International Journal of Clinical Pharmacy最新文献

{"title":"Performance evaluation of large language models in real-world perinatal medication consultations: a cross-sectional study.","authors":"Ran Wang, Yifan Li, Xuewei Feng, Xin Feng","doi":"10.1007/s11096-026-02138-8","DOIUrl":"https://doi.org/10.1007/s11096-026-02138-8","url":null,"abstract":"<p><strong>Introduction: </strong>Perinatal medication consultation is a core clinical pharmacy service that involves a complex benefit-risk assessment for both maternal and fetal safety. Large language models (LLMs) have emerged as potential tools to improve access to medication information, yet their performance and safety in real-world, pharmacist-led perinatal consultation settings, particularly in non-English contexts, remain insufficiently evaluated.</p><p><strong>Aim: </strong>To evaluate and compare the performance of multiple advanced large language models in addressing real-world Chinese perinatal medication consultation queries and to assess their potential role as supervised adjunctive tools within clinical pharmacy services.</p><p><strong>Method: </strong>This cross-sectional study evaluated seven LLMs using real-world clinical data from pharmacist-led medication consultations at the Pharmacy Clinic of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University. A standardized test set of 64 perinatal medication consultation questions was developed from 15,280 electronic consultation records collected between April 2014 and April 2024. The evaluated models included international (GPT-5.1, Grok 3, Gemini 3.0) and domestic (DeepSeek, Wenxin Yiyan, Kimi K2, Tongyi Qianwen) models. Senior clinical pharmacologists independently assessed responses across four dimensions-relevance, accuracy, usefulness, and empathy-using a 10-point Likert scale. Results are reported primarily as median (IQR), with mean ± SD additionally provided as a secondary descriptor to facilitate comparison with prior literature.</p><p><strong>Results: </strong>Among the 448 model-generated responses, inter-rater consistency was excellent (ICC = 0.91, 95% CI 0.88-0.94). Significant differences in overall performance were observed among the models (Kruskal-Wallis H = 187.4, p < 0.001; ε<sup>2</sup> = 0.41, large effect). GPT-5.1 achieved the highest median total score [9.3 (IQR: 8.8-9.6); mean ± SD: 9.1 ± 0.8], outperforming all other models (all Bonferroni-corrected p < 0.01; all r > 0.50, large effect sizes), followed by Kimi K2 [8.5 (IQR: 7.9-9.1); mean ± SD: 8.4 ± 1.2] and DeepSeek [8.3 (IQR: 7.6-8.9); mean ± SD: 8.2 ± 1.1]. Tongyi Qianwen demonstrated the lowest overall performance [6.7 (IQR: 5.9-7.4); mean ± SD: 6.8 ± 1.3]. Accuracy was the primary determinant of performance differences. Performance gaps were more pronounced in complex clinical scenarios involving comorbidities or benefit-risk trade-offs, whereas domestic models demonstrated relative advantages in consultations involving traditional Chinese medicine.</p><p><strong>Conclusion: </strong>LLMs have demonstrated variable performance in response to perinatal medication consultation queries. While high-performing models show potential to support pharmacist-led perinatal medication consultations by improving access to information, their current performance supports use only as supervised, a","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770761","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 consolidated framework for implementation research (CFIR) informed exploration of a primary care intervention to support deprescribing for problematic polypharmacy in older adults living with frailty (DEPPLOY) in England: a qualitative study.","authors":"Liz Breen, Amrit Daffu-O'Reilly, Aliya Darr, Jonathan Benn, Beth Fylan, Jonathan Silcock, George Peat, D K Theo Raynor, Duncan R Petty, Syed Tabish Zaidi, Alison Bravington, Nazreen Butt, Hannah Hartley, Daisy Halligan, David P Alldred","doi":"10.1007/s11096-026-02140-0","DOIUrl":"https://doi.org/10.1007/s11096-026-02140-0","url":null,"abstract":"<p><strong>Introduction: </strong>The incorporation of deprescribing into structured medication reviews (SMR) is a patient-centred and cost-effective practice in primary care settings. Pharmacists have a key role in deprescribing among older people to improve quality of life and reduce adverse events, but patients and healthcare professionals may be resistant to reducing their medication, and evidence around how deprescribing happens in practice is currently lacking. This study explores the implementation of a co-designed intervention in a single English General Practice (UK).</p><p><strong>Aim: </strong>To explore key stakeholders' perceptions of a co-designed primary care intervention to involve patients and their families in deprescribing and its broader intervention context, guided by the Consolidated Framework for Implementation Research (CIFR).</p><p><strong>Method: </strong>Qualitative semi-structured interview study with a purposive sample of staff, and patients with frailty, to explore perceptions of the deprescribing initiative. Data were analysed using an a priori framework structured by the domains of the CIFR.