Pharmacy doi: 10.3390/pharmacy14060130

Authors: Ana Mulej Ivana Marinović Iva Matković Vesna Bačić Vrca Luka Torić Dino Kasumović Matija Crnogorac Ivica Horvatić Ivana Samardžić

Chronic kidney disease (CKD) affects more than 10% of the global population and represents one of the leading causes of mortality. This study aimed to assess the pharmacotherapy of hospitalized patients aged ≥ 65 years with CKD, focusing on the prevalence of polypharmacy, potentially inappropriate medications (PIMs), potentially clinically significant drug–drug interactions (DDIs), the use of renal-risk drugs (RRDs). A prospective observational study was conducted at the Department of Nephrology and Dialysis of University Hospital Dubrava, including 100 participants. A clinical pharmacist obtained the Best Possible Medication History (BPMH) within 24 h of hospital admission. A total of 1324 comorbidities were recorded (median 12 per patient), along with 985 prescribed medications. Polypharmacy (5–9 drugs) was observed in 43% of patients, while excessive polypharmacy (≥10 drugs) was present in 48%. A total of 258 PIMs were identified, with 89% of patients having at least one PIM (mean 2.6 per patient). Nearly 94% of patients had significantly impaired renal function (G3–G5), and 82% were exposed to inappropriately prescribed RRDs. Contraindicated medications based on renal function were identified in 62% of patients, while 52% had at least one medication prescribed at an unadjusted dose. A total of 1097 potentially clinically significant DDIs were identified, with a mean of 10.9 interactions per patient. The results indicate a high prevalence of polypharmacy, PIMs, potentially clinically significant DDIs and inappropriately prescribed RRDs among older hospitalized patients with CKD, increasing the risk of adverse events and unfavorable treatment outcomes. The findings highlight the importance of the 24 h period following hospital admission as an early opportunity for identifying medication-related problems and optimizing pharmacotherapy in highly vulnerable patients, such as elderly patients with CKD. The study also emphasizes the importance of early involvement of a clinical pharmacist in the pharmacotherapy review and obtaining the BPMH.

Pharmacy doi: 10.3390/pharmacy14060129

Authors: Ghada Elba Shaheena Fakir Rishabh Sharma Halak Patel Caitlin Carter Tejal Patel

Introduction: The development of technology to support medication management and adherence among older adults is rising. Many of these technologies offer diverse features, which add complexity when making a choice. Evidence-based decision aids can inform decision-making in such situations. To inform the development of such a decision aid, it is necessary to review the literature on the development and validation of decision aids that impact medication adherence. Therefore, this study aims to review the available literature on digital decision aids that examine the impact on medication adherence and investigate their features, development, and validation processes. Methods: Adopting the Arksey and O’Malley scoping review framework, a comprehensive search was conducted using PubMed, Embase, CINAHL, IPA and Scopus, using four key concepts: medication adherence, decision aids/tools, older adults, and software/technology. Eligibility criteria included studies that enrolled older adults with a mean/median age of 65 years, published protocols for studies that supported decision-making, published in the English language, and examined and reported the development and/or validation and/or evaluation of digital decision aids. Results: Our search identified 3526 records. After removing 947 duplicates, 2579 records underwent title and abstract screening, of which 726 proceeded to full-text screening. Following full-text screening, one research protocol met all eligibility criteria and was included in the review. An additional 16 systematic reviews were examined to identify potentially relevant studies from their reference lists; however, none of the studies identified through this supplementary screening met the eligibility criteria. Conclusion: The limited number of eligible studies shows a substantial gap in the literature on the development and validation of digital decision aids that support medication adherence among older adults. Further research in this field is needed to develop and validate evidence-based and user-centered digital decision aids for this population.

Pharmacy doi: 10.3390/pharmacy14060128

Authors: Desirée N. Shapiro Nikki Ashtiani Raphael Cuomo Candis M. Morello

Background: Health professional training is inherently challenging, with elevated rates of burnout, stress, and diminished well-being. Dedicating curricular time to well-being education may build awareness and skills to help students navigate these demands. Methods: A 10-week well-being elective was designed and implemented for health professional students. Participants in the intervention group were predominantly pharmacy students. This pilot feasibility study used a pre- and post-intervention survey design with a comparison group. Course evaluation, self-reported confidence, knowledge, skills, and attitudes about well-being practices, and measures of empathy, compassion, stress, social support, and burnout were assessed [n = 29 intervention, n = 24 comparison]. Results: Students in the elective reported high satisfaction in the course and significantly greater improvements than those in the comparison group in confidence applying wellness strategies in their personal and academic lives, identifying mental health and wellness resources, preparing nourishing meals, showing up authentically, using mindfulness, practicing self-compassion, as well as in frequency of reflecting on wellness, practicing mindfulness and self-compassion, and applying wellness strategies (all p < 0.05). Prioritization of wellness and feelings of social connection also improved significantly more than in the comparison group. At 6-week delayed follow-up, participants reported significantly greater increases in confidence in preparing nourishing meals, showing up authentically, applying mindfulness, as well as in frequency of mindfulness practice, reflection on wellness, and greater gains in social connection (all p < 0.05). No significant between-group differences were observed on the validated measures of empathy, burnout, or self-compassion. Conclusions: A novel well-being elective designed for health professional students significantly improved select well-being-promoting behaviors and emotional connectedness among participating students. Scalable curricula may bolster student well-being and foster community in demanding academic environments.

Pharmacy doi: 10.3390/pharmacy14060127

Authors: Shinya Kajiura Nobukazu Ryu Shingo Chikaoka Yuta Yagi Naohiko Nakamura Atsushi Kato Ryuji Hayashi

The Japanese label specifies suvorexant 20 mg once nightly for adults and 15 mg once nightly for older adults, but dose selection has not been characterized across all doses. We conducted a single-center retrospective drug-utilization study of outpatient prescriptions and inpatient medication orders at a Japanese university hospital during 2023–2025. Dose and prescription-date age were reconstructed, and patient-cluster bootstrap confidence intervals addressed repeated prescriptions. Among 3755 records, 15 mg accounted for 68.4%, 20 mg for 29.9%, and 10 mg and other calculable doses each for 0.9%. Of 3685 age-classifiable 15/20 mg records, 2529 were concordant with the operational age-based framework (68.6%; 95% CI 62.5–74.2). Non-concordance predominantly comprised 15 mg in patients younger than 65 years (841/1646; 51.1%); 20 mg in patients aged 65 years or older occurred in 315/2039 records (15.4%). Concordance was 65.0% in outpatient and 73.8% in inpatient records. Full-dose retention revealed uncommon 7.5- and 30-mg selections that a binary analysis would omit. Together, these findings provide a descriptive, single-center, full-dose, age- and setting-stratified basis for medication-use evaluation and targeted contextual review.

Pharmacy doi: 10.3390/pharmacy14060126

Authors: Nqobani M. Dabengwa Sue F. Burton Shabnam Shaik

This study explored pharmacy students’ lived experiences of mental health support structures at a University in South Africa. A qualitative phenomenological design was employed, with data collected through semi-structured interviews (n = 20) and document analysis of institutional mental health resources (2020–2024). Thematic analysis revealed five interrelated themes: awareness and visibility of support; barriers to access and utilization; institutional responses to mental health crises; cultural and contextual misalignment; and informal support and coping strategies. Although formal support services were available, students experienced them as fragmented, reactive, and insufficiently integrated into academic life. Barriers to access included long waiting times, stigma, and concerns about confidentiality. Institutional responses to crises were perceived as academically focused, with limited psychological follow-up. Students relied heavily on informal networks, including peers, family, and spirituality. These findings highlight a disconnect between institutional provision and student experience, underscoring the need for more integrated, culturally responsive, and student-centred approaches to mental health support within pharmacy education.

Pharmacy doi: 10.3390/pharmacy14060125

Authors: Sherilyn K. D. Houle

In Ontario, Canada, pharmacists and pharmacy technicians who have completed an approved injection training program are authorized to administer vaccines against 16 vaccine-preventable diseases, with other vaccines requiring an order from a physician or nurse practitioner authorizing their administration to a patient. Authorization to administer vaccines is separate from authorization to dispense vaccines. Some of these vaccines can be dispensed without a prescription, while others require a prescription for the pharmacist to be able to dispense the vaccine and/or to be able to bill the cost of the vaccine to a private insurance plan. Currently, Ontario pharmacists do not have authorization to prescribe any vaccines, whether it be for dispensing or insurance billing purposes. This article describes current practice in Ontario related to vaccine accessibility, summarizes vaccine-prescribing scope of practice adopted by other Canadian provinces and territories, and describes the potential benefits of expanding the pharmacist scope of practice in Ontario to include the prescribing of vaccines.

Pharmacy doi: 10.3390/pharmacy14050124

Authors: Lina Altayeb Hend Talkhan Rayah Asiri Rawan Aloqran Arwa Al Saeed Khalid Orayj

Objectives: This study aimed to assess pharmacy students’ curricular exposure to deprescribing, their attitudes and preparedness to perform core deprescribing steps, and their understanding of interprofessional roles in the deprescribing process. Methods: A cross-sectional online survey that included undergraduate pharmacy students in their fifth or sixth year of study, who were enrolled in Saudi universities during the academic year 2025/2026. A 43-item self-administered validated questionnaire was used. The independent-samples t-test was used to examine differences in attitudes and preparedness among participants via SPSS 27. Results: In total, 367 students from 23 universities participated in the study; 54.0% were female, and 62.1% were in their fifth year. Familiarity with the term ‘deprescribing’ was reported by 55.3% of participants. Participants demonstrated highly positive attitudes toward the benefits of deprescribing, moderate toward misconceptions, and low toward barriers, with mean percentage scores of 85.08%, 66.50%, and 41.93%, respectively. Participants indicated moderately positive perceptions toward the non-experiential curriculum preparedness to identify and practice deprescribing and self-perception of the ability to perform core deprescribing steps, with mean percentage scores of 70.2% and 77.24%, respectively. Statistically significant differences were observed in the perception of curriculum preparedness by gender (p = 0.038), familiarity with the term deprescribing (p < 0.001), and exposure to deprescribing in the required pharmacy curriculum (p < 0.001). Participants perceived clinical pharmacists as having the greatest role across most stages of the deprescribing process. Conclusions: Undergraduate pharmacy students in Saudi Arabia recognize the value of deprescribing but have limited curricular exposure and moderate perceived preparedness to deprescribe.

Pharmacy doi: 10.3390/pharmacy14050123

Authors: Mohamed A. Albekery Helal F Hetta Shatha A. Almikhlal Aisha Y. Alfraih Nora Aldhuhayyan Zahra Alarbsh Abdulrahman Abdullah Alnijadi Monther Alsultan Abdullah Al Hamid

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain, inflammation, and fever. Although many NSAIDs are available without a prescription, inappropriate use may increase the risk of renal, gastrointestinal, and cardiovascular complications. This study evaluated NSAID dispensing patterns and potential risk practices in community pharmacies in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study was conducted in 90 community pharmacies across Al-Ahsa, Al-Dammam, and Jubail Industrial City between February and March 2025. Data on demographics, NSAID type, indication, dosage, frequency, duration, and concomitant medication use were collected and analyzed descriptively. Results: Among the 171 documented NSAID dispensing cases, 98 (57.3%) occurred without a prescription, whereas 73 (42.7%) involved prescription-based dispensing. Ibuprofen (62%) and diclofenac (36.3%) were the most commonly dispensed agents, with oral tablets being the preferred formulation (76.6%). Most documented treatment durations were short (3–7 days) with once- or twice-daily dosing. Common documented indications included dental conditions, pain, and inflammation, although the indication was not specified in 57.3% of cases. At least one potential interaction was identified in 11(7.8%, 95% CI 4.4–13.4%) of the 141 cases with concomitant medication use, corresponding to 13 (5.9%, 95% CI 3.5–9.9%) potential interaction pairs. Conclusions: Frequent non-prescription NSAID dispensing, incomplete documentation, and potentially clinically relevant drug interactions highlight the need to strengthen medication review, documentation, public awareness, regulatory oversight, and pharmacist counseling in community pharmacy practice.

Pharmacy doi: 10.3390/pharmacy14050122

Authors: Katarina Wickman Cecilia Lenander Gabriella Caleres Sara Modig

The medication-related problems identified by clinical pharmacists during hospitalisation may be better addressed after patient discharge and recovery from acute illness. This approach enables follow-up and may reduce the risks associated with multiple medication changes. However, inadequate information transfer at discharge is a recognised patient safety risk. Referral-based communication between clinical pharmacists and general practitioners (GPs) is a novel procedure in southern Sweden. This retrospective observational study aimed to describe the patient population, medication-related problems, their clinical relevance, and resulting GP actions. Data were collected from pharmacist referrals and electronic medical records between Q4 2021 and Q4 2023. Medication-related problems were categorised, recommendations were assessed for clinical relevance, and follow-up within six months after discharge was analysed to determine whether GPs accepted the recommendations. Forty patients with 58 medication-related problems were included. Women accounted for 70% of the patients, the median age was 79.5 years, and 75% had extensive polypharmacy. Adherence problems were most common (22%). Overall, 98% of the recommendations were considered clinically relevant. Of the 48 assessable recommendations, 77% were implemented in primary care. No statistical association between clinical relevance and implementation was detected (odds ratio 2.27, p = 0.247, CI 0.57–9.04). Pharmacist referrals at discharge may support information transfer and provide clinically relevant recommendations that improve medication safety.

Pharmacy doi: 10.3390/pharmacy14050121

Authors: Francisco Ibarra Evan Cheng Benjamin Falkenstein

The optimal fixed-dose strategy for managing warfarin-associated hemorrhages remains unknown and few studies have evaluated the use of Factor VIII Inhibitor Bypass Activity (FEIBA). This retrospective cohort study’s primary efficacy outcome was the percentage of patients who achieved a post-FEIBA INR ≤ 1.5 following receipt of the old and new dosing regimens. In the old group patients received 500 or 1000 units for an INR < 5 or ≥5, respectively. In the new group patients received 1000, 1500, or 2000 units for an INR < 5, 5–9.9, or ≥10, respectively. Eighteen patients were included in each group. The median (IQR) pre-FEIBA INR in the old and new groups was 6.1 (3.1–12.9) and 5.3 (3.4–13.0), respectively [difference: −0.8 (95 CI%, −7.2 to 6.5)]. The median (IQR) post-FEIBA INR in the old and new groups was 1.6 (1.4–2.1) and 1.4 (1.2–1.5), respectively [difference: −0.2 (95% CI: −0.6 to 0.0)]. A post-FEIBA INR ≤ 1.5 was achieved in 14 (78%) patients in the new group and 9 (50%) patients in the old group (relative risk: 1.56; 95% CI, 0.91 to 2.7; p = 0.16). The post-FEIBA INR values in the patients who did not achieve a post-FEIBA INR ≤ 1.5 in the new group were 1.6, 1.6, 1.8, and 2.4. Among patients with a baseline INR ≥ 10, significantly more patients in the new group achieved a post-FEIBA INR ≤ 1.5 compared to the old group (86% vs. 17%, respectively). These findings suggest that the new FEIBA dosing regimen may improve INR reversal compared with the previous regimen, particularly among patients with a baseline INR ≥ 10, but larger studies are needed to confirm this observation.

Pharmacy doi: 10.3390/pharmacy14050120

Authors: Johanna Dicken Daniel Dönisch Jan Hensen Olaf Zube Thilo Bertsche

Background: Therapeutic drug monitoring (TDM) for piperacillin/tazobactam has become established in intensive care. TDM should be used in a structured approach to optimize dosing. We evaluated a newly designed TDM- and algorithm-based clinical-pharmacy-service to determine whether it is appropriate for optimization. Methods: We developed a clinical pharmacy service providing algorithmic recommendations for optimizing piperacillin/tazobactam dosing based on piperacillin TDM. After implementing the clinical pharmacy service, we evaluated the treatment of intensive-care patients with piperacillin/tazobactam in terms of achieving the minimum-inhibitory-concentration-(MIC)-related target concentration at the following four time points: t1, t2, t3, and t4 (1–4 working days after piperacillin/tazobactam therapy was started). Results: A total of 132 patients (including 36% women), median age 78 years, received piperacillin/tazobactam therapy. Sepsis or septic shock was the most common indication (43%), while a pulmonary focus was most frequent (40%). From 132 patients (t1), 19% had “too low piperacillin concentrations”, 20% “appropriate concentrations”, and 61% “too high concentrations”. After recommendations were given (acceptance rate 100%) the corresponding numbers from 93 remaining patients (t2) were 16%, 35%, and 48%, from 49 patients (t3) 8%, 53%, and 39% and from 29 patients (t4) 38%, 45%, and 17%. In (t1), dose reduction was the main recommendation (49%). The number of patients with “appropriate concentrations” increased in one comparison (t1–t2: n.s.; t1–t3: p = 0.0013; t1–t4: n.s.; Bonferroni-corrected McNemar test), while “too high concentrations” decreased (t1–t2: p = 0.0080; t1–t3: p = 0.0056; t1–t4: p = 0.0095). “too low concentrations” were not influenced (t1–t2: n.s.; t1–t3: n.s.; t1–t4: n.s.). Conclusions: Inappropriate piperacillin plasma concentrations were common. A TDM- and algorithm-based clinical-pharmacy-service especially decreased the number of overdosed patients in routine practice.

Pharmacy doi: 10.3390/pharmacy14050119

Authors: Bridget Clark Nabeelah Mukadam Tamara Lebedevs Stephanie Wai Khuan Teoh

(1) Objective: This study aims to evaluate the pre-admission clinic (PAC) pharmacist for high-risk obstetric patients’ admissions on medication management processes, workflow efficiency, and staff satisfaction. (2) Methods: Data collected over a 12-month period, from March 2025 to February 2026, were analysed. Data collected included clinic type, patient attendance, mode of pharmacist review, and follow-up requirements. Multidisciplinary healthcare professionals were invited to complete a satisfaction survey to identify themes relating to service value, workflow impact, and opportunities for improvement. (3) Results: A total of 1039 interviews with obstetric patients, equating to an average of 19.98 interviews per week. A total of 999 patients were involved in the 1039 interviews held, 40/999 (4%) patients required additional follow-up telephone interview and 14 patients (14/999, 1.4%) required in-person interview for interpreter services, detailed discussion or hearing impairment. Thirty-two staff responded to a survey and demonstrated a consistent trend across anaesthetists, nursing and midwifery staff, and pharmacists. All respondents either agreed or strongly agreed that a PAC pharmacist in the obstetric setting was valuable and beneficial to clinical workflow and medication management processes, and that they were satisfied with the PAC pharmacy service. (4) Conclusions: The PAC pharmacist demonstrated a positive impact on medication management for obstetric patients within the pre-admission setting.

