International Journal of Clinical Pharmacy最新文献

{"title":"Near-miss dispensing errors in Japanese community pharmacies: error types and associated factors across dispensing stages.","authors":"Takashi Umino, Tsugumichi Sato, Yoshiaki Shikamura, Kazushige Ijuin, Asuka Fujisawa, Yuki Iwama, Mayu Usami, Tomoe Asai, Mai Shimoyama, Rumoi Takahashi, Takehisa Hanawa","doi":"10.1007/s11096-026-02208-x","DOIUrl":"https://doi.org/10.1007/s11096-026-02208-x","url":null,"abstract":"<p><strong>Introduction: </strong>The types and causes of dispensing errors vary across the stages of the complex dispensing process in community pharmacies. Notably, the analysis of near-miss reports may facilitate improvements in healthcare environments and operational practices.</p><p><strong>Aim: </strong>We aimed to identify the characteristics of the factors contributing to near-miss errors at each stage of the dispensing process and to determine which factors require priority action.</p><p><strong>Method: </strong>We conducted a secondary analysis of near-miss dispensing errors voluntarily reported by community pharmacies through the near-miss reporting system of the Japan Council for Quality Health Care. The associations between various types of near-miss errors and their contributing factors were estimated using multivariate logistic regression models.</p><p><strong>Results: </strong>Among the 45,483 near-miss incidents, most were reported during the dispensing and accuracy-checking stages (n = 35,384, 77.8%). At the prescription data entry stage, near-miss errors were primarily associated with the usability of computer systems and look-alike/sound-alike (LASA) drug names. At the dispensing and accuracy-checking stage, the characteristic contributing factors included LASA drug names and similar appearances, patient preferences for brand name/generic, user-friendliness of equipment, and human factors among pharmacists. During the medicine supply stage, factors associated with inadequate confirmation of the patient's understanding were identified. Finally, at the post-supply stage, patient-related factors and insufficient communication were identified as key contributors.</p><p><strong>Conclusion: </strong>Based on the reported near-miss events, priority actions are required to address LASA drug names and similar appearances, generic prescription systems, labour-intensive dispensing practices, the usability of computer systems and equipment, and inadequate communication with patients.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes and practices among Australian community pharmacists towards naloxone and overdose prevention: a national cross-sectional study.","authors":"Louisa Picco, Monica Jung, Rose Laing, Jeffrey Bratberg, Beth Sproule, Suzanne Nielsen","doi":"10.1007/s11096-026-02219-8","DOIUrl":"https://doi.org/10.1007/s11096-026-02219-8","url":null,"abstract":"<p><strong>Introduction: </strong>Naloxone is an opioid overdose reversal drug that is available for free without a prescription via participating community pharmacies in Australia.</p><p><strong>Aim: </strong>To investigate Australian community pharmacists' knowledge, attitudes, practices, and provision of naloxone and overdose prevention, and identify barriers to and correlates of naloxone provision.</p><p><strong>Method: </strong>Data were collected between January and April 2025 via an anonymous, cross-sectional questionnaire among Australian community pharmacists who were recruited using a randomised representative sampling approach. Data pertaining to pharmacy and pharmacist-related characteristics, pharmacists' knowledge and attitudes towards naloxone, overdose prevention, and provision of naloxone, including barriers to provision, were captured. Multivariable logistic regression was conducted to determine the pharmacy (including jurisdiction, geographic location, pharmacy type, and provision of other harm reduction services) and pharmacist (including gender, years of experience, knowledge of, and attitudes towards naloxone and overdose prevention) characteristics associated with stocking naloxone.</p><p><strong>Results: </strong>Of the 730 pharmacists who completed the online questionnaire, approximately three-quarters (n = 534, 73.2%) stocked naloxone. Most pharmacists had positive attitudes towards naloxone (85%), and good or excellent self-reported knowledge (81%) of naloxone and overdose prevention. Logistic regression analyses revealed that pharmacies that had significantly greater odds of stocking naloxone were located in Australia's least populous states/territories (Australian Capital Territory, Northern Territory, Tasmania, South Australia) (aOR: 2.32; 95% CIs 1.17-4.61) and Queensland (aOR: 2.12; 95% CIs 1.17-3.83), provided Opioid Agonist Treatment (aOR: 2.77; 95% CIs 1.82-4.24), and had pharmacists with good or excellent knowledge of naloxone (aOR: 4.43, CIs 2.75-7.12; aOR: 6.19, CIs 3.53-10.84 respectively) and very positive attitudes towards naloxone supply (aOR: 2.29, 95% CIs 1.23-5.25). Lack of time to develop, implement and/or sustain the program (59.4%) and lack of training among pharmacy staff (44.6%) were identified as key barriers among the minority of pharmacists that did not stock naloxone.