Search Results (946)

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations. Full article

Background: Antimicrobial resistance (AMR) is a major global health threat, and Cyprus reports one of the highest levels of community antibiotic consumption in the EU. Despite their central role in antibiotic access and counselling, the stewardship practices and perspectives of community pharmacists in this regulated setting are not well documented. Methods: We conducted semi-structured qualitative interviews with 20 community pharmacists to explore their perspectives on antibiotic use and AMR. Results: We analysed the data using reflexive thematic analysis, revealing five key themes: regulation and control of dispensing; pharmacist–patient interaction and misuse; antimicrobial stewardship and public education; safety and professional responsibility; and systemic barriers. Pharmacists reported strict adherence to prescription-only rules, and described regulation and e-prescribing as a practical ‘shield’ that legitimised refusals and redirected some misuse from overt non-prescription requests towards attempts to reuse, extend, or ‘top up’ prior prescriptions and household leftovers. They described managing frequent patient demands for antibiotics for self-limiting conditions and using brief counselling scripts, written aids, and symptomatic alternatives to promote appropriate use. Participants emphasised the risks of antibiotic-related harms, including AMR and other health consequences, while also highlighting workload, access constraints, and communication difficulties as barriers to effective counselling. Overall, the findings indicate that community pharmacists in Cyprus function as front-line antimicrobial stewards. Conclusions: These accounts position community pharmacists in Cyprus as front-line antimicrobial stewards. Policy should consider supporting this function by providing enhanced communication tools, improving access pathways for timely prescriber review (including outside routine hours), and strengthening links between community pharmacy and national AMR action plans. Full article

Background/Objectives: This study aimed to perform a comparative analysis of the original Viagra^® product and sildenafil-containing tablets obtained from illegal sources (the darknet). Specifically, the analyzed material consisted of samples seized by Polish law enforcement authorities from unverified vendors operating within the Central European darknet market. The study utilized thermal methods, specifically Thermogravimetry (TG), Derivative Thermogravimetry (DTG), and calculated Differential Thermal Analysis (c-DTA), as well as colorimetric analysis based on the International Commission on Illumination (CIE) L*a*b* system. Methods: Thermal analyses enabled the assessment of the thermal stability of the tested samples, identification of characteristic stages of thermal decomposition, and determination of differences in thermal behavior between the pure substance, the original preparation, and darknet samples. In turn, color measurements in the CIE L*a*b* space allowed for an objective comparison of tablet appearance and determination of the degree of color similarity to the original product. Results: The obtained results showed that only a few samples (V1, V3, V4, V6, V8) exhibited features similar to the original Viagra^®, both in terms of thermal profile and color. Most of the tested tablets were characterized by significant variability in physicochemical properties, indicating a lack of quality control and inconsistency in formulation. Samples V2 and V7 deviated particularly strongly—both thermally and visually—suggesting that they might not contain the original active substance or contained it in a different chemical form. Conclusions: The use of combined thermal and colorimetric methods proved to be an effective tool in the identification of counterfeit pharmaceutical products, enabling simultaneous evaluation of their composition and authenticity. The results confirm the validity of employing integrated physicochemical analyses for the detection of falsified medicines present on the illegal market. Full article

Background: Clinical pharmacists are increasingly demonstrating their value within primary care; this process directly improves patient experiences and outcomes. However, many undergraduate pharmacy students have little or no experience in this area, so that when they first qualify from training, their previous lack of exposure could affect future patient care in this environment. Aim: This study aims to evaluate how pharmacy undergraduate students’ learning and development of competencies are managed and received by general practitioner (GP) educators, clinical tutors, students, and patients in a general practice setting. Design and setting: The General Practice Pharmacy Educational Placement (GPEP) for undergraduates was designed and delivered in half-a-day each week across five weeks in general practice. Students observed patient consultations, interviewed patients, conducted medication reviews, used medicines reconciliation techniques, and also produced patient care plans. Method: Students participating in GPEP completed both pre- and post-course questionnaires rating eight learning outcomes, using a five-point Likert scale. Data analysis incorporated multivariate principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) strategies, and thematic analysis was applied to student focus groups, patient interviews, and GP staff interviews. Following the patient medication interview, students recorded findings and potential interventions for consideration. Results: A total of 112/157 students (71%) completed the questionnaires (June 2016–March 2019), with significant statistical differences in student confidence (p < 0.0005 for all learning outcomes). Thematic analysis revealed largely positive attitudes towards GPEP. Healthcare professionals highlighted benefits and challenges of GPEP. More than 40 issues relating to medicines optimisation and patient safety were identified, with some requiring immediate interventions from GP teams. Conclusions: GPEP demonstrated a positive clinical impact, improving patient safety. The undergraduate activities may encourage students to consider roles in primary and community care, enabling a resilient and able future workforce. Full article

