Pharmacy

17 pages, 562 KiB

Open AccessArticle

Detection of Problems Related to Hormonal Contraceptives in Community Pharmacy: Application of a Structured Questionnaire in Women of Childbearing Age

by Raquel Sicilia González, Susana Abdala Kuri, Chaxiraxi Morales Marrero, Adama Peña Vera, Alexis Oliva Martín and Sandra Dévora Gutiérrez

Pharmacy 2025, 13(4), 112; https://doi.org/10.3390/pharmacy13040112 - 21 Aug 2025

Abstract

The use of hormonal contraceptives is essential to ensure effective and safe contraception. However, factors such as inadequate prescription, poor adherence, or lack of information can lead to drug-related problems (DRPs) and negative outcomes associated with medication (NOMs). Methods: An observational, descriptive, cross-sectional [...] Read more.

The use of hormonal contraceptives is essential to ensure effective and safe contraception. However, factors such as inadequate prescription, poor adherence, or lack of information can lead to drug-related problems (DRPs) and negative outcomes associated with medication (NOMs). Methods: An observational, descriptive, cross-sectional study was conducted between January and June 2024 in two community pharmacies in Tenerife. It included 316 users of hormonal contraceptives over the age of 18. The main instrument was a structured questionnaire, administered through individual interviews conducted in the Personalized Care Area (PCA). Results: Combined Oral Contraceptives (COCs) were the most frequently used method (72.2%). Adverse reactions were reported by 47.2% of participants, mainly psychiatric disorders (28.1%). Emergency contraception had been used at least once by 43.8% of the respondents. Among COC users, 68.9% reported difficulties with daily adherence, and only 36.7% had adequate knowledge in case of missed doses. Conclusions: Community pharmacists may play a key role in reproductive health by providing personalized counselling, referring patients to other levels of care, and promoting the rational and safe use of hormonal contraceptives. Full article

(This article belongs to the Special Issue Pharmacy Practice for Women’s/Reproductive Health)

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10 pages, 191 KiB

Open AccessArticle

Reflecting on Uncertainty Tolerance in Student Pharmacists Following an Inpatient Rounding Simulation: A Pilot Mixed-Methods Study

by Nicole E. Cieri-Hutcherson and Collin M. Clark

Pharmacy 2025, 13(4), 111; https://doi.org/10.3390/pharmacy13040111 - 20 Aug 2025

Abstract

Background: With increasing involvement of pharmacists in clinical situations and expanding scope of practice, the expectation and management of uncertainty is a desirable component of pharmacy education, leading to improved uncertainty tolerance (UT) as pharmacists. Methods: The purpose of this pilot study was [...] Read more.

Background: With increasing involvement of pharmacists in clinical situations and expanding scope of practice, the expectation and management of uncertainty is a desirable component of pharmacy education, leading to improved uncertainty tolerance (UT) as pharmacists. Methods: The purpose of this pilot study was to determine whether an inpatient rounding simulation (IRS) that exposes student pharmacists to a level of uncertainty leads to changes in tolerance of ambiguity scale (TAS) scores and self-reflection comments. A pre-/post-observational, pilot survey study was conducted, including student pharmacists in their second professional year at the United States School of Pharmacy who were enrolled in an associated lab-based course in Spring 2024. Student teams completed a mock IRS and responded to clinical questions in a timed environment. Students completed pre-/post-simulation TAS and self-reflection on uncertainty/UT within the simulation. Pre-/post-simulation TAS scores were analyzed with a paired t-test. Qualitative analysis was used to identify themes in self-reflection. Results: 59 students responded (48% response rate). TAS was not different pre-/post-IRS (63.2 vs. 62.6, p = 0.63). When individual subscales were compared, a statistically significant difference was found in the insolubility subscale (10.5 vs. 9.5; p = 0.02). Themes of uncertainty that emerged during qualitative analysis of pre-simulation included the clinical question posed to the team. Student pharmacists overcame uncertainty pre-simulation by working with their team and relying on the availability of resources. Themes of uncertainty emerging during qualitative analysis of post-simulation included discerning the best answer. Student pharmacists overcame uncertainty post-simulation by working with their team and cited working with their team as a positive aspect of the IRS experience. Conclusions: In this pilot study, student pharmacists had high TAS scores both pre- and post-simulation. Students utilized their teams and cited this as a positive in an uncertain environment. Full article

(This article belongs to the Section Pharmacy Education and Student/Practitioner Training)

19 pages, 827 KiB

Open AccessArticle

Developing Soft Skills for Sustainable Community Pharmacy Practice Through a Competency-Based Modular Programme

by Ivana Zimonjić, Lazar Dražeta, Valentina Marinković and Tatjana Milošević

Pharmacy 2025, 13(4), 110; https://doi.org/10.3390/pharmacy13040110 - 20 Aug 2025

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Abstract

This study explored a competency-based soft-skills programme supporting evolving community pharmacy professionals’ roles and sustainable practice in Serbia. Four researchers with academic and practice backgrounds developed the programme using healthcare guidelines and the International Pharmaceutical Federation’s competency framework. The process involved defining objectives, [...] Read more.

