International Journal of Clinical Pharmacy最新文献

Introduction: Muslim patients may avoid medicines containing ingredients prohibited by their faith (haram), such as alcohol, gelatine, or porcine derivatives. While Islamic law permits exceptions based on necessity (darura) or biotransformation (istihala), the way these principles influence medication adherence and shape patient-healthcare provider (HCP) interaction is underexplored.

Aim: To explore how Muslims apply Islamic reasoning to medication adherence decisions involving medicines containing haram ingredients.

Method: Thirteen ethnically diverse Muslim adults were purposively sampled for semi-structured interviews. A prior scoping review and mosque-based public and patient involvement (PPI) informed the interview guide. Interview data were analysed using Braun and Clarke's Reflexive Thematic Analysis (RTA), with themes constructed inductively. Data interpretation was guided by the Necessity-Concerns Framework (NCF) and locus of control (LOC) theory. Rigour was supported through member checking, peer debriefing and reflexive journalling.

Results: Four themes emerged: (1) Halal as worldview: the halal-haram spectrum functioned as a moral lens for daily behaviour and intake, extending to medication use. (2) Motivations for consumption: halal was linked to perceived health and spiritual benefit, while haram signalled impurity and harm. (3) Minor illness or major disease: darura and istihala were applied flexibly in chronic or life-threatening illness, whereas participants avoided prohibited medicines for minor conditions, favouring complementary remedies. Practical workarounds included switching dosage forms or opening gelatine capsules and discarding the shell to minimise religious harm. Decisions were shaped by perceived severity, symptom burden, financial considerations, and the extent to which HCPs were perceived as trustworthy, culturally competent, and responsive to religious disclosure, all of which influenced adherence. (4) Personalised care: participants valued shared decision-making, transparent disclosure of religiously relevant excipients, and a reasonable degree of religious literacy among HCPs; scepticism about halal certification underscored the need for clearer labelling and guidance.

Conclusion: Islamic reasoning influenced how participants engaged with medicines deemed haram. Supporting adherence requires pharmacy practice that incorporates religious literacy and responds to concerns about transparent labelling and faith-sensitive communication. These steps will strengthen patient-centred care by aligning religious and ethical reasoning with treatment decisions, fostering trust, enhancing adherence, and supporting more equitable care for Muslim patients.

Introduction: Febrile neutropenia (FN) in patients with hematological malignancies is associated with high morbidity and mortality due to bacterial infections, particularly from Gram-negative pathogens. Imipenem is widely used in this setting; however, altered pharmacokinetics in these patients may compromise treatment efficacy, necessitating individualized dosing strategies.

Aim: This study aimed to develop a population pharmacokinetic model for imipenem in Chinese adult patients with FN and hematological malignancies and to identify optimal pharmacokinetic/pharmacodynamic (PK/PD) targets to guide dosing and predict antimicrobial efficacy.

Method: A prospective, single-center, open-label study was conducted involving 121 hospitalized patients who contributed 207 plasma samples. Imipenem concentrations were measured by high-performance liquid chromatography. Pharmacokinetic modeling was performed using NONMEM, incorporating patient-specific covariates. Monte Carlo simulations were used to evaluate dosing regimens, and antimicrobial efficacy was assessed based on clinical and microbiological outcomes. The predictive value of PK/PD indices was analyzed using logistic regression and ROC curve analysis.

Results: A two-compartment model best described imipenem pharmacokinetics. Creatinine clearance (CLCR), gamma-glutamyltransferase (GGT), and vancomycin (VAN) co-administration significantly influenced imipenem clearance. The final model was: CL (L·h^-1) = 21.36 × (CLCR/110.39)^0.444 × (GGT/55.4)^-0.119 + VAN × 3.78; V1 = 42.9 L, Q = 3.7 L·h^-1, and V2 = 59 L. The PK/PD index most strongly associated with efficacy was f%T > MIC, with an optimal threshold of 90.48% (AUC_ROC = 0.728, P = 0.024). Simulation results suggested that a 4 g·day^-1 regimen (1000 mg q6h, 3-h infusion) is optimal for most patients with MIC ≤ 2 mg·L^-1. However, no standard regimen was effective for Pseudomonas aeruginosa or Acinetobacter baumannii at higher MICs.