</p><p><strong>Conclusion: </strong>A large proportion of community pharmacies in Australia stocked naloxone, with variability across states/territories. While pharmacists' attitudes and knowledge were positive overall, there remains scope to increase provision of adequate education and targeted support to strengthen community pharmacies' harm reduction capacity and provide equitable access.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative analysis to identify implementation strategies for a deprescribing clinical practice guideline using the CFIR-ERIC Matching Tool: perspectives from consumers and professional stakeholders.","authors":"Hui Wen Quek, Xisco Reus, Kenneth Lee, Veronika Seda, Leon Adams, Osvaldo P Almeida, Gillian E Caughey, Jennifer Gowan, Kerryn Hart, Andrew Heredia, Anne-Marie Hill, Lisa Kalisch Ellett, Dina LoGiudice, Arduino A Mangoni, Anthony Marinucci, Treasure McGuire, Nilufeur McKay, Vasi Naganathan, Christopher Ng, Maz Osborne, Kevan R Polkinghorne, Constance D Pond, Sepehr Shakib, Angela Shiu, Andrew Stafford, Tim Whitmore, Christopher Etherton-Beer, Amy Page","doi":"10.1007/s11096-026-02218-9","DOIUrl":"https://doi.org/10.1007/s11096-026-02218-9","url":null,"abstract":"<p><strong>Introduction: </strong>Deprescribing is the planned withdrawal or dose reduction of medicines when harms outweigh benefits or when they are no longer required. Following publication of the Clinical Practice Guideline for Deprescribing in Older People in September 2025, supporting its uptake into routine practice is a critical next step.</p><p><strong>Aim: </strong>This study aimed to identify implementation strategies, informed by stakeholder-perceived barriers, to support the implementation of deprescribing guidelines.</p><p><strong>Method: </strong>A qualitative analysis was undertaken of open-text responses collected during the guideline public consultation (24 April-31 May 2025). Inductive thematic analysis identified implementation barriers, which were then deductively mapped to the Consolidated Framework for Implementation Research (CFIR). Relevant CFIR constructs were entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool to generate implementation strategies. Strategies were ranked by cumulative percentage endorsement and grouped using ERIC concept-mapping clusters.</p><p><strong>Results: </strong>Of 313 survey respondents, 248 provided responses relevant to implementation. Three barrier themes were shared across consumer and professional/policy stakeholder groups. Theme 1: 'Knowledge gaps, beliefs, and limited readiness to deprescribe' describes gaps in consumers' and clinicians' knowledge, beliefs about medication use and deprescribing, and limited confidence or willingness to engage in deprescribing. Theme 2: 'Communication, hierarchy, or social influences limiting deprescribing' describes communication gaps, entrenched prescribing norms, power imbalances, and social influences that limited shared decision-making. Theme 3: 'System-level structures misaligned with deprescribing practice' describes broader healthcare system barriers, including financial, policy, workforce, organisational, and information-related constraints. Consumers additionally highlighted a lack of person-centred and adaptable approach for deprescribing, while professional/policy stakeholders identified barriers related to medicine formulations and guideline format and usability. Barriers mapped predominantly to the CFIR Inner Setting domain. The highest-ranked implementation strategy was 'Identify and prepare champions', within the 'Develop stakeholder interrelationships' cluster.</p><p><strong>Conclusion: </strong>Deprescribing barriers were largely situated within the Inner Setting domains. Recommended strategies emphasised stakeholder engagement and local champions, supporting locally led, relationship-based implementation approaches. Future work should evaluate the feasibility, acceptability, and effectiveness of these strategies in practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of clinical interventions made by pharmacists, doctors and nurses in a hospital post-discharge telephone service: a retrospective cohort study.","authors":"Kum Chuan Leong, Darshana Meanger, Philip Wu, Alex Wong, Wee Tjun Tee, Michelle Simango, Bianca Levkovich","doi":"10.1007/s11096-026-02207-y","DOIUrl":"https://doi.org/10.1007/s11096-026-02207-y","url":null,"abstract":"<p><strong>Introduction: </strong>Clinician-led post-discharge telephone follow-up programs are effective in resolving medication-related problems (MRPs) in older adults. Our hospital offers a post-discharge telephone service, Talk-To-You-Tomorrow (TTYT), to general medicine patients to support medication management following hospital discharge. However, little is known about the the types of interventions used to address MRPs between clinicians within post-discharge telephone services.</p><p><strong>Aim: </strong>To compare the types of interventions utalised (pharmacists versus non-pharmacist clinicians) in addressing MRPs for general medicine patients identified through a post-discharge telephone follow-up (TFU) service.