Pharmacy doi: 10.3390/pharmacy14050118

Authors: Núbia Vieira Alves Geórgia Almeida Sant’Ana Jorge Fernando Carrozza Gabriela Moraes Oliveira Carlos Ferreira Santos Adriana Maria Calvo

Background/Objectives: The use of antidepressants and anxiolytics has increased worldwide, raising concerns about treatment patterns, medication safety, and rational use. This study aimed to characterize the frequency, utilization patterns, and safety-related aspects of antidepressant and anxiolytic use among healthcare students and university staff at a Brazilian public university. Methods: A cross-sectional study was conducted between September 2024 and June 2025 using an online questionnaire administered to students and staff at the University of São Paulo, Brazil. Descriptive statistics and multivariable logistic regression were applied to characterize medication utilization patterns and evaluate factors associated with antidepressant and/or anxiolytic use. Results: Among the 300 participants, 167 (55.7%) reported antidepressant and/or anxiolytic use during the previous six months. Most users reported treatment for more than one year (59.9%), anxiety as the primary indication (68.3%), and prescription by a healthcare professional (93.4%). A total of 203 medications were reported, with selective serotonin reuptake inhibitors being the most common pharmacological class (42.4%). Among users, 99 (59.3%) reported at least one self-reported adverse effect, most commonly excessive drowsiness, reduced libido/sexual dysfunction, dry mouth, headache, and nausea. No statistically significant independent associations were identified between antidepressant and/or anxiolytic use and the evaluated sociodemographic characteristics. Conclusions: Antidepressant and anxiolytic use was frequently reported and was characterized by predominantly long-term, professionally prescribed treatment and frequent self-reported adverse effects. These findings may inform institutional strategies to improve access to mental healthcare while promoting the rational and safe use of psychotropic medications within university settings.

Pharmacy doi: 10.3390/pharmacy14050117

Authors: Mari Maese Nozomi Ito Haruka Shiokawa Shingo Kondo Yuko Okamoto Hiroki Iwata Shunsuke Urushibata Katsunori Yamaura

“Triple whammy” prescriptions, combining non-steroidal anti-inflammatory drugs (NSAIDs), renin–angiotensin system (RAS) inhibitors, and diuretics, increase acute kidney injury (AKI) risk. To clarify the frequency and profiles of these prescriptions and identify vulnerable populations, we analyzed the AHI partners database to estimate the number of individuals prescribed these three drug classes. In the single-agent analysis, loxoprofen was the most commonly prescribed NSAID (66.3%), olmesartan (19.4%) and telmisartan (15.9%) were the predominant RAS inhibitors, and furosemide (19.6%) and spironolactone (16.0%) were the most frequently used diuretics. Dual-drug combinations showed patterns consistent with the single-agent results for NSAIDs and diuretics. By contrast, sacubitril/valsartan was the most common RAS inhibitor when combined with diuretics, frequently utilized for heart failure management. In triple whammy prescriptions, NSAIDs and diuretics patterns mirrored those of single-agents. The annual number of triple whammy prescriptions showed a statistically significant downward trend over the study period by the Mann–Kendall trend test (p = 0.048). Notably, sacubitril/valsartan was the leading RAS inhibitor (46/199 patients, 23%), showing a higher proportion than its single-agent use (7.4%). Heart failure patients prescribed these two causative drugs are highly vulnerable to “triple whammy” prescriptions. Awareness of inadvertent NSAID additions is warranted to mitigate potential AKI risks.

Pharmacy doi: 10.3390/pharmacy14050116

Authors: Vedrana Aljinović-Vučić Jasenka Mršić-Pelčić

Background/Objectives: Self-medication and keeping medicine inventory in households are common practices, even among healthcare professionals and healthcare professions students. Despite their knowledge of appropriate medicine use and storage, these practices are not always responsible and may pose health risks. This study aimed to describe self-medication practices, contents of home pharmacies, and habits of keeping medicine inventories in households of medical and pharmacy students at the Faculty of Medicine, University of Rijeka. Methods: In this cross-sectional study conducted in 2025, 60 third-year medical and pharmacy students interviewed members of their households regarding contents of home pharmacies and self-medication practices and compiled inventories of medicines kept at home. Results: Of the participating students, 70.0% were female. Healthcare professionals (physicians or pharmacists) were present in 23.3% of households. Medicines were stored in a designated location (“home pharmacy”) in 65.0% of households, whereas only one household reported having no medicines. Expired medicines and/or medicines with an unknown purpose were found in 41.6% of households. No household reported that medicines were accessible to children younger than 14 years. Inventories of stored medicines were obtained from 54 households (90.0%). Analgesics and antipyretics were present in 92.6% of households and were used for self-medication in 96.0% of them. Cough and cold preparations were found in 35.2% of households and used for self-medication in 94.7%. Antibiotics were present in 31.5% of households and used for self-medication in 52.9%, while anxiolytics were found in 16.7% of households and used for self-medication in 33.3%. Conclusions: Stocking medicine supplies and practicing self-medication are common among households of third-year medical and pharmacy students at the Faculty of Medicine, University of Rijeka. Analgesics and antipyretics were the most frequently stored medicines used for self-medication. The presence of expired medicines and the self-medication of prescription-only medicines highlight the need for greater emphasis on responsible self-medication, safe medicine storage, and rational medicine use within healthcare professions education.

Pharmacy doi: 10.3390/pharmacy14050115

Authors: Tania Bayoud Sarah Alghanem Fajer Al-Sejari Mai Alhazami Pierre Moreau

Objectives: Our primary objectives were to evaluate the integration and impact of Entrustable Professional Activities (EPAs) within a competency-based add-on PharmD curriculum and to describe the types and frequency of EPAs performed by PharmD trainees as an assessment tool during their placements at secondary and tertiary care practice sites. A secondary objective was to report, categorize, and quantify patients’ drug therapy problems (DTPs) with the rate of recommendations’ acceptance by preceptors. Methods: A descriptive study for 2437 EPAs (concerning 1295 patients) was performed by 56 PharmD trainees during their experiential training year from January 2018 to November 2021. Results: The most frequent EPA performed by trainees was Medication Therapy Management (MTM) (718; 29.5%), followed by Medication Reconciliation (MedRec) (636; 26.1%), prescription/order review (546; 22.4%), and medication counseling (284; 11.7%). A total of 1224 DTPs were encountered through MTM, MedRec, and prescription/order reviews, with “drug not indicated” being the most common DTP (16.7%). Anti-infectives (25.1%), cardiovascular (21.8%), endocrine (12.5%), and gastrointestinal (12.1%) agents made up most of the 1612 medicines involved in medication-related DTPs. The majority of interventions were accepted by preceptors (91%). The rejection rate was 3.6%, owing primarily to medical expertise, clinical judgment, and the personal opinion of preceptors. Patients’ age (older adults), gender (females), and admission type (newly admitted patients) were associated with a higher risk of experiencing DTPs. Conclusions: Our findings demonstrate that incorporating EPA-based practice and assessment into pharmacy training can ensure graduates are not only knowledgeable but also trusted to perform essential tasks independently, ultimately optimizing the safety and quality of patient care.

Pharmacy doi: 10.3390/pharmacy14050114

Authors: Cindy V. Valencia Robin L. Corelli Shin-Ping Tu Melissa M. Gosdin Elisa K. Tong

Community pharmacies are increasingly providing health care services like tobacco treatment and disease-related management but need sustainable models for implementation. As several state Medicaid programs reimburse for community health worker (CHW) services, one promising model is to have pharmacy technicians engage with patients as designated CHWs. This qualitative study interviewed staff in seven California pharmacies about their experience with and perspectives on implementing community pharmacy technicians as CHWs. Guided by implementation science frameworks, data were hand-coded and analyzed iteratively using thematic analysis. Relative advantage and compatibility of CHWs was high across all pharmacies. Pharmacy culture aligned with CHW values, and CHW integration helped formalize the work that pharmacy staff were already doing. Challenges included the complexity of billing and obtaining payment for services provided. Despite these barriers, pharmacies successfully integrated and expanded their CHW services, ranging from social service connections to tobacco treatment or disease-related management education. Pharmacy peer networks, health plan champions and patient outcome improvements accelerated diffusion. Community pharmacies provide a trusted setting for delivering both CHW education and extending health care services, but broad implementation will need health plans to improve policy and procedure with guidance specifically for the pharmacy context that helps overcome administrative barriers.

Pharmacy doi: 10.3390/pharmacy14050113

Authors: Tracy Zhang Minh-Hien Le Noah Zlotnik Amanda Yee Anjali Patodia Zubin Austin

Artificial intelligence (AI) tools are being used in pharmacy practice in a variety of ways, such as enhancing the safety and efficiency of dispensing, compounding medications and helping pharmacists identify drug–drug interactions. The further development and use of these innovative technologies will be necessary to ensure patients can continue to access high-quality care amidst a growing health human resource crisis. However, in the field of pharmacy practice, little is known about actual or potential risks these tools pose to patients. A scoping review was conducted to map these risks. A database search of Ovid Medline, Ovid Embase, Ebsco CINAHL, and Web of Science, and a grey literature search were conducted. Three major potential risks were described in the literature: inaccuracies associated with AI outputs, privacy and data security concerns, and risks associated with algorithmic bias. Despite these potential risks, there is still a large gap in the literature regarding the study of risks of AI in pharmacy practice. While characterizing all risks associated with this rapidly changing technology may be impossible, further exploration of risk, perhaps using novel approaches to understanding risk itself, is warranted if these technologies are to be adopted responsibly and used safely.

Pharmacy doi: 10.3390/pharmacy14050112

Authors: Efi Mantzourani David McRae Egerton Hunter Grace Naylor Emma Hinks Andrew Evans Rebecca Cannings-John

The NHS-funded Common Ailments Service (CAS) in Wales enables community pharmacists to manage 28 common ailments by providing advice and/or medication free of charge without the need for patients to book an appointment. The aim of this study was to evaluate the patient experience of the CAS using patient reported experience measures (PREMs) and determine the feasibility of digital data capture collected directly from patients through a pharmacist-led manual recruitment model. The study used prospective, primary data collected through an online survey accessible via a Quick Response code and census recruitment. A total of 3660 surveys were included in the analysis, completed between 27 October 2025 and 31 March 2026. Overall experience was rated as excellent by 95.1% of participants. A theory-based framework analysis of 1499 free-text comments across the six domains of healthcare quality confirmed the high standard of care provision, primarily influenced by consultation quality, convenience, accessibility, and short waiting times. It also identified targeted areas for improvement, such as the need for seamless referrals from other areas of primary care and consistent availability of the service across all pharmacies. While digital PREMs captured high-quality insights, the pharmacist-led recruitment model reached a “feasibility ceiling”, with an overall response rate of 3.2%.

Pharmacy doi: 10.3390/pharmacy14050111

Authors: Abdullah Al-Juhaishi Nilushi Karunaratne Annie Chen-Chen Anisha Kaur Sandhu Kirsten Galbraith Betty Exintaris

Resilience, the capacity to recover from adversity, manage stress, and maintain well-being, is vital for pharmacy students to manage academic stress, clinical challenges, and future professional demands. Despite its recognised importance, pharmacy curricula often lack structured resilience education. This pilot study aimed to design, implement, and evaluate resilience-focused activities within Monash University’s Bachelor of Pharmacy (Hons)/Master of Pharmacy program. This study employed a descriptive cross-sectional educational evaluation design using a single post-intervention survey to explore student perceptions following participation in curriculum-integrated resilience activities within the Skills Coaching program. Sessions used reflective frameworks and interactive small-group activities facilitated by staff and pharmacists across the Australian and Malaysian campuses. In 2022, 1061 students participated, with feedback response rates between 26 and 40%. Students reported perceived improvements in their understanding of resilience following participation in the sessions. Likert-scale responses indicated improved understanding of resilience and highlighted strong engagement with case discussions and reflective exercises. Findings from this pilot inform curriculum refinement, assessment design, and faculty development to support sustainable integration of resilience education in pharmacy programs. This work also supports the lead author’s doctoral research to develop a comprehensive resilience curriculum for undergraduate pharmacy education.

Pharmacy doi: 10.3390/pharmacy14050110

Authors: Rachele Aspesi Paolo Levantino Giulia Ciancarella Andrea Nacci Pietro Tasegian Diego Maria Michele Fornasari

Background: Acute sore throat (pharyngitis) accounts for 10–30% of ambulatory visits annually. Bacterial etiology, primarily Group A Streptococcus, is confirmed in only 20–34% of cases, and inappropriate antibiotic administration remains frequent, contributing to antimicrobial resistance. Community pharmacists play a key role in symptomatic management and stewardship, but real-world practices remain underexplored. Methods: A 16-item online questionnaire surveyed 629 Italian community pharmacists via professional networks, covering demographics, diagnostic tools, symptom assessment, treatment preferences, and follow-up. Responses were analyzed using descriptive statistics and interpreted within a multidisciplinary expert framework. Results: Italian community pharmacists (n = 629), predominantly mid-career and experienced individuals, prioritize targeted symptom questioning (flu-like signs (59.96%), fever (48.73%), pain intensity (49.64%)) and medical referral over formal diagnostic tools like the Centor criteria (unused in 53.66% of cases). A total of 46.74% report performing a Strep A test in fewer than 20% of patients. Topical sprays (83.33%) and lozenges (44.69%), especially containing flurbiprofen (94.19%), dominate recommendations, followed by systemic analgesics (45.79%). For mild cases, anti-inflammatory/analgesic sprays/lozenges (35.42%) and antiseptic lozenges (35.61%) dominate, while in severe cases, drugs with anti-inflammatory or analgesic effects are often preferred (72.47%). Most pharmacists request a follow-up (73.22%). Conclusions: Italian community pharmacists report a predominantly topical-first approach focused on symptomatic treatment and referral when appropriate. Diagnostic gaps and inconsistent follow-up represent actionable targets. The findings inform training outputs prioritizing simplified triage, expanded symptom checklists, spray/lozenge optimization, and 3–5-day call-backs. This work aims to promote pharmacists’ antimicrobial stewardship to reduce antibiotic use while enhancing patient-centred sore throat care in Italy’s pharmacy network.

Pharmacy doi: 10.3390/pharmacy14050109

Authors: Katarina Wickman Sara Modig Cecilia Lenander Gabriella Caleres

Older people are at increased risk of medication-related problems, which may be identified by clinical pharmacists during hospital medication reviews. Some problems are better managed in primary care, where follow-up is possible. Medication-related communication by pharmacists may improve information transfer in care transitions, but this practice remains uncommon in Sweden. This qualitative study explored clinical pharmacists’ experiences and perceptions of writing referrals to primary care. Data were collected through four focus groups and three supplementary interviews with 19 clinical pharmacists from hospitals and primary care, and analysed using qualitative content analysis. Eleven participants had experience writing referrals, although none did so regularly. Four categories emerged: role of the pharmacist, current work procedures, pharmacist–physician relationship and facilitating factors. Pharmacists believe they can contribute to patient safety through involvement in transitions of care. An overall concept of an underused competence permeated the categories. Referrals identifying medication-related problems are hindered by limited pharmacist integration into the healthcare team and limited continuity. Writing referrals was considered a new procedure requiring collaboration with unfamiliar partners. Organisational changes, including increased pharmacist continuity and clearer pharmacist roles, are needed to implement referral practices. Further research is needed to evaluate effects on medication treatment and patient outcomes.

Pharmacy doi: 10.3390/pharmacy14040108

Authors: Sierra Scodellaro Stefanie Triantafilou Iris Cohn

Pharmacogenetics (PGx) aims to optimize drug therapy by predicting medication response based on genetic variation in drug-metabolizing enzymes. However, observed drug metabolism may differ from genotype-predicted metabolizer status given external or acquired influences. This phenomenon is known as phenoconversion. As PGx testing becomes increasingly integrated into clinical care, understanding the contributing factors of phenoconversion is important for interpreting test results and guiding treatment. This scoping review aimed to categorize reported contributors of phenoconversion affecting CYP2D6, CYP2C19, and CYP3A4 metabolism. A structured literature search was conducted across Ovid MEDLINE®, Embase Classic + Embase, EBM Reviews, and Clarivate Web of Science. Records were screened using predefined inclusion and exclusion criteria, and data were extracted from eligible studies describing factors associated with metabolic activity inconsistent with genotype-predicted phenotypes. From 6008 records identified, 43 studies met the inclusion criteria. Reported contributors clustered into pharmacological factors, including drug–drug and drug–drug–gene interactions, clinical factors such as inflammation, physiological and demographic factors including pregnancy and age-related changes, and environmental influences such as smoking. Pharmacological contributors were most frequently studied, whereas environmental and demographic influences were less well characterized. These findings highlight the multifactorial nature of phenoconversion and underscore the need for further investigations to support phenoconversion integration into PGx-informed clinical decision-making.

Pharmacy doi: 10.3390/pharmacy14040107

Authors: Cosmika Goswami Yoni Carmel Rosalind Gittins Gazala Akram

Community pharmacies provide vaccinations through nationally commissioned or private services. In Great Britain, pharmacies are regulated by the General Pharmaceutical Council (GPhC) and inspected for compliance against the 26 Standards for registered pharmacies. GPhC inspection outcomes between 2022 and 2024 were examined for differences between pharmacies offering vaccination services and those who did not. Inspection data from 2197 pharmacies, consisting of 1918 (87.3%) ‘brick-and-mortar’ pharmacies and 279 (12.7%) ‘other’ types (predominantly online pharmacies) were analysed. In total, 1922 (87.5%) pharmacies met all 26 Standards. Pharmacies providing vaccinations demonstrated higher compliance with Standards relating to governance, service delivery, and suitability of premises. Independent single-owner pharmacies and independent pharmacy chains were more likely to not meet standards. A gradient effect was observed across pharmacy-ownership categories, with progressively higher odds of inspection failure as the ownership model size decreased. Analysis of inspector comments identified three key factors influencing inspection performance: governance and organisational oversight; suitability of the physical environment; and staff competence and training. Strengthening governance structures, workforce development and infrastructure support, particularly in smaller independent pharmacies, may improve consistency in regulatory compliance, and support safe, high-quality delivery of vaccination services from community pharmacies.

Pharmacy doi: 10.3390/pharmacy14040106

Authors: Ioana Popovici Manuel J. Carvajal Rawan Alkhamisi

The U.S. pharmacist workforce has undergone significant growth and demographic changes, particularly increased female participation and part-time employment. However, limited evidence exists on how labor supply behavior varies by gender and employment status. This study used a nationally representative sample of 12,064 pharmacists from the 2019–2022 American Community Survey (ACS) to examine heterogeneity in labor supply decisions. Ordinary Least Squares (OLS) regression models were estimated separately by employment status (full-time versus part-time) and gender. The dependent variable was the number of hours worked. Independent variables included wage rate, age, marital status, number of children, and race/ethnicity. Findings showed that women were more than twice as likely to work part-time as men and minority pharmacists were largely underrepresented in the study sample relative to nonminority pharmacists. Gender gaps in wages, hours worked, and demographic and family characteristics also differed markedly between full-time and part-time pharmacists. Finally, findings lent support to the contention than women are more likely to work fewer hours than men as they are expected to spend more hours at home raising children. Understanding how individual characteristics shape pharmacists’ labor supply, and how these relationships differ by gender and employment status, is essential for workforce planning and healthcare human resources policy.

