Drug Use and Patient Safety in Primary and Secondary Care Settings

Abstract submission deadline

31 August 2026

Manuscript submission deadline

31 October 2026

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Topic Information

Dear Colleagues,

The intricate relationship between drug use and patient safety in primary and secondary care settings is a critical area of healthcare that demands thorough investigation and continuous improvement. This Topic aims to explore the multifaceted aspects of medication management, including prescribing practices, administration, monitoring, and patient education, within diverse healthcare environments. With the rising complexity of pharmacotherapy and the increasing prevalence of chronic conditions, ensuring safe and effective medication use across care settings is paramount.

In primary care, the focus is often on initiating therapy, managing chronic diseases, and preventing adverse drug events through vigilant monitoring and patient engagement. Meanwhile, secondary care settings, which typically involve more specialized and acute interventions, present unique challenges related to the transition of care, medication reconciliation, and managing complex therapeutic regimens.

The objective of this Topic is to consolidate contemporary research and clinical insights to enhance patient safety related to drug use in primary and secondary care settings. By highlighting best practices, innovative strategies, and the latest advancements in medication safety, we aim to provide healthcare professionals with the knowledge and tools necessary to reduce medication errors, prevent adverse drug reactions, and improve overall patient outcomes. We welcome contributions that address these critical issues through empirical research, reviews, case studies, and policy analyses.

Dr. Kingston Rajiah
Dr. Ashuin Kammar-García
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Healthcare healthcare	3.4	5.5	2013	21.5 Days	CHF 2700	Submit
Hospitals hospitals	-	-	2024	38.1 Days	CHF 1000	Submit
Journal of Clinical Medicine jcm	3.3	5.2	2012	16.6 Days	CHF 2600	Submit
Medicina medicina	2.9	4.6	1920	17.4 Days	CHF 2200	Submit
Medicines medicines	-	-	2014	30.6 Days	CHF 1400	Submit
Safety safety	2.4	3.9	2015	34.4 Days	CHF 1800	Submit

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Published Papers (9 papers)

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All Healthcare Hospitals JCM Safety Medicina Medicines

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Open AccessArticle

Cardiovascular Outcomes Associated with Romosozumab Versus Denosumab in Chronic Kidney Disease

by Jheng-Yan Chen, Tse-Yu Chen, Kuan-Kai Tung, Ya-Lien Deng, Cheng-Ying Lee, Chi-Ruei Li and Hsu-Tung Lee

Medicina 2026, 62(7), 1302; https://doi.org/10.3390/medicina62071302 - 6 Jul 2026

Viewed by 219

Abstract

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed [...] Read more.

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed to compare the cardiovascular and survival outcomes associated with romosozumab versus denosumab in adults with CKD. Materials and Methods: In this retrospective propensity score-matched cohort study, we utilized de-identified electronic health records from the TriNetX Global Collaborative Network, where eligible participants were adults aged 40 to 90 years with CKD who initiated either romosozumab or denosumab. Patients with bone/bone marrow malignancies or recent acute cardiovascular events were excluded. Following 1:1 propensity score matching based on demographics, diagnoses, medications, and laboratory characteristics, patients were followed for up to 1095 days. The primary outcome was a composite cardiovascular measure (all-cause mortality, acute myocardial infarction, or cerebrovascular event), while secondary outcomes included the individual components of the composite outcome and acute heart failure. Outcomes were evaluated using fixed-window cumulative risks, risk ratios (RRs), odds ratios, and hazard-ratio estimates. Results: After 1:1 propensity score matching, 1201 patients remained in each cohort; the mean age was 74.1 years in the romosozumab cohort and 74.2 years in the denosumab cohort, and 94.9% and 93.8%, respectively, were women. Romosozumab was associated with lower 1095-day cumulative risk of the composite cardiovascular outcome than denosumab (12.6% vs. 18.8%; RR, 0.668 [95% CI, 0.553–0.808]), as well as lower cumulative risk of cerebrovascular event (5.0% vs. 7.0%; RR, 0.714 [95% CI, 0.518–0.985]), all-cause mortality (6.6% vs. 9.5%; RR, 0.693 [95% CI, 0.526–0.913]), acute myocardial infarction (3.8% vs. 6.2%; RR, 0.613 [95% CI, 0.429–0.878]), and heart failure (2.7% vs. 6.1%; RR, 0.438 [95% CI, 0.292–0.659]). Conclusions: In this propensity score-matched EHR cohort of adults with CKD, cardiovascular and survival estimates associated with romosozumab versus denosumab varied by follow-up window and analytic approach. Although 1095-day fixed-window cumulative risks were lower in the romosozumab cohort, corresponding time-to-event estimates were neutral or directionally inconsistent. These findings should not be interpreted as evidence of cardioprotection or causal superiority but rather as showing no clear and consistent excess cardiovascular risk signal for romosozumab compared with denosumab. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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13 pages, 338 KB  