</p><p><strong>Method: </strong>A retrospective cohort study investigated interventions provided to general medicine patients between June 2022 to May 2023 who underwent TTYT in a large metropolitan health service. Contemporaneous records were used to identify patients with MRPs and there corresponding interventions. MRPs were categorised using the Drug Evaluation Tools (NESA: necessity, effectiveness, safety and adherence). Interventions were classified using The Swiss Society of Public Health Administration and Hospital Pharmacists tools (patient-level, prescriber-level, drug-level and other interventions). Primary outcome was the difference in interventions (pharmacists versus non-pharmacist clinicians). Secondary outcome was the types of MRPs identified by different clinicians. Outcomes were evaluated using the Pearson's χ² test. Odds of MRP identification by clinician group were estimated with an adjusted odds ratio (OR) and 95% confidence interval (CI).</p><p><strong>Results: </strong>From 3,815 TTYT consultation records, 526 patients had MRPs. All MRPs had at least one intervention (227 pharmacist's and 299 non-pharmacist clinicians'). Pharmacists liaised with other clinicians the most (7.9% (18/227) vs 4.7% (14/299)) versus non-pharmacist clinicians who utilised more drug-level interventions (18% (53/299) vs 13.2% (30/227)). There were no statistically significant differences in the intervention types across pharmacists versus non-pharmacists (X² (3, N = 526) = 4.271, p = 0.234) and MRP types identified by different clinicians (X² (6, N = 526) = 11.777, p = 0.067). The odds of a pharmacist identifying an MRP was 2.27 times greater than non-pharmacists (p < 0.001, CI: 1.82-2.82).</p><p><strong>Conclusion: </strong>Clinicians mostly provided patient-level interventions however, no difference in the types of MRP's identified in a post-discharge TTYT consult between various clinicians. Importantly, pharmacists were more likely identifying a MRP than other clinicians, which highlights the beneficial role of a pharmacist in medication management and their impact on medication safety.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a core competency framework for psychiatric pharmacists: a Europe-wide e-Delphi consensus study conducted by the European Society of Clinical Pharmacy Mental Health Special Interest Group.","authors":"Ivana Tašková, Rosalind Gittins, Nikolaus Riesenhuber, Matej Stuhec, Martina Hahn, Nicole Šafářová, Daniela Fialová, Ita Fitzgerald","doi":"10.1007/s11096-026-02213-0","DOIUrl":"https://doi.org/10.1007/s11096-026-02213-0","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus on essential clinical activities of psychiatric pharmacists is currently unavailable. Agreement on core non-clinical roles relating to research, education, leadership and management is also unavailable. Consensus on the core clinical and non-clinical functions of psychiatric pharmacists is urgently required to standardise the training of specialist pharmacists in psychiatric pharmacy and ensure the provision of high-quality patient care.</p><p><strong>Aim: </strong>The European Society of Clinical Pharmacy (ESCP) Mental Health Special Interest Group (SIG) aimed to develop a pan-European consensus-based core competency framework outlining clearly defined clinical and non-clinical competencies of psychiatric pharmacists.</p><p><strong>Method: </strong>A modified two-round e-Delphi method was used. Experts were purposively recruited and were eligible if they had at least three years of clinical experience in psychiatric pharmacy and were currently employed in a hospital-based clinical pharmacy service. Initial criteria were informed primarily by the International Pharmaceutical Federation Mental Health Care Handbook and elements of the College of Mental Health Pharmacy Advanced Pharmacist Mental Health Curriculum, and were adapted for the European context. Consensus was defined a priori as ≥ 80% agreement, a median score ≥ 3, and an interquartile range ≤ 1.</p><p><strong>Results: </strong>Of the 39 experts who agreed to participate, 32 (82.1%) completed Round 1 and 27 (69.2%) completed Round 2. Experts represented 13 European countries in Round 1 and 12 countries in Round 2. Thirty-three of the 45 initial criteria achieved consensus in Round 1. In Round 2, a further seven criteria achieved consensus, resulting in 40 final criteria for inclusion within the framework.</p><p><strong>Conclusion: </strong>The framework identifies 40 core criteria across seven domains of psychiatric pharmacy practice. This framework should be used to support the harmonised training of specialist psychiatric pharmacists, workforce development, and service planning across European healthcare systems. Future research should prioritise assessing factors affecting the effectiveness of implementation of criteria within each domain across clinical contexts and countries.