Pharmacy doi: 10.3390/pharmacy14040105

Authors: Russell D. Wilson Paroma Arefin Sujit S. Sansgiry

Current Good Manufacturing Practice (cGMP) training is federally mandated for pharmaceutical manufacturing personnel and plays a critical role in ensuring product quality and patient safety. Despite extensive evidence supporting Cognitive Load Theory (CLT) and Mayer’s Cognitive Theory of Multimedia Learning (CTML), their application to cGMP training has not been evaluated. This study examined whether a CLT/CTML-informed cGMP video training strategy could improve instructional efficiency and learner experience among pharmacists. A randomized repeated-measures crossover study was conducted among 49 pharmacists. Participants completed both an enhanced CLT/CTML-informed training strategy and a standard training strategy in randomized order. Instructional efficiency, calculated from learner performance and perceived mental effort, and learner experience outcomes were assessed using paired-samples t-tests. Compared with the standard training strategy, the CLT/CTML-enhanced strategy resulted in higher assessment scores (78% vs. 72%, p = 0.04), lower perceived mental effort (2.4 vs. 3.5, p < 0.001), and greater instructional efficiency (0.50 vs. −0.50, p < 0.001). Learner experience ratings, including satisfaction, perceived knowledge gain, and likelihood of future recommendation, also improved significantly (all p < 0.001). Applying CLT and CTML principles to cGMP video training significantly improved instructional efficiency and learner experience, supporting theory-informed instructional design as a practical approach for complex regulatory education.

Pharmacy doi: 10.3390/pharmacy14040104

Authors: Maria Victoria Tejada-Simón

Background: Game-based learning (GBL) and active engagement strategies have shown promise in health professions education; however, their application in foundational basic science courses, which serve as critical academic gatekeepers in professional pharmacy programs, remains underexplored. Objective: This study evaluated the effect of a multimodal suite of faculty-developed, web-based GBL activities and active engagement strategies on academic performance, learning management system (LMS) engagement, and student perceptions in a required first-year (P1) pharmacy biochemistry course. Methods: A cross-sectional, descriptive study was conducted with 117 P1 pharmacy students. Game-based activities (including Jeopardy, Rapid Fire, and Crossword Puzzle games) were developed using WiscOnline and deployed via Blackboard alongside pre-class activities, a Workbook, and a Padlet discussion board. Engagement was measured via LMS access metrics, academic performance via examination scores, and perceptions via an end-of-semester anonymous Poll Everywhere survey. Results: The cohort achieved a mean examination score of 81.59%, with 83.8% earning a passing grade. A positive association was observed between game access frequency and grade group performance (R2 = 0.8241), though individual-level correlations did not reach statistical significance. Student perceptions were overwhelmingly positive, with over 90% of respondents agreeing that GBL activities were enjoyable, facilitated learning, and provided valuable practice opportunities. Conclusions: Low-cost, faculty-developed GBL tools can be successfully integrated into foundational pharmacy science courses, yielding high engagement and positive student perceptions. These findings underscore the importance of extending active learning research to foundational basic science courses and offer a replicable model for health professions programs seeking to enhance student engagement at this critical curricular stage.

Pharmacy doi: 10.3390/pharmacy14040103

Authors: Richard Henry Parrish

The fragmentation of clinical information across health systems, community pharmacies, and specialty providers continues to undermine medication safety and emergency care, particularly when patients are unconscious or otherwise unable to communicate their history. The dominant response to this fragmentation has been the construction of a centralized data infrastructure—health information exchanges, prescription drug monitoring programs (PDMPs), and federated electronic health record (EHR) networks—that aggregates clinical information into institutional databases that are queryable by providers, insurers, regulators, and, in many jurisdictions, law enforcement. This article argues that the same care-coordination problems can be addressed through an architecturally different approach in which the patient, not the institution, holds the integrative artifact. The proposed design, here labeled the Guardian Card (a conceptual architecture, not a commercial product), pairs an HL7 Fast Healthcare Interoperability Resources (FHIR) clinical payload with the SMART Health Cards verifiable-credential framework and a dual-modality (QR code plus near-field communication) physical carrier. After describing the technical architecture, hardware options, and a five-phase deployment roadmap, the design is situated within the surveillance-critical scholarship that has documented PDMP function creep, third-party doctrine erosion, racial disparities in algorithmic prescribing oversight, and the surveillance-instrumentarian repackaging of nominally de-identified prescription data. The Guardian Card is offered as one operational implementation of a patient-controlled medication-record architecture, with community pharmacy and long-term post-acute care, where the Pharmacist eCare Plan integration is most feasible as a recommended first-deployment venue.

Pharmacy doi: 10.3390/pharmacy14040102

Authors: Saleh Alghamdi

Background: Pharmacist-led interventions in Gulf Cooperation Council (GCC) countries have been increasingly studied, yet their overall effectiveness across clinical and healthcare outcomes remains incompletely defined. To address this gap, a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies published between 2000 and 2025 was conducted, following PRISMA 2020 and Cochrane standards. Methods: Searches of PubMed/MEDLINE, Scopus, Web of Science, and CENTRAL identified 437 records, of which 20 studies met the inclusion criteria; 13 contributed meta-analyzable data as randomized controlled trials and seven as quasi-experimental studies. Results: Pooled random-effects estimates favored pharmacist-led care for HbA1c, fasting glucose, low-density lipoprotein cholesterol, diastolic blood pressure, and medication knowledge, although these estimates carried substantial, largely unexplained heterogeneity and were rated as low to very low certainty under GRADE. The effects on systolic blood pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, unplanned healthcare use, and antimicrobial utilization were favorable but not statistically significant. Quasi-experimental studies consistently demonstrated reductions in mortality and readmissions, though hospital and ICU length of stay remained variable. Risk of bias was judged as some concerns for randomized trials and moderate to serious for quasi-experimental studies, with substantial heterogeneity observed across blood pressure and lipid outcomes. Conclusions: Overall, pharmacist-led interventions in GCC settings were associated with improvements in glycemic control and LDL cholesterol, with additional benefits in mortality and readmissions, although the certainty of evidence was low to very low, owing to substantial heterogeneity and the predominance of non-randomized designs for the inpatient outcomes. These findings underscore the need for standardized intervention models and outcome measures.

Pharmacy doi: 10.3390/pharmacy14040101

Authors: Seshadri Sekhar Chatterjee Soumitra Das Adesh Agrawal

Clozapine-induced hypersalivation (CIH) affects 30–80% of patients on clozapine and is a major contributor of non-adherence. Current managements, largely based on systemic anticholinergics, can worsen other clozapine-related side effects. Here sublingual tropicamide 1% eye drops can be a low-cost alternative worth evaluating. We report a case series of seven patients with schizophrenia treated with sublingual tropicamide 1% ophthalmic solution (4–8 drops/day) for CIH. Treatment response was assessed by patient-reported percentage reduction in salivation. All seven patients reported improvement (25–80%). One patient reported a transient bitter taste; no systemic anticholinergic effects occurred. Sublingual tropicamide was associated with patient-reported improvement in CIH and was well tolerated in this small, uncontrolled series. Its short duration of action and local administration may offer practical advantages over systemic anticholinergics, though the mechanism remains unproven. Randomised trials with validated outcome measures are needed to establish its efficacy and safety.

Pharmacy doi: 10.3390/pharmacy14040100

Authors: Aleksandar Jovanović Radmila Veličković Radovanović Ivana Tadić Milica Drobac Bojana Vidović Dragana Pavlović Marina Odalović Dušanka Krajnović

Background/Objectives: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. Methods: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. Results: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; p < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (p < 0.01). Conclusions: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use.

Pharmacy doi: 10.3390/pharmacy14040099

Authors: Haroon Malak Madeeha Mirza Stephen F. Gambescia Basil H. Aboul-Enein

The COVID-19 pandemic compelled higher education to resort to e-learning, posing new challenges to the teaching/learning of pharmacy students worldwide. While digital learning provided flexibility, diverse technological infrastructure and institutional availability of resources greatly influenced the student experience. This scoping review aims to assess the perceptions relating to the pivot to e-learning among pharmacy students in the League of Arab States due to the COVID-19 pandemic and how the shift affected student engagement, learning outcomes, and institutional preparedness. Following PRISMA-ScR guidelines, a comprehensive search across ten databases was conducted to identify relevant studies published between January 2020 and December 2025. Forty studies satisfied the inclusion criteria. Pharmacy students in this region responded to the transition to e-learning in diverse ways. While most appreciated the convenience of online modalities, several challenges were consistently enumerated. These were limited technological infrastructure, reduced interpersonal interaction, and disruption of hands-on practical training. Blended learning approaches were largely favored, particularly for their ability to marry online theoretical instruction with face-to-face experiential learning. Reliability and validity issues of internet-based tests were felt by both faculty and students. Stress and mental health problems among students surfaced. Student complaints in general depicted pharmacy education’s need for pedagogic reform, better infrastructure, and student mental health services during e-learning. Areas identified from this review are instructional technology infrastructure improvement, adopting a blended learning strategy, and the need to consider the mental health of students learning at a distance.

Pharmacy doi: 10.3390/pharmacy14040098

Authors: Tomasz Karczewski Jennifer M. L. Stephens Dawid Karczewski Sahar Feizizadeh Dhwani Dixit Mihaela Olsen

Background/Objectives: Primary-care access in Alberta, Canada, is shaped by geography, attachment, timeliness, continuity, and local service capacity. Rural communities may face travel burden, workforce fragility, and intermittent services, whereas suburban communities may have nearby facilities but still experience delayed access, low attachment, and fragmented episodic care. Rural Wyoming has some similar geographic and workforce constraints, although the jurisdictions differ in financing, regulation, and pharmacist scope. This systematic review and narrative synthesis examined evidence on coordinated community pharmacist–family physician care in rural and suburban Alberta and considered, separately, the contextual relevance of the findings to rural Wyoming and comparable frontier settings. Methods: We searched PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library using controlled vocabulary and free-text terms to identify English-language peer-reviewed studies and practice-relevant evidence published from 1 January 2010 to 19 April 2026. Two authors screened titles/abstracts and full texts and resolved decisions by consensus. Methodological appraisal used design-appropriate Critical Appraisal Skills Programme criteria, and outcome-level certainty was considered using GRADE domains. Results: Thirty-four eligible peer-reviewed or practice-evaluation records were included in the narrative synthesis, and seven official contextual or methodological sources supported jurisdictional interpretation. Evidence was strongest for hypertension, cardiovascular risk reduction, medication management, and chronic disease monitoring. No included study directly compared the same intervention in Alberta and Wyoming; evidence for emergency-department effects and equivalent effectiveness across settings was limited. Conclusions: Coordinated pharmacist–family physician care may extend access to selected medication-related and chronic disease services when supported by documentation, referral, follow-up, and red-flag protocols. Application to Wyoming should be treated as a context-dependent proposition requiring local adaptation and prospective evaluation, not as demonstrated transferability or a substitute for physician-led longitudinal primary care.

Pharmacy doi: 10.3390/pharmacy14040097

Authors: David R. Axon Becka Eckert Alyx Meilinger Maren Steffen Haylee Bingham Justin Pacheco Houston Swann Kayleen Tubbs

Objective: To explore fourth-year student pharmacists’ perspectives of the skills they develop by completing a research project in the pharmacy curriculum at one United States College of Pharmacy. Methods: Semi-structured interviews were conducted with a sample of fourth-year student pharmacists until thematic saturation was achieved. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify main themes. All records were reviewed by two researchers, and consensus was sought at each step of the analysis. Results: Eleven interviews were conducted. Three themes related to skills developed by students while completing a research project were apparent from the final reconciled code list: Theme 1—critical analysis skills; Theme 2—residency preparedness skills; and Theme 3—interpersonal skills. Critical analysis skills helped students review the literature and appropriately translate the findings into clinical settings. Residency preparedness skills described how students perceived completing a research project would prepare them for a residency program. Interpersonal skills were inter-related and consisted of collaboration, communication, conflict resolution, leadership, and project management skills. Conclusions: These study findings should be considered by curriculum committees as changes to the pharmacy program are considered. Future research is suggested to explore other perspectives of the research process.

Pharmacy doi: 10.3390/pharmacy14040096

Authors: Antonio Ivanov Ines Hababa-Ivanova Savina Elitova Svetoslav Stoev Violeta Getova-Kolarova

Oncology conditions are increasingly defined by their molecular profiles, and drug repurposing exploits this new evidence to identify new therapeutic uses of authorized/investigational medicinal products outside their original indication(s). This scoping review mapped original research published between January 2022 and December 2024 to determine the impact of automated processes and artificial intelligence in generating oncology candidates for drug repositioning, and 42 individual projects met the eligibility criteria and were analyzed. The included studies demonstrate extensive use of computational approaches for candidate prioritization, large-scale data integration, and hypothesis generation in oncology drug repurposing, creating opportunities for positive impact on efficiency. The included projects most commonly were target-oriented and disease-oriented and used multiple databases and computational validation procedures, while experimental and clinical validation were less frequently reported. The available open-access literature suggests substantial activity in China and India, which can support the notion that digitalization represents an important instrument in healthcare systems of low- and middle-income countries but should be interpreted cautiously. While the search was limited to PubMed and open-access English-language publications, we identified a relatively small number of drug-oriented projects, the importance of providing publicly accessible source code to reduce development costs, and the predominant role of academic institutions.

Pharmacy doi: 10.3390/pharmacy14040095

Authors: Gustavo A. Hernández-Fuentes Iván Delgado-Enciso Alejandra E. Hernández-Rangel Jesús E. Castrejón-Antonio Héctor R. Galván-Salazar Janet Diaz-Martinez Nibardo Cobian-Gutiérrez José Guzmán-Esquivel Alicia Olvera-Montejano Carmen Meza-Robles Alberto M. Ramírez-Montes Fabian Rojas-Larios Gabriel Ceja-Espíritu Daniel A. Montes-Galindo

Science communication is increasingly recognized as a key component of higher education; however, its integration into disciplinary training remains limited, particularly in pharmaceutical sciences. This study analyzes the Panamacani initiative as an institutional science communication initiative embedded within pharmacy education, based on editorial practice within the Pharmaceutical Chemist Biologist program at the Universidad de Colima, Mexico. A descriptive institutional case study was conducted using data from the first five issues (2023–2025), comprising 58 published contributions. Institutional participation, authorship profiles, and audience engagement were evaluated through descriptive statistics and editorial records. Results showed that 70.7% of contributions originated from the host institution, while 29.3% involved external institutions, indicating progressive expansion. Undergraduate students accounted for 44.8% of authorship, with a gradual increase in participation from postgraduate students and researchers. External contributions reached up to 50% in one issue, suggesting increased visibility beyond the host institution. Article visibility totaled approximately 1500 views, with applied health topics receiving the highest level of audience attention. These findings suggest that editorial-based initiatives may provide opportunities for student participation in science communication, peer review, and knowledge dissemination. However, the present study did not directly evaluate educational outcomes or competency development. This model may represent a scalable framework for integrating science communication activities into pharmacy education while fostering public engagement with science.

Pharmacy doi: 10.3390/pharmacy14040094

Authors: Rosalind Gittins Roya Vaziri Ian Maidment

Misuse of over-the-counter (OTC) and prescription-only medicines (POMs) is increasingly recognised as a public health and medicine-safety concern. Although specialist substance misuse services (SMS) increasingly support people affected by OTC/POM misuse, little is known about how SMS staff perceive the characteristics, challenges, and treatment needs of this population. This study explored the experiences of SMS staff to address this evidence gap and inform pharmacy practice and service development. Confidential semi-structured interviews were conducted with staff across five community adult English SMS. Audio recordings were transcribed verbatim and analysed thematically using NVivo®. Twenty interviews with varied professionals achieved data saturation. Three overarching themes emerged: (1) characteristics of OTC/POM misuse; (2) staff-perceived patterns among people who misuse OTC/POM; and (3) negative experiences and concerns. Dependence on orally administered opioids (particularly codeine-containing products), benzodiazepines and gabapentinoids predominated. Polypharmacy including illicit substance use was also reported. Withdrawal symptoms frequently perpetuated misuse, and abrupt supply cessation created additional risks. Routine enquiry about OTC/POM misuse and provision of tailored harm-reduction interventions are essential. The findings suggest that pharmacists may have an important role in early identification of problematic OTC/POM use, harm-reduction interventions, medicine review and facilitating referral into appropriate treatment pathways. Further research should examine whether dedicated OTC/POM pathways are required and explore differences in demographic and treatment needs across medicine types.

Pharmacy doi: 10.3390/pharmacy14040093

Authors: Michelle Gyr Heather Brown Victoria Crisp Milan du Plooy Noora Al Hasooni Natalia Popowicz Liza Seubert Tanya Burgess

Background: Voluntary Assisted Dying (VAD) legislation in Western Australia (WA) introduced new responsibilities for community pharmacists, including the safe disposal of unused VAD substances. Pharmacists may receive VAD-related enquiries; however, their preparedness, including their knowledge of VAD, remains largely unexplored. Aim: To explore Western Australian community pharmacists’ knowledge of VAD and their role as Authorised Disposers under the Voluntary Assisted Dying Act 2019 (WA). Methods: Community pharmacists in WA were invited to participate in an anonymous, online survey consisting of multiple choice and open-ended questions. Results: Of 143 respondents, 76% were aware that VAD is an end-of-life option; despite this, 64% were uncertain about its relevance to their role. Almost one-third had received VAD-related enquiries. Of these, 40% could not provide information, with half attributing this to insufficient knowledge. Among those yet to receive a VAD-related enquiry (n = 115), 75% felt ‘not confident’ to respond, with 76% attributing this to lack of knowledge. A total of 63% of participants were unaware that they may be requested to perform authorised disposal. Uncertainty surrounding the process and the legal and ethical aspects were frequently mentioned. Conclusion: WA Community pharmacists demonstrate awareness of VAD legislation but have gaps in knowledge, particularly regarding authorised disposal. Further training and resources are essential.

Pharmacy doi: 10.3390/pharmacy14040092

Authors: Shambel Nigussie Amare Kwang Choon Yee Myra Leung Mark Naunton Abbey Wilson Annika Rooney Omar Gannash Mary Bushell

Background: Since 2014, all Australian jurisdictions have progressively amended legislation to authorise pharmacists to administer vaccines, evolving from restricted pilots to an essential public health pillar. Objective: This review analyses the longitudinal evolution of pharmacist-administered vaccinations (PAVs), documenting changes in authorised vaccines, age eligibility, and regulatory frameworks across all Australian jurisdictions. Methods: A retrospective review of Australian jurisdictional legislation, regulations, and policy documents was undertaken. Searches included official legislative registers, Government Gazettes, Health Department protocols, and professional guidance published by Pharmaceutical Society of Australia (PSA) and The Pharmacy Guild of Australia between 2014 to 2026. Documents were independently reviewed by five authors, followed by secondary verification and consensus-based adjudication to resolve discrepancies and confirm findings. Results: PAVs scope was expanded from a single influenza pilot in 2014 to include over 21 vaccine-preventable diseases by 2026. The COVID-19 pandemic catalysed rapid reform, leading to the standardisation of age eligibility (largely ≥5 years). A landmark milestone occurred in 2025 when South Australia enabled pharmacists to administer any vaccine within their professional scope. Conclusion: Legislative reforms have significantly enhanced vaccine accessibility. However, jurisdictional fragmentation persists. National harmonisation, using a competency-based model similar to South Australia, is recommended to streamline delivery and optimise public health outcomes.