Introduction: Vaccination has led to significant decreases in mortality over the last century but requires high levels of uptake to be successful in reducing a wide range of infectious diseases in communities. Vaccine hesitancy is on the rise in the United States with most adults not receiving all recommended vaccinations, and childhood vaccinations are declining. Living in a rural community with a lack of access to resources may further limit uptake of vaccines. Identifying strategies to enhance vaccine confidence and access may assist in increasing vaccine uptake. The purpose of this study was to describe the landscape of existing community-based vaccination efforts and assess the components of a successful community-based vaccination program in rural eastern North Carolina. To reach this purpose, we conducted qualitative interviews with those involved in running community-based vaccine education and navigation programming in rural eastern North Carolina.” Methods: Researchers conducted 25 semi-structured interviews with participants involved in vaccination efforts in three rural counties in Eastern North Carolina. Interviews were transcribed, coded in NVivo version 14, and analyzed using thematic analysis to synthesize insights from participants. Results: Study participants held manager or coordinator roles in area health agencies, clinics, and pharmacies. Reported strengths of current vaccine efforts in Eastern North Carolina included patient education, strong partnerships between organizations providing vaccines, and ability to engage community members. Successful vaccine efforts have engaged participants through social media, flyers, trusted leaders, and the provision of convenient vaccine appointments. Areas for improvement in vaccine efforts included engaging a wider audience at vaccine events, building trust in vaccines among community members, and expanding vaccine education for hard-to-reach populations. Participants supported the development of a proposed community-based education and navigation program and felt that community members would be interested. Identified challenges included low participation due to vaccine hesitancy which could be overcome through incentives and delivery from trusted individuals. Conclusions: We found that there is still a need for trust building, education, and patient engagement within the landscape of existing community-based vaccination efforts for vulnerable populations in rural eastern North Carolina. Study participants indicated support for the development of a vaccine education program and researchers determined the project to be feasible. Based on the results of this study, researchers developed and implemented an integrated vaccine education and navigation program in Eastern North Carolina. Full article

Background: Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to comprehensively evaluate antibiotic dispensing patterns and factors influencing this to reduce AMR. Methods: A previously piloted questionnaire was administered to patients exiting three different categories of community pharmacies in a rural province. The questionnaire included data on the prevalence of antibiotics dispensed, whether without a prescription, and the rationale for this. Results: A total of 465 patients leaving community pharmacies with a medicine were interviewed. 54.4% of interviewed patients were dispensed at least one antibiotic, with 78.7% dispensed these without a prescription from either independent or franchise pharmacies. Metronidazole (36.1%) and azithromycin (32.7%) were the most dispensed antibiotics. STIs were the most common infectious disease for which an antibiotic was dispensed (60.1%), with 99.6% dispensed without a prescription. Upper respiratory tract infections (URTIs) were the most common infection where antibiotics were dispensed with a prescription (60.0%), with little dispensing without a prescription (7.1%). The most frequently cited reasons for obtaining antibiotics without a prescription were prior use (56.8%), long waiting times at PHC clinics (15.6%), and financial constraints (6.0%). Conclusions: There is an urgent need to review community pharmacists’ scope of practice, including allowing them to prescribe antibiotics for infectious diseases such as UTIs, similar to other countries. Concomitantly, utilise trained community pharmacists to engage with prescribers to improve future antibiotic use, especially for URTIs. Full article

Background and Objectives: Osteoporosis risk in real-world, outpatient settings is shaped by intersecting socio-demographic, environmental, and clinical factors. We evaluated predictors of fracture risk status among adults seeking care in community pharmacies in Lahore, Pakistan. Materials and Methods: We conducted a cross-sectional study across urban and suburban pharmacies using a validated questionnaire aligned with international guidelines. Participants were classified as lower risk (osteopenia/osteoporosis without fragility fracture) or high risk (≥1 fragility fracture with clinical osteoporosis). Associations between candidate factors and risk status were examined using univariate and multivariable logistic regression analyses. Results: Of 286 participants, 53.1% were classified as lower risk. After adjustment, most sociodemographic characteristics were not independently associated with fracture risk status, except monthly income. Strong associations were observed for diabetes (AOR = 0.005, 95% CI 0.0007–0.040; p < 0.001), short-term glucocorticoid use (AOR = 32.33; p = 0.004), current smoking (AOR = 14.23; p = 0.002), ex-smoking (AOR = 4.95; p = 0.042), and lack of sunlight exposure (AOR = 7.09; p = 0.019). CKD, rheumatoid arthritis, and vitamin D insufficiency demonstrated borderline non-significant trends. Multivariable modeling did not include “not tested” categories or sparse variables. Conclusions: In Lahore’s community pharmacies, diabetes, CKD, RA, glucocorticoid exposure, smoking, and sunlight/vitamin D-related factors were the dominant correlates of osteoporosis fracture risk status, whereas most socio-demographic factors exerted limited independent effects. Pharmacy-anchored screening and counseling focused on these high-yield clinical indicators alongside timely BMD referral and guideline-concordant therapy may help identify individuals at elevated fracture risk. Full article