Conclusion: This study highlights the importance of individualized dosing in FN patients with hematological malignancies. CLCR, GGT, and VAN co-administration significantly affect imipenem pharmacokinetics. Achieving f%T > MIC of 90.48% is critical for efficacy. Additional agents may be needed for infections caused by highly resistant organisms such as Pseudomonas aeruginosa and Acinetobacter baumannii.

Introduction: Pharmacist-led interventions improve medication outcomes, but existing evidence on adherence remains limited by heterogeneous tools and qualitative outcomes. The proportion of days covered (PDC) offers a quantifiable measure of adherence, with recommended threshold (PDC ≥ 80%) supporting evidence-based optimization of pharmacy services in chronic care management. However, studies using PDC to evaluate pharmacist interventions versus usual care show heterogeneity.

Aim: This study aimed to systematically review and meta-analyze the effect of pharmacist-led interventions versus usual care using standardized PDC-based outcomes, and synthesize quantifiable evidence for pharmacy practice.

Method: Five databases were searched from inception to March 2024. Eligible studies included randomized controlled trials (RCTs) or non-randomized studies evaluating pharmacist-led interventions versus usual care with adherence measured by PDC. Two reviewers independently screened studies and extracted data. RCTs were assessed using Cochrane risk of bias 2.0 and non-randomized studies with the Newcastle-Ottawa Scale. Meta-analyses were conducted using random-effects models (I² ≥ 40%) to pool mean differences (MD) for continuous outcomes (mean PDC) and risk ratios (RR) for binary outcomes (PDC ≥ 80%). Subgroup analyses explored variability by region, sample size, baseline adherence, publication year, PDC calculation method, intervention duration, and delivery modality. Sensitivity analyses were conducted restricting to RCTs or excluding low-quality studies.

Results: Twenty-nine studies were included in the analysis. Quality appraisal identified 54.5% of non-randomized studies as high quality, and the majority of RCTs were rated as low risk or some concerns. Pharmacist-led interventions significantly enhanced adherence versus usual care, with a pooled MD of 0.08 (95% CI 0.04-0.12) for mean PDC and an RR of 1.09 (95% CI 1.06-1.13) for adherence rate. Greater effects were observed for lipid-lowering (MD = 0.08, 0.04-0.11) and hypotensive medications (MD = 0.06, 0.03-0.10) than for antidiabetics (MD = 0.02, 0.01-0.03), for 6-month (MD = 0.12, 0.07-0.17) versus 12-month interventions (MD = 0.03, 0.01-0.06), and for telephone-based delivery (RR = 1.16, 1.06-1.28) versus multifaceted counterparts (RR = 1.12, 1.01-1.25). High heterogeneity was observed across pooled analyses. Sensitivity analyses confirmed the robustness of results.

Conclusion: Pharmacist-led interventions enhance medication adherence in mean PDC and adherence rate. These consistent effects across different durations and delivery methods show their adaptability and scalability in clinical settings, highlighting their value in real-world pharmacy practice.

Introduction: It is important for health professional societies to involve members in defining their roles and future activities including research priorities.

Aim: This study aimed to identify members' views on the areas of research that European Society of Clinical Pharmacy (ESCP) should prioritise in delivering research support, research projects and education.

Method: An online questionnaire was initially developed by the ESCP Research Committee and reviewed by the research team. It included structured and open-ended items related to respondents' demographics, research experience, views on future research priorities, topics that ESCP should prioritise, and barriers to research involvement. After testing face and content validity, the questionnaire was sent to all ESCP members (N = 417). Descriptive statistics and summative content analysis were used.

Results: Eighty-two responses were received (response rate: 19.7%). Research on real-world processes that facilitate the implementation of clinical pharmacy services into every-day practice was the priority for most respondents (n = 77, 93.9%). Respondents believed that ESCP should focus on research support for implementation science (n = 52, 63.4%) and methods to analyse clinical judgement and decision-making (n = 48, 58.5%). The perceived barriers to developing high-quality research in clinical pharmacy were reported as a lack of knowledge, skills and training, limited funding opportunities and insufficient time.

Conclusion: Research topics identified will help to inform ESCP and its committees on the priorities for research activities of the society in the near future, as well as other collaborating professional organisations of the current priority research objectives of ESCP in the international context.

Background: Monitoring safety throughout a medicine's lifecycle is essential. Pharmacovigilance systems are rich sources contributing to this aim in a real world context.

Aim: To identify and estimate disproportionality rates associated with the drugs that are most frequently reported to induce acute kidney injury (AKI).

