Research in Social & Administrative Pharmacy最新文献

Background: Hospital discharge is a critical step in transitions of care, exposing patients to adverse drug events. Community pharmacists play a key role in post-discharge medication management. However, they often face challenges clarifying hospital discharge prescriptions due to limited access to relevant information and communication gaps between hospital and ambulatory care.

Objectives: This study aims to investigate how hospital pharmacy hotlines can improve communication and support community pharmacists in resolving drug-related problems (DRPs) on hospital discharge prescriptions.

Methods: Pharmaceutical hotlines answered by hospital pharmacists were implemented in three regional hospitals. Community pharmacists could use the hotline when facing DRPs or to obtain additional information about the hospital discharge prescriptions. For each query, the rate of resolution without physician involvement and the type of DRP were documented. Satisfaction was assessed through online questionnaires at the end of the study.

Results: The hotlines were implemented during 2 months in two hospitals and 6 months in the third. Community pharmacists raised 185 questions using the hotlines, 54 % of which were resolved without the need to contact the physician. The most common DRPs were unclear or incomplete prescriptions (n = 60, 32 %), medication unavailability (n = 29, 16 %), and drug-drug interactions (n = 22, 12 %). Of the 95 community pharmacies surveyed, 46 responded, with 87 % expressing satisfaction with the hospital pharmacy hotlines.

Conclusion: The hospital pharmacy hotlines proved to be an effective tool to improve intraprofessional collaboration and support community pharmacists in managing hospital discharge prescriptions, with more than half of DRPs resolved without the need to contact the physician.

Background: Deprescribing is beneficial in reducing medication burden and improving patient outcomes. Deprescribing success is influenced by both patient and health care professional barriers and enablers. Pharmacists can play an important role in deprescribing success, yet little is known about this profession's specific barriers and enablers to deprescribing.

Objectives: The primary objective of this study was to summarize the literature on pharmacists' barriers and enablers to deprescribing across multiple healthcare settings.

Methods: A systematic review of the available literature was completed. MEDLINE, EMBASE, and CINAHL databases were searched from inception to December 5, 2025. Studies were included if they explored pharmacist perspectives on barriers and enablers to deprescribing of medications using qualitative or quantitative methodologies. Inductive thematic synthesis was used to identify barriers and enablers from qualitative studies. Barriers and enablers were mapped to the Capability, Opportunity, Motivation behavioural framework. The quality of included studies was assessed with the Critical Appraisal Skills Programme tools for qualitative and quantitative studies.

Results: A total of 47 studies were included in this review. Studies utilized qualitative (n = 32), quantitative (n = 9) and mixed (n = 6) methodologies. There was a total of 2762 pharmacist participants working in a variety of healthcare settings, including hospital, community, long-term care and speciality or consultant practices. The meta-synthesis of qualitative studies identified 5 enablers and 9 barriers. Opportunistic barriers included lack of interprofessional collaboration, prescriber and patient/caregiver unwillingness, absence of deprescribing algorithms, and insufficient clinical information. Motivational barriers included pharmacist scope of practice, stable clinical conditions, competing priorities, and a lack of financial incentives. Opportunistic enablers include patient interest, interprofessional collaboration, and deprescribing resources. Motivational enablers included professional responsibility and deprescribing to address drug therapy problems.

Discussion: There was a variety of practice settings and deprescribing focuses (i.e., potentially inappropriate medications, benzodiazepines, opioids) in the included studies. These differences may limit the applicability of findings to specific practice sites or medication classes. Nevertheless, the findings of this study highlight that structural changes such as advancing pharmacist scope of practice, redesigning renumeration models, integrating healthcare systems and improving the data sharing are required to optimize pharmacist's role in deprescribing.

Background: Social prescribing (SP) is a person-centered approach enabling healthcare professionals to refer patients to non-clinical community services addressing social determinants of health, including physical activity, arts participation, volunteering, and support with housing, employment, and social isolation. While community pharmacists are well-positioned to contribute to SP pathways, their involvement remains limited and poorly understood.

