of 18-30. Data was coded inductively and thematic analysis was used to analyse the data.

Results: Four themes were identified. These were living with antipsychotics, influence of family and friends, gaining autonomy and consequences of young adulthood. Findings highlighted the range of side effects from antipsychotic medication and their impact on young adults, and how the choices made by health care professionals influenced the quality of shared decision-making. Health care professionals' decisions directly influence the quality of life for service users. Young adults with psychosis acknowledge the effectiveness of antipsychotics but see the side effects as significant obstacles in their lives.

Conclusion: The study found that health care professionals provided limited acknowledgement and support for antipsychotic side effects, which significantly impacted the young adults' lives. Young adults want to be fully informed of their medication and potential side effects but support from friends and family was a potential barrier. Changes in practice are needed including an adjustment in clinical language used by health care professionals, giving information to service users' post-psychosis and ensuring health care professionals are trained in shared decision-making.

Introduction: Individuals with advanced chronic kidney disease (CKD) have elevated risks for stroke, venous thromboembolism (VTE), and bleeding, yet their exclusion from major trials leaves uncertainty about dosing of apixaban and rivaroxaban.

Aim: To map existing evidence on apixaban and rivaroxaban dosing practices and associated clinical outcomes in patients with advanced CKD, predominantly not receiving dialysis, treated for atrial fibrillation (AF) and/or venous thromboembolism (VTE), and to identify knowledge gaps in this area.

Method: A scoping review was conducted following the Arksey and O'Malley framework and reported per PRISMA-ScR guidelines. The search, developed with a medical librarian, was conducted in MEDLINE, Embase, Cochrane, and CINAHL through May 7, 2025. Duplicates were removed, and records managed in Covidence. Two reviewers independently screened titles, abstracts, and full texts. We included studies of apixaban or rivaroxaban dosing in adults with advanced CKD (mostly non-dialysis) with AF or VTE reporting thromboembolic or major bleeding outcomes. Non-English articles and publication types (e.g., abstracts, case series, editorials) were excluded. Data was extracted using a structured form and summarized to address the study aim.

Results: Thirty-four studies were identified: seven VTE, six combined AF/VTE, and 21 AF. Standard-dose apixaban and rivaroxaban were more commonly used and associated with lower, though non-significant, rates of recurrent VTE and major bleeding compared to warfarin. In apixaban groups, standard-dose 5 mg BID had fewer VTE events than the 2.5 mg BID dose but more major bleeding events which were also not statistically significant. In AF studies, both standard and reduced-dose apixaban (5 mg BID and 2.5 mg BID), and reduced-dose rivaroxaban (15 mg daily), significantly reduced major bleeding risk versus warfarin. Stroke reductions were not consistently significant but trended lower with apixaban and rivaroxaban compared to warfarin. In the only AF study comparing apixaban and rivaroxaban, both doses of rivaroxaban (20 mg or 15 mg daily) had higher bleeding rates than apixaban. One of four AF studies showed higher bleeding with standard versus reduced-dose apixaban.

Conclusion: This review summarizes apixaban and rivaroxaban dosing for AF/VTE in advanced CKD, revealing gaps such as limited dose-comparison studies, heterogeneous outcomes and sparse data in non-dialysis. Robust trials are urgently needed.

Introduction: Sports pharmacy is a developing field in which pharmacists support athlete health, promote safe medication use, and contribute to anti-doping efforts. Despite international recognition of pharmacists' potential roles, limited evidence exists on pharmacy students' knowledge and perceptions of this area, particularly in Northern Ireland.

Aim: To explore pharmacy students' perceptions and experiences of sports pharmacy, with a particular focus on its relevance to pharmacy education, professional roles, and career aspirations.

Method: An exploratory qualitative design was employed, using Braun and Clarke's inductive thematic analysis. Sixteen MPharm students (Years 1-4) from a university in Northern Ireland participated in semi-structured interviews conducted online between January and May 2025. Data were coded independently by two researchers, with themes developed through consensus.

Results: A total of sixteen students were interviewed. Data saturation was reached at the fourteenth interview, when no new codes or themes were identified, and this was confirmed through researcher consensus following review of coded transcripts. Six key themes were developed from analysis of the full dataset. Interviews lasted between 30 and 45 min (mean length = 37 ± 5 min): (1) Lack of curricular embedding, (2) Latent recognition of professional relevance, (3) Constraints in curriculum integration, (4) Feasible ways for embedding sports pharmacy, (5) Envisioned professional evolution, and (6) Motivation shaped by exposure and identity. Awareness was consistently low across all years. Students recognised sports pharmacy's value for athlete safety and career development, but expressed concerns about curriculum overload, limited expertise, and variable relevance. Practical solutions included guest lectures, interdisciplinary workshops, and optional or elective modules to provide exposure without adding to the curriculum burden. Sports pharmacy was perceived as an expanding niche with potential to shape future roles for pharmacists.

