Search Results (206)

Chronic diseases are a leading cause of death worldwide and have a significant negative impact on public health, overall well-being, national economies, and the long-term sustainability of already burdened health systems. In addressing some of the current health challenges, the contribution of pharmacists and community pharmacies is of particular significance. Pharmacists play a vital role in the medication use process, enhancing the efficacy of pharmacological interventions and facilitating the delivery of health services. Community pharmacies occupy a key position within the healthcare system, acting as a primary point of contact with the public and frequently representing the most accessible healthcare facility for patients. In recent times, community pharmacies have undergone a process of adaptation, shifting from a narrow focus on the dispensing of medications towards a more comprehensive approach that is patient-centered and incorporates a range of healthcare services, while also prioritizing the quality of the services provided. This work aims to explore the role of pharmacists in the provision of pharmaceutical services in three countries with distinct healthcare systems, examining how these services operate, the requirements for their delivery, the associated remuneration structures, and the extent of out-of-pocket costs for patients—ultimately analyzing their impact on health outcomes. Full article

Objectives: To determine the willingness of Jamaican pharmacists to stock and dispense smoking cessation aids and determine barriers to selling products. Design: A descriptive study that utilized pharmacist-completed surveys. The participants received a sectionalized survey and a structured questionnaire tool. Data collection took place over six weeks. Setting: Pharmacists practicing in pharmacies registered by the Pharmacy Council of Jamaica (PCJ) Participants: A total of fifty-seven registered community pharmacists. Results: Most pharmacies (87.7%) do not stock smoking cessation aids. The most identifiable products were nicotine patches/nicotine gum. Pharmacists’ barriers to selling were cost (42%), lack of knowledge of the process of obtaining cessation aids (27.3%), and low demand from patients/clients (22.7%). Most pharmacists (86%) were willing to stock cessation aids. Of the total product requests, 61.2% were lodged by persons 26–50 years old. The stocking of products was not independent of location (p < 0.005). Conclusion: The barriers to the availability of smoking cessation aids, once adequately addressed, could positively enhance the achievement of smoking cessation practices. Full article

Diabetes is a growing chronic disease with complications that impose a significant burden on healthcare systems worldwide. Pharmacists are readily accessible for diabetes management beyond simply dispensing medications. Consequently, they are involved in disease prevention and detection, therapy management, and patient monitoring. However, with the current escalating impact of diabetes, pharmacists must upgrade their strategies by integrating guidelines from sources like the American Diabetes Association (ADA) 2024 with pharmacy expertise. This perspective serves as a guide for pharmacists, identifying key foundations involved in diabetes management, highlighting five crucial steps for optimal disease control, ranging from prevention strategies to pharmacist-led counseling interventions. We employed PubMed, CDC, WHO guidelines, and key reference texts. Searches were performed using combinations of terms such as “pharmacist”, “type 2 diabetes”, “diabetes prevention”, “pharmacist intervention”, and “diabetes management”, covering publications from January 2010 to March 2025. Studies were included if they focused on pharmacist-led prevention, intervention, or management strategies related to type 2 diabetes (T2D) and were published in English. Studies focusing exclusively on type 1 diabetes were excluded. Generative artificial intelligence was employed to order and structure information as described in the acknowledgments. Conflicting evidence was resolved by giving relevance to recent systematic reviews, randomized trials, and major guidelines. Additional insights were gained through consultations with PharmD professionals experienced in diabetes care. Evidence from selected studies suggests that pharmacist-led care models may enhance and promote the early detection of T2D, improve therapy adherence, enhance glycemic control, and increase overall treatment efficiency. This work suggests that pharmacists must play a key role in diagnosing, preventing, managing, and mitigating the consequences associated with T2D. They must contribute to early treatments with appropriate training and involvement to improve therapeutic outcomes and reduce diabetes-related complications. Full article