Objective: To characterize qualitative literature examining pharmacist participation in social prescribing, identifying factors influencing implementation.

Methods: A systematic review following ENTREQ and PRISMA guidelines searched eight databases (Web of Science, PubMed, Scopus, CINAHL, PsycINFO, Cochrane Library, Embase, MEDLINE) for qualitative or mixed-methods studies published up to March 2025. Two reviewers independently screened 4949 records after duplicate removal. Thematic synthesis following Thomas and Harden's approach was conducted, with themes mapped to the Consolidated Framework for Implementation Research (CFIR). Quality was assessed using the CASP checklist; confidence in findings was evaluated using GRADE-CERQual.

Results: Six studies (n = 274 participants; UK = 3, Canada = 2, Norway = 1) met inclusion criteria. CASP quality scores ranged from 4.5/10 to 9/10. The analysis revealed multilevel barriers and enablers organized across CFIR domains. Major barriers included knowledge deficits and complexity concerns (intervention characteristics), patient stigma and policy gaps (outer setting), workload pressures and inadequate infrastructure (inner setting), professional identity tensions (individual characteristics), and absent implementation planning (process). Key enablers included intervention adaptability, community need recognition, pharmacy accessibility, professional motivation, and existing competencies. GRADE-CERQual assessment indicated moderate to high confidence in most review findings.

Conclusions: While pharmacists demonstrate strong motivation for SP involvement, substantial barriers exist across all CFIR domains. Successful implementation requires comprehensive strategies addressing knowledge gaps through standardized training, organizational restructuring to manage workload, adequate funding models, and system-wide infrastructure development. The evidence suggests a phased implementation approach, beginning with Healthy Living Pharmacies and supported by multi-stakeholder collaboration.

Purpose: This study aimed to examine the relationship of frailty and statin prescription in older stroke survivors, and to compare the relationship between participants with and without type 2 diabetes.

Methods: A cross-sectional study was conducted in older patients with ischemic stroke in a tertiary hospital in Malaysia. Frailty assessments prior to discharge from hospital were determined using the Clinical Frailty Scale (CFS) version 2.0. Odds ratios (ORs) were estimated from logistic regression models to examine the relationship between frailty and the prescription of statins.

Results: There were 282 participants (mean age 80.8, SD 6.3), 132 with diabetes and 162 were female. The mean CFS score was 6.1 (SD 1.1) in all participants, 6.0 (SD 1.1) in participants without diabetes, and 6.2 (SD 1.0) in participants with diabetes (p = 0.099). Statin was the most commonly prescribed medication at discharge (69.0 %). There was no significant difference on statin prescription rates between participants with and without diabetes (71.0 % vs. 67.3 %, p = 0.508). Increased CFS score was significantly associated with reduced odds of receiving statins in all participants (adjusted OR 0.64, 95 % CI 0.46-0.88), and in participants without diabetes (adjusted OR 0.55, 95 % CI 0.33-0.90), but not in participants with diabetes (adjusted OR 0.73, 95 %CI 0.46-1.18).

Conclusion: Frailty was associated with reduced odds of receiving statins in the study population. The differences in the relationship between frailty and statin prescriptions among participants with and without diabetes may suggest a personalized approach in secondary prevention for older patients after strokes.

Background: The implementation of new services in healthcare is complex, and an effective strategy is required to produce the desired patient outcomes. This paper aims to describe the implementation of a pharmacist-led post-discharge medication review clinic and outline the clinical pharmacist activities provided during the clinic review.

Method: The Knowledge to Action (KTA) framework was used to map the actions involved for the planning, implementation and review of outcomes of the clinic. The Consolidated Framework for Implementation Research (CFIR) was used to describe dependent and independent barriers and facilitators encountered throughout the implementation process. The clinical pharmacist activities provided during the clinic review were defined according to local guidelines.