Open AccessArticle

Knowledge of Complementary Medicine and Therapies Among Family Physicians and the General Population in Saudi Arabia

by Safaa M. Alsanosi

Healthcare 2026, 14(13), 1930; https://doi.org/10.3390/healthcare14131930 - 1 Jul 2026

Viewed by 116

Abstract

Background: Complementary Medicine and Therapies (CMTs) are increasingly used worldwide, particularly in Saudi Arabia, due to growing interest in holistic and integrative healthcare. However, concerns regarding safety, regulatory awareness and evidence-based use persist, while comparative knowledge data between family physicians and the general [...] Read more.

Background: Complementary Medicine and Therapies (CMTs) are increasingly used worldwide, particularly in Saudi Arabia, due to growing interest in holistic and integrative healthcare. However, concerns regarding safety, regulatory awareness and evidence-based use persist, while comparative knowledge data between family physicians and the general population remain limited. This study aimed to compare knowledge of CMTs between family physicians and the general population in Saudi Arabia. Methods: A comparative cross-sectional analysis was conducted using two independent datasets collected in Saudi Arabia from a total of 1307 participants. Variables related to the participants’ demographic characteristics, and their knowledge of and information sources on CMTs, were harmonised prior to analysis. Between-group comparisons were performed using Chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05. Results: The family physicians demonstrated significantly higher levels of knowledge of CMTs than the general population. While 35.5% of the physicians demonstrated good knowledge levels, 82.0% of the public participants exhibited poor or low knowledge. However, knowledge of regulatory and quality control measures governing CMTs remained limited among both the physicians (21.0%) and the public (24.6%). Both the physicians (66.1%) and the members of the public (34.8%) primarily relied on healthcare professionals as major sources of information on CMTs. Significant associations were observed between the participant group and the knowledge-related variables, overall knowledge levels and information sources (p < 0.001). Conclusions: Strengthening public education, physician training and regulatory awareness may support safer and more evidence-based integration of CMTs within healthcare systems. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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12 pages, 225 KB  

Open AccessReview

Exploring Non-Pharmacological Interventions as Part of Multimodal Management to Prevent Opioid Misuse in Adults Prescribed Opioids for Chronic Pain

by Manar A. Alrashid, Maya S. Zumot and Salim Fredericks

J. Clin. Med. 2026, 15(11), 4079; https://doi.org/10.3390/jcm15114079 - 25 May 2026

Viewed by 533

Abstract

In recent years, there has been an unprecedented upsurge in opioid prescriptions for pain management. Consequently, the widespread availability of these medicines has led to an increase in misuse and abuse. This has led to a greater number of overdose-related deaths. The high [...] Read more.