Conclusion: Pharmacy students valued the potential of sports pharmacy but highlighted challenges in embedding it within an already overloaded curriculum. Flexible and targeted approaches, such as electives and guest lectures, may enhance awareness while accommodating diverse student interests. Future research should evaluate such strategies and their impact on preparing pharmacists for roles in sports pharmacy and anti-doping.

Introduction: Middle-aged adults (45-64 years), who constitute a large proportion of the population, are at risk of potentially inappropriate medicine (PIM) prescribing due to their high prevalence of multimorbidity. Drug class duplication, the concurrent prescription of two or more medicines from the same pharmacological class, is a commonly reported PIM criterion in studies using the PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria.

Aim: To determine the prevalence of drug class duplication, stratified by sex and age group, and its associated factors among middle-aged adults using a South African pharmaceutical benefit management (PBM) company's medicine claims database.

Method: A cross-sectional study was conducted using data from 1 January 2023-31 December 2023. Drug class duplication was assessed across 14 pharmacological drug classes. Prevalence of drug class duplications was analysed by sex and age group, with associations tested using Pearson's chi-square test. Spearman's correlation coefficient (r_s) was used to assess the correlation between drug class duplication and potential associated factors.

Results: Of the 195,446 patients analysed (51.9% female; mean age 53.69 years [standard deviation (SD) 5.41, 95% confidence interval (CI) 53.665-53.713]), 48.8% experienced one or more drug class duplication. Duplication was similar between sexes (p = 0.1685) and higher in older age groups (p < 0.0001, Cramér's V = 0.2). The most prevalent drug class duplications were 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) (n = 36,887, 18.9%); non-steroidal anti-inflammatory drugs (NSAIDs) (n = 30,829, 15.8%); angiotensin-converting enzyme (ACE) inhibitors (n = 25,646, 13.1%); angiotensin II receptor blockers (ARBs) (n = 22,411, 11.5%); calcium-channel blockers (CCBs) (n = 15,716, 8.0%); selective serotonin reuptake inhibitors (SSRIs) (n = 12,139, 6.2%); and beta-receptor blockers (β-blockers) (n = 11,577, 5.9%). Strong correlations were observed between drug class duplication and the number of Chronic Disease List (CDL) conditions per patient (r_s = 0.680, 95% CI 0.678-0.683), and number of prescriptions per patient (r_s = 0.638, 95% CI 0.636-0.641). Correlation with the number of medicine items per prescription per patient was moderate (r_s = 0.391, 95% CI 0.388-0.400), and weak with age (r_s = 0.232, 95% CI 0.227-0.236) (all p < 0.0001).

Conclusion: Drug class duplication was common, highlighting that targeted interventions may be useful to improve patient safety.

Introduction: The clinical relevance of pharmacists' interventions (PIs) is complex to determine. The CLEO tool is a multidimensional scoring system to assess the relevance of PIs across three dimensions: clinical, economic, and organisational impact.

Aim: This study aimed to nationwide validate the CLEO tool by clinical pharmacists in German hospitals using structured and representative clinical cases.

Method: The German CLEO version was adapted to the German hospital setting and supplemented with practical examples. Fifty up-to-date cases from the inpatient setting were developed in a multistage process following the Identification, Situation, Background, Assessment, Recommendation structure. In the first round, each rater was randomly assigned 20 from the pool of 50 clinical cases, ensuring that all cases were evaluated by multiple raters. After a 14-day washout period, the same 20 cases were reassessed by the same raters. In the second round, all raters from the first round were invited again, and a subset who volunteered assessed another 20 cases after intensified training. Inter- and intra-rater reliability were calculated using Krippendorff's α and the intraclass correlation coefficient (ICC). User feedback was collected through a 16-item questionnaire.

Results: A total of 79 pharmacists from 56 hospitals participated in the first round; 27 completed the second round as well. Inter-rater reliability was poor across all three CLEO dimensions (Krippendorff's α < 0.67), both overall and among experienced clinical pharmacists. Intra-rater reliability was good for all dimensions (ICC 0.63-0.74), highest for the clinical dimension (0.74). Most raters (77%) needed less than one minute per case. Overall, the CLEO tool was perceived by users as appropriate, precise, acceptable and feasible (mean score 5.36; 7-point Likert scale; 1 = strongly disagree, 7 = strongly agree).