Results: The KTA framework provided the key steps to implement the clinic service, monitor patient outcomes, that included 30-day hospital readmissions, and review clinic processes. Follow-up and troubleshooting of patient non-attendance and referral pathways were a key component of utilising the circular nature of the KTA framework. Facilitators included hospital funding models, growing evidence for pharmacist-led medication review and support from key stakeholders. Barriers included running costs, patient understanding of the service, attendance, and technology constraints. The clinic review included five key clinical pharmacist activities: confirmation of a best possible medication history, medication reconciliation, medication review, patient education, and communication of medication related problems identified with the patient's healthcare team.

Conclusion: The KTA framework was a useful tool for implementing the pharmacist-led post-discharge medication review clinic, adapting and monitoring processes and improving knowledge of key stakeholders. Identified barriers and facilitators are relevant to implementing future clinic models.

Pharmacy regulation is undergoing a transformation away from prescriptive, bright-line rules toward a standard of care (SOC) framework. Unlike bright-line regulation that dictates specific tasks or thresholds, SOC regulation directs pharmacists to act within their education, training, and competence-mirroring the approach used in medicine and nursing. This model evolves naturally with scientific and clinical advancements, allowing pharmacists to implement new services without waiting for regulatory updates. States that have adopted SOC regulation, including Idaho, Iowa, and Alaska, show improved service innovation without compromising patient safety. This manuscript dispels common concerns related to SOC regulation. For example, fears that SOC is vague or permissive are unfounded; it reinforces accountability and empowers boards to sanction unsafe care based on professional judgment rather than outdated checklists. Further, SOC regulation modernizes pharmacy oversight, enabling a more responsive, evidence-based, and patient-centered practice. Adopting this model nationwide would align pharmacy with other health professions and better position pharmacists to meet contemporary healthcare needs for the betterment of patient care.

Background: Interprofessional collaborative care can be beneficial for managing chronic obstructive pulmonary disease (COPD) but may be difficult to implement in practice.

Objective: To map the evidence describing pharmacists' activities, the extent of collaboration, and the outcomes of collaborative pharmacist-physician care in individuals with COPD across healthcare settings.

Method: Scoping review according to the Arksey & O'Malley framework. A comprehensive search from January 2003 to August 2024 was conducted using Scopus, MEDLINE, Web of Science, Embase, and Google Scholar. Inductive analysis was used to organize pharmacist activities. Outcomes were organized according to the Economic, Clinical, Humanistic outcome (ECHO) model.

Results: Eighteen articles were included. Most studies originated from the USA (n = 11; 61%) and used observational research designs (n = 15; 83%) to evaluate outcomes. Studies were conducted in primary care clinics (n = 6; 33.3%), inpatient hospital wards, hospital-based outpatient clinics, and community pharmacies (n = 4 in each; 22%) and mostly involved pharmacist collaboration with family physicians and pulmonologists. The main pharmacist activities were: 1) Medication optimization (n = 16; 89%), 2) COPD monitoring (n = 18; 100%), 3) Screening and diagnosis (n = 4; 22%), and 4) Other activities (n = 12; 67%). Pharmacists were co-located with physicians in 12 studies (67%), and 8 (44.4%) studies scored high on collaboration (≥6 out of 10). Eleven studies (61%) reported 9 different clinical outcomes (e.g., COPD hospitalizations) and most studies reported improvements. Eight studies (45%) measured humanistic outcomes most commonly quality of life and symptoms using tools like the COPD assessment test (CAT) score and many studies reported no significant intervention effects. Seven studies (39%) measured economic outcomes and most reported cost savings (n = 7; 100%).

Conclusion: Pharmacists' activities, the extent of collaboration and outcomes of collaborative care varied. This information may help to support the implementation of new COPD-focused services. Further rigorously designed research is needed to explore the effect of collaborative community pharmacist-physician care in COPD management.

Background: People with intellectual disability experience inequities in access to primary healthcare and pharmacists are well positioned to support this population. This study aimed to co-create a pharmacist-led primary care service framework for people with intellectual disability, grounded in participatory principles and informed by stakeholders lived experience.