In recent years, there has been an unprecedented upsurge in opioid prescriptions for pain management. Consequently, the widespread availability of these medicines has led to an increase in misuse and abuse. This has led to a greater number of overdose-related deaths. The high prevalence of drug misuse was born of multiple and complex societal factors. However, from a medical perspective, critical contributors to the dire consequences of the crisis have been the need for chronic pain relief, as well as mental health issues within communities. Chronic pain coupled with psychological distress exacerbates patients’ predicaments and thus further fuels the crisis. Anxiety and depression have bidirectional and complex relationships with pain. The somatic symptoms associated with anxiety potentially worsen pain, whilst pain emanating from a chronic condition worsens anxiety. The same relational dynamic applies to depression and pain. Thus, these psychopathological states may be major contributors to the opioid abuse epidemic. Thus, psychosocial management as a first-line treatment instead of starting with drug treatments seems an enlightened approach to this problem. Cognitive behavioral therapy (CBT) has been proven to be effective in managing specific symptoms associated with chronic pain. Similarly, patient education has been shown to be a viable alternative to drugs for certain aspects of chronic pain treatment. We consider that the opioid crisis could be addressed with a greater reliance and emphasis on non-pharmacological approaches to managing chronic pain patients. This mini-review examines non-pharmaceutical and monitoring-based interventions to reduce opioid misuse risk among adults prescribed opioids for chronic non-cancer pain. Studies were identified through PubMed/MEDLINE, Scopus, and Google Scholar using terms related to chronic pain, prescription opioid misuse, opioid use disorder, cognitive behavioral therapy, patient education, prescription drug monitoring programs, digital health, telehealth, and non-pharmacological interventions. Studies were included if they focused on adults with chronic pain who were prescribed opioids or at risk of misuse, and evaluated interventions aimed at reducing unsafe opioid use, misuse risk, or opioid-related harm. Evidence was synthesized narratively to identify key intervention approaches, limitations, and clinical implications. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

14 pages, 264 KB  

Open AccessArticle

Patient Satisfaction with Clinical Pharmacist Communication and Its Association with Treatment-Related Problems: A Cross-Sectional Study in Jordanian Public Hospitals

by Mohammad Ali AL-Qarni, Ahmet Sami Bosnak and Esra’ O. Taybeh

Healthcare 2026, 14(9), 1176; https://doi.org/10.3390/healthcare14091176 - 28 Apr 2026

Viewed by 636

Abstract

Background: Treatment-related problems (TRPs), including patient adherence, knowledge, and medication errors, affect hospitalized patients’ outcomes worldwide. Effective clinical pharmacist communication is essential for proper patient counselling and medication safety. However, the effect of clinical pharmacist communication skills on TRPs has not been adequately [...] Read more.

Background: Treatment-related problems (TRPs), including patient adherence, knowledge, and medication errors, affect hospitalized patients’ outcomes worldwide. Effective clinical pharmacist communication is essential for proper patient counselling and medication safety. However, the effect of clinical pharmacist communication skills on TRPs has not been adequately studied. Objective: This study aimed to assess patients’ satisfaction with clinical pharmacists’ communication components (appropriate timing, language, and empathy) and examine their association with TRPs, including patient adherence, knowledge, and medication errors. Method: A cross-sectional study was conducted in two Jordanian public hospitals between October 2023 and April 2024 through a structured questionnaire to assess patients’ satisfaction, adherence, and knowledge. Medication errors were detected in collaboration with other healthcare providers through reviewing medical records and direct patient assessment based on the American Society of Health-System Pharmacists classification. Data analysis was conducted using SPSS version 27. Results: A total of 613 adult inpatients were included. Overall, 82.1% (n = 503) of patients were satisfied with the clinical pharmacist communication, 75.5% (n = 463) showed good adherence, and 76% (n = 466) showed good knowledge. A total of 42.4% of medication errors (n = 260) were identified. Errors with harm or fatalities were not observed. The regression results showed that the overall satisfaction level was positively associated with patients’ adherence rate (B = 0.59; p < 0.001) and patients’ knowledge (B = 0.978; p < 0.001) and negatively associated with the number of medication errors (B = −0.024; p < 0.001). Conclusions: Clear, timely, and empathetic communication by clinical pharmacists was associated with patient satisfaction and was linked to better patient adherence and knowledge and fewer medication errors. Improving communication skills among clinical pharmacists could be a practical way to reduce TRPs. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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16 pages, 1410 KB  

