International Journal of Clinical Pharmacy最新文献

Introduction: Rapid patient throughput on maternity wards results in pharmacist resources being directed towards discharge processes, primarily focused on patients who have undergone caesarean section (CS) due to their discharge medication requirements. This occurs at the expense of admission processes, including best possible medication history (BPMH) documentation.

Aim: To evaluate the impact of a pharmacist-led elective caesarean section (ELCS) pre-admission clinic (PAC) on efficiency of pharmacist workflows, BPMH documentation, and patient preparedness for analgesic supply on discharge.

Method: A retrospective observational study was undertaken at an Australian tertiary obstetric public hospital where an ELCS PAC was introduced through reallocation of clinical pharmacist resources. The PAC pharmacist attempted telephone contact with all patients scheduled for ELCS, within 1 week before surgery. The pharmacist obtained and documented a BPMH, and where appropriate, encouraged patients to purchase paracetamol and ibuprofen pre-operatively. Data were collected from electronic medical records and dispensing records for 1 month pre- and 2 months post-implementation, including: CS classification (elective or emergency); whether PAC was completed and timing of completion before CS; number of BPMH documented per day; timing of BPMH completion after CS; pharmacist staffing levels; and whether paracetamol and ibuprofen were dispensed on discharge.

Results: During the 3-month study period, 1863 patients were admitted to the maternity wards, with 654 patients birthing via CS. Elective CS accounted for 43.3% (283/654) of CS deliveries, with 57.2% (162/283) of these patients reviewed in ELCS PAC. Post-implementation, workflow efficiency increased, with 19.9% more BPMH documented per pharmacist per day (3.87 vs 4.64, p = 0.012). Overall BPMH completion increased for all patients who underwent CS (83.7% vs 93.3%, p < 0.001). Timeliness of BPMH documentation improved for ELCS patients, with higher BPMH completion on the day of surgery (19.8% vs 34.5%, p = 0.019). Patients reviewed in PAC were less likely to require discharge supply of paracetamol (52% vs 37.1%, p = 0.031) and ibuprofen (80% vs 56.4%, p < 0.001).

Conclusion: Reallocation of resources to introduce the ELCS PAC enhanced workflow efficiency and BPMH completion. Patient preparedness improved, with reduced reliance on hospital supply of simple analgesics on discharge.

Introduction: Lung cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for > 85% of cases. Traditional Chinese Medicine (TCM) has played an integral role in NSCLC management, particularly in combination with chemotherapy. Although the safety and efficacy of TCM injections have been widely studied, comprehensive pharmacoeconomic evaluations remain limited.

Aim: This review aimed to evaluate the safety, efficacy, and cost-effectiveness of five TCM injections, Marsdenia tenacissima, Aidi, Kanglaite, Kangai, and Shenqi Fuzheng, in combination with chemotherapy for the treatment of advanced NSCLC.

Method: A systematic literature review identified 165 randomized controlled trials (RCTs) published between 2000 and 2024. A Bayesian network meta-analysis (NMA) was performed to compare the objective response rates (ORR) and adverse events (AEs) among the five TCM injections plus chemotherapy versus chemotherapy alone. A decision tree model with a 6-month time horizon was constructed from the healthcare system perspective, incorporating direct medical costs, including drug administration, monitoring, and AE management. The incremental cost-effectiveness ratios (ICERs) were calculated based on incremental ORR improvements. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model.

Results: All five TCM injections combined with chemotherapy demonstrated superior ORR compared with chemotherapy alone. Kanglaite injection showed the highest ORR improvement (12.5%) and lowest incidence of leukopenia and hepatic dysfunction. However, Kangai injection exhibited the lowest ICER of $19.56 per 1% ORR gain, indicating the highest cost-effectiveness. The ICERs for the remaining regimens were $43.38 (Marsdenia tenacissima), $29.68 (Aidi), $56.94 (Kanglaite), and $28.08 (Shenqi Fuzheng) per 1% ORR. Sensitivity analyses confirmed the robustness of these findings, with ORR and injection costs identified as the key drivers.

Conclusion: Among the five TCM injections evaluated, Kangai injection combined with chemotherapy has emerged as the most cost-effective regimen for advanced NSCLC. These findings support the integration of TCM into evidence-based cancer care, and highlight the need for further pharmacoeconomic research, particularly in real-world clinical settings.

Introduction: Breast cancer is the most prevalent malignancy in women worldwide. Docetaxel-based chemotherapy is commonly used for treatment, but its clinical application is often constrained by hematologic toxicity, particularly severe bone marrow suppression. The early identification of high-risk patients is essential to prevent complications and optimize therapeutic outcomes. Machine learning offers advanced capabilities for risk prediction by capturing complex patterns beyond those of traditional statistical models.