Methods: Within a Participatory Action Research approach, two co-design workshops (online) were conducted with 18 stakeholders, including people with intellectual disability, carers, and health professionals, in the Newcastle/Hunter Region, Australia. A convergent qualitative approach integrated workshop transcripts, field notes, and facilitator debriefs via reflexive thematic analysis to iteratively develop and validate themes. Nominal Group Technique was used to prioritise and refine service concepts.

Results: Stakeholders co-developed a preliminary six-domain service framework: (1) Medication Management; (2) Preventative Care; (3) Monitoring and Referral; (4) Interprofessional Collaboration; (5) Communication and Education; and (6) Availability and Accessibility. Key features included structured chronic disease screening, immunisation delivery, flagging of physical challenges to prompt follow-up, shared care planning across professionals, and communication supports ensuring health literacy.

Conclusion: The participatory co-design process produced a preliminary, stakeholder-validated, multi-dimensional framework. Given the limited lived-experience representation and short duration of engagement, the framework should be considered an early prototype requiring further refinement, pilot testing, and broader validation before generalisation.

Purpose: Pharmacists face increasing demands in the workplace, particularly in community pharmacy settings where staffing shortages, high workloads, and expanding clinical roles contribute to burnout. While burnout has been widely documented, there is limited research exploring other aspects of work-related quality of life, such as compassion fatigue and compassion satisfaction. This study investigates work-related quality of life among community pharmacists in the United States focusing on burnout, compassion fatigue, and compassion satisfaction.

Methods: A cross-sectional, descriptive survey was administered to community pharmacists using the Professional Quality of Life (ProQOL) instrument. Quantitative data were analyzed using descriptive statistics and one-way ANOVA (p = 0.05 set a priori). Open-ended responses were analyzed by three researchers to identify recurring themes.

Results: Among 202 community pharmacists, most reported moderate levels of compassion satisfaction (76.5 %), burnout (68.6 %), and secondary traumatic stress (68.6 %). Pharmacists dispensing over 150 prescriptions per day had significantly higher burnout scores compared to those dispensing 100-149 prescriptions per day (p = 0.02). No other practice or demographic variables were statistically significantly associated with ProQOL scores. Thematic analysis identified three core themes: contributors to burnout (high workload, low staffing, chain pharmacy pressures); consequences of burnout (emotional exhaustion, disengagement); and compassion satisfaction as a protective factor linked to meaningful patient relationships.

Conclusion: Findings highlight the emotional impact of community pharmacy practice on pharmacists, as well as the negative impact of burnout and compassion fatigue on patient care and relationships. Results support the need for organizational strategies that enhance pharmacist well-being through improved workplace conditions and professional fulfillment.

Despite their expanding patient-facing roles and increased involvement in mental health services, pharmacists' interactions with clients remain largely medicines-focused. This limitation is compounded by a reported lack of pharmacists' confidence and inadequate training in both mental health conditions and communication skills. The interrelated concepts of person-centredness, therapeutic alliance, and empathy play a pivotal role in effective mental health consultations, positive client outcomes, and high-quality care delivery. Grounded in the interpretivist and pragmaticist paradigms, this critical review of the literature enabled the development of a meta-framework that unifies this triad. The resulting model conceptualises person-centredness across three interconnected levels: the Consultation (analogous to the therapeutic alliance), the Systems (focusing on multidisciplinary collaboration and leadership), and the Intrapersonal (encompassing the practitioner's intellectual, practical, and phenomenological attributes). Functioning as an integral, unifying component across the entire model, empathy is detailed as a three-stage process at the Consultation level between pharmacist and client, involving exploration, shared understanding, and optional therapeutic action. Presented both as a conceptual model and comprehensive series of targeted recommendations, this work provides timely guidance, enabling pharmacists to deliver high-quality, holistic, and meaningful mental health care, with the aim of improving client outcomes and fostering effective interprofessional working relationships.