Open AccessArticle

Five-Year Drug Survival and Discontinuation Reasons for Eight Biological Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis: A Retrospective Analysis of 1182 Patients from the Niigata Orthopedic Surgery Rheumatoid Arthritis Database (NOSRAD)

by Nariaki Hao, Naoki Kondo, Katsumitsu Arai, Naoko Kudo, Takehiro Murai, Junichi Fujisawa, Yasufumi Kijima, Rika Kakutani and Hiroyuki Kawashima

J. Clin. Med. 2026, 15(5), 2075; https://doi.org/10.3390/jcm15052075 - 9 Mar 2026

Viewed by 862

Abstract

Background: Continuity of care for rheumatoid arthritis patients within regional networks enables stable long-term clinical data collection, despite chronic rheumatologist shortages in Japan. We determined 5-year drug survival and discontinuation reasons for eight biological disease-modifying antirheumatic drugs (bDMARDs) using a regional multicenter [...] Read more.

Background: Continuity of care for rheumatoid arthritis patients within regional networks enables stable long-term clinical data collection, despite chronic rheumatologist shortages in Japan. We determined 5-year drug survival and discontinuation reasons for eight biological disease-modifying antirheumatic drugs (bDMARDs) using a regional multicenter registry. Methods: We retrospectively analyzed 1182 patients initiating their first (naïve, n = 784) or subsequent (switch, n = 398) bDMARD between May 2001 and August 2022 across five institutions. The primary endpoint (5-year drug survival) and secondary endpoints (discontinuation risk factors and cumulative incidence of reasons) were evaluated using Kaplan–Meier curves, Cox proportional hazards, and Fine & Gray models. Results: Baseline characteristics varied significantly among bDMARDs. Five-year drug survival in the naïve cohort ranged from tocilizumab (50.8%) to golimumab (22.6%); in the switch cohort, from abatacept (42.6%) to infliximab (10.0%). In multivariable Cox analysis of naïve patients, male sex (hazard ratio [HR] = 1.49, 95% confidence interval [CI] = 1.09–2.02), lower baseline 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) (HR = 0.90, 95% CI = 0.82–0.99), and absence of methotrexate co-therapy (HR = 0.73, 95% CI = 0.55–0.97) predicted discontinuation. The lower baseline DAS28-ESR association potentially reflects successful courses toward intentional cessation following remission. Discontinuations were attributed to inadequate response (27.1%), non-adverse events (25.3%), and adverse events (17.3%). Conclusions: Tocilizumab and abatacept demonstrated the highest retention rates in biologic-naïve and switch cohorts, respectively. Early, individualized drug selection and dose optimization are crucial to maximizing long-term bDMARD effectiveness before switching. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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14 pages, 711 KB  

Open AccessArticle

A Vanished Association Between Proton Pump Inhibitors and Clostridioides Difficile Infection After Minimizing Bias

by Bin Wu, Zhiyao He and Ting Xu

J. Clin. Med. 2026, 15(1), 230; https://doi.org/10.3390/jcm15010230 - 27 Dec 2025

Cited by 1 | Viewed by 1429

Abstract

Background: The gut microbiome might be affected by proton-pump inhibitors (PPIs), increasing the risk of Clostridioides difficile infection (CDI); however, the association between PPIs and Clostridioides difficile infection (CDI) remains controversial. Aim: The aim of this study is to reevaluate the association [...] Read more.