Aim: This study aimed to identify the risk factors associated with bone marrow suppression in breast cancer patients receiving docetaxel-based chemotherapy, and to develop and validate predictive models using machine learning algorithms.

Method: This retrospective case-control study included 119 patients with breast cancer treated with docetaxel-based chemotherapy at the Hainan Hospital of Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, from January 2020 to December 2024. Patients were divided into bone marrow suppression (n = 57; WHO grades II-IV) and non-suppression (n = 62; grades 0-I) groups based on WHO toxicity criteria. Multivariate logistic regression was used to identify independent risk factors. Three prediction models, logistic regression, random forest, and AdaBoost, were constructed and evaluated. A five-fold cross-validation with 50 repetitions was performed to ensure model stability and reliability.

Results: Multivariate analysis revealed that a low baseline lymphocyte count (OR = 4.95, 95% CI 1.62-17.0), decreased white blood cell (WBC) count (OR = 0.62, 95% CI 0.40-0.9), and reduced prealbumin level (OR = 0.98, 95% CI 0.97-0.99) were significantly associated with severe bone marrow suppression (all p < 0.05). Among the models, AdaBoost achieved the best overall performance (AUC = 0.81; specificity = 94%; accuracy = 77%). The random forest model showed the highest sensitivity (83%), while logistic regression was more interpretable but demonstrated a lower predictive ability (AUC = 0.69).

Conclusion: Pretreatment lymphocyte count, WBC count, and prealbumin level are reliable predictors of docetaxel-induced bone marrow suppression. The AdaBoost model demonstrates high specificity (94%) in identifying low-risk patients, supporting accurate risk stratification and personalized care in breast cancer treatment.

Background: Vaccination rates for influenza and pneumococcal disease globally remain below targets for patients with cancer. Pharmacists already provide vaccinations in the community, highlighting an opportunity to bridge the gap by expanding hospital pharmacists scope of practice to deliver vaccinations in outpatient oncology settings.

Aim: To explore the perceptions of multidisciplinary healthcare professionals (HCPs) for the potential expansion of pharmacists' role to include a vaccination clinic for patients undergoing cancer treatment.

Method: Semi-structured interviews were conducted with nurses, doctors, and pharmacists who were purposively sampled. Data analysis used a deductive coding approach, with data themed against the constructs of Role Theory: ambiguity, conflict, overload, identity, overqualification and underqualification.

Results: Nineteen HCPs (6 nurses, 6 doctors, 7 pharmacists) participated. Participants identified the need for improved vaccination delivery, but considered this service not currently part of core business in the outpatient oncology setting. Role ambiguity was identified regarding which clinicians are ultimately responsible, with medical specialists inferring this to be the responsibility of primary care. Pharmacists' identity was strongly linked to vaccination services in the community, but not in hospitals. HCPs thought oncology pharmacists had the knowledge to expand their role to deliver vaccination services. Pharmacists, while motivated, identified that adding responsibility could cause overload without appropriate resources.

Conclusion: HCPs supported the inclusion of vaccination administration into the pharmacist's role and highlighted that an appropriately vaccine-trained oncology pharmacist would improve access to vaccines for patients with cancer.

Introduction: Antithrombotic agents are considered as high-risk medications, particularly during the perioperative period, because of the increased risk of bleeding. Balancing bleeding and thrombosis risks is crucial in the context of invasive procedures. The specific role of community pharmacists (CPs) in perioperative antithrombotic management remains unclear.

Aim: This study aimed to explore the role of CPs in perioperative antithrombotic management, focusing on their experiences, and the barriers and facilitators to expand their involvement.

Method: A qualitative study was conducted in Belgium between March and May 2024 using semi-structured, in-depth interviews with CPs. The Theoretical Domains Framework guided the development of the interview guide to ensure comprehensive coverage of relevant domains. Interviews were transcribed verbatim and analysed thematically using open and axial coding in NVivo 14 by two independent researchers. Participants were randomly sampled and recruited until no new themes were generated.

Results: A total of 13 CPs (7 female; median age 48 years, IQR 34-58) participated in the in-depth interviews. Four key themes emerged: (i) current involvement of CPs in perioperative antithrombotic management, (ii) factors influencing CPs' role, (iii) aspirations and perceived opportunities for role expansion, and (iv) proposed strategies to optimise CPs' contributions. CPs described their current role as limited and mainly reactive, with their involvement typically occurring postoperatively. Reported barriers included insufficient knowledge of antithrombotic protocols, time constraints, inconsistent and non-transparent hospital guidelines, lack of access to relevant medical records, and difficulty reaching hospital-based prescribers. Facilitators included CPs' unique position to oversee a patient's full medication regimen, strong and trusted patient relationships, early post-discharge contact, and intrinsic motivation to contribute more actively. Participants expressed a desire for more proactive and collaborative involvement, supported by structured training. They also stressed the importance of clear, well-accessible guidelines that are as uniform as possible across hospitals. Lastly, they emphasised the need for better accessibility to prescribers to facilitate more effective communication.