This study explored a competency-based soft-skills programme supporting evolving community pharmacy professionals’ roles and sustainable practice in Serbia. Four researchers with academic and practice backgrounds developed the programme using healthcare guidelines and the International Pharmaceutical Federation’s competency framework. The process involved defining objectives, selecting methods, designing and organising activities, accreditation, and evaluating outcomes based on the Kirkpatrick model. From January 2021 to March 2025, the “Galenika Academy” was implemented through webinars, accredited tests, onsite courses, and a mobile application. Satisfaction was assessed via a validated online questionnaire among participants attending ≥80% of sessions, following evaluation of attendance and test performance. The programme reached 5107 participants, 10,427 webinar views, and 8252 test completions. The “Galiverse” mobile app, launched in February 2023, had 5558 users by March 2025. The most attended webinar was “Burnout” (787). Average test success was 82.9%, with 95.3% for “Resilience” and 61.0% for “Team Management.” Satisfaction was 95.5% for content, 94.2% for quality, 92.3% for materials, 77.1% for the application, and 96.3% would recommend it. Among those reporting improved resilience, 96.9% believed it could positively impact pharmacy operations. Pharmacists found the programme relevant and effective. Further research is needed to evaluate its impact on practice and patient outcomes. Full article

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17 pages, 343 KiB

Open AccessSystematic Review

Pharmacist-Led Interventions for Polypharmacy Management in Older Adults: A Systematic Review of Strategies and Outcomes in the United Kingdom and the Republic of Ireland

by Fionnuala McGrory and Mohamed Hassan Elnaem

Pharmacy 2025, 13(4), 109; https://doi.org/10.3390/pharmacy13040109 - 19 Aug 2025

Viewed by 127

Abstract

Polypharmacy in older adults increases risks of adverse drug reactions (ADRs), hospitalisations, and mortality. Pharmacist-led interventions using validated tools (e.g., STOPP/START, MAI, STOPPFrail) aim to optimise prescribing, yet their impact on clinical and economic outcomes in UK/Ireland health systems remains underexplored. This systematic [...] Read more.

Polypharmacy in older adults increases risks of adverse drug reactions (ADRs), hospitalisations, and mortality. Pharmacist-led interventions using validated tools (e.g., STOPP/START, MAI, STOPPFrail) aim to optimise prescribing, yet their impact on clinical and economic outcomes in UK/Ireland health systems remains underexplored. This systematic review aimed to critically assess the impact of pharmacist-led deprescribing interventions on PIP, clinical outcomes, and costs in older adults (≥65 years) across the UK and Ireland. Following PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for studies (2010–2024). Eligible studies included randomised trials, observational designs, and intervention studies in hospitals, care homes, community pharmacies, and intermediate care settings. Fourteen studies met the inclusion criteria. The risk of bias was assessed using CASP checklists. Narrative syntheses and heat maps summarised the findings. Twelve of fourteen studies reported positive outcomes: reductions in potentially inappropriate medications, ADRs, medication burdens, and falls/fall risks. Medication appropriateness improved significantly in 35% of studies using the MAI. STOPPFrail reduced PIMs in care homes, while the MAI enhanced complex hospital reviews. Community interventions improved adherence and reduced the use of fall risk drugs. No studies demonstrated a reduction in hospitalisations, mortality, or the length of stays. Economic analyses showed mixed cost-effectiveness. Key barriers included low uptake of pharmacist recommendations and short follow-up periods. Pharmacist-led interventions have significantly improved the prescribing quality and reduced medication-related risks, but they fail to impact hospitalisations or mortality due to implementation gaps. Context-specific tools and policy reforms—including expanded pharmacist roles and electronic decision support—are critical for sustainability. Future research should focus on long-term outcomes, cost-effectiveness, and multidisciplinary integration. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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16 pages, 290 KiB

Open AccessReview

Analysis of Legislative and Regulatory Frameworks Governing Community Pharmacy in Bulgaria and North Macedonia

by Anna Todorova, Mariya Ivanova, Magdalena Pesheva, Dijana Miceva and Bistra Angelovska

Pharmacy 2025, 13(4), 108; https://doi.org/10.3390/pharmacy13040108 - 8 Aug 2025

Viewed by 404

Abstract

The common border between Bulgaria and North Macedonia, alongside the regulatory requirements stemming from Bulgaria’s membership in the European Union, provide grounds for comparing the legislative environment in both countries. This article presents a comparative case study of the regulatory frameworks governing community [...] Read more.

The common border between Bulgaria and North Macedonia, alongside the regulatory requirements stemming from Bulgaria’s membership in the European Union, provide grounds for comparing the legislative environment in both countries. This article presents a comparative case study of the regulatory frameworks governing community pharmacies in Bulgaria and North Macedonia. The aim of this study is to examine the specific features of current legislation related to the operation of community pharmacies, and to identify similarities, differences, and gaps in the organizational structure of pharmacy services, the population’s access to pharmaceutical care, and the qualification requirements for personnel working in community pharmacies. Bulgaria has been a member of the European Union since 2007, while the Republic of North Macedonia has had official EU candidate status since 2005. This provides a basis for comparing the regulatory frameworks of an EU and a non-EU system within the same regional context. In both countries, the overall pharmacy-to-population ratio exceeds the European average (3.3 pharmacies per 10,000 inhabitants), indicating sufficient availability. However, pharmacies are predominantly concentrated in major urban areas. In Bulgaria, challenges remain in ensuring access to pharmaceutical services in smaller and rural settlements, while in North Macedonia, the provision of such services is better ensured. The findings of this case study may be particularly relevant for countries undergoing health system reforms or EU harmonization processes. Full article

(This article belongs to the Special Issue Advances in Rural Pharmacy Practice)

13 pages, 1674 KiB

Open AccessArticle

The Role of the Clinical Pharmacist in Hospital Admission Medication Reconciliation in Low-Resource Settings

by Tijana Kovačević, Sonja Nedinić, Vedrana Barišić, Branislava Miljković, Emir Fazlić, Slobodan Vukadinović and Pedja Kovačević

Pharmacy 2025, 13(4), 107; https://doi.org/10.3390/pharmacy13040107 - 2 Aug 2025

Viewed by 373

Abstract

Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in [...] Read more.