Pharmacy doi: 10.3390/pharmacy14040091

Authors: Abdullah Hashim Almalki Nourah Abdulaziz Alorainan Muhjah Abdulhakim Bukhari Fahad Ali Dokhaikh Salma Mohamed Abbas Quqandi Reyan Hatem Merdad Laila Fahad Sadagah

Background: Hyperkalemia (HK) is a common complication of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and the risk is often increased by concomitant use of a mineralocorticoid receptor antagonist (MRA). The effect of SGLT2i co-prescription on this risk in routine clinical practice remains incompletely understood. Methods: This is a secondary analysis of a published retrospective cohort of 905 adult RAASi users attending outpatient clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia (IRB: NRJ22J/279/11), followed for a median of 28 months. Patients were classified as RAASi alone (n = 723) or RAASi plus MRA (n = 182). Beta-blockers and digoxin were excluded from the exposure definition. Effect modification by SGLT2i was assessed using logistic regression with a multiplicative interaction term. Results: MRA addition was associated with significantly higher rates of any HK (48.4% vs. 28.9%; RR 1.67, 95% CI 1.38–2.02, p < 0.001) and moderate-to-severe HK (13.7% vs. 6.9%; RR 1.99, 95% CI 1.26–3.12, p = 0.003). Overall, RAASi discontinuation rates were similar between groups. SGLT2i co-prescription significantly modified the association between MRA use and HK-driven RAASi discontinuation (interaction p = 0.004): among patients without SGLT2i, MRA addition was associated with a more than 5-fold increase in HK-driven discontinuation (21.1% vs. 4.1%; RR 5.11, p = 0.001), whereas no significant excess risk was observed among SGLT2i users (1.8% vs. 4.2%; RR 0.44, 95% CI 0.12–1.57, p = 0.190), although this subgroup estimate was imprecise. CKD (aOR 2.16, 95% CI 1.56–2.99) and age ≥ 75 years (aOR 1.64, 95% CI 1.04–2.58) were the strongest independent predictors of HK. Conclusions: MRA addition to RAASi substantially increases HK burden, and SGLT2i co-prescription appears to protect against HK-driven RAASi discontinuation in combined RAASi–MRA-treated patients. In patients with established indications for SGLT2i, co-prescription may confer the additional benefit of preserving RAASi continuity in the setting of MRA combination therapy.

Pharmacy doi: 10.3390/pharmacy14040090

Authors: Sébastien Chanoine Quentin Perrier Elisa Vitale Arnaud Tanty Benoît Allenet Pierrick Bedouch

Background: Pharmacy students in France complete an equivalent six-month full-time hospital placement during the fifth year of their university curriculum. At our school, it includes a clinical pharmacy within a medical ward, with daily supervision by a clinical pharmacist and a pharmacy resident. This training has been strengthened by the introduction of a workplace-based formative assessment conducted at the end of the clinical pharmacy rotation, alongside weekly clinical case discussions at the school, culminating in an end-of-year oral assessment. Objective: To assess the performance, determinants, and acceptability of this assessment model. Methods: We conducted a retrospective, single-center study over ten academic years (2013–2023). The evaluation combined three complementary components: the workplace-based clinical assessment based on real patient interactions, the case-based oral assessment, and students’ satisfaction. Results: Nearly one thousand students were included. Students’ performances remained stable over time. Higher scores were observed among students with prior clinical experience and those enrolled in hospital-focused training pathways. Student satisfaction was high, particularly in settings with direct pharmaceutical supervision, which was strongly associated with improved perceived learning, engagement, and supervision quality. Conclusions: Beyond performance measurement, this model appears to foster clinical reasoning, professional development, and student engagement, suggesting its relevance for competency-based pharmacy education.

Pharmacy doi: 10.3390/pharmacy14040089

Authors: Ashna Talwar Jeffrey Sherer Susan Abughosh Satabdi Chatterjee Rajender R. Aparasu

Delirium is a transient neuropsychiatric condition that is a severe and prevalent condition affecting 2.6 million older adults each year. Alzheimer’s disease (AD) and anticholinergic medication use are risk factors for delirium. This study evaluated the association between cumulative anticholinergic burden (CAB) and risk of delirium among older adults with AD initiating cholinesterase inhibitors (ChEIs). This retrospective cohort study used 2013–2017 Medicare claims data, and included adults 65 years and older with AD who initiated any of the ChEIs (donepezil, rivastigmine, and galantamine) after a 12-month washout period. CAB, as the primary exposure, was measured on the index date and calculated as the monthly total standardized daily dose of anticholinergic medications. A multivariable Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) generated using generalized boosted models was used to evaluate the risk of delirium associated with the CAB. This study identified 143,320 older adults with AD who initiated ChEIs. Most patients were in the low/no burden (62.73%) group, followed by high burden (21.12%) and moderate burden (16.14%). Overall, delirium diagnosis was observed in 19.11% of the cohort. The Cox regression model with IPTW found that moderate (aHR, 1.56; 95% CI, 1.52–1.61; p < 0.0001) and high CAB (aHR, 1.45; 95% CI, 1.42–1.49; p < 0.0001) were associated with an increased risk of delirium compared to low/no burden. Among older adults with AD initiating ChEIs, moderate and high CAB were associated with an increased risk of delirium compared with low/no CAB. These findings highlight the need to carefully reduce the CAB, especially dose and duration, along with utilizing anticholinergic alternatives in older adults with AD.

Pharmacy doi: 10.3390/pharmacy14030088

Authors: Mirthe A. M. Oude Lansink Bart J. F. van den Bemt Caroline H. P. A. van de Steeg-van Gompel Marcia Vervloet Liset van Dijk Charlotte L. Bekker

The implementation of medication adherence interventions is suboptimal. To guide implementation, this study aimed to tailor an existing implementation determinant framework to support the assessment of the implementability of such interventions in a specific context prior to implementation, and to investigate whether experts can assess in advance which determinants are important for implementing medication adherence interventions. In a Delphi study, experts rated determinants based on constructs of the Consolidated Framework for Implementation Research (CFIR) in terms of their importance for implementing medication adherence interventions. Determinants were then prospectively evaluated in four Dutch living labs implementing medication adherence interventions. The results were compared to assess agreement between expert opinion and real-world practice. Of 40 evaluated CFIR determinants, 16 were important in the majority of the living labs. These determinants concerned the inner setting, characteristics and roles of involved individuals, and implementation process domains of the CFIR. After comparing the prospective evaluation with Delphi results, expert opinions matched living lab observations for 18 out of 40 determinants (45%) regarding (un)importance. The CFIR was tailored to primary care medication adherence interventions based on practice observations, offering a potentially helpful framework to assess implementability of these interventions in specific contexts in advance. Determinant frameworks could benefit from incorporating real-world practice data.

Pharmacy doi: 10.3390/pharmacy14030087

Authors: Taiwo Opeyemi Aremu Carinne Brody Shadi Doroudgar Ikenna Chidozie Ezejiaku Shahin Teimourtash

Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a non-probability, cross-sectional electronic survey of adults aged 18–49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan–Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n = 399; 95% confidence interval [CI], 82.7–89.2%), likely reflecting a health-engaged convenience sample. Influenza-like illness was reported by 38.4%; median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15–4.34) and greater trust in Centers for Disease Control and Prevention (CDC) or public health agencies (aOR, 1.46; 95% CI, 1.05–2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusions: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication. Findings should be interpreted in light of non-probability recruitment and likely overrepresentation of health-engaged respondents.

Pharmacy doi: 10.3390/pharmacy14030086

Authors: Ariel Dulaney Anne Taylor Haley Phillippe Renee Delaney Lindsey Hohmann

Opioid misuse continues to be a major public health issue in the United States. Older adults (≥65) are at particular risk of harm from opioids due to changes in opioid pharmacokinetics with age; however, healthcare professionals lack training and confidence in addressing opioid harm reduction strategies in this population. Therefore, the purpose of this study was to improve healthcare professional knowledge and beliefs regarding opioid harm reduction strategies amongst older adults. An 8 h interprofessional conference was conducted 1 May 2025 to educate healthcare providers about opioid misuse prevention strategies for older adults. This study utilized a quasi-experimental one-group pretest–posttest design to assess changes in healthcare professional knowledge and beliefs before and after the conference. Healthcare professionals in the U.S. were recruited to participate in the conference via email listservs with national reach, predominantly concentrated in Alabama. Data were collected at pre- and post-conference via an anonymous online survey informed by the Theory of Planned Behavior and Health Belief Model. Primary outcome measures included: (1) knowledge of opioid use and misuse in older adults (5 items); (2) prescribing and dispensing attitudes surrounding opioids and medications for opioid use disorder (MOUD) (5 items); (3) perceived susceptibility to harm from opioids (4 items); and (4) perceived barriers to opioid harm reduction in older adults (17-items). Constructs were measured using multiple-choice questions (knowledge) and Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, intention to join a Microsoft Teams working group for ongoing collaboration was assessed through a single categorical (Yes/No/Unsure) multiple-choice question at post-conference. Data were analyzed using descriptive statistics, and differences in mean knowledge, attitudes, susceptibility, and barriers scale scores from pre- to post-conference were analyzed using Wilcoxon signed-rank tests (alpha = 0.05). Of N = 75 survey respondents, the majority were White (86.7%), female (74.7%), 50 years of age on average, and employed as pharmacists (68%). Overall, mean (SD) knowledge (83.73% [19.92] versus 90.67% [12.45]; p = 0.011) and perceived susceptibility (3.82 [0.63] versus 4.03 [0.63]; p = 0.002) increased from pre- to post-conference, while perceived barriers decreased (2.71 [0.54] versus 2.54 [0.58]; p = 0.001). Despite an upward trend, there was no statistically significant change in the mean prescribing and dispensing attitudes from baseline to post-conference. Additionally, 34.7% intended to join the Microsoft Teams working group at post-conference. Findings support the utility of interprofessional educational interventions to increase healthcare provider knowledge and beliefs regarding opioid harm reduction strategies amongst older adults.

Pharmacy doi: 10.3390/pharmacy14030085

Authors: Antonio Ivanov Veselina Ruseva Ines Hababa-Ivanova Violeta Getova-Kolarova Hristina Lebanova Ilko Getov

Drug repurposing is often promoted as a faster, lower-risk alternative to de novo discovery, yet substantial barriers continue to limit successful implementation. We performed a scoping review of articles included in PubMed and ScienceDirect with the aim to identify and categorize challenges and analyze the intersections between them. Our review included 73 articles which revealed scientific, clinical, regulatory, economic, and implementation barriers, with the principal being the clinical translation of generated candidates. Scientific challenges include the necessity for new Phase II/III trials to validate efficacy, safety, and optimal dosing in new therapeutic contexts. Across disease areas, domain-specific barriers include subgroup-dependent responses in oncology, resistance and penetration challenges in anti-infectives, and data scarcity in rare diseases. Computational and AI-assisted approaches face fragmented data, model robustness, and insufficient validation. In addition, off-patent drugs face evidence requirements as rigorous as those for de novo entities, yet lack the market exclusivity incentives required to attract private investment. Additionally, an “institutional bottleneck” hinders academic researchers from bringing findings “on-label” due to a lack of regulatory infrastructure and collaborative frameworks. We conclude that drug repurposing requires a distinct translational paradigm involving multi-stakeholder collaboration and early regulatory engagement to bridge the gap between laboratory discovery and patient access.

Pharmacy doi: 10.3390/pharmacy14030084

Authors: Ani Paunova Angelina Mollova-Kyosebekirova Maria Koleva Ekaterina Uchikova Nikoleta Parahuleva

Background: Precision medicine aims to improve early, individualized risk stratification using biologically relevant biomarkers. In early pregnancy, markers reflecting placental function remain limited. Kisspeptin, a placentally derived peptide that rises during normal gestation, has emerged as a potential indicator of pregnancy viability. Objectives: We aimed to evaluate evidence on maternal serum kisspeptin levels and placental KISS1/KISS1R expression in early pregnancy loss, and to assess its potential relevance as a precision biomarker within personalized pharmacy and individualized monitoring frameworks. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar (up to 2025) was conducted according to the PRISMA 2020 guidelines. Studies assessing circulating kisspeptin and/or placental expression in early pregnancy loss versus viable pregnancies were included. A formal meta-analysis was not performed due to substantial heterogeneity in study design, biological material, assay methods, gestational age, and outcome reporting formats. Under these conditions, quantitative pooling was considered methodologically inappropriate; therefore, qualitative synthesis was performed. Results: Six studies met the inclusion criteria. Most reported significantly lower maternal serum kisspeptin levels in early pregnancy loss, with good discriminatory accuracy. Immunohistochemical analyses showed reduced placental and choriodecidual KISS1/KISS1R expression in miscarriage and recurrent pregnancy loss, indicating disrupted local signaling. Concordant systemic and tissue findings suggest that circulating kisspeptin reflects placental dysfunction. Conclusions: Kisspeptin appears to be a promising precision biomarker for monitoring early pregnancy viability and supporting individualized pharmaceutical care. Standardized assays and large prospective studies are needed before routine clinical implementation.

Pharmacy doi: 10.3390/pharmacy14030083

Authors: Esther Spinatsch Sabrina Zelger Samuel S. Allemann

Emergency contraception (EC) is a time-sensitive pharmacy service in which consistent, patient-centred counselling is important but can be challenging to deliver in routine practice. This prospective implementation study evaluated the feasibility and real-world use of a digital counselling support tool for pharmacist-led EC consultations in Swiss community pharmacies. The tool combines patient self-reporting with structured, evidence-based support for pharmacist counselling. All EC consultations between 1 November 2023 and 14 February 2026 using the tool in 10 Swiss community pharmacies were analysed descriptively (n = 3428), alongside a voluntary anonymous post-consultation survey (n = 148) assessing patient-reported experience and acceptance. Median total consultation duration was 11:32 min, including 4:27 min of direct pharmacist counselling, indicating partial transfer of assessment to the digital pre-consultation phase. Ulipristal acetate was dispensed in 71% and levonorgestrel in 26% of consultations. Prior to counselling, 80% of patients reported uncertainty regarding the optimal active ingredient, underscoring the relevance of pharmacist involvement. Survey respondents rated the tool as easy to use (97%), discreet (99%), and trustworthy (98%); 85% preferred it over standard paper-based procedures. These findings demonstrate the feasibility and patient acceptance of integrating a digital tool into routine EC services and suggest that such tools may support structured, evidence-based counselling within community pharmacy practice.

Pharmacy doi: 10.3390/pharmacy14030082

Authors: Taylor Clark Ioana Sandru Samantha Kunkel Sarah Lynch

Thirty-one U.S. states and the District of Columbia currently authorize pharmacists to prescribe hormonal contraception. Expansion of pharmacist scope of practice into areas such as contraceptive prescribing represents an extension beyond traditional baseline licensure authority. As a result, jurisdictions frequently require additional training to address competency, patient safety, and liability considerations. Because regulation of pharmacy practice occurs at the state level, training requirements vary across jurisdictions. State boards of pharmacy websites and publicly available regulatory materials were reviewed to identify training requirements for pharmacists authorized to prescribe hormonal contraception. Relevant statutes, regulations, and prescribing protocols were examined. Identified requirements were extracted and categorized into thematic groupings based on the level and type of training specified. Most jurisdictions require pharmacists to complete training beyond standard pharmacy education prior to prescribing hormonal contraception. Such requirements are characteristic of newly expanded scope-of-practice authorities, where regulators seek to verify competency and mitigate liability risk. As prescribing activities become more fully incorporated into pharmacy practice acts and professional education, separate training requirements may diminish over time.

Pharmacy doi: 10.3390/pharmacy14030081

Authors: Amie M. Ashcraft Anthony Peluso Taylor Thompson Amy Brenwalt Sidney Sisson Melody Phillips Courtney S. Pilkerton Charles D. Ponte

Independent community pharmacies serve as critical healthcare access points in rural areas, yet they consistently underperform chain pharmacies on contraceptive access measures. This narrative commentary draws on mystery caller studies, implementation research, and policy analyses to examine pharmacy-based contraceptive access in the United States (US). Using emergency contraception (EC) as a case study, we show that independent pharmacies stock EC at dramatically lower rates than chains (e.g., 14.6% vs. 76.3% in West Virginia), provide less accurate information about purchase requirements and timing, and impose more barriers to access. Because independent pharmacies account for 76.5% of pharmacies in rural areas, this disparity concentrates contraceptive inaccessibility in communities already facing the highest rates of unintended pregnancy, maternal mortality, and maternity care deserts. This pattern extends beyond EC to pharmacist-prescribed contraception and over-the-counter daily oral contraceptives. These disparities reflect systemic barriers, such as inadequate reimbursement, limited training infrastructure, and absence of corporate support, rather than failures of individual pharmacies. Drawing on implementation research and the success of West Virginia’s COVID-19 vaccination model, this paper proposes coordinated, sector-specific strategies to transform independent pharmacies from barriers into bridges for rural women’s contraceptive access.

Pharmacy doi: 10.3390/pharmacy14030080

Authors: Shantanu Rao Kimberly A. Pesaturo Jennifer Grundey Timothy Burkart Devyn Warnement

Background: The rigor of the Doctor of Pharmacy (PharmD) curricula is reflected in its math- and science-heavy prerequisite requirements. As such, it is critical to evaluate whether students perceive high school coursework and experiences as adequate preparation for PharmD programs. Methods: Pre-professional and professional PharmD students from three institutions completed a survey assessing satisfaction with high school preparation, including math and science education, skill development, and exposure to pharmacy-related experiences. Results: A total of 148 responses were analyzed; 72% identified as female and 81% as White (non-Hispanic/Latino). Most respondents reported satisfaction with their high school math (80.4%) and science (82.4%) education, and 73.7% felt academically prepared for pharmacy school. Additionally, 79.8% were satisfied with skills gained in high school. Experiences such as attending pharmacy-related events (81.1%), contact with healthcare professionals (87.8%), and prior employment (85.2%) were widely viewed as beneficial. Students highlighted communication, problem-solving, and time management as key skills developed. However, gaps were noted in study strategies, presentation abilities, and time management. Conclusions: Students generally felt well-prepared academically and skill-wise for PharmD programs. Expanding pharmacy-related exposure and targeted skill development opportunities in high school may further enhance readiness for future pharmacy students.

