Approximately 280 million adults worldwide are diagnosed with depression. Undiagnosed and untreated patients with depression have a reduced quality of life and may lead to suicidal ideation. Increasing diagnostic and treatment access is critical, and community pharmacies are advantageously positioned to provide mental health services such as screening, treatment, and education. Patients visit community pharmacies more often than primary care providers, enabling regular depression screening and medication management. Despite their potential, few review articles comprehensively address the role of community pharmacy interventions in managing depression. The objective of this review is to systematically describe the current literature on depression interventions provided in community pharmacy settings.
Studies published in English that reported depression-related interventions conducted in community pharmacy settings and by community pharmacists or students were included. PubMed and Web of Science databases were searched for published articles using keywords. Data were extracted and summarized on study design, setting, pharmacist interventions, patient demographics, and outcomes. Both experimental and observational studies were analyzed.
Twenty-three studies were included, comprising randomized and non-randomized controlled trials, feasibility studies, cohort studies, and cross-sectional analyses conducted across multiple countries. Interventions included pharmacist or student pharmacist-led depression screenings, cognitive behavioral therapy, antidepressant adherence support, and referral services. Community pharmacists utilized tools such as the Patient Health Questionnaire-9 (PHQ-9) and Geriatric Depression Scale-15 (GDS-15) and provided mental health counseling. Studies demonstrated positive trends in adherence, depression symptom improvement, patient satisfaction, and screening reach. Barriers included lack of training, reimbursement mechanisms, and workflow integration.
Community pharmacies offer a promising, underutilized setting for depression screening and intervention. Pharmacist-led services can support early identification of depression and medication adherence. Future work should standardize intervention protocols, assess long-term outcomes, and address implementation barriers to scale these services in diverse practice settings.
Opioids are classified as high-alert medications by the Institute for Safe Medication Practices due to their potential for significant harm when misused. To address these risks, our institution established an interprofessional pain consult team in 2016. In 2017, pain pharmacists developed an opioid stewardship service which aligned with the 2018 Joint Commission pain management standards focusing on oversedation, safe prescribing, high-risk patients, and quality improvement. By 2023, both services expanded across multiple hospitals, adapting to site-specific needs.
Following a 2019 merger which expanded our health system to 12 acute-care hospitals and one long-term acute care hospital across four regions (North, East, South, and Central), we leveraged telehealth in 2020 to enable remote pain consults by providers and pharmacists. Our interprofessional model includes three dedicated pain management pharmacists and five dedicated pain management providers conducting daily consultations, opioid stewardship reviews, quality improvement initiatives, and site-specific education. Collaborating closely with hospitalists, specialists, and surgical teams, treatment recommendations are communicated directly to primary teams. Outcomes tracked via the electronic health record include relative value units billed, the number and types of interventions, provider acceptance rates, and preventable naloxone events analyzed using descriptive statistics.
Our adaptable, interprofessional pain program model used the Interprofessional Education Collaborative (IPEC) competencies to address opioid safety through tailored local practices, role-defined collaboration, and integrated communication. By aligning values, ethics, and teamwork, we achieved data-driven improvements, including reduced intravenous (IV) opioid use, naloxone events, and high provider acceptance.
Improvements are driven by, but not limited to, opioid stewardship, education, pain consults, orderset enhancements, policy updates, prescriber compliance, and adherence to evidence-based practices. Annual goals are tailored to patient outcomes and site-specific needs. The interprofessional pain management team has enhanced patient safety and care quality through targeted opioid interventions and consultative support.
As artificial intelligence (AI) continues to rapidly reshape health care, there is a critical need for clear frameworks for clinicians to ensure ethical, equitable, and effective integration and use of AI in patient care. Key integrations of AI include enhancing health communications, patient engagement, clinicians' training, pharmaceutical advertising, clinical decision-making, and automation of clinical operations and workflow. However, there are growing concerns related to regulatory gaps, the spread of misinformation, security threats, patient and data privacy leaks, and widening health disparities gaps. These concerns are exacerbated by limited institutional infrastructure and limited AI literacy of clinicians and patients. Recent policy developments reflect efforts to guide responsible AI development and use. While progress has been made, the lack of standardized human oversight remains a critical gap, particularly as policies may not fully consider the challenges and complexities at institutional, societal, technical, and individual levels. Thus, herein, the Drug Information Practice and Research Network (DI PRN) of the American College of Clinical Pharmacy (ACCP): (1) explores current and emerging multifaceted challenges, a call to action, and opportunities of AI integration in health care including examination of the regulatory, ethical, operational, and health equity implications; and (2) provides practical recommendations for responsible use of AI through DI PRN-developed example case-based approaches and best practices infographics to enhance AI literacy for diverse learners including clinicians, trainees, and patients. This DI PRN opinion paper highlights the importance of proactive governance frameworks and equips and empowers diverse learners with practical AI literacy tools to confidently engage with AI technologies in patient care.
Over the past decade there have been notable expansions in pharmacist roles in the treatment and prevention of human immunodeficiency virus (HIV). This review aims to describe pharmacist-led interventions and their integration into team-based models at each point in the HIV care continuum.
A systematic search of MEDLINE via Ovid, Embase via Elsevier, and Web of Science Core Collection (Clarivate) was conducted to identify studies that described pharmacists' involvement in HIV care and pre-exposure prophylaxis. Each identified article was independently reviewed by two of ten clinical pharmacists.