Medication discrepancies at hospital admission are common and may lead to adverse outcomes. Medication reconciliation is a critical process for minimizing medication discrepancies and medication errors at the time of hospital admission. This study aimed to evaluate the role of clinical pharmacists in identifying pharmacotherapy-related issues upon patient admission in a low-resource setting. A prospective observational study was conducted at a university hospital between 1 March and 31 May 2023. Within 24 h of admission, a clinical pharmacist documented each patient’s pre-admission medication regimen and compared it with the medication history obtained by the admitting physician. Discrepancies and pharmacotherapy problems were subsequently identified. Among 65 patients, pharmacists documented 334 medications versus 189 recorded by physicians (p < 0.01). The clinical pharmacist identified 155 discrepancies, 112 (72.26%) of which were unintentional. The most frequent type was drug omission (91.07%), followed by incorrect dosage (4.46%), incorrect dosing interval (2.68%), and medications with unknown indications (1.79%). Most discrepancies were classified as errors without harm (53.57%), while 41.07% were potentially harmful. These findings underscore the importance of integrating clinical pharmacists into the healthcare team. Their active participation during hospital admission can significantly enhance medication safety and reduce preventable adverse drug events. Full article

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62 pages, 4641 KiB

Open AccessReview

Pharmacist-Driven Chondroprotection in Osteoarthritis: A Multifaceted Approach Using Patient Education, Information Visualization, and Lifestyle Integration

by Eloy del Río

Pharmacy 2025, 13(4), 106; https://doi.org/10.3390/pharmacy13040106 - 1 Aug 2025

Viewed by 458

Abstract

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate [...] Read more.

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

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21 pages, 716 KiB

Open AccessReview

Improving Hemorrhoid Outcomes: A Narrative Review and Best Practices Guide for Pharmacists

by Nardine Nakhla, Ashok Hospattankar, Kamran Siddiqui and Mary Barna Bridgeman

Pharmacy 2025, 13(4), 105; https://doi.org/10.3390/pharmacy13040105 - 30 Jul 2025

Viewed by 828

Abstract

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s [...] Read more.

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s role in hemorrhoid management beyond traditional over-the-counter (OTC) and prescription approaches. The 2024 American Society of Colon and Rectal Surgeons (ASCRS) guidelines introduce updates on the use of phlebotonics, a class of venoactive drugs gaining recognition for their role in symptom management, yet largely underutilized in U.S. clinical practice. In parallel, novel clinical tools are reshaping how pharmacists engage in assessment and care. The integration of digital decision-support platforms and structured evaluation algorithms now empowers them to systematically evaluate symptoms, identify red flag signs, and optimize patient triage. These tools reduce diagnostic variability and improve decision-making accuracy. Given their accessibility and trusted role in frontline healthcare, pharmacists are well-positioned to bridge these critical gaps by adopting emerging treatment recommendations, leveraging algorithm-driven assessments, and reinforcing best practices in patient education and referral. This narrative review aims to equip pharmacists with updated insights into evidence-based hemorrhoid management strategies and provide them with structured assessment algorithms to standardize symptom evaluation and treatment pathways. By integrating these innovations, pharmacists can enhance treatment outcomes, promote patient safety, and contribute to improved quality of life (QoL) for individuals suffering from hemorrhoidal disease. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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Graphical abstract

8 pages, 192 KiB

Open AccessBrief Report

Accuracy and Safety of ChatGPT-3.5 in Assessing Over-the-Counter Medication Use During Pregnancy: A Descriptive Comparative Study

by Bernadette Cornelison, David R. Axon, Bryan Abbott, Carter Bishop, Cindy Jebara, Anjali Kumar and Kristen A. Root

Pharmacy 2025, 13(4), 104; https://doi.org/10.3390/pharmacy13040104 - 30 Jul 2025

Viewed by 828

Abstract

As artificial intelligence (AI) becomes increasingly utilized to perform tasks requiring human intelligence, patients who are pregnant may turn to AI for advice on over-the-counter (OTC) medications. However, medications used in pregnancy may pose profound safety concerns limited by data availability. This study [...] Read more.

As artificial intelligence (AI) becomes increasingly utilized to perform tasks requiring human intelligence, patients who are pregnant may turn to AI for advice on over-the-counter (OTC) medications. However, medications used in pregnancy may pose profound safety concerns limited by data availability. This study focuses on a chatbot’s ability to accurately provide information regarding OTC medications as it relates to patients that are pregnant. A prospective, descriptive design was used to compare the responses generated by the Chat Generative Pre-Trained Transformer 3.5 (ChatGPT-3.5) to the information provided by UpToDate^®. Eighty-seven of the top pharmacist-recommended OTC drugs in the United States (U.S.) as identified by Pharmacy Times were assessed for safe use in pregnancy using ChatGPT-3.5. A piloted, standard prompt was input into ChatGPT-3.5, and the responses were recorded. Two groups independently rated the responses compared to UpToDate on their correctness, completeness, and safety using a 5-point Likert scale. After independent evaluations, the groups discussed the findings to reach a consensus, with a third independent investigator giving final ratings. For correctness, the median score was 5 (interquartile range [IQR]: 5–5). For completeness, the median score was 4 (IQR: 4–5). For safety, the median score was 5 (IQR: 5–5). Despite high overall scores, the safety errors in 9% of the evaluations (n = 8), including omissions that pose a risk of serious complications, currently renders the chatbot an unsafe standalone resource for this purpose. Full article