Background: The gut microbiome might be affected by proton-pump inhibitors (PPIs), increasing the risk of Clostridioides difficile infection (CDI); however, the association between PPIs and Clostridioides difficile infection (CDI) remains controversial. Aim: The aim of this study is to reevaluate the association between PPIs and CDI based on pharmacovigilance data, taking competition bias into account. Methods: PPI-related CDI adverse event reports, based on the Food and Drug Administration adverse event reporting system database from 2004 to 2023, were analyzed. Included PPI cases were stratified into CDI and non-CDI groups. Disproportionality analysis was performed using the reporting odds ratio (ROR) and information component (IC). The effect of competition bias on signal detection was quantitatively investigated. Age-stratified analyses were conducted to assess residual confounding. Results: A total of 238,470 PPI reports were included, with 1268 cases in the CDI group and 237,202 cases in the non-CDI group. Initial analysis revealed a significant PPI-CDI association (ROR = 2.36, 95% confidence interval (95%CI) 2.19 to 2.53; IC = 1.21, 95%CI 0.97 to 1.45), with CDI signals detected for five PPI agents, including pantoprazole, omeprazole, lansoprazole, rabeprazole, and dexlansoprazole. After excluding competition from antibacterial drugs, CDI signal strength decreased substantially (ROR = 1.47, 95%CI 1.34 to 1.62; IC = 0.55, 95%CI 0.23 to 0.87), retaining a significant CDI signal only for rabeprazole and pantoprazole. Upon further exclusion of antibacterial or immunosuppressive drug users and renal injury event cases, CDI signal strength decreased (ROR = 1.48, 95%CI 1.32 to 1.66; IC = 0.56, 95%CI 0.18 to 0.94), with pantoprazole as the sole CDI signal drug. Age-stratified analyses demonstrated complete signal loss after antibacterial drug adjustment across all age groups. Conclusions: The current large-scale pharmacovigilance study indicated that the observed PPI-CDI association may be mediated predominantly by antibacterial drug co-exposure rather than PPI direct causation. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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11 pages, 674 KB  

Open AccessArticle

Determination of Drug Use Behaviors and Related Reasons of Adult Patients Applying to Family Health Centers

by Elif Deniz Şafak, Hilal Yüksel, Yusuf Kırış, Nimet Mısırlıoğlu Alper and Mümtaz M. Mazıcıoğlu

Healthcare 2025, 13(22), 2850; https://doi.org/10.3390/healthcare13222850 - 10 Nov 2025

Viewed by 693

Abstract

Aim: This study was conducted to determine the drug use behaviors of patients applying to primary healthcare centers and the factors affecting these behaviors. Material and method: This cross-sectional, analytic study included 913 individuals applying to family health centers for various reasons in [...] Read more.

Aim: This study was conducted to determine the drug use behaviors of patients applying to primary healthcare centers and the factors affecting these behaviors. Material and method: This cross-sectional, analytic study included 913 individuals applying to family health centers for various reasons in Kayseri, Türkiye. All subjects completed a questionnaire that asked about sociodemographic characteristics and attitudes towards drug use via the Morisky Medication Adherence Scale and the Adult Health Literacy Scale. Data were analyzed using descriptive statistics. Results: A total of 913 individuals, comprising 288 (31.5%) men and 625 (68.5%) women, participated in this research. The average age of the participants was 41.79. Of the 913 subjects included, 23% reported that they would wait for recovery from a disease without any treatment attempt, while 53.5% reported that they visited a doctor, and 63.5% reported that they initially consulted a family health center. A total of 38.5% reported that they self-medicated without consulting a doctor. In addition, 79% of the subjects reported that they used medicine without a prescription. Conclusions: It was observed that age, gender, social insurance, educational status, level of health literacy, and presence of chronic diseases affect drug use behaviors. A weak, negative correlation was found between Morisky Medication Adherence scores and health literacy. Additionally, it was determined that only checking the expiration date before using a drug had an impact on drug adherence. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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13 pages, 1264 KB  

Open AccessArticle

Managing Bone Metastases with Denosumab: Real-World Data and Critical Monitoring Points in Breast, Lung, and Prostate Cancers

by Sibel Oyucu Orhan, Bedrettin Orhan, Şeyma Esenbuğa, Seda Sali, Burcu Caner, Birol Ocak, Ahmet Bilgehan Şahin, Adem Deligönül, Türkkan Evrensel and Erdem Çubukçu

Medicina 2025, 61(9), 1637; https://doi.org/10.3390/medicina61091637 - 10 Sep 2025

Cited by 4 | Viewed by 3463

Abstract

Background and Objectives: Advanced solid organ tumors, particularly breast, lung, and prostate cancers, frequently metastasize to bone, leading to debilitating skeletal-related events (SREs). Denosumab, a RANKL inhibitor, is crucial in preventing SREs. This study aimed to comparatively evaluate the efficacy and adverse [...] Read more.