Conclusion: CPs' role in perioperative antithrombotic management is currently limited, particularly preoperatively. Addressing identified barriers and implementing the suggested improvements could strengthen their role. Further research is needed to validate these findings and guide future interventions.

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been suggested to exert anti-inflammatory effects in the gastrointestinal tract based on preclinical and observational studies. Whether these effects translate into a reduced risk of inflammatory bowel disease (IBD), compared with other antidiabetic agents of similar therapeutic rank, remains unclear.

Aim: This study aims to evaluate the association between SGLT-2i use and the risk of IBD in patients with type 2 diabetes mellitus (T2DM), using dipeptidyl peptidase-4 inhibitors (DPP-4i) as an active comparator.

Method: A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database from 2016 to 2022. Patients with T2DM who initiated SGLT-2i or DPP-4i therapy were included. Propensity score matching (1:4) was performed based on key covariates. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated for incident IBD, including its subtypes ulcerative colitis (UC) and Crohn's disease (CD), using Cox proportional hazards models and Fine and Gray competing risk models (considering death as a competing event), with further adjustment for residual confounding. Sensitivity analyses were conducted using alternative induction periods and several on-treatment approaches that accounted for treatment discontinuation.

Results: Among 258,355 patients (51,671 SGLT-2i users and 206,684 DPP-4i users), the incidence of IBD was lower in the SGLT-2i group (12.51 vs. 35.83 per 100,000 person-years). SGLT-2i use was associated with a significantly reduced risk of IBD (aHR: 0.391; 95% CI 0.237-0.645; p < 0.001), with consistent results across multiple sensitivity analyses.

Conclusion: In this nationwide real-world cohort, SGLT-2i use was associated with a lower risk of IBD compared with DPP-4i among patients with T2DM. These findings suggest potential gut-protective effects of SGLT-2i and support their consideration in clinical decision-making for patients at elevated risk of IBD. Further prospective studies are warranted to validate these observations and elucidate the underlying mechanisms.

Background: Diabetes prevalence among individuals of Chinese background in Australia is about three times higher than the general population.

Aim: The aim of this study was to identify specific barriers and enablers of medication-taking among adults of Chinese background living with type-2 diabetes mellitus (T2DM) in Australia.

Method: Qualitative semi-structured interviews were conducted with: (1) adults (18 + years) with T2DM of Chinese heritage currently prescribed diabetes medications; (2) health professionals involved in the care of people with T2DM of Chinese heritage. Participants were recruited from a national registry and single specialist clinic. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive content analysis based on the 14 domains of the Theoretical Domains Framework (TDF). The most relevant TDF domains were identified based on frequency counts across cohorts.

Results: A total of 25 people living with T2DM (60% male; age range: 31-72), and 11 healthcare professionals (5 endocrinologists; 5 pharmacists; 1 credentialled diabetes educator; 10 of Chinese background) participated. Barriers and enablers influencing medication-taking behaviors were identified across 13/14 TDF domains (except for 'Reinforcement'). Relevant domains most frequently identified were: Social Influences; Environmental Context and Resources; Beliefs About Consequences, and Behavioral Regulation.

Conclusion: Drawing on the TDF, potential targets for future interventions aimed at improving the uptake and maintenance of medication-taking behavior among adults with T2DM of Chinese heritage were identified. These data may support the development of culturally relevant and theoretically informed healthcare professional strategies and diabetes education programs, and ultimately, improve health outcomes for individuals with T2DM.

Introduction: In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important which led to extension of pharmacy practice beyond merely drug-oriented pharmacy-based services.

Aim: To outline the development, implementation and outcomes of the methodology that established standards for CP practice in the Czech Republic and which contributed to establishing CP as an independent postgraduate specialization with its own workplaces and full-time employment positions.

Setting: Inpatient and outpatient healthcare settings in the Czech Republic.

Development: Legislative changes in 2011 incorporated CP care into the healthcare system and the national CP methodology was published in 2014. Proactive screening of the medication lists and patient healthcare documentation was introduced. Results of CMRs are discussed with attending physicians and the plans for drug therapy adjustment are added to patient documentation. Clinical pharmacists have become standard partners for physicians on medical wards and outpatient facilities. A comprehensive clinical postgraduate training program (fully interlinked with accredited CP wards) has been established to maintain high standards of CP care.