(This article belongs to the Special Issue AI Use in Pharmacy and Pharmacy Education)

13 pages, 436 KiB

Open AccessArticle

Hospital Pharmacists’ Perspectives on Adverse Drug Reaction Reporting in Developed and Developing Countries: A Comparative Pilot Study

by Javeria Khalid, Tarilate Temedie-Asogwa, Marjan Zakeri and Sujit S. Sansgiry

Pharmacy 2025, 13(4), 103; https://doi.org/10.3390/pharmacy13040103 - 29 Jul 2025

Viewed by 375

Abstract

Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately [...] Read more.

Adverse drug reactions (ADRs) significantly affect patient safety and healthcare spending worldwide. Hospital pharmacists are uniquely positioned to address ADRs due to their crucial role in medication management. However, underreporting remains a global concern, especially in developing countries, where pharmacovigilance systems are inadequately developed. Therefore, this pilot study aimed to evaluate and compare the knowledge, attitudes, perceived barriers, and facilitators regarding ADR reporting by hospital pharmacists in a developed (US) and a developing (Pakistan) country. A cross-sectional survey was conducted, using a pre-validated questionnaire. The pharmacists, possessing a minimum of one year’s hospital experience, were selected via convenience sampling. Out of 151 respondents, included in the final analysis (US: n = 51; Pakistan: n = 100), the majority were female (62.3%), aged 29–35 years (38%), and possessed a Pharm. D degree (49.7%). The knowledge (US: 6.03 ± 0.27 vs. Pakistan:5.69 ± 0.25, p-value = 0.193) and attitude scores (US: 32.02 ± 0.73 vs. Pakistan: 32.63 ± 0.67; p-value = 0.379) exhibited no significant differences between the groups. Nonetheless, barriers at both the individual and systemic levels were more pronounced in the developing country. Important facilitators reported were mobile applications for ADR reporting, specialized training, and intuitive reporting tools. In conclusion, we found that pharmacists in both settings exhibit comparable knowledge and positive attitudes towards ADR reporting, though specific contextual barriers are present. Interventions customized to the local hospital infrastructure are crucial for enhancing ADR reporting, particularly in resource-constrained settings. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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17 pages, 1254 KiB

Open AccessArticle

Attitudes Toward COVID-19 and Seasonal Influenza Vaccines in the Post-COVID Era: A Cross-Sectional Study Among Adults in Malta

by Maria Cordina, Mary Anne Lauri and Josef Lauri

Pharmacy 2025, 13(4), 102; https://doi.org/10.3390/pharmacy13040102 - 29 Jul 2025

Viewed by 292

Abstract

The uptake of the COVID-19 and seasonal influenza (SI) vaccines have decreased in Europe and especially in Malta. The present study aimed to investigate the attitudes toward COVID-19 and SI vaccines and determine if individuals perceive that these vaccines are relevant to protect [...] Read more.

The uptake of the COVID-19 and seasonal influenza (SI) vaccines have decreased in Europe and especially in Malta. The present study aimed to investigate the attitudes toward COVID-19 and SI vaccines and determine if individuals perceive that these vaccines are relevant to protect their health and identify reasons for their responses. A cross-sectional study using an anonymous questionnaire, informed by the Theory of Planned Behavior, addressing behavior beliefs and attitudes, and targeted at adult residents in Malta, was designed on Google Forms and disseminated using social media between January and March 2024. A total of 555 responses were received. The majority of respondents did not take/intend to take the COVID-19 (75%, n = 417) or SI (64.3%, n = 362) vaccines, with females being less likely to do so (p = 0.033). Perceived lack of safety (31.3%, n = 174) was the primary reason for rejecting the COVID-19 vaccine, and perceived lack of a threat from SI (26%, n = 144) was the reason for rejecting the SI vaccine. Those having chronic conditions were positively associated with uptake of both vaccines. In the post-pandemic era, these vaccines are not envisaged as having a major role in protecting one’s health. A high degree of skepticism especially toward the combined COVID-19 and SI vaccine in terms of safety, mostly in women, is still present. Full article

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13 pages, 642 KiB

Open AccessArticle

Evaluation of Medication Adherence and Appropriateness Among Heart Failure Patients Attending the Cardiac Clinic at a Tertiary Care Hospital: A Cross-Sectional Observational Study

by Nanayakkara Muhandiramalaya Yasa Kalum Bagyawantha, Isuri Nilnuwani Dangahage, Ghanamoorthy Mayurathan and Weerasinghe Mudiyanselage Suminda Pushpika

Pharmacy 2025, 13(4), 101; https://doi.org/10.3390/pharmacy13040101 - 27 Jul 2025

Viewed by 351

Abstract

Heart failure is a chronic disease with significantly high morbidity and mortality rates, and a thorough understanding of medication adherence and appropriateness is crucial to ensure effective treatment outcomes. This cross-sectional observational study aimed to assess medication adherence, understand the influence of sociodemographic [...] Read more.