Pharmacy doi: 10.3390/pharmacy14030079

Authors: Sadia Shakeel Hina Rehman Shagufta Nesar Muskan Bhutto Imran Ahsan Mallick Márió Gajdács Shazia Jamshed

Background/Objectives: Health promotion (HPr) is increasingly recognized as an essential component of modern pharmacy practice. In developing countries like Pakistan, pharmacists’ roles are evolving from traditional dispensing toward extended pharmacy services (EPS). This study evaluated the willingness, knowledge, attitudes, and perceived barriers of pharmacists in Karachi, Pakistan, regarding the provision of HPr-focused EPS. Methods: An online, cross-sectional, observational study was conducted between October 2024 and April 2025, using a 32-item questionnaire. Purposive and snowball sampling were employed to recruit pharmacists, including interns and fresh graduates. Descriptive and inferential statistics (χ2, Fisher’s exact and Welch’s t-tests) were used for data analysis. Results: Of N = 389 respondents (mean age 29.8 ± 4.8 years), 85.1% expressed willingness to provide HPr services. A majority of respondents (72.7% and 70.4%, respectively) felt they possessed sufficient knowledge for HPr and for identifying lifestyle-related risks, while more experienced pharmacists (>1 year) reported higher confidence (p < 0.001 and p = 0.043). Positive attitudes toward public health involvement were high (82.3%), particularly among females (p < 0.001), younger pharmacists and fresh graduates (p = 0.019 and p = 0.010). However, only 39.1% believed they had sufficient time for patient education. Practicing pharmacists (n = 114) were most frequently involved in dietary advice (4.38 ± 0.89) and medication safety education (4.36 ± 0.97), while family planning counseling (2.92 ± 1.36) was the least commonly reported activity. Leading barriers identified via word cloud analysis included lack of time (n = 101), perceived lack of necessary skills (n = 96), insufficient resources (n = 91), limited technology access (n = 89), and lack of specific protocols (n = 84). Conclusions: Pakistani pharmacists demonstrate high professional willingness to engage in HPr-focused EPS. However, systemic barriers—primarily time constraints and a lack of supportive infrastructure—impede the full integration of these services into routine practice. Policy interventions, standardized protocols, and reimbursement models are necessary to leverage pharmacists’ potential in primary healthcare.

Pharmacy doi: 10.3390/pharmacy14030078

Authors: Stefanie Hehenberger Irene Lagoja

Patients with ileostomy face unique pharmacotherapeutic challenges, including altered drug absorption, yet structured pharmaceutical care for this population is rarely integrated into routine clinical practice. This retrospective monocentric cohort study evaluated the reach, effectiveness, adoption, implementation, and maintenance of a structured ileostomy-specific clinical pharmacy service using the implementation science-based RE-AIM framework at a 1245-bed teaching hospital in Vienna, Austria. Sixty-two patients (54.8% male; median age of 65.5 years) were included, receiving a median of 11 medications. A total of 324 drug-related problems (DRPs) were identified, of which 202 (62.3%) were classified as stoma-specific drug-related problems (SDRPs), representing a predefined subgroup of DRPs associated with ileostomy-related pharmacotherapy challenges. This distinction enabled separate evaluation of the clinical relevance of stoma-specific pharmaceutical interventions. The implementation rate was significantly higher for SDRP-related interventions than for general DRP recommendations (92.0% vs. 63.9%; p < 0.001), with no significant interdepartmental differences observed in either DRPs (p = 0.137) or SDRPs (p = 0.071). Patients with high-output stoma (HOS) had significantly more SDRPs than those without (p < 0.001), while no differences were observed in general DRPs. The service demonstrated wide adoption, high interprofessional acceptance, full protocol fidelity, and continuous implementation over 30 months. The findings provide implementation evidence that may support healthcare decision-makers, hospital administrators, and policy stakeholders in establishing and sustaining structured clinical pharmacy services for ileostomy patients in Austria and similar healthcare settings.

Pharmacy doi: 10.3390/pharmacy14030077

Authors: Derar H. Abdel-Qader Nadia Al Mazrouei Esra’ Taybeh Rana Ibrahim Abdullah Albassam Eman Massad Alia Saleh Sahar Jaradat Shorouq Al-Omoush

Tobacco use remains a major public health challenge in Jordan, where cigarette smoking and waterpipe use are both common and dual use is increasingly prevalent. Community pharmacies are highly accessible healthcare settings, yet structured smoking-cessation services remain underutilized. This study evaluated the clinical effectiveness and implementation of Dual-Quit Digital, a pharmacist-delivered cessation counseling program tailored to the type of tobacco used, paired with a 6-month automated WhatsApp® (Menlo Park, CA, USA) follow-up system. We conducted a pragmatic, two-arm, parallel-group, Hybrid Type 2 cluster randomized controlled trial in 16 community pharmacies in Jordan, randomized 1:1 to intervention or usual care. A total of 320 adult tobacco users were enrolled (160 per arm). The intervention combined a structured in-pharmacy pharmacist consultation, tailored behavioral support, phenotype-stratified pharmacotherapy support, and 6 months of semi-automated WhatsApp® follow-up with telepharmacy escalation for predefined red-flag responses. The control arm received usual care, consisting of opportunistic brief advice and standard over-the-counter sales without proactive follow-up. The primary outcome was biochemically verified continuous abstinence at 6 months, defined as exhaled carbon monoxide (CO) < 10 ppm and analyzed using intention-to-treat principles. Secondary outcomes included 7-day point prevalence abstinence (PPA) at 3 and 6 months, 30-day PPA at 6 months, both-product abstinence among baseline dual users, pharmacotherapy uptake and adherence, and implementation-relevant outcomes, including service reach, feasibility of recruitment, and digital engagement metrics. All 16 pharmacies were retained, and all 320 randomized participants were included in the intention-to-treat analysis. At 6 months, CO-verified continuous abstinence was achieved by 26.3% of participants in the intervention arm compared with 11.3% in the control arm (adjusted odds ratio [aOR] 2.84, 95% CI 1.55–5.18; p < 0.001). The intervention also improved 7-day PPA at 3 months (33.1% vs. 15.6%; aOR 2.68, 95% CI 1.56–4.60; p < 0.001), 7-day PPA at 6 months (30.6% vs. 14.4%; aOR 2.62, 95% CI 1.48–4.62; p = 0.001), and 30-day PPA at 6 months (28.1% vs. 11.9%; aOR 2.89, 95% CI 1.59–5.24; p < 0.001). Among baseline dual users, both-product abstinence was higher in the intervention arm (21.9% vs. 7.8%; aOR 3.30, 95% CI 1.12–9.75; p = 0.026). Pharmacotherapy initiation was more frequent in the intervention arm (72.5% vs. 28.1%; p < 0.001), as was self-reported adherence for at least 8 weeks among initiators (56.0% vs. 26.7%; p = 0.002). In the intervention arm, active patient response rates to scheduled WhatsApp® messages remained substantial, with 88.1% responding at Week 1, 73.8% at Week 4, 67.5% at Month 3, and 61.3% at Month 6; 145 red-flag triggers were captured from 62 participants, and 84.1% of escalations resulted in successful pharmacist follow-up within 48 h. The Dual-Quit Digital model significantly improved smoking-cessation outcomes compared with usual care and proved operationally feasible. These findings support integrating phenotype-stratified pharmacist counselling, pharmacotherapy support, and low-burden digital follow-up as a pragmatic cessation model for Jordan and similar settings.

Pharmacy doi: 10.3390/pharmacy14030076

Authors: Mirey Alfarah Ivy Kan Marie A. Vander Kloet

Preparing pharmacists to serve diverse populations requires a meaningful integration of equity, diversity, inclusion, and accessibility (EDIA) within pharmacy education, yet such integration remains uneven and insufficiently understood. This scoping review aimed to examine how EDIA is addressed across faculty development, curriculum content, and teaching strategies in pharmacy education. Following the guidance of the Joanna Briggs Institute, we searched six databases (Embase, Medline, APA PsycINFO, CINAHL, ERIC, and Web of Science) for studies published between 2014 and 2025. After screening 3031 records, 86 studies met the inclusion criteria. Most studies focused on curriculum (48/86) and teaching strategies (35/86), while very few examined faculty development (3/86). Research was heavily concentrated in the United States of America and relied predominantly on survey-based methods. EDIA topics were often addressed in isolation with a strong emphasis on intercultural communication and limited attention to areas such as disability, migration, and socioeconomic status. Intersectional approaches were rare. Overall, EDIA in pharmacy education appears fragmented and commonly implemented as standalone initiatives rather than integrated across programs. These findings highlight important gaps in faculty development in pharmacy education, methodological diversity, and global representation, and they point to persistent structural gaps and the need to strengthen faculty development initiatives specific to pharmacy education and to move beyond isolated initiatives toward a sustained, program-level integration of EDIA.

Pharmacy doi: 10.3390/pharmacy14030075

Authors: Carmen Abeyaratne Nadine Fawal Kirsten Galbraith

This study aimed to evaluate the suitability of previously validated Entrustable Professional Activities (EPAs) for pharmacists carrying out medication management reviews (MMRs) and further align them with nationally accepted performance outcomes (POs). This was a two-phase study involving Subject-Matter Experts (SMEs). Phase 1 aimed at assessing the relevance of 14 EPAs previously validated for use in a provisionally registered pharmacist training programme to the role of MMR pharmacists utilising a five-point Likert scale. A 70% threshold for “agree” and “strongly agree” was used to qualify an EPA for phase 2. During phase 2, EPAs were mapped for their ability to demonstrate APC performance outcomes for MMRs and the results were descriptively reported. Of the eight SMEs recruited, seven completed both surveys. Of the 14 EPAs, 12 qualified for phase 2. In phase 2, the 12 EPAs were mapped against 24 POs. Five EPAs were matched with 100% agreement to six POs. To our knowledge, this is the first study of its kind to map pre-validated EPAs to POs for credentialing in the scope of MMR pharmacists in Australia. A total of 12 EPAs were applicable to pharmacists working in the MMR space, and five were able to be directly mapped to six POs.

Pharmacy doi: 10.3390/pharmacy14030074

Authors: Lily M. Tews Daniel T. Abazia Hayley Blackburn Kiri Carmody Mary Barna Bridgeman

Heat waves have intensified since the 1960s, leaving older adults uniquely susceptible to heat-related illnesses, including hyperthermia and fluid-electrolyte imbalances. While clinicians recognize that certain medications increase heat vulnerability, the specific interplay between drug use and patient characteristics remains unclear. This scoping review, following the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, investigated the risk of heat-related illness associated with medication use in older adults to identify research gaps. Investigators queried four databases for English-language primary literature (2000–2025) based on predefined Population, Concept, and Context criteria. Additionally, a grey literature search mapped existing United States (U.S.) mitigation strategies. Two reviewers independently screened studies via Covidence, and one extracted data. Results included 61 primary studies and 41 grey literature sources. While epidemiological data confirm higher heat-related morbidity and mortality in older populations, few experimental studies evaluate medication’s specific role. Despite many public health efforts, specific, evidence-based guidance on managing drug-heat interactions is limited. Diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), anticholinergics, and antipsychotics were the medication classes most frequently associated with heat-related illness. This review underscores a critical need for research into the confluence of age, multimorbidity, and polypharmacy to inform future clinical mitigation and protect vulnerable populations.

Pharmacy doi: 10.3390/pharmacy14030073

Authors: Katarina Fehir Šola Slaven Falamić Maja Ortner Hadžiabdić Piotr Merks

Background/Objectives: Pharmacists play an essential role in healthcare delivery across Europe, yet growing professional demands, organisational constraints, and evolving practice models may negatively affect job satisfaction and professional fulfilment. This study aimed to evaluate job satisfaction and professional perception among pharmacists across multiple European countries and to identify sociodemographic and workplace-related factors associated with these outcomes. Methods: A cross-sectional, web-based survey was conducted between October 2023 and January 2024 among licensed pharmacists from 17 European countries. Eligible participants were pharmacists employed in community pharmacies, hospitals, clinical pharmacy services, or the pharmaceutical industry. The questionnaire, developed and administered in English, collected sociodemographic and professional data and included two composite measures: the Job Satisfaction Scale (12 items) and the Pharmacist Professional Perception Scale (6 items). Responses were recorded using 5-point Likert scales. Descriptive statistics and inferential analyses were performed using SPSS version 27.0. Results: A total of 789 pharmacists participated (median age 40 years; 80.1% female). The mean job satisfaction score was 3.26 (SD 0.88), with the lowest scores related to staffing adequacy and salary, and the highest to collegial relationships. The mean professional perception score was 3.08 (SD 0.81), indicating moderate perceived professional recognition. Significant associations were identified between both scales and workplace setting, income level, employment status, geographical region, education, and professional experience (p < 0.05). Conclusions: In this multi-country convenience sample, pharmacists reported moderate levels of job satisfaction and professional perception, with variation across workplace and sociodemographic factors. These findings should be interpreted cautiously, as the sample is not representative of all European pharmacists; however, they suggest that staffing conditions, remuneration, professional recognition, and career development opportunities may be relevant areas for further investigation and policy attention.

Pharmacy doi: 10.3390/pharmacy14030072

Authors: Atanas Toshev Stanislav Gueorguiev Anna Mihaylova Violeta Getova-Kolarova Vasil Madzharov Dimitar Mirchev Elina Petkova-Gueorguieva

The COVID-19 pandemic exposed significant vulnerabilities in the European Union’s health security architecture and highlighted the need for stronger coordination mechanisms for managing cross-border health threats. In response, the European Union established the Health Emergency Preparedness and Response Authority (HERA) as a central body responsible for strengthening preparedness, coordinating procurement, and supporting the development and availability of medical countermeasures. This study examines the potential role of drug repurposing as a strategic tool within the evolving EU health crisis preparedness framework. A narrative literature review and policy analysis were conducted using scientific publications indexed in PubMed and Scopus, as well as institutional and regulatory documents from the European Commission, the European Medicines Agency (EMA), and other relevant organisations. The findings indicate that drug repurposing offers important advantages during health emergencies, including shorter development timelines, lower research costs, and the possibility of leveraging existing manufacturing and regulatory infrastructures. At the same time, several challenges remain, particularly regarding regulatory coordination, intellectual property considerations, and the scalability of pharmaceutical production during periods of increased demand. The analysis suggests that drug repurposing could evolve from an ad hoc response mechanism into a more institutionalised component of EU health crisis preparedness. Integrating repurposing strategies into HERA’s threat prioritisation, regulatory coordination, and industrial preparedness mechanisms may significantly enhance the European Union’s ability to respond rapidly and effectively to future health emergencies.

Pharmacy doi: 10.3390/pharmacy14030071

Authors: Radiana Staynova Daniela Kafalova Evelina Gavazova Katerina Slavcheva Nelina Neycheva Adelina Boyanova Desislava Andonova Hristina Stoynova

Virtual patients (VPs) and artificial intelligence (AI) are being implemented in pharmacy education across various countries in order to learn different techniques to improve communication skills, identify drug-related problems, assess the pharmacist’s role in the self-medication process or assess students’ knowledge acquisition. The objective of this study was to assess the benefits of integrating VPs and AI in pharmacy education, particularly their impact on pharmacy students’ knowledge and skills in self-medication counselling. A literature search was conducted across PubMed, Scopus and Web of Science databases. Studies focused on the integration of VPs and AI tools in pharmacy education and their impact on students’ knowledge, counselling and communication skills related to self-medication, were evaluated. Eligible studies were full-text, peer-reviewed research articles published in English. No restrictions were applied regarding publication year. A total of 857 articles were identified through electronic databases and 9 met the inclusion criteria. Six studies were conducted in the USA and one each in Portugal, Sweden and Indonesia. Most studies employed a pre–post-study design. Six studies utilized VP simulations, while the remaining three implemented AI-based tools. Key outcomes covered in analyzed articles included improvements in knowledge score, communication, and consultation skills, along with positive perceptions, including increased student satisfaction and confidence levels. Using VP simulations and AI tools in pharmacy education could positively impact students by enhancing their knowledge as well as their confidence and counselling skills.

Pharmacy doi: 10.3390/pharmacy14030070

Authors: Tomohiko Tairabune Terutaka Goto Kentaro Yamazaki Kenzo Kudo Ken-Ichi Sako Tomoji Maeda Takeshi Chiba

The use of generic medicines (GEs) is being promoted to reduce healthcare costs. This study aims to evaluate the effect of a pharmacist-led educational intervention on the number of patients switching from brand-name medicines to GEs among patients who preferred brand-name products. Pharmacists provided a standardized explanation using pamphlets about GEs to patients who wished to use brand-name medicines and allocated time to answer questions. Basic knowledge about GEs (nine items) and perceptions of GE use (three items) were assessed before and after the intervention to determine whether changes influenced switching behavior. Between 1 March and 30 July 2025, 40 patients were enrolled in the analysis. Following the intervention, the number of patients using one or more brand-name medicines significantly decreased to 25. Knowledge and perceptions of GEs significantly increased after the intervention and were associated with an increased rate of switching to GEs. Binominal logistic regression analysis identified age ≥ 65 years as a strong factor associated with preference for brand-name medicines (OR, 16.45; 95% CI, 1.48–182.65; p = 0.02). These findings indicate that pharmacist-led educational interventions are effective in promoting GE use among patients who prefer brand-name medicines. In the future, we plan to conduct comparative studies with a control group to further investigate the factors that lead to patients strongly preferring the use of brand-name medicines.

Pharmacy doi: 10.3390/pharmacy14030069

Authors: Daniel Baecker

Teaching organic chemistry is also important for pharmacists to understand the synthesis and mechanism of action of organic drug molecules. Unfortunately, organic chemistry is considered one of the most difficult subjects. This impression affects students’ motivation. To provide students with a learning aid and hopefully boost their motivation, this pilot study tested the integration of 28 elevenies—a special form of short poem—during a semester in an organic chemistry lecture for pharmacists. An anonymous and voluntary questionnaire was conducted at the end of the lecture sessions to assess perceptions of the use of elevenies as a teaching tool. Overall, the student feedback on the implementation of elevenies was positive. In general, students felt (with nearly 94% agreement) that a wider variety of learning methods, such as elevenies, should be incorporated into university teaching. They found elevenies, a type of literature, suitable for summarizing content of organic chemistry, a natural science. The majority (about 65%) stated that they secretly looked forward to the presentation of the elevenies during the lecture, indicating an increase in motivation. In addition, 83% of the respondents wanted to adduce elevenies to repeat and learn the teaching material. However, only about 20% could imagine writing elevenies themselves as part of the learning process. With 94% approval, the respondents gave a clear vote to retain elevenies in future semesters. This suggests the students’ perception of elevenies as an educational tool. Their ease of use could certainly be extended to other subject areas, provided that the topics addressed are not too complex.

Pharmacy doi: 10.3390/pharmacy14030068

Authors: Hanna Keidong Margit Valge Kaja-Triin Laisaar Afonso Miguel das Neves Cavaco Daisy Volmer

Background: Medication adherence is essential for treatment effectiveness and safety, but pharmacy students may find it difficult to assess adherence comprehensively during medication reviews (MRs). This study examined how pharmacy students assess medication adherence in real-world MRs and explored whether complementary adherence frameworks could support broader evaluation. Methods: This observational exploratory study was conducted in the integrated MSc (Master of Science) Pharmacy program at the University of Tartu, Estonia. During the internship, 21 pharmacy students performed a Brown Bag MR with patients aged 65 years or older who used at least 5 prescription medications. Data included patient interviews, e-prescription records, and a validated MR documentation form. An expert panel applied the World Health Organization Medication Adherence Model (WHO-MAM) and the Perceptions and Practicalities Approach (PAPA) to identify adherence determinants not captured by the student-used MR tool. Descriptive statistics and qualitative content analysis were used. Results: Students mainly documented therapy- and patient-related issues, such as incorrect dosing, side effects, and interactions, while socioeconomic and healthcare system factors were rarely identified. Students identified potential adherence-related issues in 19% of cases, whereas experts identified such issues in 57% of cases. Additional gaps included limited recognition of financial barriers, access difficulties, and social support factors. Conclusions: In this exploratory study, pharmacy students identified medication-use-related problems during MRs, but broader adherence-related determinants were less consistently documented. These preliminary findings suggest that structured frameworks such as WHO-MAM and PAPA may be useful for broadening adherence assessment in experiential pharmacy education.