</p><p><strong>Results: </strong>Interviews (24 in total) were conducted with 13 staff involved in delivering the intervention and 5 patients living with frailty who completed a structured medication review with recommended medication changes. Key factors (mapped to CFIR domains) included: an imperative for formal training around the intervention delivery (Inner setting), engagement with SMR delivery linked to payment through national agendas (Outer setting); the importance of the fit of the intervention with existing processes around prescribing practice and infrastructure (Inner setting); increased understanding of the aims of deprescribing among patients and recognition of the extended pharmacist role in primary care deprescribing (Individuals); recognition that the successful delivery of the intervention was a team effort (Implementation process).</p><p><strong>Conclusion: </strong>Structured medication reviews are a suitable mechanism to discuss and make deprescribing decisions as part of a shared consultation. Resources which support the patient through the deprescribing process can engage patients and promote greater satisfaction with service delivery. Operationally, staff can also benefit from tools which facilitate greater understanding of the process and fit within their usual practice plus improving patient care and saving medication costs. Barriers and facilitators to implementation success should be noted and addressed for upscaling and process sustainability.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770729","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":"Designing a computerized decision support system for asthma chronic disease management in community pharmacies.","authors":"Tony Xin Ning, Terry Li, Jamie Kellar, Mina Tadrous, Natalie Crown, Lisa Dolovich, Samir Gupta","doi":"10.1007/s11096-026-02142-y","DOIUrl":"https://doi.org/10.1007/s11096-026-02142-y","url":null,"abstract":"<p><strong>Introduction: </strong>We previously built and validated the Electronic Asthma Management System (eAMS)-a clinic-based asthma computerized clinical decision support system (CDSS) which is in clinical use.</p><p><strong>Aim: </strong>Herein, we sought to adapt and optimize the eAMS for implementation in community pharmacy practice.</p><p><strong>Method: </strong>We iteratively developed a system prototype (the eAMS-Pharm) with input from clinical pharmacists, and asthma, knowledge translation, and eHealth experts. After face-validation by three external community pharmacists, we used a rapid-cycle development process for optimization of system design (format), content, and user workflows (usability). This involved a sequential and repeated three-stage process: (1) system prototype demonstration and testing in 90 min, semi-structured virtual focus groups with target end-users; (2) analysis of focus group findings; and (3) corresponding modifications to the prototype, then re-testing in another focus group. This process continued until we reached pre-defined stopping criteria. We used a questionnaire to gather demographic information and further usability data and feedback. Community pharmacy team members were recruited from an existing pharmacy database.</p><p><strong>Results: </strong>Stopping criteria were met after six focus group cycles with 28 participants [23 (83%) pharmacists, 4 (14%) registered pharmacy technicians/assistants, and 1 (3%) pharmacy student]. User feedback and corresponding system improvements spanned usability, workflow, and prescriber communication domains. The optimized system consisted of a pharmacy portal with a patient dashboard, patient and provider versions of a point-of-care questionnaire, an interactive CDSS producing guideline-based recommendations, automated documentation, and pre-formatted prescriber communications. The System Usability Scale score was 82.9 ± 16.8 (maximum 100), and user responses to Likert scale-based assessments of eAMS-Pharm design, content, workflow, impact, and overall impressions were highly favorable.</p><p><strong>Conclusion: </strong>We built and optimized a chronic disease CDSS for use in community pharmacies, identifying and addressing pharmacy-specific barriers to implementation. The system achieved a high system usability score and highly favorable ratings for perceived system benefits, likelihood of clinical use, and patient benefits. The eAMS-Pharm can now be evaluated for uptake, care impact, and outcome impact in real-world settings. Our findings surrounding users' design, content, and usability/workflow preferences, and our unique development strategy, can also inform future pharmacy-based chronic disease CDSS design.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770807","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":"Pharmacist involvement in antifungal stewardship programs: a systematic review of clinical, utilization, and economic outcomes.","authors":"Emre Kara, Nese Sahin, Fatma Gul Yumrucu, Gokhan Metan","doi":"10.1007/s11096-026-02149-5","DOIUrl":"https://doi.org/10.1007/s11096-026-02149-5","url":null,"abstract":"<p><strong>Introduction: </strong>Antifungal stewardship programs are increasingly implemented to optimize antifungal use. Pharmacists are frequently involved in these programs; however, their specific contributions and impact have not been systematically characterized.