Heart failure is a chronic disease with significantly high morbidity and mortality rates, and a thorough understanding of medication adherence and appropriateness is crucial to ensure effective treatment outcomes. This cross-sectional observational study aimed to assess medication adherence, understand the influence of sociodemographic factors on medication adherence, and assess the medication appropriateness for heart failure patients attending the cardiac clinic at National Hospital Kandy (NHK). This study was conducted among 325 heart failure patients attending the cardiac clinic at the NHK. Medication adherence was assessed using the brief medication questionnaire (BMQ) after detailed medication history interviews. Statistically significant associations between total BMQ scores and sociodemographic factors were determined at 95% confidence interval. The appropriateness of the newly prescribed medication lists was assessed using the medication appropriateness index (MAI). Among the 325 patients recruited, the mean total BMQ score was 1.16; 11.7% of the participants were adherent to their medications whereas 15.4% had poor adherence. Most participants (52.0%) were in the probable poor adherent level. Statistically significant associations were observed between total BMQ score and age, sex, and education level. The mean MAI score was 0.56. Medication adherence among heart failure patients was poor and some sociodemographic factors influenced medication adherence. The appropriateness of prescribed medications was found to be acceptable. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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13 pages, 391 KiB

Open AccessArticle

The Use of RE-AIM to Evaluate a Pharmacist-Led Transitions of Care Service for Multivisit Patients at a Regional Hospital

by Courtney E. Gamston, Salisa C. Westrick, Mafe Zmajevac, Jingjing Qian, Greg Peden, Dillon Hagan and Kimberly Braxton Lloyd

Pharmacy 2025, 13(4), 99; https://doi.org/10.3390/pharmacy13040099 - 23 Jul 2025

Viewed by 336

Abstract

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital [...] Read more.

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital using the RE-AIM framework. In this quasi-experimental, non-randomized study, individuals with ≥2 recent hospitalizations received pharmacist-led discharge medication reconciliation and counseling, management of drug-related problems, post-discharge telephonic visits, and social support. The reach, effectiveness, implementation, and maintenance RE-AIM dimensions were assessed using patient and service records. Outcomes included 30-day readmission rates for individuals completing ≥1 outpatient pharmacist visit (intervention) versus those unreachable in the outpatient setting (comparison), completed interventions, implementation features, and service adaptations. Chi-square and Fisher’s exact tests were used for comparison of categorical variables and the t-test was used for continuous variables. From February 2022 to August 2023, 72.7% of the 66 service participants participated in the intervention (reach). Additionally, 30-day readmission was 22.9% (intervention) versus 55.6% (comparison; p = 0.01). In total, 2279 interventions were documented (effectiveness). The service was adapted (implementation) and expanded to include additional populations (maintenance) to enhance sustainability. Based on RE-AIM evaluation, the pharmacist-led TOC intervention appears to be a sustainable solution for addressing readmission in multivisit patients. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

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11 pages, 202 KiB

Open AccessBrief Report

CalOPT: A Specialty Pharmacy–Dietitian Quality Improvement Initiative for Calcium Optimization in Patients with Osteoporosis Risk

by Jennifer Cerulli, Alisha Roberts, Ellie Wilson and Scott Guisinger

Pharmacy 2025, 13(4), 100; https://doi.org/10.3390/pharmacy13040100 - 23 Jul 2025

Viewed by 263

Abstract

A total of 38% of Americans do not meet the Recommended Dietary Allowance (RDA) for calcium including those at risk for osteoporosis. To increase the percentage of patients at risk for osteoporosis who achieve goal calcium RDA intake, a collaborative specialty pharmacy-registered dietitian-nutritionist [...] Read more.

A total of 38% of Americans do not meet the Recommended Dietary Allowance (RDA) for calcium including those at risk for osteoporosis. To increase the percentage of patients at risk for osteoporosis who achieve goal calcium RDA intake, a collaborative specialty pharmacy-registered dietitian-nutritionist (RDN) quality improvement program was developed. Patients aged 18 to 90 years old receiving osteoporosis therapy (denosumab, teriparatide, zoledronic acid) or medications that increase bone loss (elagolix, oral prednisone) were provided with a structured assessment and educational intervention. Daily calcium intake included patient self-reported dietary intake plus supplement use. Written and verbal education on increasing dietary intake based on patient preferences was provided with 5 calcium-rich food-source store coupons. Recommendations for supplement selection (citrate vs. carbonate) and/or medication-related problem resolution were provided. Follow-up occurred at 3–6 months. Fifty patients enrolled [94% female, mean age 66.6 years (SD 15.3)] were taking denosumab (36), teriparatide (1), zoledronic acid (1), elagolix (7) and prednisone (5). The mean baseline daily dietary calcium intake was 500 mg (SD 247) with none achieving goal intake with diet alone. Average calcium supplement use in 22 (44%) patients was 686 mg daily (SD 284). At baseline, 17 (34%) met goal daily calcium intake compared to 30 (60%) at post intervention follow-up (p = 0.009). Over half of the store coupons were redeemed. A specialty pharmacy-RDN customized intervention program provides a model for aiding patients to modify calcium intake. Full article

(This article belongs to the Section Pharmacy Practice and Practice-Based Research)

11 pages, 452 KiB

Open AccessReview

Lysergic Acid Amide (LSA), an LSD Analog: Systematic Review of Pharmacological Effects, Adverse Outcomes, and Therapeutic Potentials

by Paula S. C. C. Castro, Kae Leopoldo, Maria Olivia Pozzolo Pedro, Juliana Takitane, Henrique Silva Bombana, André Brooking Negrão, Jaqueline R. Scholz and João Maurício Castaldelli-Maia

Pharmacy 2025, 13(4), 98; https://doi.org/10.3390/pharmacy13040098 - 21 Jul 2025

Viewed by 1577

Abstract

Objective: To systematically review the scientific literature on lysergic acid amide (LSA), focusing on its physical, neurobiological, and social effects, as well as its potential risks and therapeutic uses. Methods: A systematic review was conducted across PubMed, Google Scholar, and Web [...] Read more.