First-line treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) is pharmacological but is associated with poor success rates in adults. The potential to discontinuously use stimulants may confound adherence assessment. Approximately 30–50% of adults with ADHD will experience depressive episodes, and associated treatment with antidepressants is generally recommended. It can therefore be expected that patients with a formal F90 diagnosis would show higher medication adherence than patients without a diagnosis and that the simultaneous use of antidepressants would increase adherence to ADHD medication. The primary aim was to explore the influence of factors of ADHD diagnosis and comorbid antidepressant use on stimulant adherence. A retrospective, longitudinal pharmacoepidemiological study was conducted on South African community pharmacy dispensing records for 2012–2016 for all patients aged between 18 and 40 years with any record of receiving a drug classified as “Central nervous system other” by the MIMS in 2015. Patients endorsed with an ADHD-linked diagnostic code (F90) were identified and contrasted with those receiving ADHD-indicated medication in the absence of a confirmatory diagnostic code. Two methods were applied to assess adherence to ADHD and/or depression treatment drugs: monthly medicine plotting and Proportion of Days Covered (PDC). Patients were classified as being more or less adherent based on monthly medicine plotting criteria. A study population of 89 patients was identified: 50 had F90 diagnostic codes and 39 were classified as “Non F90”. Adherence as measured based on PDC was generally higher for antidepressant use than for methylphenidate for patients classified as being more adherent. A trend towards higher consumption of antidepressants was shown for the treatment-adherent group. Diagnostic code distinction revealed significantly higher adherence rates to methylphenidate for F90 code patients. Adherence rates to antidepressants appeared to be generally higher for non-F90 patients. Many factors may influence adherence to ADHD-indicated drugs; however, the impact of a confirmed diagnosis may be a strong determinant of motivation to be adherent to ADHD pharmacotherapy. Full article

The COVID-19 lockdown had significant consequences on the mental health of millions of people, leading to the increasing prescription and use of psychotropic drugs. Due to the lack of data in the current literature, this study aims to estimate the trends in the consumption of anxiolytics, antipsychotics, and antidepressants before and during the pandemic on people in the South Italian region. We conducted a retrospective observational study, retrieving prescriptions of anxiolytics, antipsychotics, and antidepressants dispensed in pharmacies of the Basilicata region (South Italy) for the period 2019–2021. We presented the data, expressed in Daily Defined Doses (DDDs) for 1000 persons/day (DHD), on a total resident population of 95,021, dividing the age groups into categories <30, 30–50, 50–70, and >70 years. We conducted a linear regression model to examinate consumption trends across years. Software XLSTAT was used for statistical analysis. During the study period, more than 85,000 boxes of psychotropic medications were dispensed. The research showed an increase in the sales of all three categories of drugs examined, with a greater rise in benzodiazepines (88.5%) and selective serotonin reuptake inhibitors (81.9%) in 2021 compared to 2019, especially among women under 30 years. The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact on the population’s mental health. Full article

Very few studies, all employing surveys, have investigated the perceptions of community pharmacists regarding antimicrobial stewardship (AMS). A qualitative inquiry exploring factors affecting community pharmacists’ participation in AMS may assist in the implementation of AMS in the primary care setting. This study aimed to explore the perceived barriers and enablers of community pharmacists’ participation in AMS. One-on-one semi-structured telephone interviews were conducted with a sample of community pharmacists from across Australia. Interviews were transcribed verbatim and analysed using the Framework Analysis method. Twenty community pharmacists (70% female), representing urban, regional, and remote areas of Australia participated in the study. Pharmacists identified a discord between clinical needs of patients and practice policies as the primary source of excessive prescribing and dispensing of antibiotics. The fragmented nature of the primary healthcare system in Australia was seen as limiting information exchange between community pharmacists and general practitioners about antibiotic use, that was encouraging inappropriate and, at times, unsupervised use of antibiotics. The existing community pharmacy funding model in Australia, where individual pharmacists do not benefit from any financial incentives associated with clinical interventions, was also discouraging their participation in AMS. Pharmacists suggested restricting default antibiotic repeat supplies, reducing legal validity of antibiotic prescriptions to less than the current 12 months, and adopting a treatment duration-based approach to antibiotic prescribing instead of the ‘quantity-based’ approach, where the quantity prescribed is linked to the available pack size of the antibiotic. Structural changes in the way antibiotics are prescribed, dispensed, and funded in the Australian primary care setting are urgently needed to discourage their misuse by the public. Modifications to the current funding model for pharmacist-led cognitive services are needed to motivate pharmacists to participate in AMS initiatives. Full article

Background: Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). Methods: We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. Results: We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. Conclusions: Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices. Full article

Background: Although psychotropic medications (PMs) have enormous adverse events and may cause serious harm if administered inappropriately, there is a scarcity of research concerning the patterns and appropriateness of prescribing these medications in primary care in Jordan. This study aimed to investigate the patterns and appropriateness of PM prescription in primary care, as well as the types and frequency of pharmacist interventions in community pharmacies. Methods: A prospective observational study was conducted in 16 community pharmacies across Jordan. A data reporting sheet was developed, validated, piloted to ensure its applicability, and filled out over 12 weeks (April to June 2023), covering three regions in Jordan. Results: Overall, 426 patients with 469 prescriptions containing 919 PM orders were observed. Among the PMs prescribed, 19.4% were prescribed inappropriately. Among the PMs, 78.7% were dispensed by pharmacists. The inappropriate prescription categories (n = 178) were overprescribing (45, 25.3%), underprescribing (19, 10.7%), inappropriate medication choice (39, 21.9%), inappropriate duration of medication therapy (64, 36.0%), and inappropriate medication dosage (11, 6.2%). The top therapeutic category requested was anti-epileptics (23.9%). Conclusions: This study evaluated the prescribing patterns and appropriateness of PMs in Jordan, revealing notable instances of inappropriate PM prescriptions alongside varied and extensive pharmacist interventions. Full article