Method: A case/non-case study was conducted, using data extracted in 2022 from the Portuguese National Pharmacovigilance Database for the period between 01/01/2009 and 12/31/2020. Cases were identified using the 'Acute Renal Failure' standardized MedDRA query, all remaining reports were considered non-cases, and a random sample without replacement of 4 non-cases per case was extracted. Data were expressed as the reporting odds ratio (ROR) and the 95% confidence interval.

Results: During this 11-year period, 352 AKI cases were identified, representing 0.7% of the 53,505 reports received. A total of 559 different drugs were considered 'suspect' in these AKI cases. Three therapeutic subgroups (ATC2) showed a significant ROR: antithrombotic agents (ROR 6.72; 95% CI 2.23-20.22), antivirals for systemic use (ROR 4.02; 95% CI 2.76-5.87), and antineoplastic drugs (ROR 2.14; 95% CI 1.48-3.11). Additionally, we identified individual drugs with significant RORs where no class effect was observed, namely mycophenolic acid, ciclosporin, tacrolimus, simvastatin, prednisolone, vancomycin, and deferasirox. In total, eleven drugs were identified as potentially associated with the occurrence of AKI.

Conclusion: This study highlights the importance of clinical pharmacy activities in closely monitoring renal function of people with known risk factors or those prescribed medications known to increase the risk of AKI. Some of the medications identified require further investigation to validate their association with AKI.

Diabetes mellitus is a progressive disorder that requires the active participation of individuals with diabetes to improve management and delay the onset of acute and chronic complications. Effective diabetes care necessitates a multifaceted approach involving insulin therapy, non-insulin anti-diabetic drugs and lifestyle adjustments. Self-management and self-care are integral, yet distinct, components of diabetes care. While both play a pivotal role in optimising diabetes care, their distinctions and similarities are often misunderstood. These terms are frequently used interchangeably. Although some activities are unique to each concept, inconsistencies exist in the published literature. Self-management refers to patient behaviours guided by healthcare professionals, whereas self-care encompasses autonomous actions patients take to maintain health and prevent complications. Both concepts involve activities that foster long-term collaboration between patients and healthcare professionals.

Background: The second victim phenomenon, referring to the impact of patient safety incidents on healthcare professionals, also affects pharmacists. Dispensing errors or inadequate counselling cause anxiety, reduced motivation, and staff turnover. Support programmes exist for healthcare professionals, but not specifically for pharmacists.

Aim: To explore pharmacists' perceptions of tailored education to enhance competencies in overcoming second victim experiences, including (i) potential impacts, (ii) recommended content for professional development and undergraduate curricula, (iii) preferred design and delivery methods, and (iv) experience with existing programmes.

Method: A qualitative focus group study using the experiences, opinions, and recommendations approach was conducted in Serbia. Data were collected through a semi-structured guide and a self-reported questionnaire on participation in existing programmes. Discussions continued until saturation. Recordings were transcribed verbatim and analysed using the inductive thematic approach with MAXQDA software. Descriptive statistics summarised programme participation.

Results: Participants perceived tailored education as necessary for improving error response, empowering individuals and the profession, and enhancing pharmaceutical care. Thematic analysis identified four themes: (i) impacts of tailored programmes, (ii) topics for professional development, (iii) topics for undergraduate curricula, and (iv) programme design and delivery. Key areas included soft skills, risk and stress management. Undergraduate education should strengthen communication, motivation, and career development. Preferred methods were workshops and blended learning. Of 25 participants, 20 (80%) attended support programmes; 20 (80%) reported improved competence, and 20 (80%) would recommend them to colleagues.

Conclusion: Community pharmacists perceived tailored education addressing second victim experiences as important for professional resilience and improving pharmaceutical care.

Introduction: The Pharmacists in PCN Program integrated primary care clinical pharmacists as a core members of the interprofessional team in Primary Care Networks (PCNs) across British Columbia (BC), Canada. Patient experiences after receiving care from pharmacists in a team-based primary care setting have not been extensively studied.

Aim: To describe patient experiences while receiving care from a pharmacist as a member of the interprofessional team in PCNs across BC.

Method: A survey was conducted over a 66-week period between May 30, 2022 and September 1, 2023, and was administered online through Qualtrics®. A questionnaire was distributed to 2714 patients who completed their initial patient appointment with a pharmacist and had a valid e-mail in their health record.