Implementation: Based on the CP care methodology approved by professional medical and pharmaceutical societies and accepted by the Ministry of Health and health insurance companies, three inpatient procedures and one outpatient procedure became eligible for reimbursement thus facilitating the further development of CP practice and independent CP departments. Currently, the Czech Republic has 58 CP facilities and nearly 200 specialized clinical pharmacists.

Evaluation: The provision of CP care according to current national guidelines was shown to provide an effective and cost-effective approach by the results of two extensive studies; the calculated economic cost-benefit ratio was determined at 1:3-4.2. The number of clinical pharmacy specialists and facilities is steadily increasing.

Conclusion: The development of methodological approach accompanied by changes concerning reimbursement in the Czech Republic have led to the establishment of a stable and well-defined environment for clinical pharmacists to become full-time experts in both inpatient and outpatient settings. Clinical pharmacists are now recognized as skilled experts who are respected for their valuable contribution to inter-professional cooperation within medical teams.

Background: Over three million people annually experience myocardial infarction (MI). As MI survival rates increase, so does the importance of secondary prevention medications. International guidelines recommend using several medications to prevent further morbidity.

Aim: To synthesise the qualitative literature on the facilitators and barriers faced by MI survivors and their families/caregivers regarding medication management and, thus, medication adherence post-discharge.

Method: This systematic review was conducted and reported following the PRISMA-2020 guidelines. Five databases were searched from inception until the 13th of August 2024. The inclusion criteria were articles focused on people aged 18 years or older who experienced MI and were discharged from acute care settings to home settings, as well as caregivers of individuals who met the above-mentioned criteria. Qualitative and mixed-methods studies with qualitative elements were deemed eligible for inclusion. The theoretical domain framework was used to analyse the findings. The quality of the included studies was assessed using the JBI Critical Appraisal tool for qualitative research. The Confidence in the Evidence from the reviews of qualitative research approach was applied to assess confidence in qualitative evidence synthesis.

Results: Of the 14,002 titles, 11,354 remained after duplicates were removed. Of the 234 full-text screenings, fifteen were included. A total of 533 people who experienced MI and 25 spouses from eight different countries were included. The most prominent facilitator that emerged was "beliefs about consequences", whilst "lack of knowledge" and "environmental context and resources" were the most prominent barriers to medication management reported.

Conclusion: Patients face multiple challenges that affect their medication adherence post-MI. These findings highlight important considerations for creating an individualised, tailored approach to enhance medication adherence post-MI.

Systematic review registration: PROSPERO CRD42023424844.

Introduction: Polypharmacy, typically defined as the use of five or more medications, has become increasingly common among older adults due to the rising prevalence of multimorbidity. While polypharmacy can be clinically necessary, it poses substantial risks for adverse drug events, including acute kidney injury (AKI). Drug-induced AKI accounts for a significant proportion of hospital-acquired cases and can result in prolonged hospitalization, increased healthcare costs, and higher mortality. Despite growing concern over these risks, the incidence of AKI associated with polypharmacy and the specific clinical and pharmacological factors contributing to this risk remain poorly quantified across different populations and setting.

Aim: To estimate the incidence of AKI among adults exposed to polypharmacy and identify key drug-related and clinical risk factors.

Method: A systematic review and meta-analysis were conducted and reported following PRISMA guidelines. We searched eight international and Chinese databases from inception to April 2025 for observational studies involving adults (≥ 18 years) receiving polypharmacy that reported AKI incidence or related risk factors. Eligible studies were assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was used to calculate pooled AKI incidence. A narrative synthesis summarized the definitions of polypharmacy and identified associated risk factors.

Results: Ten studies comprising over 302,000 participants were included; six studies provided data suitable for meta-analysis. The pooled incidence of AKI among patients exposed to polypharmacy was 18% (95% CI 2%, 45%). Key risk factors included high medication burden (≥ 5 or ≥ 10 medications), cardiovascular drug combinations, use of nephrotoxic agents, pre-existing renal impairment, frailty, and exposure to intensive care. Definitions of polypharmacy varied substantially across studies, including count-based thresholds, class-specific definitions, and risk-based exposure models.

Conclusion: Polypharmacy is significantly associated with an increased incidence of AKI, particularly among hospitalized and clinically vulnerable individuals. The lack of standardized definitions for polypharmacy complicates evidence synthesis and cross-study comparisons. Standardized terminology and risk-adjusted prescribing practices are essential to improve medication safety and renal outcomes in at-risk populations.