Background and Objectives: Advanced solid organ tumors, particularly breast, lung, and prostate cancers, frequently metastasize to bone, leading to debilitating skeletal-related events (SREs). Denosumab, a RANKL inhibitor, is crucial in preventing SREs. This study aimed to comparatively evaluate the efficacy and adverse effect profiles of denosumab in patients with bone metastases originating from these three common cancer types. Materials and Methods: This retrospective study included 146 patients treated with denosumab for bone metastases. Data on demographics, SREs before and during denosumab treatment, serum creatinine, calcium, and magnesium levels (at baseline, 3, and 6 months), other adverse effects, and survival were analyzed. Results: Before denosumab, SREs were present in 36.3% of patients (breast: 43.4%, prostate: 28%, lung: 33.8%). During denosumab treatment, SRE rates markedly decreased across all groups (breast: 9.4%, prostate: 16.0%, lung: 8.8%), with no significant intergroup difference in on-treatment SREs. Significant decreases in serum calcium levels were observed at 3 and 6 months post-denosumab initiation in breast (p < 0.0001) and lung cancer patients (p = 0.001). Mean creatinine levels significantly decreased in lung (p < 0.0001) and prostate (p = 0.020) cancer patients at 3 and 6 months. Overall survival significantly differed, with lung cancer patients having the shortest median survival (p < 0.005). Conclusions: Denosumab effectively reduces the incidence of SREs in patients with bone metastases from breast, lung, and prostate cancer. However, clinicians must diligently monitor for hypocalcemia, a notable adverse effect, particularly at 3 and 6 months after starting denosumab, with specific caution warranted in patients with lung cancer. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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15 pages, 462 KB  

Open AccessArticle

Association Between Different Patterns of Opioid and Benzodiazepine Use and Risks of Emergency Department Visits and Hospitalizations: A Retrospective Cohort Study

by Fang-Yu Su, Ming-Che Tsai, Yee-Yung Ng and Shiao-Chi Wu

Healthcare 2025, 13(16), 2073; https://doi.org/10.3390/healthcare13162073 - 21 Aug 2025

Viewed by 2236

Abstract

Background: In 2016, the U.S. FDA warned against concurrent use of opioids and benzodiazepines (BZDs) due to risks of respiratory depression and death. However, limited data exist in Asian populations. Methods: Using the Chang Gung Research Database in Taiwan, we conducted [...] Read more.

Background: In 2016, the U.S. FDA warned against concurrent use of opioids and benzodiazepines (BZDs) due to risks of respiratory depression and death. However, limited data exist in Asian populations. Methods: Using the Chang Gung Research Database in Taiwan, we conducted a retrospective cohort study of 418,549 patients prescribed opioids between 2008 and 2018. Patients were categorized into four groups based on BZD use: opioid-only (PureO), past BZD use (PastB), continuous BZD use (ContiB), and newly initiated BZD use (NewB). Multivariate logistic regression was used to evaluate all-cause emergency department (ED) visits and hospitalizations during the one year follow-up following one year of co-use. Results: Compared with PureO, co-use groups had significantly higher odds of hospitalization (ContiB: aOR = 1.74; PastB: 1.54; NewB: 1.48) and ED visits (ContiB: 2.09; PastB: 2.04; NewB: 1.51). Elevated risks were also observed among older adults, and patients with depression, stroke or transient ischemic attack, chronic obstructive pulmonary disease, chronic kidney disease, as well as those with higher Charlson Comorbidity Index scores. Conclusions: Our findings support the need for cautious prescribing and individualized deprescribing strategies to reduce avoidable acute healthcare utilization. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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