The task of repackaging resident’s medication into medication organizers is increasingly outsourced from nursing homes to pharmacies, presenting an opportunity to redefine the interaction between nursing and pharmaceutical staff. This study investigated whether outsourcing medication repackaging changes the quality and subjects of collaboration between the two professions. A cross-sectional survey was developed targeting heads of nursing in German nursing homes. A simple random sample of 1415 nursing homes was contacted by phone. Respondents participated either by phone or by online survey. Quality of collaboration was measured using Kenaszchuk’s Interprofessional Collaboration Scale (ICS) with its subscales Communication, Accommodation and Isolation. Topics of interaction were ascertained using items along a medication management phase model. Differences in response frequencies were analyzed using Fisher’s exact test. A total of 268 nursing homes participated (response: 18.9%). Of these, 132 (49.3%) had outsourced repackaging. Respondents at nursing homes with in-house medication repackaging rated the subscale Accommodation more favorably (p = 0.008), while Communication and Isolation showed no difference. Of the 13 individual ICS items, “passing on information” (Communication) was rated better by respondents at homes with outsourced repackaging (p = 0.019) and “consideration of convenience” (Accommodation) more favorably by respondents at homes with in-house repackaging (p = 0.042). Nursing staff at homes with outsourced medication repackaging interacted with pharmaceutical staff more frequently on medication changes (p < 0.001), but less frequently on tablet splitting (p = 0.035). In conclusion, outsourcing medication repackaging has a limited impact on the quality of interprofessional collaboration between the two professions but may have the potential to reduce ambiguities regarding splitting tablets. Full article

Background/Objectives: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used globally to manage pain and inflammation. The rising prevalence of polypharmacy and potential drug–drug interactions (pDDIs) magnified by the prolonged and irrational use of NSAIDs may jeopardize patient medication safety. This study aims to analyze the pattern in prescribing NSAIDs and assess the extent of polypharmacy and pDDIs in community pharmacies located in Ras Al Khaimah. Methods: A quantitative cross-sectional study was conducted in randomly selected community pharmacies over six months (July 2024 to December 2024). Prescriptions pertaining to NSAIDs were assessed for prescribing patterns; incidence of polypharmacy and pDDIs were identified using Lexicomp’s drug interaction database. Chi-square tests assessed associations between treatment variables and polypharmacy, while logistic regression explored predictors of pDDIs. Results: In a total of 600 prescriptions, 1865 drugs were prescribed, including 908 NSAIDs. Celecoxib (28.2%) and ketoprofen (27.6%) remained the most predominant oral and topical NSAIDs prescribed. Aspirin and celecoxib were most commonly linked with pDDIs. A total of 357 pDDIs were identified, averaging 1.87 ± 1.39 per prescription. Most were of minor severity (60.22%), risk category C (43.97%), and fair reliability (59.38%). Gender, nationality, and comorbidities were significantly associated with polypharmacy (p < 0.001). Logistic regression showed nationality (p = 0.016), comorbidities (p < 0.001), and drug count (p = 0.007) as key predictors of pDDIs. Conclusions: Frequent NSAIDs prescribing, incidence of polypharmacy, and pDDIs underscore the attention for more cautious, evidence-based prescribing practice. Enforcing a robust regulatory framework, coupled with strengthening medication-use policies and pharmacist-led thorough medication history review and ongoing monitoring is paramount to improve patient safety and clinical outcomes. Full article