Objective: To systematically review the scientific literature on lysergic acid amide (LSA), focusing on its physical, neurobiological, and social effects, as well as its potential risks and therapeutic uses. Methods: A systematic review was conducted across PubMed, Google Scholar, and Web of Science up to December 2023, using keywords such as “ergine,” “lysergic acid amide,” and “legal high.” Studies were included if they reported original human data on the physical, neurobiological, psychological, or social effects of LSA; seventeen studies were included. Animal studies, in vitro research, and non-original articles were excluded. Two independent reviewers screened and selected the studies, with a third resolving discrepancies. Data were extracted using a standardized form. The review followed PRISMA guidelines and was prospectively registered on the Open Science Framework. Results: LSA is primarily consumed through preparations made from the seeds of Convolvulaceae plants. Reported effects include euphoria, hallucinations, nausea, and anxiety. Severe adverse outcomes, such as psychosis, hypertension, and hospitalization, have also been documented. Some evidence suggests its potential therapeutic application for cluster headaches. However, variability in dosing and misinformation on digital platforms heighten the risks associated with LSA use. Conclusions: LSA poses significant health risks, exacerbated by online misinformation and variability in its effects, and a lack of scientific studies. Further research is essential to clarify its pharmacological profile, establish guidelines for safe use, and raise public awareness about its dangers. Full article

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20 pages, 813 KiB

Open AccessReview

The Role of Pharmacists in Delivering Pharmaceutical Services to Breast Cancer Patients in Clinical and Community Settings: A Scoping Review

by Yuyao Pei, Ruoxin Huang, Feng Chang, Yuanhui Hu, Sarah Versteeg and Yufen Zheng

Pharmacy 2025, 13(4), 97; https://doi.org/10.3390/pharmacy13040097 - 21 Jul 2025

Viewed by 544

Abstract

(1) Background: Patient-centered care for individuals with breast cancer requires multidisciplinary cooperation to ensure the appropriate use of medication and prevent medication-related problems. Pharmaceutical care has been associated with improved adherence in breast cancer management, a factor linked to patient outcomes and mortality. [...] Read more.

(1) Background: Patient-centered care for individuals with breast cancer requires multidisciplinary cooperation to ensure the appropriate use of medication and prevent medication-related problems. Pharmaceutical care has been associated with improved adherence in breast cancer management, a factor linked to patient outcomes and mortality. This study aims to summarize and explore the provision and utilization of pharmaceutical services for breast cancer patients by pharmacists. (2) Methods: A scoping review was performed to assess the pharmacist’s role in providing pharmaceutical services for patients with breast cancer. A comprehensive review of four databases (PubMed, Ovid Embase, Ovid International Pharmaceutical Abstracts, and Scopus) was completed between 1 January 2012 and 8 April 2025 according to PRISMA-ScR framework. (3) Results: A total of 46 articles met the inclusion criteria, which included RCTs, observatory studies, cohort studies, and reviews. Findings suggest that both clinical and community pharmacists play an important role in prevention, management, and education for breast cancer patients. (4) Conclusions: Pharmacists can improve health outcomes by providing pharmaceutical service in breast cancer care. Optimizing interventions, expanding services, and evaluating long-term cost-effectiveness is needed in the future. Full article

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16 pages, 647 KiB

Open AccessArticle

Medical Cannabis Use and Healthcare Utilization Among Patients with Chronic Pain: A Causal Inference Analysis Using TMLE

by Mitchell L. Doucette, Emily Fisher, Junella Chin and Panagiota Kitsantas

Pharmacy 2025, 13(4), 96; https://doi.org/10.3390/pharmacy13040096 - 15 Jul 2025

Viewed by 1796

Abstract

Introduction: Chronic pain affects approximately 20% of U.S. adults, imposing significant burdens on individuals and healthcare systems. Medical cannabis has emerged as a potential therapy, yet its impact on healthcare utilization remains unclear. Methods: This retrospective cohort study analyzed administrative data from a [...] Read more.

Introduction: Chronic pain affects approximately 20% of U.S. adults, imposing significant burdens on individuals and healthcare systems. Medical cannabis has emerged as a potential therapy, yet its impact on healthcare utilization remains unclear. Methods: This retrospective cohort study analyzed administrative data from a telehealth platform providing medical cannabis certifications across 36 U.S. states. Patients were classified as cannabis-exposed if they had used cannabis in the past year, while unexposed patients had no prior cannabis use. Outcomes included self-reported urgent care visits, emergency department (ED) visits, hospitalizations, and quality of life (QoL), measured using the CDC’s Healthy Days measure. Targeted Maximum Likelihood Estimation with SuperLearner estimated causal effects, adjusting for numerous covariates. Results: Medical cannabis users exhibited significantly lower healthcare utilization. Specifically, exposure was associated with a 2.0 percentage point reduction in urgent care visits (95% CI: −0.036, −0.004), a 3.2 percentage point reduction in ED visits (95% CI: −0.051, −0.012) and fewer unhealthy days per month (−3.52 days, 95% CI: −4.28, −2.76). Hospitalization rates trended lower but were not statistically significant. Covariate balance and propensity score overlap indicated well-fitting models. Conclusions: Medical cannabis use was associated with reduced healthcare utilization and improved self-reported QoL among chronic pain patients. Full article

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17 pages, 271 KiB

Open AccessReview

The Role of Pharmacists in Identifying and Preventing Drug-Related Problems in PCOS Management

by Hristina Lebanova, Vesselina Yanachkova and Svetoslav Stoev

Pharmacy 2025, 13(4), 95; https://doi.org/10.3390/pharmacy13040095 - 11 Jul 2025

Viewed by 600

Abstract

Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age, often requiring complex pharmacological management. The heterogeneity of the syndrome and the use of on- and off-label therapeutic agents—ranging from insulin sensitizers and ovulation inducers to oral contraceptives and [...] Read more.

Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age, often requiring complex pharmacological management. The heterogeneity of the syndrome and the use of on- and off-label therapeutic agents—ranging from insulin sensitizers and ovulation inducers to oral contraceptives and herbal supplements—pose significant challenges, including adverse effects, drug interactions, and poor adherence. This narrative review explores the role of pharmacists in identifying and mitigating drug-related problems (DRPs) associated with PCOS therapy. Through thematic synthesis of the current literature, the study highlights common DRPs such as suboptimal drug selection, inappropriate dosing, prolonged therapy duration, and treatment-related safety concerns. It underscores the value of pharmacists’ interventions in enhancing medication adherence, optimizing therapeutic regimens, providing patient education, and monitoring adverse events. A structured, patient-level pharmaceutical care model is proposed, emphasizing personalized assessment, interdisciplinary collaboration, and continuous follow-up. The integration of clinical pharmacists into PCOS care teams has the potential to improve treatment effectiveness, patient satisfaction, and long-term health outcomes. Pharmacists’ contributions are especially critical given the widespread use of off-label therapies and supplements with variable evidence of benefit. Tailored pharmaceutical care can thus bridge the existing gaps in PCOS management and enhance the quality of life for the affected individuals. Full article

(This article belongs to the Special Issue Women's Special Issue Series: Pharmacy and Pharmacists)

17 pages, 222 KiB

Open AccessArticle

Enhancing the Role of Community Pharmacists in Medication Safety: A Qualitative Study of Voices from the Frontline

by Annesha White, Erika L. Thompson, Solyi Kim, Janice A. Osei, Kimberly G. Fulda and Yan Xiao

Pharmacy 2025, 13(4), 94; https://doi.org/10.3390/pharmacy13040094 - 9 Jul 2025

Viewed by 766

Abstract

Preventable adverse drug events (ADEs) remain a significant threat in community settings, a challenge that is critical in community pharmacy settings where continuity of care and healthcare access can be limited. This qualitative study explored the perspectives of 13 community pharmacists through focus [...] Read more.

Preventable adverse drug events (ADEs) remain a significant threat in community settings, a challenge that is critical in community pharmacy settings where continuity of care and healthcare access can be limited. This qualitative study explored the perspectives of 13 community pharmacists through focus groups and interviews to identify barriers and propose solutions to enhance their role in patient care. Pharmacists emphasized their critical position in ensuring safe medication use, particularly for older adults managing multiple chronic conditions. Key findings revealed five themes: (1) defining medication safety as minimizing risk and empowering patients; (2) characteristics of the “perfect patient,” including medication awareness and proactive engagement; (3) the pharmacist’s role in detecting and resolving medication-related problems; (4) systemic barriers such as time constraints, lack of access to patient records, insufficient privacy, and undervaluation of pharmacists’ roles; and (5) proposed solutions including private counseling areas, increased staffing, integrated electronic health records, and legislative recognition of pharmacists as healthcare providers. Strengthening collaboration with physicians and empowering patients through education were also highlighted as key strategies. These findings underscore the need for systemic changes—especially in light of lessons learned during the pandemic—to support pharmacists in delivering comprehensive medication management and improving patient safety. Full article

(This article belongs to the Collection New Insights into Pharmacy Teaching and Learning during COVID-19)

10 pages, 190 KiB

Open AccessArticle

Type II Diabetes Mellitus and COVID-19: Exploring Insulin Management in Patients from Family Medicine Clinics

by Chinemerem Opara, Annesha White, Kimberly G. Fulda, Somer Blair, Clare Aduwari, Nihitha Nukala and Yan Xiao

Pharmacy 2025, 13(4), 93; https://doi.org/10.3390/pharmacy13040093 - 4 Jul 2025

Viewed by 383

Abstract

The COVID-19 pandemic disrupted routine care for individuals with type 2 diabetes mellitus (T2DM), raising concerns about its impact on glycemic control and medication management. This study evaluated the relationship between insulin use and glycemic control among T2DM patients during the pandemic. A [...] Read more.