Pharmacy doi: 10.3390/pharmacy14030067

Authors: Jéssica Azevedo Aquino Denise Alves Guimarães Mariana Linhares Pereira Luanna G. Resende Silva João Pedro Vasconcelos Paolinelli André Oliveira Baldoni

Background: The implementation of pharmaceutical care (PC) in Primary Health Care (PHC) faces challenges related to interprofessional integration, management support, and infrastructure, despite its potential to improve patient-centered care. Objectives: To analyze, from the perspective of pharmacists working in PHC, the facilitating factors and barriers to the implementation of PC in the public health system in a post-implementation context. Methods: This is a qualitative, exploratory study, with eight individual semi-structured interviews conducted remotely between December 2024 and February 2025. The interviews were recorded, transcribed, and subjected to thematic content analysis by a trained team, with peer validation. Results: The main facilitators identified were: a solid relationship with the team, participation in continuing education, and a bond with patients. Barriers included a lack of adequate infrastructure, workload, staff turnover, and resistance from the health team. Management support, although frequently cited as a facilitator, did not always translate into concrete actions for service implementation. Even in the face of these barriers, the implementation of PC contributed to strengthening patient-centered care, the clinical protagonism of pharmacists, and improving health outcomes. Conclusions: The analysis highlighted that the sustainability of PC depends on structural and relational conditions that go beyond individual training. The study reveals that, after implementation and continuing education processes, organizational barriers persist that limit the consolidation of PC, highlighting the need for institutional policies and ongoing management support to effectively integrate pharmacists into healthcare.

Pharmacy doi: 10.3390/pharmacy14030066

Authors: Edward Chisholm Ying Zhang Chiranjeev Sanyal

During the COVID-19 pandemic, Health Canada temporarily exempted pharmacists from specific restrictions under the Controlled Drugs and Substances Act (CDSA), allowing them to prescribe opioids. However, it is not yet established whether opioid dispensing patterns differ between urban and rural pharmacists. This study aims to assess the impact of the CDSA subsection 56(1) temporary exemption on opioid prescribing practices among urban and rural pharmacists between 1 February 2018 and 30 April 2022. Descriptive statistics and visualizations assessed differences in opioid prescribing between urban and rural pharmacists under the CDSA exemption. Initial analyses employed linear regression to examine changes, followed by evaluation of temporal dependence using autocorrelation and residual analysis. When appropriate, a suitable time series model was subsequently applied. Following the CDSA exemption, the mean weekly proportion of opioid claims prescribed by urban pharmacists increased from 0.0% to 1.03%. In contrast, rural pharmacists’ prescriptions rose from 0.0% to 0.35%. The estimated mean level change was 0.667% for urban pharmacists (95% CI: 0.520–0.838%, p < 0.0001) and 0.201% for rural pharmacists (95% CI: 0.140–0.291%, p < 0.0001). The study identified distinct differences in opioid prescribing practices between urban and rural pharmacists in Nova Scotia. Furthermore, opioid prescriptions increased steadily across all patient groups, indicating evolving patterns of opioid use within the province.

Pharmacy doi: 10.3390/pharmacy14030065

Authors: Raniah A. Aljaizani Arwa A. Althumairi Khalid A. Alamer Shakil Ahmad

Older adults with type 2 diabetes mellitus (T2DM) are at high risk of polypharmacy and potentially inappropriate medication (PIM) use because of multimorbidity and complex treatment regimens. This systematic review and meta-analysis (PRISMA 2020; PROSPERO CRD420251149348) aimed to estimate the prevalence of polypharmacy and PIM use, describe PIM burden and patterns, and summarize the co-occurrence of PIMs among those with polypharmacy. On 7 September 2025, we searched PubMed, Scopus, Embase, Web of Science, and MEDLINE using a structured search strategy based on the PICO framework. Observational studies of older adults (≥65 years) with T2DM reporting polypharmacy and PIMs were included. Risk of bias was assessed using the JBI checklist, and prevalence estimates were synthesized using a random-effects meta-analysis. Five studies (13,350 participants) were included. Polypharmacy prevalence ranged from 43.6% to 95.3%, while PIM prevalence ranged from 23.4% to 74%. The co-occurrence of PIMs among polypharmacy users ranged from 39.6% to 74%. Commonly reported PIM classes included long-acting sulfonylureas, proton pump inhibitors, and benzodiazepines. Overall, polypharmacy and PIM use were frequently reported among older adults with T2DM; however, the wide variation in prevalence across studies indicates substantial clinical and methodological heterogeneity. These findings highlight the need for structured medication review and clinical context-based medication optimization beyond numerical thresholds.

Pharmacy doi: 10.3390/pharmacy14030064

Authors: Tünde Jurca Andrei-Flavius Radu Gabriela S. Bungau Annamária Pallag Anett Jolán Karetka Octavia Gligor Laura Graţiela Vicaş Florin Bănică Diana Teaha Claudia Costea Nóra Fazekas Zoltán Cserháti Ilie Cirstea Tiberiu Sebastian Nemeth

The digital transformation of healthcare requires stronger digital competencies among pharmacists, yet evidence on the effectiveness of structured training remains scarce. This study examines the impact of a blended digital health training programme delivered to practicing pharmacists in Bihor County, Romania, as part of the Romanian pilot of the EU-funded European Health Professionals’ and the DigitAl team SkillS (H-PASS) project. A single-group pre–post educational design was applied to pharmacists from Bihor County, Romania, participating in a modular digital health training programme delivered between May and July 2025. A total of 84 pharmacists completed both pre-training and post-training self-reported competency assessments comprising 18 items across three modules: digital innovation and change management, communication and collaboration, and data management and digital literacy. Paired samples t-tests, Cohen’s d effect sizes, Cronbach’s alpha, moderator analyses, and ceiling effect analyses were conducted using Python-based statistical workflows. Statistically significant improvements were observed across all three modules (all p < 0.0001), with large effect sizes (d = 1.04–1.30). Post-training internal consistency increased substantially, with overall Cronbach’s alpha reaching 0.74. The greatest item-level gains were recorded in adaptive communication, cultural adaptation of care, and data protection ethics. No significant moderation effects were found for age, gender, or years of experience. Course satisfaction showed a moderate positive correlation with competency gains (r = 0.528), while perceived improvement was not significantly associated with observed score change. A ceiling effect indicated greater gains among participants with lower baseline competencies. The Romanian implementation of the H-PASS training programme was associated with improved self-reported digital health competencies among practicing pharmacists, high-lighting its potential as a scalable model for digital upskilling in healthcare.

Pharmacy doi: 10.3390/pharmacy14030063

Authors: Mar Llamas-Velasco Mercedes Hospital Anna López-Ferrer Pedro Herranz Ricardo Ruíz-Villaverde Almudena Mateu Francisco Javier García-Latasa Raquel Rivera Lourdes Rodriguez Fernández-Freire Elena Del Alcazar Sergio Santos Salvador Arias Alvaro Gónzalez-Cantero Isabel Belinchon Gregorio Carretero Marta Ferran Diana Ruiz-Genao Noemí Eiris Antonio Sahuquillo Javier Mataix Jose-María Carrascosa Pablo de la Cueva Laura Salgado-Boquete

Background: Tildrakizumab, an anti-IL-23p19 monoclonal antibody, has demonstrated efficacy in clinical trials, but real-world evidence remains crucial for confirming its profile in diverse populations. Methods: We have conducted a multicenter, retrospective observational study within the Spanish Psoriasis Group (GPS). This study updates previous findings with a larger sample size (n = 372) and longer follow-up. We assessed absolute Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and the Dermatology Life Quality Index (DLQI) improvements, as well as safety, in patients with moderate-to-severe plaque psoriasis. Results: The cohort included a large population of patients with a high prevalence of comorbidities and prior biologic exposure. Effectiveness was high, with a significant proportion of patients achieving PASI < 1. Compared to recent real-world data, our cohort demonstrates superior complete clearance rates (PASI < 1) and includes a comprehensive DLQI assessment. Notably, 79 patients were aged ≥65 years, confirming the drug’s utility in the elderly. Safety was consistent with previous reports, with no new signals detected. Conclusions: Tildrakizumab shows robust effectiveness and safety in a complex, bio-experienced real-world population. The lack of clinical predictors of response suggests a need for future pharmacogenetic exploration.

Pharmacy doi: 10.3390/pharmacy14020062

Authors: Sandi Ali Adib Husam M. Younes

This study investigates the educational impact of an industrial field visit on the learning experience of second-year pharmacy students at Qatar University. The visit, integrated within the Pharmaceutics II course (PHAR 310), was designed to complement theoretical instruction by providing exposure to real-world pharmaceutical manufacturing and quality control processes, particularly for parenteral dosage forms. A mixed-methods approach was employed using quantitative and qualitative data derived from post-visit questionnaires. Findings indicated that students reported positive perceptions of the experience, with the majority indicating improved understanding of key pharmaceutical manufacturing concepts and strong support for the inclusion of similar activities within the curriculum. Qualitative analysis further suggested that the visit facilitated contextualization of theoretical knowledge, enhanced engagement, and supported early professional awareness. While these findings suggest that structured industrial visits may serve as a valuable complementary educational strategy in pharmacy training, the results should be interpreted with caution due to the small sample size and single-institution design. Further research incorporating larger cohorts, objective learning assessments, and longitudinal evaluation is underway to better establish the educational impact of these interventions.

Pharmacy doi: 10.3390/pharmacy14020061

Authors: Anca Lupu Ștefan Roșca Ancuța Iacob Marius Moroianu Ramona-Oana Roșca

Background: Improper disposal of unused and expired medicines represents an environmental and public health concern. In Romania, Law No. 269/2023 assigned the responsibility for collecting household pharmaceutical waste to public and private hospitals, while operational procedures were further detailed in the Ministry of Health (MoH) Instruction No. 6226/2024. Objectives: This study aimed to assess knowledge, attitudes, and practices (KAP) related to the disposal of unused and expired medicines among the general public and community pharmacy staff during the early phase of implementation of the hospital-based medicine take-back system in Romania. Methods: A cross-sectional survey using convenience sampling was conducted between 1 and 31 August 2023. Two structured questionnaires were administered: one targeting the general public/patients and another addressing community pharmacy staff. Data were analyzed descriptively using frequencies and percentages. Several items allowed multiple responses. Results: Among public respondents (n = 108; predominantly male, 90.7%; urban, 75.0%), household waste disposal was the most frequently reported method (58.3%), followed by pharmacy return (43.5%). Willingness to use a dedicated collection system was very high (96.3%). Among pharmacy staff (n = 71; predominantly female, 78.9%; urban, 74.6%), 40.8% reported no collection activity; where collection occurred, it was typically on demand. Disposal routes included transfer to specialized waste companies (56.3%) and regulated destruction (43.7%). Only 1.4% of pharmacies offered incentives, while 45.4% of the public indicated discounts could motivate returns. Conclusions: Findings indicate an implementation and communication gap during the transition to a hospital-based pharmaceutical waste collection system. Strengthening public communication on official collection points and providing clearer operational guidance may support safer disposal practices.

Pharmacy doi: 10.3390/pharmacy14020060

Authors: Jamila Alessandra Perini Thais da Silva Figueiredo Mayara Calixto da Silva Daniel Escorsim Machado Jéssica Vilarinho Cardoso

The improper disposal of household pharmaceuticals is a global public health concern, posing risks to both human health and the environment and highlighting the need to raise public awareness. This study aimed to identify individual characteristics associated with the inappropriate disposal of household pharmaceuticals and to determine which individuals may require greater awareness. This cross-sectional study included 310 participants who completed an online questionnaire collecting sociodemographic and clinical information, as well as data regarding the participants’ use, storage, and disposal of medications. Most participants were female (74%), single (57%), had a university degree (81%), and were 34 ± 12 years old; 37% had some non-communicable disease (NCD), 85% used some medication, and 62% disposed of pharmaceuticals inappropriately. Having no undergraduate degree (OR = 4.4; 95% CI = 2.01–9.8), an absence of NCDs (OR = 2.5; 95% CI = 1.1–5.6), a lack of knowledge about reverse logistics (OR = 3.6; 95% CI = 1.7–7.6) or environmental risks (OR = 13.5; 95% CI = 1.5–125), and a lack of guidance from healthcare professionals (OR = 3.6; 95% CI = 1.2–10.6) were associated with inappropriate disposal. Although most respondents (88.6%) were aware of the negative environmental impacts of improper disposal, 69.7% did not know what reverse logistics was or where to find collection points (73.5%). These findings highlight the importance of environmental education for the effective implementation of reverse logistics for household pharmaceuticals.

Pharmacy doi: 10.3390/pharmacy14020059

Authors: Ashim Malhotra

While generative AI becomes increasingly available in higher education, faculties find it challenging to design, implement, and evaluate AI-enabled personalized learning systems within accreditation-constrained professional curricula. This method paper describes ADAPT (Assessment-Driven AI for Personalized Tutoring), a home-grown AI tutoring and remediation ecosystem implemented in a required PharmD immunology course. Using standard learning management (Canvas) and assessment (ExamSoft) platforms, a 20-item quiz mapped to six immunology mastery domains (N = 34; mean 69.1%, SD 17.9; Cronbach’s α = 0.73) was used to trigger tiered, structured generative AI remediation at both individual student and cohort levels. Instructional impact was evaluated using reliability indices, item-level difficulty analyses, and paired pre/post-assessment comparisons. Following AI-guided remediation, mean performance increased to 79.8% (+10.7 percentage points), variability decreased (SD 14.4), and assessment reliability improved (ExamSoft KR-20 0.87) compared with the diagnostic exam, the first midterm exam, and the final exam, respectively. Item difficulty stabilized (mean ≈ 0.80), with sustained retention of targeted concepts on the final examination. ADAPT provides a replicable, low-cost methodological blueprint for faculties to independently construct assessment-driven AI tutoring systems and lays the foundational steps for future AI-based predictive analysis workflow for at-risk students.

Pharmacy doi: 10.3390/pharmacy14020058

Authors: Kamila Saramak Manuela Kaml Marina Peball Luisa Delazer Gerald Walser Anna Hussl Iris Unterberger Alexandra Astner-Rohracher

(1) Background: The management of epilepsy during pregnancy requires balancing effective seizure control against potential teratogenic effects of antiseizure medications (ASMs). Data on the safety of lacosamide (LCM), a third-generation ASM, during pregnancy and breastfeeding are limited. (2) Methods: To evaluate the safety and efficacy of LCM during pregnancy and breastfeeding, we report a single-centre case series and provide a comprehensive narrative review of the literature. (3) Results: In total, 22 cases of maternal exposure to LCM throughout pregnancy (1 monotherapy, 21 polytherapy) were identified, resulting in 21 live births (95.5%). Congenital malformations (atrial septal defect) were observed in one offspring exposed to LCM and levetiracetam (4.8%). Twelve newborns were breastfed (57.1%) without neurodevelopmental delay after twelve months. The literature search identified 16 studies, overall reporting data on 627 pregnancies with LCM (236 monotherapy, 391 polytherapy). Among 632 available pregnancy outcomes (3 twin pregnancies and 1 triplet in the polytherapy group) the proportion of live births was 81.3% (514/632). Major congenital malformations were reported in 2.5% (6/236) with LCM monotherapy and 11.9% (47/396) with polytherapy. (4) Conclusions: According to the literature, no major safety concerns, especially in LCM monotherapy, and no specific malformations associated with LCM exposure were identified. Conclusions are limited by the heterogeneity of studies and the small number of monotherapy-exposed cases. Larger, prospective studies with longer follow-up are required.

Pharmacy doi: 10.3390/pharmacy14020057

Authors: Zubin Austin Paul Gregory

Background: As Artificial Intelligence (AI) proliferates in society, community pharmacists must make decisions as to how to responsibly adopt this technology in their practice. Currently, there are few regulatory requirements or tools to support pharmacists in ensuring safe and ethical integration of AI in their work. Methods: An exploratory qualitative study of community pharmacists in Ontario, Canada was undertaken to examine their needs for guidance, regulation, and support in adopting AI in their practice. Results: Semi-structured interviews with 24 community pharmacists were undertaken to the point of thematic saturation. Constant-comparative analysis highlighted three key themes: (a) currently, AI is being used in unstandardized and unregulated ways; (b) pharmacists desire guidance or regulation focused on patient safety considerations; and (c) in the absence of regulation, ad hoc informal decision making is occurring. Conclusions: With or without formal regulation, AI is being adopted in pharmacy practice. Current reliance on informal network support without clear regulatory guidance raises concerns for pharmacists regarding patient safety and their work as professionals.

Pharmacy doi: 10.3390/pharmacy14020056

Authors: Evan Terrier Laura Foucault-Fruchard Nicolas Arlicot Yann Venel Mickaël Bourgeois Serge Maia Anne-Claire Dupont

Radiopharmacy is a specialized area of hospital pharmacy dedicated to the preparation and appropriate use of radiopharmaceuticals for diagnostic imaging and targeted therapies. While clinical pharmacy activities are well established in many hospital settings, their integration into radiopharmacy remains poorly documented and lacks standardization, particularly in the context of the rapid development of theranostic applications. This descriptive, cross-sectional study aimed to assess current clinical pharmacy practices in radiopharmacy across the HUGOPharm network. Between July and September 2025, an anonymous online questionnaire was distributed to radiopharmacy teams, collecting information on prescription analysis, biological monitoring, interdisciplinary collaboration, and other clinical pharmacy activities. Descriptive statistics were used to analyze responses. All participating centers reported verifying patient identity and key prescription parameters; however, substantial variability in practices was observed. Pharmacotherapeutic analysis was more frequently performed for therapeutic procedures (71%) than for diagnostic procedures (57%). Pre-procedure biological testing was common in therapeutic contexts (86%) but infrequent for diagnostic applications (29%). No center reported conducting structured medication reviews or pharmaceutical consultations. The implementation of radioligand therapies, such as [177Lu]-PSMA, was associated with enhanced safety checks and increased interdisciplinary collaboration. Overall, clinical pharmacy in radiopharmacy is developing but remains inconsistently implemented. Structured clinical pharmacy activities appear particularly relevant for theranostic procedures and may represent priorities for future practice development to support patient safety and integrated care.