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of an interpretable machine learning model for predicting vancomycin-induced nephrotoxicity in hospitalized children.","authors":"Xiuling Wang, Yao Fu, Jinxu Chen, Jie Wan, Wenqiang Kong","doi":"10.1007/s11096-026-02204-1","DOIUrl":"https://doi.org/10.1007/s11096-026-02204-1","url":null,"abstract":"<p><strong>Introduction: </strong>Vancomycin is widely used for severe Gram‑positive infections in children, but vancomycin‑induced nephrotoxicity (VIN) limits its safe application. Existing prediction models rely primarily on traditional logistic regression with limited discriminative performance in pediatric populations, and machine learning (ML) approaches have not been systematically evaluated.</p><p><strong>Aim: </strong>This study aimed to develop and internally validate an interpretable ML model for predicting VIN in pediatric patients using electronic health record (EHR) data.</p><p><strong>Method: </strong>We conducted a retrospective EHR-based study at a tertiary children's hospital. Children aged 1 month to 18 years who received vancomycin for ≥ 3 consecutive days between December 2017 and November 2024 were included. Patients with moderate-to-severe pre-existing renal dysfunction [estimated glomerular filtration rate (eGFR) ≤ 59 mL/min/1.73 m²], preterm birth, blood purification therapy, or major missing data were excluded. VIN was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or > = 50% from baseline on at least two consecutive measurements. Eight ML models were constructed and compared. Model performance was evaluated using the area under the receiver-operating-characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC), F1 score, Brier score and the area under the precision recall curve (AUPR). The optimal model was interpreted using the Shapley Additive explanation (SHAP) method. Feature sets of 6, 8, 10, and full features were compared using DeLong's test. Clinical utility was assessed via decision curve analysis (DCA).</p><p><strong>Results: </strong>A total of 1,452 children were included, of whom 206 (14.2%) developed VIN. EXtreme gradient boosting (XGboost) achieved the best predictive performance (AUROC = 0.90, AUPR = 0.74, Brier score = 0.07). A simplified 6‑feature XGBoost model (eGFR, amphotericin B, early vancomycin trough concentration, albumin, immunosuppressant use, and acyclovir/ganciclovir co-administration) achieved comparable discrimination to the full model (AUROC = 0.87; P > 0.05 by DeLong's test) with acceptable calibration (ECE 3.8%). DCA suggested favorable net benefit across clinically relevant risk thresholds.</p><p><strong>Conclusion: </strong>Our interpretable 6-feature XGBoost model demonstrated promising internal discrimination for pediatric VIN prediction. Pending external validation and temporal evaluation, this model may serve as a hypothesis-generating decision-support framework for risk stratification.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instruments for assessing healthcare professionals' knowledge, attitudes and practices regarding deprescribing: a scoping review.","authors":"Ana Carolina Figueiredo Modesto, Luis Phillipe Nagem Lopes, Mariana Del Grossi Moura, Alan Maicon de Oliveira, José Salvador Carrillo, Beatriz Birelli do Nascimento, Flávia Casale Abe, Luciane Cruz Lopes","doi":"10.1007/s11096-026-02215-y","DOIUrl":"https://doi.org/10.1007/s11096-026-02215-y","url":null,"abstract":"<p><strong>Introduction: </strong>Deprescribing is a multiprofessional process which aims to optimize medication use and improve patient safety, in which healthcare professionals' knowledge, attitudes, and practices (KAP) play a central role. The instruments used to assess KAP among nurses, pharmacists and physicians remain poorly characterised in terms of scope and measurement quality.</p><p><strong>Aim: </strong>To map and characterize the instruments used to assess healthcare professionals' knowledge, attitudes, and practices regarding deprescribing.</p><p><strong>Method: </strong>A scoping review was conducted following Joaassess healthcaree (JBI) methodology and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Primary studies were eligible if they involved nurses, pharmacists or physicians and applied any instrument assessing KAP related to deprescribing, individually or in combination, regardless of setting or country. Nine electronic databases were searched, including two grey literature sources were searched from inception to September 2024, without restrictions on language or publication date using terms related to nurses, pharmacists, physicians, deprescribing, surveys and questionnaires, and health knowledge, attitudes, and practice Study selection and data charting were performed independently by three pairs of reviewers using a standardised extraction form capturing study characteristics, instrument details, KAP domains assessed, and reported measurement properties. Data was synthesised using descriptive statistics and narrative analysis. The review protocol was registered on the Open Science Framework.