Introduction: During pharmaceutical care, community pharmacists play a crucial role by carrying out interventions aimed at preventing, detecting, and resolving drug-related problems (DRPs) and negative outcomes associated with medication (NOM), simultaneously enhancing patients’ knowledge about their treatments. The chronic use of Benzodiazepines (BZDs) is known to be associated with risks such as tolerance, dependence, and cognitive impairment. Furthermore, the combined use of BZDs with other medications or alcohol may expose patients to significant drug interactions. Objectives: This study aimed to characterize and describe the clinical profile of patients using BZDs, to evaluate the extent of polypharmacy and potential drug interactions, to investigate their level of knowledge regarding BZD treatment, and ultimately, to propose evidence-based interventions from the community pharmacy to contribute to improving patient safety and minimizing risks associated with BZD use. Method: A cross-sectional, descriptive study was conducted in a single community pharmacy in Gran Canaria (Canary Islands, Spain). The study population comprised 125 adult patients with active BZD prescriptions. Data collection was performed through pharmacist–patient structured interviews using a questionnaire that included sociodemographic, clinical, and BZD knowledge variables. Results: Lormetazepam and alprazolam were the BZDs most frequently prescribed and dispensed. Potential drug interactions with other medications were detected in 38.4% of BZD users. Notably, 61.5% of patients using BZDs also reported the concurrent use of opioid analgesics, with tramadol being the most common opioid (48.1% of BZD users were also treated with tramadol). Statistically significant differences were observed between patients with and without BZD and other drug interactions in several adverse outcome variables, including the risk of falls (p = 0.003), cognitive impairment (p = 0.047), and urinary incontinence (p = 0.016). Existing BZD dependence is detected in 25% and 22.1% of cases, respectively. Patients’ knowledge of their BZD treatment revealed critical gaps, which are identified as a challenge and a clear opportunity for intervention through pharmaceutical care services. Conclusions: The findings underscore the essential and proactive role of community pharmacists in identifying and managing drug interactions, as well as in supporting deprescribing strategies through collaborative and interprofessional care models. Full article

Background: Telepharmacy consultations (TPCs) became a routine element of pharmacy operations. However, there is limited data available on local pharmacy customer feedback related to TPC. Methods: A customer survey was developed seeking feedback on TPC. The pharmacy customers were invited to complete the survey in two local pharmacies in Germany. The survey and corresponding informed consent form were approved by the Ethics Committee. Results: In total, 178 pharmacy customers were enrolled (median age 41–50 years). From those, 37% agreed when asked whether they were generally interested in TPC. A total of 37% had the nearest pharmacy 5–15 min from their home. A total of 42% visited their pharmacy quarterly. A total of 36% used technical devices in median 1–2 h per days. A total of 33% classified their own digital skills at least as sufficient. A total of 59% would use their smartphone as a potential device for TPC. A total of 83% rated it as (slightly) important that the pharmacist providing TPC can be heard clearly. A total of 76% each (strongly) agreed that an argument for TPC would include limited mobility or pandemic/quarantine. A total of 33% (strongly) agreed that a key argument against TPC were technical requirements. A total of 75% considered situations of immobility to be the most important future perspective for TPC. Conclusions: Many pharmacy customers see TPC as an opportunity, e.g., in cases of limited mobility or during pandemic or quarantine. However, the use of appropriate technology can be a limiting factor. Full article

Background/Objectives: Risk minimization measures, including a pregnancy prevention program (PPP), have been established by the European Medicine Agency to strengthen the restrictions on valproate (VPA) use in pregnant women/women with childbearing potential. We aimed to assess pharmacists’ awareness of the new measures and behavior in terms of compliance to PPP recommendations. Methods: We performed a cross-sectional, national, non-interventional survey among pharmacists between December 2024 and February 2025. No sample size calculations were performed. Inclusion criteria were pharmacists active in community pharmacies in Romania. Results: In total, 267 pharmacists were included, balanced in terms of age groups, with a slight predominance for 31–40 year olds (33.7%) and mostly female (93.3%). More than half (60.7%) did not recall receiving any type of PPP information (direct healthcare professional communication [DHPC] or educational materials [EMs]). Participants generally read the DHPC, fully (64.1%) or partially (21.4%); all reportedly read the EMs, generally fully (73.0%). Half (145, 54.2%) dispensed VPA at least once during the last 12 months. Among this subgroup, 15.2% used the EMs, 38.6% counseled the patient regarding the VPA teratogenic risk, and 32.4% counseled on the importance of effective contraceptive measures at every VPA dispensing. Neither awareness nor behavior met the pre-established success criteria; therefore, the overall PPP compliance was not demonstrated. Conclusions: Despite notable proportions of pharmacists offering counseling when dispensing, overall PPP compliance and EM use could be enhanced. More research is needed to identify why some measures are not properly adhered to, in order to increase the overall risk mitigation efficacy. Full article