Pharmacy doi: 10.3390/pharmacy14020054

Authors: Karl M. Hess Peter Lim

Community pharmacies in the United States (US) face an increasingly unsustainable future due to declining third-party reimbursement (remuneration) and ongoing cash flow challenges following the elimination of retroactive direct and indirect remuneration (DIR) fees. These pressures have contributed to widespread pharmacy closures, the emergence of pharmacy deserts, and reduced access to care for millions of patients. Despite these challenges, community pharmacy remains the most common employment setting for pharmacy school graduates in the US. However, currently required community pharmacy Advanced Pharmacy Practice Experience (APPE) student rotations may offer limited exposure to business, management, and entrepreneurial activities, potentially leaving students underprepared for practice in this setting. US colleges and schools of pharmacy are uniquely positioned to address this gap by partnering with their community pharmacy APPE rotation sites to intentionally integrate business- and practice-focused knowledge, skills, and attitudes (KSAs) into the APPE. Equipping students with these KSAs may enhance early career readiness while also supporting the financial sustainability of US community pharmacies through the development of innovative, revenue-generating services. These efforts further align with the 2025 Accreditation Council for Pharmacy Education (ACPE) Standards and may help advance the profession. Future research should examine optimal community pharmacy APPE structures, models, and assessment strategies to maximize student preparedness and long-term community pharmacy sustainability.

Pharmacy doi: 10.3390/pharmacy14020055

Authors: Carlos Eduardo Estrada-De La Rosa Felipe Alexis Avalos-Salgado Nancy Evelyn Navarro-Ruiz Erika Fabiola López-Villalobos Roberto de Jesús Sandoval-Muñiz Monserratt Abud-González María Luisa Muñoz-Almaguer Raymundo Escutia-Gutiérrez

Background/Objectives: Gabapentinoids are first-line treatments for neuropathic pain (NP); however, real-world evidence regarding their safety and effectiveness in complex clinical populations remains limited. This study aimed to evaluate the effectiveness and safety profile of gabapentinoid therapy in patients managed within a specialized pain relief institution. Methods: A retrospective cohort study (n = 109) was conducted (January 2024 to December 2024). Effectiveness was assessed via DN4 and VAS over one year. Time to improvement was analyzed using Kaplan–Meier curves. Results: The cohort (mean age 66.2 ± 15.3 years) presented 100% comorbidity and polypharmacy (66.1% opioids; 67.9% antidepressants). Although all patients showed improvement, only 35.8% achieved “maximal improvement.” Pregabalin demonstrated faster VAS reduction than gabapentin (p = 0.029), though long-term success was comparable (p = 0.30). Significantly, 100% of patients reported at least one adverse drug event (ADE), primarily somnolence (66.1%), though no serious ADEs occurred. Lower baseline pain scores were significant predictors of therapeutic success. Conclusions: Gabapentinoids are effective for long-term NP management; however, their use is consistently associated with non-serious ADEs. In specialized settings characterized by extensive CNS-active polypharmacy, proactive pharmacovigilance and multidisciplinary oversight are essential to balance analgesic effectiveness with medication safety.

Pharmacy doi: 10.3390/pharmacy14020053

Authors: George E. MacKinnon Megan Mills Ulrich Broeckel

(1) Background: This follow-up retrospective analysis used electronic medical record (EMR) data from a health system to identify patients and medications prescribed in accordance with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: This analysis included EMR data from a clinical research data warehouse encompassing 928,291 patients seen at an academic medical center between 2020 and 2024. The study evaluated 75 commercially available medications linked to 52 evidence-based CPIC pharmacogenomic (PGx) guidelines. (3) Results: Of the 928,291 patient encounters, 709,673 medication orders were recorded, with 416,621 patients (44.8%) prescribed at least 1 of the 75 CPIC-associated medications. This compares with 845,518 patients who had an encounter in 2015–2019 with 590,526 medication orders, and 335,849 (56.9%) patients had medication orders represented by CPIC-associated medications. One to three CPIC-associated medications accounted for 76.6% of patients in 2020–2024 compared to 75.6% in 2015–2019. (4) Conclusions: The findings demonstrate that the proportion of patients prescribed a CPIC-actionable medication remained just under half of those evaluated within a single institution’s EMR. About three-quarters of patients over the ten-year period had between one to three CPIC-associated medications identified, and the top five classes of medications remained the same in the two periods. This understanding of patient volume may help organizations as they begin to assess the implementation of PGx services.

Pharmacy doi: 10.3390/pharmacy14020052

Authors: Anna Todorova Dijana Miceva Mariya Ivanova Tanya Kazakova Bistra Angelovska

National legislative frameworks governing prescribing, pricing, reimbursement, and dispensing play a decisive role in shaping access to medicines. This study examines the financial availability of medicines in Bulgaria and North Macedonia through a comparative review of national pharmaceutical legislation, pricing mechanisms, reimbursement models, and digitalisation policies, assessed in relation to European Union standards. The findings indicate that access to medicines in both countries is shaped by the combined effects of multiple regulatory and financial instruments rather than by individual policy measures. Both systems apply strict control of prescribing and dispensing, external reference pricing, and positive reimbursement lists, reflecting alignment with international recommendations. However, significant differences in policy design lead to divergent access outcomes. Bulgaria’s more advanced digitalisation of prescribing and reimbursement, including mandatory electronic prescribing for selected therapeutic groups, enhances regulatory oversight and expenditure control but is associated with higher patient out-of-pocket expenditure, partly due to the application of the standard value-added tax on medicines. In contrast, North Macedonia combines lower taxation with capped patient co-payments, higher regulated pharmacy margins, and fixed pharmacy remuneration per prescription, contributing to improved financial affordability for patients while supporting pharmacy sustainability. Additional instruments, such as the Generics without Co-Payment List, further strengthen patient financial protection. The study provides comparative evidence relevant to pharmaceutical policy reforms and highlights the importance of balanced regulatory approaches that promote affordability, system sustainability, and equitable access to medicines.

Pharmacy doi: 10.3390/pharmacy14020051

Authors: Hiroyuki Ura Noriko Matsuoka

Preconception care is globally recognized as essential for optimizing pregnancy outcomes; however, in Japan, comprehensive data on medication-related potential exposure to pregnancy-contraindicated medications among women of reproductive age remain limited. We conducted a retrospective cross-sectional descriptive study using data from Japan’s National Database of Health Insurance Claims (fiscal year 2022) to assess the potential exposure to pregnancy-contraindicated medications among women of reproductive age. Outpatient prescriptions for oral medications dispensed to women aged 15–49 years were analyzed. In total, 270 medications classified as contraindicated during pregnancy were identified, of which 75 were also contraindicated for women planning pregnancy. Of these, 58 active ingredients were restricted in both phases. Notably, 212 medications were uniquely contraindicated during pregnancy, highlighting the broader contraindication profiles during fetal development than during the preconception period. Despite these contraindications, high prescription volumes were observed for medications such as loxoprofen sodium hydrate, sodium valproate, and metformin hydrochloride among women of reproductive age. These findings illustrate a high baseline utilization of pregnancy-contraindicated medications among women of reproductive age. As most women in this demographic are neither pregnant nor actively planning conception, these volumes primarily reflect standard care rather than inappropriate prescribing. In conclusion, pharmacists serve as an important supplementary safety net by routinely confirming pregnancy status to prevent inadvertent exposure.

Pharmacy doi: 10.3390/pharmacy14020050

Authors: Omolayo Tinuke Umaru Adebowale Sylvester Adeyemi Olajumoke Aderonmu Balyodh Singh Bhangu Harjot Singh Dhaliwal Hae Lim Taiwo Opeyemi Aremu

Pharmaceutical regulation plays a central role in protecting public health by governing clinical trials, market authorization, and post-marketing safety monitoring throughout the medicine life cycle. While substantial literature describes established systems, particularly the United States Food and Drug Administration (FDA), Japan’s Pharmaceuticals and Medical Devices Agency (PMDA), and the European medicines regulatory network coordinated by the European Medicines Agency (EMA) together with national competent authorities, comparative analyses that integrate both mature authorities, emerging regulators and transnational harmonization networks remain limited. This narrative review draws on primary regulator/network documentation and targeted peer-reviewed literature to compare core regulatory functions across jurisdictions, including approval pathways and evidentiary expectations, inspection and good manufacturing practice (GMP) oversight, transparency practices, and pharmacovigilance and risk-management approaches. Across regions, we observe increasing convergence in scientific expectations through initiatives such as the International Council for Harmonisation (ICH) and reliance and work-sharing models, alongside persistent differences in legal mandates, resourcing, timelines, and data requirements. These differences are most consequential for complex products (e.g., advanced therapies) and in crisis settings, where emergency or conditional authorizations amplify the need for strong lifecycle monitoring, real-world evidence governance, and cross-border communication. We conclude by outlining opportunities to strengthen regulatory resilience and equity through fit-for-purpose harmonization, investment in enabling infrastructure, and future work on interoperable data systems, signal detection, and coordinated post-marketing evaluation.

Pharmacy doi: 10.3390/pharmacy14020049

Authors: Joel Gené Grasa Natalia Sanz López Marta Docio Alfaya Verónica Mate García Alicia Serrano García-Calvo Adrián Plaza Díaz Jesús Ruiz Ramos

Background: Hyponatremia is one of the most common electrolyte disturbances in emergency departments. This study aimed to describe the characteristics of patients presenting with drug-induced hyponatremia and analyse factors associated with 30-day revisits. Methods: Retrospective observational study including adult patients who attended the emergency department for drug-induced hyponatremia between 2020 and 2024. Results: 141 patients were analysed (mean age 80.5 years; 78% women). Thiazide diuretics were the most frequently implicated pharmacological class (50.3%). In univariable analyses, polypharmacy, dementia, and treatment changes at discharge were associated with a higher risk of revisit for hyponatremia. In the multivariable model, only polypharmacy remained significantly associated with 30-day revisits. Conclusions: Thiazide diuretics were the leading drug-related cause of hyponatremia in the emergency setting. Polypharmacy was identified as an independent factor associated with increased revisit risk, underscoring the need for systematic medication review and close clinical follow-up after hospital discharge.

Pharmacy doi: 10.3390/pharmacy14020048

Authors: Maura Kreiser Sarah Al Mansi Ismaeel Yunusa Caroline Derrick P. Brandon Bookstaver Majdi N. Al-Hasan Yorika Hammett Morgan Pizzuti

Well-designed randomized controlled trials (RCTs) have demonstrated safe and effective use of oral antimicrobial therapy for bone and joint infections. Application of data for implementation into real-world practice, however, has inherent challenges. This retrospective cohort study compared real-world use of intravenous versus oral antimicrobial therapy in bone and joint infections within a large healthcare system comprising both academic and community medical centers. The primary outcome was the proportion of treatment failure. Key secondary outcomes included the proportion of patients with logistical failure and risk factors associated with treatment and logistical failure. Among 166 patients included, 136 (82%) and 30 (18%) received predominantly intravenous and oral antimicrobial therapy, respectively. Treatment failure occurred in (77/121) 64% versus (18/25) 72% of patients in the intravenous and oral antimicrobial groups (p = 0.491; OR, 1.38; 95% CI, 0.56–3.33). Logistical failure occurred in 29% versus 47% of patients in the intravenous and oral antimicrobial groups (p = 0.150; OR, 1.93; 95% CI 0.79–4.70). Risk factors for treatment failure included peripheral vascular disease (OR, 2.61; 95% CI 1.02–7.80) and higher Charlson Comorbidity Index scores (OR, 1.18; 95% CI 1.04–1.36). Similar to previously published RCTs, treatment failure appeared comparable between groups; however, oral antimicrobial therapy was overall underutilized.

Pharmacy doi: 10.3390/pharmacy14020047

Authors: Desislava Stanimirova Guenka Petrova Zornitsa Mitkova

This systematic integrative review evaluates the effectiveness of SGLT2 inhibitors in relation to improving glycaemic control, reducing cardiovascular events, and preserving renal function based on the latest published evidence. Search for publications referenced in PubMed, from January 2020 to January 2025, was conducted; 48 abstracts were reviewed, and 27 full-text articles were included for analysis—systematic reviews, meta-analyses, narrative reviews and comparative effectiveness studies. SGLT2 inhibitors are effective in reducing glucose levels, but the magnitude of reduction varies compared to other classes of antidiabetics. A noticeable reduction in the risk of major cardiovascular events, cardiovascular and all-cause mortality was reported, particularly compared to DPP-4 inhibitors and placebo. SGLT2 inhibitors demonstrated the most pronounced and consistent benefits in reducing hospitalisation for heart failure among all other evaluated classes. However, outcomes like myocardial infarction and stroke results were inconsistent. Renal outcomes consistently favoured SGLT2 inhibitors in reducing the risk of acute kidney injury, slowing chronic kidney disease and lowering the risk of end-stage kidney disease. SGLT2 inhibitors provide consistent glucose-lowering, cardiovascular and renal benefits. However, heterogeneity in study designs, patient populations, and treatment durations does not allow drawing definitive conclusions and highlights the need for future research focused on conducting well-designed trials with standardised methodology.

Pharmacy doi: 10.3390/pharmacy14020046

Authors: Doris Cardona Valeria Santacruz-Restrepo Juliana Madrigal-Cadavid Alejandra Rendón-Montoya Angela Segura-Cardona Jorge Iván Estrada-Acevedo Marcela Agudelo-Botero

Background: Limitations in timely and equitable access to essential medicines among older adults not only constitute a clinical barrier to the effective management of chronic conditions, but also represent a violation of the fundamental right to life, health and the principles of dignity, equality and non-discrimination that safeguard this population within the framework of human rights. Objective: To examine access to essential medicines for older adults with high-cost chronic conditions as a constitutive dimension of the fundamental rights to health, life and human dignity, in accordance with international human rights standards. Design: A literature review was conducted of articles published between 2020 and March 2025 in five databases, using the search terms: “pharmacological treatment,” “access to health,” “chronic diseases,” and “barriers to access.” After evaluating the inclusion criteria (language and year) and exclusion criteria (case studies), 12 articles were selected. A narrative synthesis was performed on the following aspects: application of the principles of the right to health, barriers to access, and rights violated or at risk. Results: The expansion of health coverage faces several barriers that violate fundamental principles of the right to health: equity, accessibility to medical advances, and long-term, quality, and specialized services, thus limiting autonomy. In conclusion, guaranteeing access to pharmacological treatments in old age will contribute to building more just and humane societies through public policies on coverage and pharmaceutical education, the simplification of treatment regimens, and the implementation of programs that allow people to age with dignity, considering health a human right based on equality and non-discrimination, participation and transparency.

Pharmacy doi: 10.3390/pharmacy14020045

Authors: Kerry K. Fierke Gardner A. Lepp Alina Cernasev

(1) Background: In response to the educational challenges brought on by the COVID-19 pandemic, APPE preceptors implemented the Intention/Reflection (I/R) practice as a structured engagement tool. I/R is designed to promote engagement, motivation, metacognitive growth, and self-awareness among student pharmacists with the goal of enhancing learning experiences in diverse APPE settings. This project aimed to assess the impact of I/R strategies on student pharmacist engagement during APPEs in the post-pandemic landscape, with the overarching goal of identifying and advancing best practices in experiential pharmacy education. (2) Methods: This retrospective qualitative study included 20 student pharmacists from two U.S. colleges who participated in APPE elective rotations featuring I/R activities. Student pharmacists’ responses to five structured I/R prompts were collected and thematically analyzed by two independent researchers using qualitative data analysis software. (3) Results: Four themes were identified in the I/R responses: two themes each from the intention and reflection responses. The intention themes “Embracing Discomfort as a Catalyst for Confidence, Engagement, and Leadership Growth” and “Purposeful Precision: Growing into Adaptive Leadership” both illustrate the students’ journeys as they develop greater confidence and resilience in overcoming challenges. The reflection themes “Reflection as a Catalyst for Professional Learning and Engagement” and “Reflection as a Tool for Focused Growth and Self-Awareness” synthesized the evolution of the student pharmacist and forward thinking for future career. (4) Conclusion: Overall, participants perceived the I/R practice as transformative, citing benefits such as sustained learning, increased confidence, and continued professional development. These findings suggest that integrating I/R into experiential pharmacy education can significantly enhance student engagement and contribute to best practices for post-pandemic pharmacy training.

Pharmacy doi: 10.3390/pharmacy14020044

Authors: Ayman Allahham Seerat Fatima Ieva Stupans Thilini Thrimawithana Vivek B. Nooney

Dysphagia is common among older adults and frequently necessitates the use of thickening agents to facilitate safe swallowing of medicines, which may in turn alter their bioavailability. This study investigated the impact of two commercially available lubricants—Gloup® Forte and extremely thick water—on the in vitro dissolution behaviour of immediate-release gliclazide tablets. Dissolution studies were conducted using crushed and whole tablets in different media consisting of reverse osmosis water, phosphate buffer (pH 6.8), and 0.1 N HCl at 37 °C. Dissolution profiles were compared using similarity factor (f2) analysis and modelled using established kinetic equations. Gliclazide dissolution was significantly delayed in the presence of Gloup® Forte across all media for both crushed and whole tablets, with f2 values below 50, indicating dissimilar profiles. Dissolution kinetics confirmed that mixing the formulated gliclazide with Gloup® Forte delayed the release and reduced the dissolution rate constant for drug from both crushed and whole gliclazide tablets in media studied.

Pharmacy doi: 10.3390/pharmacy14020043

Authors: Brechje van den Boogaard Maria van de Lavoir Rani Robeyns Celine Gys Adrian Covaci Hans De Loof

Background: The issue of beta blocker poisoning has received little attention, despite the widespread use of these compounds in cardiac and neuropsychiatric care. Safety profiles differ, and some beta blockers appear in poisonings far beyond what their usage rates imply. This study characterizes beta blocker intoxication patterns in Belgium, focusing on propranolol, by integrating national prescription data, poisoning reports, and adverse drug reaction records. Methods: Belgian prescription data, poison centre reports, and European ADR databases were analysed to identify intoxication patterns and demographic or clinical characteristics associated with these events. Results: Poisoning data revealed propranolol as markedly overrepresented compared to prescription rates and was the primary beta blocker implicated in self-harm-related overdoses. These cases occurred mainly in women, younger individuals, and patients with psychiatric or cardiovascular comorbidities. Co-exposures with benzodiazepines, antidepressants, and other psychoactive agents were frequent, and propranolol was linked to more complex intoxication patterns than other beta blockers. Conclusions: Propranolol shows a distinct toxicological profile and is disproportionately involved in intoxications, especially in vulnerable groups and in combination with psychoactive drugs. These findings highlight the need for greater awareness, targeted prevention, and careful monitoring.