</p><p><strong>Aim: </strong>The aim of this systematic review was to synthesize the available evidence regarding the role and impact of pharmacists in antifungal stewardship programs, specifically focusing on clinical, utilization, and economic outcomes, using a narrative synthesis approach.</p><p><strong>Method: </strong>A systematic review was conducted. PubMed/MEDLINE and Scopus databases were searched for studies published from database inception to January 2026. Two reviewers independently screened titles, abstracts, and full texts according to predefined eligibility criteria. Data extraction was performed independently using a standardized form. Due to heterogeneity in study designs and outcomes, a narrative synthesis approach was applied. The review was reported in accordance with the PRISMA reporting guidelines. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies.</p><p><strong>Results: </strong>Fifteen studies met the inclusion criteria, the majority of which were quasi-experimental pre-post intervention studies conducted in tertiary care hospitals. Key pharmacist-driven interventions included antifungal dose optimization, de-escalation or discontinuation of therapy, facilitation of early appropriate antifungal treatment, therapeutic drug monitoring, and education or protocol development. Across studies, pharmacist involvement was associated with improvements in antifungal prescribing quality and stewardship process outcomes, including potential improvements in duration of antifungal therapy, antifungal consumption (measured by defined-daily-doses or days-of-therapy), time to appropriate therapy, and antifungal-related costs. Effects on clinical outcomes such as mortality and length of hospital stay were variable and generally not statistically significant. The overall certainty of the evidence is low to very low by the observational nature and the moderate-to-serious risk of bias of the included studies.</p><p><strong>Conclusion: </strong>Pharmacist participation in multidisciplinary antifungal stewardship teams may be associated with improved antifungal utilization and adherence to guidelines in hospitalized adults. The findings support that pharmacists are important members of multidisciplinary teams in antifungal stewardship.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770800","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":"Perspectives on shared decision making related to medications from patients with multiple long-term conditions transitioning from hospital to home: a qualitative study.","authors":"Mikas Glatkauskas, Malin Olsen Syversen, Liv Mathiesen, Michael Scott, Karin Svensberg, Berit Gallefoss Denstad, Marianne Lea","doi":"10.1007/s11096-026-02143-x","DOIUrl":"https://doi.org/10.1007/s11096-026-02143-x","url":null,"abstract":"<p><strong>Introduction: </strong>Shared decision making is particularly important for patients with multiple long-term conditions due to the nature of long-term treatments and frequent changes in medication regimens. However, the complexity of the medication regimens could exclude these vulnerable patients from shared decision making. There is little knowledge about how patients with multiple long-term conditions experience and perceive shared decision making.</p><p><strong>Aim: </strong>The aim was to explore the perspectives and experiences of patients with multiple long-term conditions regarding shared decision making related to medications before, during and after a hospital stay.</p><p><strong>Method: </strong>Semi-structured interviews with 21 patients and three next of kin were conducted. Patients ≥ 18 years, usually living at home, on at least four medications for at least two separate conditions were included. These patients were purposively sampled from two geriatric wards and one internal medicine ward at a university hospital in Norway and interviewed approximately 14 days post hospital discharge. The inclusion and interviews lasted from December 2022 to February 2024. A semi-structured interview guide was used, and the qualitative data were analyzed using directed content analysis guided by the three-talk model developed by Elwyn et al. from 2017.</p><p><strong>Results: </strong>Patients reported not being invited to be part of the shared decision-making process and perceived their limited medical knowledge as a barrier to being invited to participate. They reflected on themselves being primarily focused on single details regarding one medication option they had received. Furthermore, they were not encouraged by the healthcare professionals to discuss and compare different medication options. Both patients and next of kin described an expectation that decisions being made by healthcare professionals would be accepted although the patient did not necessarily understand the treatment plan adequately. Several patients reported that healthcare professional led decisions left little to no room for further discussion and that medication decisions and patient health goals were almost solely in the hands of the healthcare professional. Although most patients trusted the healthcare professional to act in their best interests, this reliance resulted in further disengagement from their own treatment.