Background: Community pharmacies are increasingly delivering structured services to support chronic disease management, such as Multidose Drug Dispensing (MDD). This strategy can improve adherence and safety, but evidence of its economic feasibility in Portuguese pharmacies remains limited. Objective: To estimate the cost of implementing and operating an MDD system in a community pharmacy, informing reimbursement models and policy. Methods: A micro-costing approach assessed fixed and variable expenses for serving polymedicated elderly patients. Costs were calculated in euros (2024/2025) and expressed per working day based on 253 annual preparation days. Results: First-year costs totaled €70,985.68, including €8184.00 for setup, €21,579.00 for supplies, and €41,222.68 for staff salaries. The daily operating cost was €280.58, with labour representing the major expense. A break-even analysis indicated sustainability with around 700 users at €10/month. Conclusion: Although requiring significant initial investment, MDD can become financially viable through scaling, workflow efficiency, and supportive reimbursement strategies. Full article

Background/Objectives: Osteoporosis represents a major yet underdiagnosed public health concern in developing countries, including Tunisia. Limited awareness, delayed diagnosis, and suboptimal adoption of preventive strategies contribute to increased risk of fragility fractures in aging populations. This study aimed to assess post-pandemic knowledge, attitudes, and preventive practices regarding osteoporosis in the Tunisian general population. Methods: A cross-sectional survey was conducted between February and April 2024 in six randomly selected community pharmacies in Tunis. Adults ≥ 40 years old completed a validated 31-item questionnaire assessing socio-demographic factors, osteoporosis knowledge, risk factors, screening practices, and preventive behaviors. A total of 160 fully completed questionnaires were analyzed using SPSS v22. Results: Only 60.6% of respondents reported awareness of osteoporosis. Knowledge levels were significantly higher in men (8.37 vs. 7.40; p = 0.043), urban residents (8.22 vs. 7.21; p = 0.036), participants with higher education (8.73 vs. 7.00; p < 0.001), those with a family history (8.58 vs. 7.49; p = 0.033), and individuals already diagnosed (9.19 vs. 7.63; p = 0.025). Screening rates were low: only 11.3% had ever undergone DXA testing, despite 18.8% reporting prior fractures. Preventive behaviors were inadequate: 80% did not supplement calcium, 88.1% did not use vitamin D, and 58.8% did not engage in <30 min of daily activity. Osteoporosis was reported by 13.1% of participants and 95.2% of diagnosed cases received treatment, predominantly bisphosphonates (75%). Comorbidities were significantly associated with osteoporosis (24.5% vs. 7.5%; p = 0.003). Conclusions: This study reveals suboptimal awareness, limited access to screening, and insufficient preventive behaviors regarding osteoporosis in Tunisia. Targeted educational initiatives, expansion of DXA availability, adoption of national osteoporosis guidelines, and multidisciplinary stakeholder involvement are critical to improve early detection, prevention, and management in the aging Tunisian population. Furthermore, promoting balanced nutrition that includes calcium- and vitamin D-rich foods, along with appropriate dietary supplementation when needed, is an essential preventive strategy to support optimal bone health and reduce osteoporosis risk in the general population. Full article

Food supplements (FSs) are widely used by the general population and are commonly available in community pharmacies. As highly accessible healthcare professionals, pharmacists are well positioned to provide evidence-based information and guidance regarding their safe and appropriate use. Adequate knowledge of FSs is essential for pharmacists to prevent adverse effects, identify potential interactions with other medications, and ensure rational use. The objective of this study was to assess community pharmacists’ knowledge regarding FSs and their attitudes towards dispensing and patient counseling practices. A literature review was carried out using the scientific databases PubMed, Scopus, and Web of Science. The following keywords were used: (“food supplements” OR “dietary supplements”) AND (“pharmacists’ knowledge”) AND (“pharmacists’ attitudes”). A total of 789 articles were identified from the electronic databases, of which 31 met the inclusion criteria. The majority of studies were conducted in Asia, with fewer in Europe, North America, and Australia. Cross-sectional survey-based studies represented the predominant research design. The analyzed studies showed that community pharmacists generally demonstrate insufficient knowledge regarding FSs. Nonetheless, they tend to hold a positive attitude toward the use of FSs and recognize their responsibility to counsel patients on safe consumption. Several barriers affecting pharmacists’ ability to deliver evidence-based guidance were identified, including limited training, lack of basic nutrition education, and insufficient access to reliable information sources. The findings indicate the need for targeted strategies to enhance pharmacists’ competencies and improve the quality of patient counseling in this domain. Full article