Results: We analyzed responses from 787 questionnaires (29.0% response) representing all 23 PCN communities (42 PCNs) active during the survey period. The mean (SD) age of respondents was 65.3 (14.7) years, 60.5% were female and 81.5% identified as White. Patients reported a high overall satisfaction (strongly agree/agree) with their experience of care provided by their pharmacist. Patients felt listened to during their appointment (93.2%, 703/754), that conditions, medications and their treatments were explained in a manner that was easy to understand (92.4%, 697/754), and that they were given an opportunity to ask questions (92.4%, 697/754). Pharmacists were highly acknowledged for showing sensitivity to patient values, needs and preferences (88.7%, 669/754), and that patients were treated with dignity and respect (94.6%, 713/754). Patients reported improved understanding of their medications and their health as well as increased confidence and motivation regarding their health and medication. Nearly all patients (95.3%, 714/749) wanted to see the same pharmacist again and 94.9% (711/749) would recommend their pharmacist to a friend/family member. Patients felt engaged with the decision-making process around their medications, and valued the process pharmacists used when helping them make decisions.

Conclusion: Patients reported an overall high degree of satisfaction with their experiences of care provided by pharmacists in a team-based primary care model in BC. Patients reported improved understanding and confidence of the medications and their health and reported positive experiences with the shared decision-making process.

Background: Pharmacists are integral to the multidisciplinary team; however, staffing and resource challenges limit pharmacists' impact. Aligning pharmacists by admission specialty teams, rather than traditional ward-based models, may address these challenges.

Aim: This study aimed to evaluate whether a pharmacy redesign, which included aligning pharmacists to a specialty-based model from a ward-based model, increased the number and quality of interventions made per full-time equivalent pharmacist in hospitalised patients.

Method: The pre-post observational cohort study was conducted at a 550-bed tertiary teaching hospital. The redesign of the clinical pharmacy service was conceived and implemented using redesign methodology. Implemented solutions involved alignment of pharmacists to a specialty team-based model, multidisciplinary teamwork, pharmacist clinical specialisation, an emphasis on clinical documentation, and prioritisation of patients requiring medication review. Pharmacist interventions documented pre- and post-clinical redesign were compared. Two independent reviewers classified the intervention type and determined the impact and significance.

Results: In total, 226 patients were included in the pre-cohort and 468 post. Age (mean 70 vs 69, p-value = 0.404) and other demographics were similar between the cohorts. Pharmacist interventions increased after the clinical pharmacy redesign (n = 310 vs n = 1,106). After the implementation of the clinical pharmacy redesign, there was a significant increase in the median number of clinical interventions per Full-time Equivalent pharmacist (13.5 [0-64] vs 81.5 [3-166], p = 0.004). The redesign showed a positive impact and increase in all interventions.

Conclusion: The redesign of pharmacy services increased pharmacist impact without increasing resource requirements or using screening tools, resulting in improved prioritisation of patients, identifying drug-related problems and increased interventions.

Introduction: Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essential for reducing infection rates.

Aim: To synthesize economic evaluation evidence of hepatitis B (HBV) screening strategies in LMICs.

Method: A comprehensive search of PubMed, Embase, and Scopus was conducted up to August 08, 2024. All types of economic evaluations comparing HBV screening strategies in LMICs were included. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and the Consensus Health Economic Criteria (CHEC) extended checklists. The protocol was registered in PROSPERO (CRD42023472855).

Results: Twenty-four studies were included, with 11 focusing on pregnant women, 7 on adults, and others on children or infants. Most studies were from Asia, primarily China, using model-based analyses and a provider cost perspective. Regarding antenatal screening, adding tenofovir prophylaxis for HBsAg-positive pregnant women was more cost-effective than intervention solely targeting infants. In adults, a combination of screening and treating eligible cases or immunizing non-infected individuals was more cost-effective than no screening, particularly among young adults aged 21 to 39. Notably, expanding HBV screening to the general population was more cost-effective than limiting screening to high-risk groups. In children, screening plus re-vaccination of infants or 10-year-olds born to HBV-infected mothers was cost-effective compared to no re-vaccination.

Conclusion: Overall, more comprehensive interventions were generally cost-effective across all populations. The most cost-effective strategies included tenofovir prophylaxis for HBV-infected pregnant women, screening with treatment and/or vaccination in adults, and screening combined with re-vaccination in children.