Pharmacy

17 pages, 671 KB

Open AccessArticle

Willingness, Self-Perceived Barriers, and Practices of Pharmacists Toward Extended Pharmacy Services for Health Promotion: A Cross-Sectional Survey in Karachi, Pakistan

by Sadia Shakeel, Hina Rehman, Shagufta Nesar, Muskan Bhutto, Imran Ahsan Mallick, Márió Gajdács and Shazia Jamshed

Pharmacy 2026, 14(3), 79; https://doi.org/10.3390/pharmacy14030079 - 28 May 2026

Abstract

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 [...] Read more.

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. Full article

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19 pages, 596 KB

Open AccessArticle

Implementation and Clinical Impact of a Structured Clinical Pharmacy Service for Hospitalized Ileostomy Patients: A Retrospective Observational Study Using the RE-AIM Framework

by Stefanie Hehenberger and Irene Lagoja

Pharmacy 2026, 14(3), 78; https://doi.org/10.3390/pharmacy14030078 - 27 May 2026

Abstract

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 [...] Read more.

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. Full article

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

18 pages, 694 KB

Open AccessArticle

Digital-Assisted Community Pharmacy Cessation for Dual-Tobacco Users in Jordan: A Hybrid Cluster Randomized Controlled Trial

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

Pharmacy 2026, 14(3), 77; https://doi.org/10.3390/pharmacy14030077 - 21 May 2026

Abstract

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 [...] Read more.

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. Full article

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

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21 pages, 953 KB

Open AccessReview

Equity, Diversity, Inclusion and Accessibility in Pharmacy Education: A Scoping Review

by Mirey Alfarah, Ivy Kan and Marie A. Vander Kloet

Pharmacy 2026, 14(3), 76; https://doi.org/10.3390/pharmacy14030076 - 20 May 2026

Abstract

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, [...] Read more.

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. Full article

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15 pages, 209 KB

Open AccessArticle

Entrustable Professional Activities for Pharmacists Carrying Out Medication Management Reviews

by Carmen Abeyaratne, Nadine Fawal and Kirsten Galbraith

Pharmacy 2026, 14(3), 75; https://doi.org/10.3390/pharmacy14030075 - 19 May 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Advances in Experiential Learning in Pharmacy—2nd Edition)

29 pages, 611 KB

Open AccessReview

Recognizing and Mitigating the Effects of Medication on Heat-Related Illness in Older Adults: A Scoping Review

by Lily M. Tews, Daniel T. Abazia, Hayley Blackburn, Kiri Carmody and Mary Barna Bridgeman

Pharmacy 2026, 14(3), 74; https://doi.org/10.3390/pharmacy14030074 - 17 May 2026

Abstract

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, [...] Read more.

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. Full article

(This article belongs to the Special Issue Optimizing Medication Management and Deprescribing Strategies for Older Adults)

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15 pages, 488 KB

Open AccessArticle

Professional Fulfilment in Pharmacy: A Cross-Sectional Survey of Pharmacists in 17 European Countries

by Katarina Fehir Šola, Slaven Falamić, Maja Ortner Hadžiabdić and Piotr Merks

Pharmacy 2026, 14(3), 73; https://doi.org/10.3390/pharmacy14030073 - 14 May 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Pharmacist Workforce Challenges and Solutions: Perspectives from Research and Practice)

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14 pages, 1270 KB

Open AccessPerspective

Integrating Drug Repurposing into EU Health Crisis Preparedness: The Strategic Role of Health Emergency Preparedness and Response Authority (HERA)

by Atanas Toshev, Stanislav Gueorguiev, Anna Mihaylova, Violeta Getova-Kolarova, Vasil Madzharov, Dimitar Mirchev and Elina Petkova-Gueorguieva

Pharmacy 2026, 14(3), 72; https://doi.org/10.3390/pharmacy14030072 - 12 May 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Drug Repurposing: Strengthening Outcomes of Existing Pharmaceuticals to Shift Emerging Health Challenges)

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18 pages, 4485 KB

Open AccessReview

Enhancing Self-Care Consultation Skills in Pharmacy Education: Benefits of Virtual Patients and Artificial Intelligence—A Scoping Review

by Radiana Staynova, Daniela Kafalova, Evelina Gavazova, Katerina Slavcheva, Nelina Neycheva, Adelina Boyanova, Desislava Andonova and Hristina Stoynova

Pharmacy 2026, 14(3), 71; https://doi.org/10.3390/pharmacy14030071 - 11 May 2026

Abstract

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 [...] Read more.