From 14 650 articles originally identified, 137 articles were deemed to meet inclusion. Of these, 58 were utilized by the authors in this review.
The published data included in this review demonstrate the positive impact pharmacists have on HIV treatment and prevention.
Colleges and Schools of Pharmacy (C/SoP) collect revenue from tuition and indirect cost recovery related to teaching and research. Clinical faculty services are frequently exchanged for experiential opportunities, but this practice undervalues pharmacists and their impact on patient care. Some C/SoP have adopted innovative strategies to secure reimbursement for faculty-delivered patient care services, but they have not been well described. The objective is to describe academic pharmacist payment for clinical services and to provide recommendations on how to increase clinical service revenue based on a national survey of C/SoP.
The 19-item survey was distributed to 143 (71 public/72 private) C/SoP. The survey covered: faculty billing, insurance sources, state regulation, revenue models, and barriers.
The response rate was 73% (80% public, 65% private). Nearly all C/SoP provided clinical services (97%), but only 54% bill for those services. Many public (58%) and private (49%) C/SoP bill for clinical services. Offset revenue (39%) and flat-fee contracts (19%) were the most common revenue models. The most common billable services included: Chronic Care Management (CCM) (79%), Medication Therapy Management (MTM) (71%), Immunizations (66%), and Annual Wellness Visits (45%). Of those utilizing incident-to billing services, 78% bill at level 1, but only 33% bill at level 3 or higher. Nine C/SoP reported having an employee certified in medical billing. The main barriers to collecting revenue were sites being used only for faculty provision of academic service, legal regulations, lack of pharmacist provider status, cost and difficulty of billing, and lack of interest or knowledge.
Current pharmacist care payment models indicate opportunities for all C/SoP to increase the revenue they collect from clinical services. All C/SoP should have a designated employee credentialed in medical billing and coding. Increased utilization of “incident-to” billing can generate revenue for C/SoP regardless of what happens to pharmacist provider status federally.
The medication regimen complexity-intensive care unit (MRC-ICU) score is a validated scoring tool to assess the complexity of medication regimens and can be used as a surrogate marker for pharmacist interventions. Hospitalized oncology patients often require extensive pharmacotherapy regimens like those requiring intensive care. Validation of the MRC-ICU scoring tool in this population would allow for proactive assessment of patient complexity and optimal allocation of pharmacy resources. The objective of this investigation was to validate the MRC-ICU scoring tool in hematology/oncology patients as a surrogate for pharmacist interventions.
Patients admitted to an inpatient hematology service or the ICU for over 24 h were identified for inclusion. Patient demographics and pharmacist interventions were collected, and MRC-ICU scores were calculated for every day of admission. Four items specific to oncology care were added to the original scoring tool to produce a modified score (oMRC-ICU). The primary end point was the correlation between oMRC-ICU scores and pharmacist interventions. Secondary end points were correlations between oMRC-ICU scores and patient outcomes, service, and intervention type. Descriptive statistics were used to report patient demographics and outcomes data. Spearman's rank correlation and Lasso regression were used to define end points of interest.
A total of 138 admissions were included, corresponding to 129 unique patients. Most admissions (65.2%) were to a hematology service. The median length of stay was 5 days (range 2–9) and the median time to maximum score was 1.5 days (interquartile range [IQR] 1–6). Chemotherapy, opioids/sedatives, and antimicrobials provided the highest average point contributions to MRC-ICU scores (additional data can be found in the Supporting Information). There was a strong, positive correlation between total pharmacist interventions and maximum MRC-ICU score (R s = 0.55, p < 0.0001) and oMRC-ICU score (R s = 0.57, p < 0.0001).
MRC-ICU scores are a validated surrogate marker for pharmacist interventions in hematology/oncology patients and can be utilized as a measure of pharmacist productivity without the need for daily documentation.
Numerous equations have been developed to estimate kidney function. Recently, Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equations reformulated without race have been recommended by the National Kidney Foundation (NKF)–American Society of Nephrology Taskforce and by the NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. The objective of this survey was to examine current pharmacy practices on the implementation of these recommendations.
A survey was distributed primarily to specific American College of Clinical Pharmacy Practice and Research Network listservs between February and March 2024.
There were 275 survey respondents who answered at least one question. Of pharmacists who completed the demographics section, the majority were from the United States and were female, with the most common practice sites being academic health centers and community hospitals. Regarding kidney estimation and dosing, 199 (72.4%) indicated that their institution has a kidney dose adjustment policy, with the majority (162/199, 81.4%) utilizing the Cockcroft-Gault (C-G) estimated creatinine clearance (eCrCL) equation within their policy and C-G being the only equation within some policies. Additionally, 88/275 (32%) reported rounding up serum creatinine values for elderly patients when using the C-G equation, with 47 of those 88 (53.4%) rounding it to 1 mg/dL. There was also notable variability regarding the choice of patient weight for C-G eCrCL calculations: actual body weight was used by 137/275 (49.8%), adjusted body weight by 146/275 (53%), and ideal body weight by 113/275 (41.1%). If utilizing an eGFR equation for medication dosing, 36/275 (13.1%) reported adjusting eGFR for body surface area (BSA) in all patients, and 44/275 (16%) reported adjusting for BSA in those with extreme body weights.
There is considerable variability in kidney function assessment for drug dosing by pharmacists, highlighting the need for education and adoption of non–race-based CKD-EPI equations to standardize care and improve outcomes.
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