</p><p><strong>Conclusion: </strong>Patients with multiple long-term conditions were in general unfamiliar with and uninvolved in shared decision making related to medications. Additionally, the patients reflected on a lack of invitation to team talk which resulted in limited patient involvement both in option and decision talk.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770765","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":"Concurrent use of medicines with similar adverse drug reaction profiles in older adults: identifying potential deprescribing opportunities using population-level dispensing data.","authors":"Imaina Widagdo, Tien Bui, Lauren Cortis, Andre Andrade, Elizabeth Roughead","doi":"10.1007/s11096-026-02148-6","DOIUrl":"https://doi.org/10.1007/s11096-026-02148-6","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults are more vulnerable to medicine-related harm. Identifying concurrent use of medicines with similar adverse drug reaction (ADR) profiles may support opportunities for safer prescribing and deprescribing.</p><p><strong>Aim: </strong>To examine the frequency of concurrent use of medicines with overlapping ADR profiles in older adults. A secondary aim was to examine the contribution of potentially inappropriate medicine (PIMs) to overlapping ADR profiles.</p><p><strong>Method: </strong>We used data from the 10% sample of dispensing claims from the Australian Pharmaceutical Benefits Scheme between April and June 2022. Medicines were classified by ADR risk using an adapted version of the 2018 Scottish cumulative toxicity tool, which identifies 13 ADR types based on product information. PIMs were identified using the 2024 Australian PIMs list. Individuals aged 65 years or older who were dispensed at least one medicine associated with a listed ADR were included. The outcome of interest was the percentage of persons with an overlapping ADR (dispensed at least two medicines associated with the same ADR). A secondary analysis examined changes in overlapping ADR profiles under a hypothetical scenario excluding PIMs.</p><p><strong>Results: </strong>Our analysis included 323,599 older adults, of which 75.5% (n = 244,331) had at least one overlapping ADR risk, while 64% (n = 206,815) had two or more overlapping ADR risks. Falls/fractures 70.1% (n = 226,873), constipation 53.5% (n = 173,287), and renal injury 38.5% (n = 124,471) were the most common overlapping ADR risks. Under a hypothetical scenario excluding PIMs, an additional 13,803 people would have no falls/fracture overlapping ADR risk, and 19,396 would have no overlapping ADR risk.</p><p><strong>Conclusion: </strong>Concurrent use of medicines with similar ADR profiles is common among older adults. Structured tools to identify the use of medicines with similar ADR risks may support deprescribing and safer medicine use in this population.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770851","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 real-world, therapeutic drug monitoring-informed model to predict teicoplanin daily dose in pediatric intensive care unit patients with bacterial infections.","authors":"Fusang Wang, Mei Zhang, Suiwen Ye, Jianan Yan, Xuechun Li, Jinyuan Zhang, Xiaoxia Yu, Ying Wang, Ze Yu, Fei Gao, Junyan Wu","doi":"10.1007/s11096-026-02124-0","DOIUrl":"https://doi.org/10.1007/s11096-026-02124-0","url":null,"abstract":"<p><strong>Introduction: </strong>Teicoplanin is commonly used to treat Gram-positive bacterial infections in the intensive care unit (ICU). However, evidence to support individualized therapeutic drug monitoring (TDM)-guided daily dosing of teicoplanin in pediatric ICU patients remains limited despite substantial interpatient variability in pharmacokinetics and clinical response.</p><p><strong>Aim: </strong>To develop and validate a real-world TDM-informed machine learning model to predict physician-adjusted teicoplanin daily dose in pediatric ICU patients, with the goal of supporting individualized dosing decisions in clinical pharmacy practice.</p><p><strong>Method: </strong>Clinical and TDM data from pediatric ICU patients receiving teicoplanin at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University between June 2020 and June 2023 were retrospectively collected. The outcome variable was the daily teicoplanin dose administered during routine TDM-guided clinical care. After univariate screening and sequential forward selection, the dataset was divided into training and test sets (8:2). Missing values were imputed using the random forest approach. Nine machine learning and deep learning algorithms, including gradient boosting, XGBoost, LightGBM, and TabNet, were developed and evaluated using tenfold cross-validation, with model performance assessed using the coefficient of determination (R²), root mean square error (RMSE), and mean absolute error (MAE).