</p><p><strong>Results: </strong>Of the 3,821 records screened, 49 met the inclusion criteria. Over two-thirds of the included studies were published since 2020 (n = 33, 67.3%). The evidence base was concentrated in high-income countries (n = 36/46, 78.0%; three multi-country studies were not classified by income level), particularly in the Europe and Central Asia region (n = 19, 41.0%), and most often focused solely on physicians, while studies simultaneously involving all three professional groups (physicians, pharmacists, and nurses) were less frequent (n = 8, 16.0%). Instruments commonly assessed multiple KAP domains, especially knowledge, attitudes, and practices combined (n = 12, 30.0%), whereas evidence on psychometric properties was reported in only a minority of studies (n = 13, 26.5%), among these, internal consistency and content validity were the pair most frequently reported together (n = 4, 31.0%).</p><p><strong>Conclusion: </strong>Instruments assessing healthcare professionals' KAP regarding deprescribing remain limited in scope and psychometric robustness. Expanding interprofessional coverage and strengthening validation efforts are key priorities for advancing research in this field.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a hybrid artificial intelligence framework for pharmacotherapy optimization.","authors":"Olaf Rose, Stephanie Clemens, Andreas Leiherer, Michael Bücker, Finn Petersson, Gerald Lirk, Christopher Mosch, Johanna Pachmayr, Kreshnik Hoti","doi":"10.1007/s11096-026-02205-0","DOIUrl":"https://doi.org/10.1007/s11096-026-02205-0","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacotherapy optimization in multimorbid patients is increasingly complex due to polypharmacy, fragmented data, expanding electronic health records, and workforce constraints. Conventional clinical decision support systems remain largely rule-based and often fail to adequately incorporate patient-specific context. While artificial intelligence offers new opportunities, stand-alone models remain insufficiently reliable for high-risk pharmacotherapy decision support.</p><p><strong>Aim: </strong>To develop a relevance-driven, clinician-supervised hybrid AI framework for pharmacotherapy optimization.</p><p><strong>Method: </strong>Using a design science-informed approach, an interdisciplinary research group developed a conceptual framework for AI-supported pharmacotherapy optimization. Framework development was informed by prior feasibility work, published literature, clinical practice requirements, and iterative interdisciplinary discussions. Hybrid AI was defined as the combination of retrieval-augmented generation, deterministic safety rules, and large language model reasoning.</p><p><strong>Results: </strong>Seven design principles were identified, including decomposition of clinical activities, relevance-based prioritization, hybrid reasoning under clinician oversight, integration of patient goals, transparency of evidence sources, longitudinal optimization within a governed closed loop, and evaluation as a design requirement. These principles informed a conceptual architecture integrating structured clinical data, patient preferences, longitudinal patient information, and evidence retrieval within a clinician-governed decision-support framework.</p><p><strong>Conclusion: </strong>The proposed framework conceptualizes AI as a relevance-structuring, clinician-governed decision-support layer rather than an autonomous decision-maker. By combining hybrid reasoning, patient-specific context, and professional oversight, it provides a conceptual foundation for future development, implementation, and evaluation of AI-supported pharmacotherapy systems.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Codesigning a pharmacist-led transition of care program in the emergency department: a qualitative participatory study.","authors":"Eman Alhmoud, Raja Barazi, Binny Thomas, Almunzer Zakaria, Lubna Andraous, Rasha El Enany, Palli Valapila Abdulrouf, Sameer Pathan, Hamde Nazar, Mohamed Izham Mohamed Ibrahim, Muhammad Abdul Hadi","doi":"10.1007/s11096-026-02210-3","DOIUrl":"https://doi.org/10.1007/s11096-026-02210-3","url":null,"abstract":"<p><strong>Introduction: </strong>Transitions from the emergency department (ED) to home are high-risk periods for medication-related harm. Pharmacist-led interventions may improve medication safety and care continuity, however, co-designed approaches to developing such interventions remain limited.</p><p><strong>Aim: </strong>This study aimed to co-design a pharmacist-led transition-of-care (ToC) program to improve medication management for adults discharged from the ED, with the intention of subsequently evaluating it in a pilot randomized controlled trial.</p><p><strong>Method: </strong>A two-phase qualitative study was undertaken at a general teaching hospital in Qatar within a Participatory Health Research (PHR) framework. Phase I involved one-to-one interviews and focus groups with patients, pharmacists, physicians, and nurses. Phase II consisted of a co-design workshop with decision makers, including departmental leaders and hospital administrators, followed by structured refinement through additional stakeholder meetings and an electronic prioritization survey. Data were analyzed using an inductive-deductive approach, guided by two theoretical frameworks, the Theoretical Domains Framework and the Care Transitions Framework. Five proposed interventions were evaluated against the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Safety, Equity) criteria, and identified barriers were mapped to corresponding intervention functions and implementation strategies.