Introduction: Pharmacies are important points of access and information for women seeking medication abortion. In the context of the Democratic Republic of Congo [DRC], where the legal conditions for abortion have expanded in recent years and now allow pharmacies to dispense medication abortion with a prescription, little is known about medication abortion counseling and care offered by pharmacy staff. The aim of this study was to explore the quality of information provided by pharmacy staff to customers seeking medication abortion in Kinshasa. Methodology: A cross-sectional study using the mystery client (MC) approach was conducted in 480 pharmacies between April and May 2023. Trained female (n = 9) and male (n = 3) investigators played the role of mystery clients seeking abortion medication for themselves (or their partner or relative), and they asked questions to assess the performance of pharmacy staff and the quality of the provided information. The MCs recorded the results of their visits immediately after they left the pharmacy. Data were analyzed using Stata 17.0 and QGIS. The research protocol received ethical approval from the Kinshasa School of Public Health, and the need for informed consent was waived as pharmacy providers were being observed acting in their professional capacity. Results: Misoprostol was available at 40% of pharmacies visited, while mifepristone–misoprostol was available at less than 2%. Correct dosage information for misoprostol was provided by only 23% of the providers, with the lowest proportion observed in interactions involving male partners (2.4%). During discussions, only 10.6% of the providers explained what to expect during the abortion process. The quality of information differed according to the client profile, the district, and whether the client had a prescription. Conclusions: While medication abortion can provide a safe option for women seeking to manage their own abortion, the lack of adequate information on the correct dosage and administration can hinder the effectiveness of this regimen. To fully realize the potential of this medication for reducing unsafe abortion, it is essential that pharmacy staff are trained and supported to provide high-quality information and services, and that inequities in access to medications are addressed. Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

Background: On-demand personalized drug production is currently not addressed with large-scale drug manufacturing. In our study, we focused primarily on identifying possible active pharmaceutical ingredients (APIs) for 3D Printing (3DP) in the current healthcare setting. Methods: We conducted a retrospective cross-sectional study in the Netherlands using three different sources; community pharmacies (n = 5), elderly care homes (n = 3), and the Erasmus MC Sophia Children’s Hospital. The primary endpoint was the percentage of prescriptions of medication manipulated before administration, thereby being a candidate for 3DP. Around a million prescriptions were analyzed in our study. Results: This study shows that around 3.0% of the prescribed drugs dispensed by Dutch community pharmacies were manipulated before administration, while around 10.5% of the prescribed drugs in the Erasmus MC Sophia Children’s Hospital were manipulated prior to administration. Conclusions: With our study, we show that the most manipulated drugs come from the groups of constipation, psychopharmaceutical, cardiovascular, and anti-infectant drugs. Successful introduction of a compounded API drug by 3DP does not only rely on the API, but it also comes with an optimal balance between technical, economic as well as societal impact factors. Our study gives direction for potential future research on the introduction of 3DP of medicine in the healthcare setting. Full article

Background/Objectives: Vulvovaginal candidiasis (VVC) is a common cause of vaginitis. Over-the-counter drugs are usually dispensed by pharmacy professionals to treat this condition without prior medical consultation. This study aimed at assessing the knowledge of Portuguese pharmacy professionals regarding VVC. Methods: An online questionnaire including questions about the symptoms and treatment of VVC was distributed between March and April of 2024. Results: A total of 376 professionals participated in this study. There was a significantly lower proportion of men (p = 0.007) and pharmacy technicians (p = 0.005) who correctly identified the main causative agent of VVC when compared to women and pharmacists. Only 30% of women correctly identified the number of VVC episodes in the same year they classified as complicated, but this was significantly higher (p = 0.038) than the proportion of men who identified complicated VVC (20%). Topical clotrimazole preparations were the more frequently identified medicines for the treatment of uncomplicated VVC, and fluconazole-containing medicines were the preferred choice for the treatment of complicated VVC. Conclusions: This study highlights the need to improve education and training for pharmacy professionals. By addressing these knowledge gaps, pharmacists and pharmacy technicians can provide more accurate and effective advice to patients. Full article