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. Full article

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

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14 pages, 1289 KB

Open AccessArticle

Effect of Pharmacist-Led Educational Intervention on Switching to Generic Medicine Among Patients Using Brand-Name Medicines in Japan

by Tomohiko Tairabune, Terutaka Goto, Kentaro Yamazaki, Kenzo Kudo, Ken-Ichi Sako, Tomoji Maeda and Takeshi Chiba

Pharmacy 2026, 14(3), 70; https://doi.org/10.3390/pharmacy14030070 - 11 May 2026

Abstract

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 [...] Read more.

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. Full article

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

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12 pages, 447 KB

Open AccessBrief Report

The Use of Elevenies as a Novel Tool in Organic Chemistry Teaching for Pharmacy Students

by Daniel Baecker

Pharmacy 2026, 14(3), 69; https://doi.org/10.3390/pharmacy14030069 - 8 May 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Advancing Pharmacy Education: Integrating Science and Clinical Practice)

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14 pages, 428 KB

Open AccessArticle

A Multi-Framework Approach to Medication Adherence Evaluation in Pharmacy Student-Led Medication Reviews: An Observational Exploratory Study

by Hanna Keidong, Margit Valge, Kaja-Triin Laisaar, Afonso Miguel das Neves Cavaco and Daisy Volmer

Pharmacy 2026, 14(3), 68; https://doi.org/10.3390/pharmacy14030068 - 30 Apr 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Advancing Pharmacy Education: Integrating Science and Clinical Practice)

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14 pages, 1385 KB

Open AccessArticle

From Discourse to Practice—Facilitating Factors and Barriers to the Implementation of Pharmaceutical Care in Primary Health Care: A Qualitative Study

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

Pharmacy 2026, 14(3), 67; https://doi.org/10.3390/pharmacy14030067 - 30 Apr 2026

Abstract

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 [...] Read more.

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. Full article

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11 pages, 496 KB

Open AccessArticle

Differences in Opioid Prescribing by Urban and Rural Pharmacists in Nova Scotia, Canada—A Time Series Analysis from 2018 to 2022

by Edward Chisholm, Ying Zhang and Chiranjeev Sanyal

Pharmacy 2026, 14(3), 66; https://doi.org/10.3390/pharmacy14030066 - 29 Apr 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Opioids and Opioid Use Disorder: Misuse, Overprescription and Addiction)

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17 pages, 595 KB

Open AccessReview

Prevalence and Association of Polypharmacy and Potentially Inappropriate Medications Among Older Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

by Raniah A. Aljaizani, Arwa A. Althumairi, Khalid A. Alamer and Shakil Ahmad

Pharmacy 2026, 14(3), 65; https://doi.org/10.3390/pharmacy14030065 - 28 Apr 2026

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Diabetes Management at the Pharmacy: Interventions, Adherence, and Technology)

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18 pages, 1734 KB

Open AccessArticle

Blended Learning to Enhance Competencies Among Practicing Pharmacists: A Pre–Post Evaluation of the European Health Professionals’ and the DigitAl Team SkillS Advancement Project in Romania

by 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 and Tiberiu Sebastian Nemeth

Pharmacy 2026, 14(3), 64; https://doi.org/10.3390/pharmacy14030064 - 24 Apr 2026

Abstract

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 [...] Read more.

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. Full article

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

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13 pages, 3094 KB

Open AccessArticle

Real-World Effectiveness and Safety of Tildrakizumab in a Large Spanish Multicenter Cohort from Spanish Psoriasis Group (GPS)

by 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 and Laura Salgado-Boquete Show full author list Hide full author list

Pharmacy 2026, 14(3), 63; https://doi.org/10.3390/pharmacy14030063 - 24 Apr 2026

Abstract

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 [...] Read more.

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. Full article

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

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15 pages, 1802 KB

Open AccessArticle

From Classroom to Cleanroom: Evaluating Industrial Field Visits as a Pedagogical Tool in Parenteral Pharmaceutical Manufacturing and Quality Control Education

by Sandi Ali Adib and Husam M. Younes

Pharmacy 2026, 14(2), 62; https://doi.org/10.3390/pharmacy14020062 - 17 Apr 2026

Abstract

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 [...] Read more.

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. Full article

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

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23 pages, 475 KB

Open AccessArticle

Knowledge, Attitudes, and Practices Regarding the Disposal of Unused and Expired Medicines in Romania During the Early Implementation of the 2023 Hospital-Based Collection Framework

by Anca Lupu, Ștefan Roșca, Ancuța Iacob, Marius Moroianu and Ramona-Oana Roșca

Pharmacy 2026, 14(2), 61; https://doi.org/10.3390/pharmacy14020061 - 16 Apr 2026

Abstract

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 [...] Read more.

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. Full article

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

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