</p><p><strong>Results: </strong>Phase I, comprising three focus groups with physicians (n = 6), nurses (n = 7), and clinical pharmacists (n = 6), and four interviews with two patients and two Patient and Family Advisory Council (PFAC) representatives, identified barriers, enablers, and stakeholder priorities related to medicines management that informed the Phase II co-design workshop. Stakeholders rated the five proposed interventions: discharge medication reconciliation, prescription review, patient counseling and education, pharmacist-to-pharmacist handover, and post-discharge follow-up with medication review, as highly feasible (mean 83%). All intervention components were retained due to their interdependence. Eligibility criteria for this intervention were decided as: patients discharged with new chronic diagnoses, newly prescribed high-risk medications, polypharmacy (i.e., taking ≥ 5 regular medications), and chronic disease exacerbations. A standardized workflow was co-developed, outlining patient identification and communication. Stakeholders prioritized key intervention functions and implementation strategies via structured voting.</p><p><strong>Conclusion: </strong>The pharmacist-led transition-of-care program blueprint was co-designed using a participatory, theory-informed process. The finalized program will undergo feasibility testing through a pilot randomized controlled trial and a process evaluation.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicine shortages and glaucoma care: a time-series analysis indicating population-level consequences of a national timolol eye drop shortage.","authors":"Erin Fawcett, Lisa Kalisch Ellett, Simi Sarin, Cassandra Haines, Helen Stone, Jack Janetzki","doi":"10.1007/s11096-026-02209-w","DOIUrl":"https://doi.org/10.1007/s11096-026-02209-w","url":null,"abstract":"<p><strong>Introduction: </strong>Medicine shortages can disrupt glaucoma management and necessitate therapeutic substitution. Understanding how shortages affect access to first-line treatments for glaucoma is important for optometrists when monitoring intraocular pressure control, and pharmacists when counselling patients and coordinating care during periods of limited medicine availability. Timolol, a non-selective beta-blocker, is a first-line treatment for glaucoma and ocular hypertension and has experienced international shortages in recent years. Between August 2024 and May 2025, Australia experienced a nationwide shortage of timolol-containing eye drops, raising concerns regarding continuity of care, access to treatment, and therapeutic substitution.</p><p><strong>Aim: </strong>To descriptively examine the impact of the 2024-2025 timolol eye drop shortage on dispensing patterns of antiglaucoma medicines in Australia and assess the contribution of imported products in mitigating the shortage.</p><p><strong>Method: </strong>A retrospective drug utilisation study was conducted using publicly available aggregate Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS dispensing data from January 2020 to August 2025. Monthly dispensings of antiglaucoma preparations (ATC S01E) were standardised per 100,000 population and analysed using descriptive time-series methods. Dispensing trends were compared before, during, and after the shortage, with stratification by timolol formulation, therapeutic class, and product type (locally supplied versus overseas imports).</p><p><strong>Results: </strong>The late 2024 and early 2025 timolol shortage was associated with a sustained decline in dispensing of single-ingredient extended-release timolol, decreasing from approximately 40 dispensings per 100,000 population per month before the shortage to 1.07 by March 2025. Dispensing of standard-release timolol increased temporarily in October 2024 before declining in a similar pattern. Overseas imports accounted for 24.3% of all timolol dispensings during the shortage period and peaked at 87% of timolol dispensings in March 2025. Despite regulatory approval of imported products, overall timolol utilisation remained below pre-shortage levels. Alternative therapeutic classes, including prostaglandin analogues and carbonic anhydrase inhibitors, showed modest increases in dispensing, suggesting potentially limited therapeutic substitution.</p><p><strong>Conclusion: </strong>The timolol shortage disrupted access to a cornerstone first-line treatment for glaucoma. Regulatory intervention through the approval of imported products partially mitigated the shortage but did not restore utilisation to pre-shortage levels in Australia. Future shortage management strategies should prioritise rapid policy activation and closer alignment of imported products with formulations routinely available in Australia.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}