</p><p><strong>Results: </strong>A total of 257 pediatric ICU patients (595 teicoplanin dosing records) were included in the study. Weight, age, height, teicoplanin trough concentration (TDM), glucose, creatine kinase isoenzyme-MB, total protein, concomitant imipenem and meropenem use, and upper respiratory infection were identified as key predictors. Among the nine models, the TabNet algorithm demonstrated the best performance on the test set (R² = 0.82, RMSE = 53.96 mg/day, MAE = 39.93 mg/day). The proportion of predictions within ± 30% of the observed daily dose was 81.51%.</p><p><strong>Conclusion: </strong>This real-world TDM-informed TabNet model shows strong performance in predicting the daily dose of clinician-adjusted teicoplanin in pediatric ICU patients. The model may serve as a clinical decision-support tool for pharmacists and physicians to assist individualized teicoplanin dosing within routine TDM workflows, potentially improving dosing consistency, and supporting safe and effective antimicrobial therapy.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716554","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":"Comparative predictive performance of anticholinergic burden scales for anticholinergic-related hospitalisation and emergency department visits in older adults: a population-based study of model development and temporal validation.","authors":"Valentina M Srikartika, David Youens, Rachael Moorin, Ninh Ha","doi":"10.1007/s11096-026-02145-9","DOIUrl":"https://doi.org/10.1007/s11096-026-02145-9","url":null,"abstract":"<p><strong>Introduction: </strong>Anticholinergic burden scales are widely used to guide medication review in older adults, yet their ability to predict clinically important adverse outcomes remains uncertain, as most evidence is based on associations rather than validated risk prediction. In the absence of a gold standard, the clinical value of these scales depends on whether they can discriminate between individuals at risk and provide accurate absolute risk estimates.</p><p><strong>Aim: </strong>To compare the predictive performance of six anticholinergic burden scales for hospitalisation/emergency department (ED) visits related to anticholinergic adverse effects, assess internal and temporal validation of cognitive impairment models across scales, and examine the risk gradient across increasing anticholinergic burden levels for cognitive impairment across scales.</p><p><strong>Method: </strong>A retrospective cohort study using linked population-level administrative health data of adults aged ≥ 65 years in Western Australia (2015-2019). Development cohorts were from 2015-16 (N = 323,682) and 2016-17 (N = 334,304), and the temporal validation cohort was from 2017-18 (N = 330,684). Six anticholinergic burden scales were calculated annually. Logistic regression models with common predictor structure including demographic and clinical predictors were used to predict any hospitalisation/ED visit related to anticholinergic adverse events (falls/fractures/dizziness, cognitive impairment, or constipation/urinary retention). Model performance was assessed using the c-statistic, calibration slope, and Brier score. Cognitive impairment models were further evaluated using bootstrap internal validation (200 replications), temporal validation, and predicted risk estimation across exposure deciles.</p><p><strong>Results: </strong>Across initial model comparisons, Korean Anticholinergic Burden Scale (KABS) showed the highest c-statistics for each outcome, although between-scale differences were small. Cognitive impairment showed the highest discrimination across scales and was selected for further validation. In temporal validation, c-statistics for cognitive impairment ranged from 0.795 to 0.806, with the highest value observed for KABS, and calibration slopes ranging from 1.024 to 1.032 across scales. Predicted risk of cognitive impairment increased across exposure deciles for all scales, with the highest-decile risk ranging from 5.27% for TSDD-SAMS to 7.58% for KABS.</p><p><strong>Conclusion: </strong>KABS showed slightly higher and more consistent predictive performance than the other scales, particularly for cognitive impairment, although between-scale differences were modest. Presenting validated absolute risk estimates across exposure groups may improve clinical interpretability and support risk stratification, but wider validation and clinical judgement remain essential before routine use.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716593","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":"Association between unresolved drug-related problems and 6-month hospital readmissions following pharmacist-led medication reviews: a retrospective observational study.","authors":"Kaja Zorjan, Barbara Tašker, Astrid Marovič, Maja Petre","doi":"10.1007/s11096-026-02139-7","DOIUrl":"https://doi.org/10.1007/s11096-026-02139-7","url":null,"abstract":"<p><strong>Introduction: </strong>Unresolved drug-related problems may cause preventable medication-related harm and contribute to hospital readmissions. Comprehensive medication reviews conducted by clinical pharmacists are used to identify and address drug-related problems in hospital settings. However, the clinical relevance of drug-related problems that remain unresolved after identification, particularly in relation to hospital readmissions, remains unexplored.