Background: Special low-protein foods are essential in the dietary treatment of phenylketonuria (PKU). In the UK, these are available on prescription through the General Practitioners (GPs) and distributed via nutritional home delivery companies or pharmacies. Methods: A 58-item online non-validated semi-structured questionnaire was emailed to British Inherited Metabolic Disease Group (BIMDG) dietitians and dietetic support workers (DSW)/administrators working in PKU to ascertain the main system issues and errors with the supply of low-protein prescription foods (LPPF). Results: 73% (n = 53/73) of dietitians and 72% (n = 18/25) of DSW/administrators responded. A total of 80 questionnaires (representing 44 paediatric and 36 adult PKU centres) were completed. A total of 50% (n = 40/80) of respondents reported patient/caregiver problems accessing LPPF at least weekly. The most common problems were unavailable products (82%), missing LPPF in deliveries (79%), and delayed deliveries (66%). For 64% of respondents, >25% of their patients had recurring problems accessing LPPF, and 69% of respondents spent ≥1 h/week and 11% >5 h/week correcting LPPF patient supply issues. The most common foods patients experienced supply issues with were bread (96%), pasta/rice (41%) and milk replacements (35%). This was associated with GP prescription errors (65%), LPPF prescriptions sent to incorrect dispensers/suppliers (60%), and manufacturer supply issues (54%). Problems with patients/caregivers included not ordering LPPF in a timely way (81%), not responding to messages from home delivery companies (73%) and poor understanding of the ordering process (70%). The majority (93%) of respondents reported that prescription issues impacted their patients’ blood Phe control. Suggestions for improving access to LPPF included centralisation of the system to one supplier (76%) and apps for ordering LPPF (69%). Conclusions: The supply of LPPF for PKU in the UK is problematic; it may adversely affect the ability of patients to adhere to dietary management, and a review investigating patient access to LPPF is urgently required. Full article

This study explored controlled substance (CS) diversion surveillance practices within hospital pharmacies across the United States. A survey with questions based on published CS diversion risk points was conducted in May 2024. A total of 66 participants from 31 states responded, with 54.5% from single facilities and the remaining from health systems. Most respondents were pharmacy directors, managers, or those in dedicated drug diversion roles. Over 70% have dedicated surveillance teams and use drug diversion software. Results highlight variation in practices, with larger institutions generally showing better compliance. Compliance in procurement and receiving was high for access measures; however, auditing of processes was lower. The lowest procurement compliance was in monitoring periodic automatic replacement (PAR) levels and validating orders with wholesalers. Storage practices showed high compliance in deploying cameras, but low compliance in monitoring them. Dispensing practices had high compliance for restricting CS in automated dispensing cabinets, but low incidence of witness verification during stocking. Waste and disposal practices were well-followed, but training on detecting potential signs of medication tampering was less common. The survey highlights that while strategies to prevent CS diversion exist, their implementation varies. Enhancing monitoring, auditing, and training is essential to strengthen diversion prevention efforts in hospital pharmacies. Full article

Introduction: Antimicrobial resistance poses a significant threat to global health, and community pharmacists are positioned to play a crucial role in mitigating this issue. The present study aimed to evaluate the extent of compliance among community pharmacists in Saudi Arabia with relevant regulations and clinical guidelines in the management of suspected infectious diarrhea. Method: This cross-sectional study employed simulated patients presenting with diarrhea to assess the management practices within 200 community pharmacies in two major cities across Saudi Arabia. Trained pharmacy students presented pharmacists with three case scenarios involving adult patients with diarrhea. Statistical analysis included descriptive statistics and chi-square tests to examine the relationships between pharmacist characteristics and practice categories. Results: The findings of this study indicate that the performance of community pharmacists in managing diarrhea is suboptimal. Notably, less adequate practice emerged as the predominant outcome at 63% (n = 126). Only 14% (n = 28) of pharmacists demonstrated adequate practice, while 23% (n = 46) exhibited poor investigative practice. Metronidazole dispensing increased across scenarios, from 16.92% (n = 11) in Scenario 1 to 30.3% (n = 20) in Scenario 3. Most pharmacists inquired about the patient’s age (72%; n = 144); however, only a limited number probed for symptoms of dehydration (5.5%, n = 11) and medication history (3%, n = 6). A significant association was found between geographical location and practice performance (p = 0.015). Conclusions: This study reveals significant deficiencies in the management of infection-related diarrhea, underscoring the urgent need for enhanced training and regulatory measures within community pharmacy settings in Saudi Arabia to improve patient care and effectively address antimicrobial resistance (AMR). Full article