The COVID-19 pandemic disrupted routine care for individuals with type 2 diabetes mellitus (T2DM), raising concerns about its impact on glycemic control and medication management. This study evaluated the relationship between insulin use and glycemic control among T2DM patients during the pandemic. A retrospective analysis was conducted using deidentified clinical and prescription data from two family medicine clinics, comparing data from the pre-COVID-19 period (1 March 2019–13 March 2020) and during the COVID-19 pandemic (14 March 2020–31 March 2021). Patients included had at least two A1c values before the COVID and one during the COVID. A1c control was defined as less than 8%. Among 992 patients, 238 experienced a change in A1c status: 128 improved and 110 worsened. Mean A1c remained stable at 8.2 across both periods. A majority of patients who improved were using insulin during the COVID-19 era, although some discontinued insulin at some point during the study period. These findings suggest that consistent insulin therapy may have helped maintain glycemic control despite healthcare disruptions. This study highlights the importance of sustained medication management and suggests that integrating telehealth and pharmacist-led care could support diabetes control during future healthcare system challenges. Full article

(This article belongs to the Collection New Insights into Pharmacy Teaching and Learning during COVID-19)

13 pages, 327 KiB

Open AccessArticle

Polysubstance Use and Social Sequelae in Women of Reproductive Age with Recent Marijuana Use

by Sean Hyungwoo Kim, Hua Min, Hong Xue and Panagiota Kitsantas

Pharmacy 2025, 13(4), 92; https://doi.org/10.3390/pharmacy13040092 - 2 Jul 2025

Viewed by 349

Abstract

Polysubstance use (PSU) involving marijuana among women of reproductive age (WRA) is linked to psychosocial harm, yet research on the combined effects of marijuana with stimulants, opioids, tobacco, and binge drinking remains limited. The purpose of this study was to assess the prevalence [...] Read more.

Polysubstance use (PSU) involving marijuana among women of reproductive age (WRA) is linked to psychosocial harm, yet research on the combined effects of marijuana with stimulants, opioids, tobacco, and binge drinking remains limited. The purpose of this study was to assess the prevalence of PSU in WRA with past month MJ use and examine the association between PSU status and social sequelae, including getting in trouble with the law, relationship difficulty with others, and lower achievement in job or educational settings, in this group of women. We used data from the United States 2015–2019 National Survey on Drug Use and Health, which included 11,895 non-institutionalized WRA (18–44 years old) with reported use of MJ in the past month. Descriptive statistics, chi-squared tests, and multivariable logistic regression analyses were conducted to describe the sample and assess associations between PSU and social sequelae. Nearly 4.5% of the women who used MJ in the past month had experienced social sequelae regardless of PSU status. Women who used three or more substances along with MJ had the highest adjusted odds (AOR = 3.18, 95% CI 1.90, 5.31) of social sequelae relative to monosubstance MJ users. Concurrent use of multiple substances significantly increased the likelihood of social sequelae among women MJ users. Full article

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12 pages, 715 KiB

Open AccessArticle

Visual Thinking to Explore “Relational Pharmacology”: Systemic Maps for Managing Non-Selective Antidepressants in Cardiovascular Prevention

by Irene García-Domínguez, Azahara Rodríguez-Luna and Manuel Machuca

Pharmacy 2025, 13(4), 91; https://doi.org/10.3390/pharmacy13040091 - 27 Jun 2025

Viewed by 1781

Abstract

Relational pharmacology introduces an innovative approach using visual thinking to understand how drugs interact with multiple body systems, addressing the limitations of the traditional “reductionist approach”. While conventional pharmacology focuses on individual drug effects, it struggles with the complexities of polypharmacy, where multiple [...] Read more.

Relational pharmacology introduces an innovative approach using visual thinking to understand how drugs interact with multiple body systems, addressing the limitations of the traditional “reductionist approach”. While conventional pharmacology focuses on individual drug effects, it struggles with the complexities of polypharmacy, where multiple medications interact via shared metabolic pathways. This article highlights integrating systemic maps into educational methodologies to empower students in identifying and assessing medication risks. By visualizing the body and drug therapy as interconnected systems, students can better understand complex pharmacological interactions beyond linear frameworks. This approach enables active learning and real-life case analysis, such as cardiovascular prevention with non-selective antidepressants, where multiple drug interactions must be considered. It also fosters global health education by promoting the exchange of effective teaching practices and addressing challenges in healthcare training. Systemic maps prepare students for clinical decision-making by enhancing their ability to manage risks and complex cases effectively. Full article

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15 pages, 988 KiB

Open AccessReview

Historical Process, Status and Future Development of Pharmacovigilance Systems in Chinese Medicine

by Xue Wang, Yinfeng Wang, Xiaomeng Zhang, Bing Zhang and Zhijian Lin

Pharmacy 2025, 13(4), 90; https://doi.org/10.3390/pharmacy13040090 - 26 Jun 2025

Viewed by 509

Abstract

The definition of pharmacovigilance was first proposed in the 1970s to safeguard public health and the safety of drug use, and to improve the quality of life of patients. China’s traditional medicine has also always contained the idea of vigilance for the safe [...] Read more.

The definition of pharmacovigilance was first proposed in the 1970s to safeguard public health and the safety of drug use, and to improve the quality of life of patients. China’s traditional medicine has also always contained the idea of vigilance for the safe use of medicines in the process of development. In this article, we will discuss the origin and development of the idea of pharmacovigilance in China, the establishment of a realistic system, and the current status of pharmacovigilance construction, and look forward to the development of pharmacovigilance in the future. Full article

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16 pages, 735 KiB

Open AccessSystematic Review

Clinical Outcomes of Pharmacist Involvement in Cardiac Arrest and Trauma Resuscitations: A Scoping Review

by Harshita Patel, Myles Wee, Aaron M. Tejani and Anthony Lau

Pharmacy 2025, 13(4), 89; https://doi.org/10.3390/pharmacy13040089 - 24 Jun 2025

Viewed by 931

Abstract

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of [...] Read more.

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes. Full article

(This article belongs to the Topic Optimization of Drug Utilization and Medication Adherence)

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Pharmacy, Volume 13, Issue 4 (August 2025) – 24 articles

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