</p><p><strong>Aim: </strong>To examine the association between unresolved drug-related problems and 6-month all-cause hospital readmission, and to describe drug-related problem identification, intervention acceptance, and resolution during pharmacist-led comprehensive medication reviews.</p><p><strong>Method: </strong>A retrospective observational study was conducted in a tertiary hospital (2019-2022). Inpatients and outpatients referred by doctors for a pharmacist-led comprehensive medication review with ≥ 1 identified drug-related problem were included. The primary outcome was all-cause hospital readmission within 6 months following the medication review. Additional process measures included doctors' acceptance of pharmacists' recommendations, drug-related problem resolution status assessed based on follow-up documentation at 6 months, and the number of additional drug-related problems identified by pharmacists beyond those detected by doctors.</p><p><strong>Results: </strong>A total of 177 patients undergoing 185 comprehensive medication reviews were included, in whom 505 drug-related problems were identified (mean 2.7 per review, standard deviation 2.0). Clinical pharmacists identified 73.9% of all drug-related problems and proposed interventions for 88.9% of them. Overall, 70.2% of pharmacists' recommendations were accepted by doctors. In a patient-level multivariable analysis adjusting for age, sex, comorbidities, medication count, total drug-related problem count, and the number of comprehensive medication reviews, the presence of any unresolved drug-related problems (OR = 4.02, 95% CI: 1.12-14.39, p = 0.033) and the number of unresolved drug-related problems (OR = 1.74, 95% CI: 1.10-2.74, p = 0.017) were independently associated with higher readmission risk, as was comorbidity count (OR = 1.47, 95% CI: 1.01-2.15, p = 0.046).</p><p><strong>Conclusion: </strong>In this retrospective study, the presence of unresolved drug-related problems following pharmacist-led comprehensive medication reviews was independently associated with four-fold higher odds of hospital readmission within 6 months. These findings highlight unresolved drug-related problems as a strong, independent marker of increased readmission risk. Prospective studies are needed to determine whether interventions that successfully resolve DRPs can causally reduce readmissions.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716518","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":"Cost-effectiveness of toripalimab plus bevacizumab versus sorafenib as first-line treatment for advanced hepatocellular carcinoma in China and the United States healthcare systems.","authors":"Junhao Yang, Haixia Ding","doi":"10.1007/s11096-026-02133-z","DOIUrl":"https://doi.org/10.1007/s11096-026-02133-z","url":null,"abstract":"<p><strong>Introduction: </strong>Toripalimab combined with bevacizumab has demonstrated significant clinical efficacy and survival benefits in patients with advanced hepatocellular carcinoma (HCC). However, the high cost of this combination therapy raises concerns regarding its cost-effectiveness in healthcare systems in China and the U.S.</p><p><strong>Aim: </strong>This study evaluated the cost-effectiveness of toripalimab plus bevacizumab compared with sorafenib from the perspectives of the Chinese and U.S. healthcare systems. The findings are intended to inform value-based pricing strategies, reimbursement decisions, and clinical resource allocation.</p><p><strong>Method: </strong>A partitioned survival model (PSM) was developed to estimate incremental cost-effectiveness ratios (ICERs) from the healthcare system perspective. Willingness-to-pay (WTP) thresholds were set at $40,011 per quality-adjusted life year (QALY) in China and $100,000-$150,000 per QALY in the U.S. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model outcomes.</p><p><strong>Results: </strong>In China, toripalimab plus bevacizumab produced an ICER of $55,764.00/QALY compared with sorafenib, exceeding the local WTP threshold of $40,011/QALY. In the U.S., the ICER was $460,054.17/QALY, which also exceeded the commonly accepted WTP thresholds. Sensitivity analyses indicated that the discount rate and the proportion of patients receiving subsequent anti-cancer therapies were the primary cost drivers in China and the United States, respectively. Probabilistic sensitivity analysis showed a 0.7% and 1.5% probability of cost-effectiveness at WTP thresholds of $100,000/QALY and $150,000/QALY in the U.S., respectively. In China, the probability of cost-effectiveness was 3.2% at a WTP threshold of $40,011/QALY.</p><p><strong>Conclusion: </strong>At current pricing levels, toripalimab plus bevacizumab is unlikely to be cost-effective compared with sorafenib in either China or the U.S. These findings highlight the need for value-based pricing strategies and more efficient allocation of healthcare resources.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689898","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}