Conclusion: Since clinical pharmacy is still a developing discipline in German hospitals, differences in clinical practice and professional expertise complicate the evaluation of PIs. While intra-rater reliability was good, the validation of the CLEO tool in Germany did not achieve satisfactory inter-rater reliability. The CLEO tool may be useful within institutions with shared standards, but broader application across diverse settings in Germany requires additional training, further research and standardisation of clinical pharmacy services.

Introduction: Evidence 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.

Aim: To 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.

Method: Pharmacists 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.

Results: Seventy-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.

Conclusion: Formative 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.

Introduction: Prescribing cascades occur when new medications are initiated to treat adverse drug reactions (ADRs) caused by an initial medication (index). Although using lower dose of the index medication is often recommended as a general strategy to address adverse drug reactions that may trigger potential prescribing cascades, evidence supporting a dose-dependent relationship for many prescribing cascades is limited.

Aim: The aim was to examine the dose-dependent relationship across a range of index medications related to various potential prescribing cascades, for which the dose-dependent relationship between the index medication and the ADR was not yet known.

Method: A cohort study was conducted using prescription sequence symmetry analysis with data from over 600 Dutch community pharmacies (2015-2020). We assessed 18 potential prescribing cascades involving ACE inhibitors (ACEIs), statins, antidepressants, dihydropyridine calcium channel blockers (DCCBs), and other drug classes. Index medication doses were categorized based on the World Health Organization (WHO) Defined Daily Dose (DDD) into low (< 0.50 DDD), medium (0.50-1.50 DDD), and high (> 1.50 DDD). The adjusted sequence ratio (aSR) quantified the likelihood of marker drug initiation after vs. before the index drug, corrected for prescribing trends; aSR > 1 indicated a potential prescribing cascade.

Results: Twelve of the 18 potential prescribing cascades showed a dose-dependent relationship. All angiotensin converting enzyme inhibitor (ACEI) related cascades demonstrated increasing aSRs with higher doses. ACEIs associated with cough showed increasing aSRs, from 0.86 to 2.09 at low dose to 1.29 to 2.78 at high dose across four cascades. Dose-dependent relationships were also found for statins, antidepressants, and DCCBs. No such relationship was observed for cascades involving proton pump inhibitors, diuretics, and non-steroidal anti-inflammatory drugs.

Conclusion: Medication dose can play a significant role in potential prescribing cascades. Healthcare professionals should be aware of the potential contribution of dose to prescribing cascade development. The study design precludes causal inference, and confirmation is needed to support further clinical recommendations.

Introduction: Hypertension, a leading global cause of death with high prevalence and poor control, faces a critical issue of poor medication adherence. Existing predictive models for medication adherence suffer from limitations such as small sample sizes, insufficient inclusion of multiple factors, and a lack of nationally representative longitudinal data on the Chinese population.

Aim: This study aimed to develop an interpretable machine learning model for predicting medication adherence among Chinese hypertensive patients.

Method: Using data from the China Health and Retirement Longitudinal Study, we categorized medication adherence as "high" or "low" based on consistency across two survey waves. Predictors included demographics, physical/psychological capability, motivation, and social-environmental factors. After missing data imputation via random forest, feature selection was performed using least absolute shrinkage and selection operator regression. Seven machine learning algorithms were trained and evaluated, with interpretability provided by Shapley additive explanations (SHAP) analysis. A Shiny-based web application was developed for model visualization and functions.

Results: Among 2773 hypertensive patients aged ≥ 45 years, 53.2% had low medication adherence. XGBoost performed best (area under the receiver operating characteristic curve = 0.828, accuracy = 0.726, F1-score = 0.713) in the test set. SHAP analysis indicated that better adherence was associated with the presence of multiple chronic conditions, overweight or obesity, cardiometabolic multimorbidity, older age, depression, residence in an urban area, sleep duration exceeding 8 h, a lack of bidirectional financial support, and disability in instrumental activities of daily living. In contrast, residence in the western region, smoking, and being employed were associated with non-adherence. The developed online tool provided real-time, personalized risk assessments, with predictions made interpretable via the SHAP framework to quantify key factors' contributions and offer transparent decision support.

Conclusion: This study developed an XGBoost machine learning model and online tool to predict medication adherence in Chinese hypertensive patients. The tool provided immediately actionable and transparent risk stratification, enabling targeted intervention. Future research should perform external validation of the model using electronic medical records or objective adherence data, thereby enhancing its generalizability and practical utility.