Pharmacy doi: 10.3390/pharmacy14020042

Authors: Alejandra E. Hernández-Rangel Gustavo A. Hernández-Fuentes Iván Delgado-Enciso Hortensia Parra-Delgado Jesús E. Castrejón-Antonio Héctor R. Galván-Salazar Alicia Olvera-Montejano José Guzmán-Esquivel Fabian Rojas-Larios Josuel Delgado-Enciso César G. Silva-Vázquez Uriel Díaz-Llerenas Juan M. Sánchez-Galindo Mario A. Alcalá-Pérez Daniel A. Montes-Galindo

Background/Objectives: Improper medication use, premature treatment discontinuation, and inadequate disposal contribute to irrational drug consumption and environmental contamination. Although pharmaceutical take-back programs have expanded globally, real-world evidence on household medication accumulation in academic and community settings remains limited. This study aimed to describe longitudinal patterns of medication collection during an eleven-year university-based take-back campaign, with detailed pharmacological characterization available for selected post-pandemic years. Methods: Real-world data were analyzed from a sustainable medication take-back campaign conducted annually at the University of Colima between 2015 and 2025. Expired or unused medications were voluntarily returned by students and community members. Total collected weight was recorded for all years, while detailed classification by dosage form, Anatomical Therapeutic Chemical (ATC) group, and Mexican regulatory fraction (Fractions II, IV, V, and VI) was performed for years with complete records (2023–2025). All materials were disposed of through an authorized hazardous-waste company in compliance with NOM-052-SEMARNAT-2005. Descriptive analyses were performed using SPSS version 29.0. Results: Approximately 3.9 tons of pharmaceutical products were collected over eleven years, reflecting persistent household accumulation of unused or expired medicines. In the years with detailed analysis, oral solid dosage forms predominated. In 2025, ATC groups M, A, and C were most frequently returned, consistent with medications used for chronic conditions. Therapeutic composition varied annually, with NSAIDs/analgesics predominating in 2023–2024 and antibiotics in 2025. Across analyzed years, 5–7% of collected items corresponded to non-medication products. Conclusions: This long-term campaign provides valuable real-world evidence on medication non-use and disposal, highlighting ongoing challenges in rational medicine use, treatment continuity, and environmentally responsible pharmaceutical waste management.

Pharmacy doi: 10.3390/pharmacy14020041

Authors: Jessica Pace Andrew Bartlett Tiffany Iu Jonathan Penm

(1) Background: Simulation is an effective way to develop practical pharmacy skills; combining simulation and self-reflection can increase impacts on learning. While existing literature highlights the benefits of reflection in developing self-awareness, critical thinking, and professional skills, there are few specific insights into how reflective practices enhance learning in patient counselling role-plays. This study aimed to explore pharmacy students’ perceptions of self-reflection and peer and educator feedback on the development of patient counselling skills. (2) Methods: Thematic analysis of student reflections on learning in patient counselling activities. Responses to four structured self-reflection prompts were collected and analyzed thematically. (3) Results: Reflections from 201 students were analyzed. We identified four themes and ten associated subthemes: impact of peer feedback (subthemes supportive peer dynamics and developing a personal counselling style through peer practice); impact of self-reflection and assessment (subthemes goal setting through self-reflection and video review as a tool for skill refinement); impact of educator feedback (subthemes feedback variation in learning growth and addressing self-doubt); and professional identity (subthemes value pharmacists can bring, struggles in real-life practice, incorporating feedback to working opportunities, and reinforcing skills to self-reflect in future practice). (4) Conclusions: Integrating consistent, high-quality feedback from educators and peers with self-reflection in patient counselling activities is perceived as valuable to enhancing enhances students’ learning experiences and preparing them for professional practice.

Pharmacy doi: 10.3390/pharmacy14020040

Authors: Stephanie W. K. Teoh Tamara Lebedevs Geena Dickson Marcus Femia Nabeelah Mukadam

(1) Background: Medication-related problems (MRPs) are a significant burden on health care systems. Pharmacists play an important role in preventing and reducing MRPs through clinical review, education, and policy governance. This study analyzed pharmacist interventions within a 92-bed neonatal clinical care unit to better understand MRPs and guide targeted medication safety initiatives. (2) Methods: All pharmacist interventions documented in REDCap® between 1 July 2022 and 30 June 2025 were analyzed identifying MRP incidence, types, and acceptability following interventions. (3) Results: A total of 873 pharmacist interventions were recorded during the study period. The most common MRPs were related to dosing errors (320/873, 36.7%), compliance with hospital policy (152/873, 17.4%), no indication apparent (106/873, 12.1%), drug interactions (66/873, 7.6%), and inadequate laboratory monitoring (40/873, 4.6%). Of these, 545/873, 62.4% were accepted by prescribers, while 228/873, 26.1% had unknown outcomes at the time of data entry. 343/873, 39.3% of interventions documented were from the Neonatal Intensive Care Unit, involving medications such as gentamicin (n = 46/343, 13.4%), benzylpenicillin (n = 37/343, 10.8%), caffeine (n = 34/343, 9.9%), parenteral nutrition (n = 23/343, 6.7%), and morphine (n = 16/343, 4.7%) and meropenem (n = 16/343, 4.7%)). (4) Conclusions: Regular analysis of pharmacist interventions provides valuable insights into local MRP trends and highlights opportunities for quality improvement and education.

Pharmacy doi: 10.3390/pharmacy14020039

Authors: Dušan Vukmirović Dušanka Krajnović Marina Odalović

Diabetes mellitus is a growing global health challenge, and digital health technologies offer new opportunities to support self-management. Mobile applications can benefit both patients and healthcare professionals; however, awareness and integration of these tools into community pharmacy practice remain limited. As accessible frontline providers, pharmacists are well positioned to promote digital health, yet their readiness and engagement require further investigation. A cross-sectional survey was conducted among community pharmacists in Serbia using a structured questionnaire. Developed through a consensus-based process, the instrument assessed pharmacists’ awareness, attitudes, and experiences with digital health technologies, focusing on mobile applications for diabetes self-management. Only 15.8% of pharmacists were aware of such applications, and 2.4% reported receiving relevant training. Higher digital health technology literacy was associated with greater awareness, confidence, and preference for digital learning. Most participants supported expanding pharmacists’ roles in advising patients on digital tools and expressed interest in structured education and official guidance. These findings indicate limited awareness and training in mobile health applications among community pharmacists. Enhancing digital competencies through targeted education and structured guidance may facilitate greater integration of digital tools into routine pharmacy practice and strengthen pharmacists’ roles in chronic disease management.

Pharmacy doi: 10.3390/pharmacy14020038

Authors: Sepideh Sharif Carla Dillon Shane Scahill Carlo Marra

Introduction: This repeated cross-sectional study examined community pharmacies in Aotearoa New Zealand and the services they provide, including retail, dispensing, and expanded scope services (e.g., minor ailment management). Methods: Two cross-sectional surveys were conducted in 2021 (n = 504) and 2023 (n = 1000). Both assessed demographics, service use, and perceptions of pharmacists. The 2021 survey focused on trust, approachability, and role awareness, while the 2023 survey added willingness to pay, telehealth use, and comparisons with other health professionals. Best–Worst Scaling and logistic regression quantified and compared preferences. Results: Prescription filling remained the most preferred service, while beauty product sales were least preferred. Preference for vaccination declined, indicating post-pandemic shifts in preventive care. Trust in pharmacists remained high, with strong comfort discussing health needs. Awareness of pharmacist roles improved slightly, though cost barriers persisted. Conclusions: Consumer priorities for prescription services remained stable, while interest in vaccination declined. The low preference for non-clinical retail activities suggests pharmacies should focus on health services. The high trust in pharmacists supports expanded clinical roles, but targeted policies and funding are needed to reduce cost barriers and enhance equitable access to primary healthcare.

Pharmacy doi: 10.3390/pharmacy14010037

Authors: Ashim Malhotra

As pharmacy career pathways diversify, professional doctoral programs such as PharmD face increasing pressure to demonstrate measurable workforce readiness outcomes within accreditation-constrained curricula. This study describes and evaluates PharmReaDy, a longitudinal, theory-informed workforce readiness platform embedded within a U.S. PharmD program. Guided by Tinto’s student retention framework, the platform integrates curricular, co-curricular, and experiential elements, including an industry-focused elective course, national professional competitions, targeted skills workshops, micro-credentialing opportunities, and experiential placements. Outcomes were assessed using enrollment trends, aggregate course evaluation data, academic performance indicators, and downstream participation in industry-aligned opportunities. Enrollment in the elective increased from 8 to 20 to 30 students across three offerings. Mean course evaluation scores across seven learning domains remained consistently high, ranging from 3.7 to 3.9 on a 4-point scale, with no statistically significant differences between cohorts (Welch’s t-tests, adjusted p > 0.05) and small positive effect sizes observed over time (Hedges’ g ≈ 0.20–0.29). Students demonstrated strong academic performance and increased participation in industry-focused competitions, scholarships, and post-graduate fellowship pathways. Findings from PharmReaDy indicate that workforce readiness can be meaningfully operationalized as a structured educational function embedded within professional curricula rather than being exclusively deferred to post-graduate training.

Pharmacy doi: 10.3390/pharmacy14010036

Authors: Marius Calin Chereches Mihaela Simona Naidin Alexandra Grosan Radu Antoniu Patrascu Anca-Maria Capraru Marina Daniela Dimulescu Adina Turcu-Stiolica

Although pharmacist-led vaccination is a global standard for expanding immunization coverage, its adoption in Romania remains at an early stage. While previous studies have focused on early adopters, this research evaluates barriers, perceptions, and readiness among community pharmacies that do not yet provide this service, thereby addressing a critical knowledge gap regarding the “non-vaccinating” majority. A cross-sectional mixed-methods study was conducted among 208 pharmacists representing national chains, regional networks, and independent pharmacies. Quantitative data were analyzed using Chi-square tests and Spearman correlations to identify structural disparities, while a thematic analysis was employed to explore qualitative insights related to professional identity and operational barriers. We identified a clear mismatch between pharmacies’ willingness to provide vaccination services and their practical ability to implement them. Independent pharmacies demonstrated a strong intention to adopt vaccination services (71.4%) but were limited by financial constraints, with high implementation costs identified as a significant barrier (p = 0.014). In contrast, national pharmacy chains had sufficient resources yet faced marked staff resistance, with 43.9% reporting extreme reluctance (p = 0.038). These chains were concentrated in the capital region (p = 0.002), thereby positioning other pharmacies as key providers in underserved areas. Furthermore, thematic analysis revealed a deep-seated “professional identity” crisis, in which pharmacists struggle with the transition from medication specialists to clinical practitioners. The expansion of vaccination services cannot rely on a “one-size-fits-all” strategy. Successful national implementation requires a segmented policy approach, including financial subsidies to support independent pharmacies, change management strategies to engage the corporate workforce, and targeted regulatory education for regional networks to prevent vaccination deserts.

Pharmacy doi: 10.3390/pharmacy14010035

Authors: Petya Milushewa Nataliya Chenesheva Valentina Petkova

Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease requiring effective pharmacological treatment, sustained self-management, and patient education. Pharmacists are increasingly recognized as key contributors to diabetes care; however, their role remains underutilized in Bulgaria. This study aimed to assess self-management behaviors, medication adherence, patient awareness, and the perceived role of pharmacists among patients with T2DM in Bulgarian primary care. Methods: A cross-sectional observational study was conducted among 105 patients with T2DM using an anonymous questionnaire based on the Diabetes Self-Management Questionnaire and supplementary items adapted to the local healthcare context. Data were analyzed using descriptive statistics and non-parametric tests to explore associations between demographic characteristics, treatment patterns, self-management behaviors, and educational needs. Results: Most patients were treated with oral antidiabetic therapy (90.0%), predominantly metformin-based regimens (64.0%). Adherence to prescribed pharmacological treatment was high (93.0%), while adherence to dietary recommendations (70.0%), regular physical activity (60.0%), and blood glucose self-monitoring (63.0%) was less consistent. Although 92.0% of participants reported good or excellent disease awareness, 41.0% expressed a need for additional education, particularly regarding confidence in managing hypoglycemia and the use of digital monitoring tools. More than half of respondents (54.0%) had received diabetes-related information from a pharmacist; however, only 38.0% expressed willingness to participate in pharmacist-led education, while 34.0% were undecided. Female sex was associated with a higher prevalence of comorbidities (p = 0.010), while increasing age was associated with reduced metformin use (p = 0.004). Conclusions: Despite good pharmacological adherence and self-reported awareness, gaps remain in lifestyle-related self-management and patient education. The findings support an expanded role for pharmacists in diabetes care, particularly through structured educational and counseling interventions to enhance self-management and complement physician-led treatment.

Pharmacy doi: 10.3390/pharmacy14010034

Authors: Ashim Malhotra

Critical thinking is emphasized across ACPE Standards 2025, the Pharmacist Patient Care Process, interprofessional education (IPE) frameworks, and licensure preparation (NAPLEX). Despite this, pharmacy education lacks a practical, theory-grounded framework that operationalizes critical thinking as an observable, assessable reasoning process, particularly in team-based and interprofessional contexts. We developed the AIM (Analyze–Interpret–Manage) framework by integrating the Delphi Consensus definition of critical thinking with the AAC&U VALUE framework, translating foundational theory into a concise, measurable, stage-based model applicable to both individual and collective cognition. AIM was tested using qualitative analysis of transcripts of student team discursive narratives of an assigned IPE scenario. Reasoning behaviors were coded by AIM stage and mapped to the 2016 IPEC Core Competencies and the 2025 NAPLEX competencies to ensure professional relevance and external validity. AIM reliably distinguished discrete stages of critical thinking across teams, revealing consistent patterns in how learners analyzed information, interpreted clinical and ethical significance, and managed decisions collaboratively. Mapping demonstrated strong alignment between AIM stages and IPEC and NAPLEX competencies. Our novel AIM framework offers a scalable approach for defining, teaching, and assessing team-based critical thinking in pharmacy education. By operationalizing critical thinking as a staged reasoning process aligned with professional standards, AIM fills a critical gap between educational theory, interprofessional practice, and licensure preparation.

Pharmacy doi: 10.3390/pharmacy14010033

Authors: Parker Kaleo Natt Patimavirujh Kristen Greene Nicholas Piccicacco Melissa O’Neal

Penicillin (PCN) allergies are frequently reported despite a true prevalence of less than 1%, leading to unnecessary avoidance of beta-lactams, broader antimicrobial use, and increased healthcare costs. Pharmacist-driven de-labeling programs offer a strategy to improve antimicrobial stewardship. This single-center, retrospective study evaluated hospitalized adults with a documented PCN allergy and screened by the pharmacist-driven penicillin allergy de-labeling service (PADLS) between 16 January and 26 June 2025. Patients were categorized into a screened cohort and a Full Allergy Reconciliation (FAR) cohort if interviewed using PEN-FAST. Eligible patients underwent direct oral challenge (DOC), penicillin skin testing (PST) plus DOC, or direct de-labeling based on PEN-FAST scoring. Sixty-three patients were screened, and 32 (50.8%) underwent full reconciliation. Among FAR patients, the median PEN-FAST score was 0, and 25 (78.1%) underwent DOC. De-labeling was successful in 28 FAR patients (87.5%). One patient (4%) experienced a mild reaction. Allergy field updates occurred in 69.8% of screened and 96.9% of FAR patients. Antibiotic optimization occurred in 12 FAR patients, saving 78 days of therapy. Estimated cost savings totaled $37,632. PADLS effectively and safely de-labeled PCN allergies, resulting in improved antimicrobial selection, and could generate cost savings, supporting broader implementation of pharmacist-led allergy stewardship programs.

Pharmacy doi: 10.3390/pharmacy14010032

Authors: Yasmine Soualy Stéphane C. Renaud Jade Torchio Juliette Fouillet Julie Ensenat Léa Rubira Cyril Fersing

Nuclear medicine is a medical specialty combining parenteral radioactive drug handling and complex clinical workflows, making systematic process-related incident (PRI) analysis essential to support healthcare quality improvement. This study reports a four-year single-center retrospective analysis of PRIs in a nuclear medicine department and describes the development and implementation of a scenario-based radiopharmacy training program for nuclear medicine technologists (NMTs) derived from these findings. PRIs were extracted from the institutional reporting system and categorized according to a structured classification. Training scenarios were designed from recurrent radiopharmacy-related PRIs, and their impact was evaluated using a knowledge questionnaire administered pre and post training. A total of 223 PRIs were analyzed, of which 38.6% (n = 86) were related to the radiopharmaceutical circuit. Among these, 28.3% occurred exclusively within the radiopharmacy cleanroom. Administration (19%), dispensing (15%), delivery and reception (15%), and preparation and quality control (15%) of radiopharmaceuticals were the most frequently involved stages. No PRI exceeded a moderate criticality level. Eight NMTs participated in the training program, consisting of an analysis of videos depicting the developed scenarios. The mean knowledge score increased significantly from 7.51/10 before training to 8.46/10 four weeks after training (p = 0.02), with marked improvements in hygiene- and radioactivity-related topics. These results support the use of retrospective PRI analysis as an operational basis for specific, scenario-based training to strengthen safety practices in radiopharmacy settings.

Pharmacy doi: 10.3390/pharmacy14010031

Authors: Derar H. Abdel-Qader Abdullah Albassam Esra’ Taybeh Nadia Al Mazrouei Rana Ibrahim Reham Aljalamdeh Salim Hamadi Alia Saleh Sahar Jaradat Shorouq Al-Omoush

Background: Topical Corticosteroids (TCS) are potent therapeutic agents associated with severe local and systemic adverse effects if misused. In Jordan, the unauthorized supply of TCS for cosmetic purposes and the mismanagement of dermatological conditions remain significant public health concerns. This study utilized a repeated-measures simulated patient (SP) methodology to evaluate community pharmacists’ stewardship of TCS across a spectrum of clinical risks. Methods: A national cross-sectional study was conducted across 380 randomly selected community pharmacies in Jordan. Each pharmacy received four covert visits (N = 1520) corresponding to four distinct clinical scenarios representing different risk levels: cosmetic whitening, acne management, fungal infection, and pediatric diaper rash. The primary outcome was appropriate Practice, defined as the refusal to dispense unsafe medication or the provision of evidence-based alternatives. Results: Stewardship behavior varied significantly by clinical context (p < 0.001). Pharmacists demonstrated a hierarchy of safety, adhering to guidelines most strictly in the Pediatric scenario (82.1% appropriate refusal) but frequently abandoning safety standards in the Cosmetic scenario (30.0% appropriate refusal). Notably, 70.0% of pharmacists dispensed potent steroids for facial whitening, and 26.1% voluntarily offered to compound unauthorized steroid mixtures (Khaltat). In the acne scenario, 52.1% dispensed the contraindicated TCS, while only 37.9% appropriately switched the patient to an evidence-based alternative. In the fungal scenario, 60.0% failed to visually inspect the lesion, leading to a 40.0% rate of inappropriate TCS dispensing. Multivariable regression indicated that pharmacists working in chain pharmacies (aOR: 2.15, 95% CI: 1.68–2.75) and those holding advanced degrees (PharmD/MSc) (aOR > 1.38) were significantly more likely to practice appropriate TCS stewardship. High workload (>200 prescriptions/day) was a significant barrier to safety (aOR: 0.55). Conclusions: Community pharmacists in Jordan exhibited selective TCS stewardship, demonstrating high vigilance for pediatric safety, but widespread illegal practice regarding cosmetic misuse and differential diagnosis that may be unethical. The study results warrant the need for further urgent research to understand why these practices are occurring and how best to address them.