International Journal of Clinical Pharmacy最新文献

{"title":"Evidence on interventions that target prescribing appropriateness in older adults attending the emergency department and other acute care settings: a scoping review.","authors":"Lauren Fernandes, Daniel McCarthy, Claire McCormack, Aoife Leahy, Anne Harnett, Abdirahman Mohamed, Ahmed Gabr, Margaret O'Connor, Rose Galvin","doi":"10.1007/s11096-026-02170-8","DOIUrl":"10.1007/s11096-026-02170-8","url":null,"abstract":"<p><strong>Introduction: </strong>Potentially inappropriate prescribing (PIP) has been associated with various adverse clinical outcomes, particularly in the context of ageing, multimorbidity and polypharmacy. Despite growing interest in front door frailty initiatives in the emergency department (ED) and acute geriatric units (AGUs), no review has focused specifically on interventions targeting PIP, as defined by validated criteria, across both ED and AGU settings.</p><p><strong>Aim: </strong>This scoping review aimed to map the evidence on interventions addressing PIP in older adults attending EDs or AGUs, identify evidence gaps and highlight areas for future research.</p><p><strong>Method: </strong>This scoping review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Medline, Embase, CINAHL Ultimate, Web of Science, Cochrane CENTRAL and grey literature sources were searched from 1991 to 2025 for studies evaluating interventions targeting PIP, defined using validated criteria, in adults aged ≥ 65 years attending the ED or AGUs.</p><p><strong>Results: </strong>Our search returned 8643 results. Twenty-one studies were identified for inclusion, four of which were randomised controlled trials. The 18 interventions identified encompassed pharmacist-led medication reviews, clinical decision support systems (CDSS), educational/academic detailing programmes or combined approaches. While PIP was frequently a primary outcome measure, few studies reported clinical outcomes or explored prescriber adherence and experiences of older adults and prescribers.</p><p><strong>Conclusion: </strong>Pharmacist-led medication reviews, CDSS and educational/academic detailing were the main intervention approaches identified. Evidence was heterogeneous and focused mainly on prescribing-related outcomes, with limited assessment of clinical outcomes, prescriber adherence, communication pathways and stakeholder feedback. Future studies should incorporate longer-term follow-up and evaluate patient-centred and implementation outcomes.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1773-1786"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of antidepressant administration on physical performance and perceived exertion in athletes: systematic review and meta-analysis.","authors":"Jeongha Yun, Sohyeon Park, Kalynn Park, Chaeyoon Kim, Margo Mountjoy, Mark Stuart, Sandy Jeong Rhie","doi":"10.1007/s11096-026-02206-z","DOIUrl":"10.1007/s11096-026-02206-z","url":null,"abstract":"<p><strong>Introduction: </strong>Antidepressants are commonly prescribed in athletes with depressive disorders, yet their potential effects on physical performance and perceived exertion remain unclear, and existing evidence is limited and inconsistent.</p><p><strong>Aim: </strong>This systematic review and meta-analysis aimed to evaluate the effects of antidepressant use on objective physical performance and perceived exertion in athletes.</p><p><strong>Method: </strong>A systematic literature search was conducted in PubMed, the Cochrane Library, Web of Science, and SPORTDiscus through March 2025. Eligible studies were randomised controlled trials (RCTs) published in English that enrolled elite, competitive, or recreational athletes; compared antidepressant administration with placebo or no treatment; and reported at least one objective or subjective performance-related outcome. Meta-analyses were performed using random-effects models, and pooled mean differences with 95% confidence intervals (CI) were calculated. This systematic review and meta-analysis was registered in PROSPERO (CRD420251123740).</p><p><strong>Results: </strong>Ten crossover RCTs involving 99 male athletes were included. Interventions included a norepinephrine reuptake inhibitor (reboxetine), a norepinephrine-dopamine reuptake inhibitor (bupropion), and selective serotonin reuptake inhibitors (fluoxetine or paroxetine). Acute antidepressant administration was associated with a small increase in rating of perceived exertion (RPE; mean difference 0.52 points on the Borg 6-20 scale, 95% CI 0.01-1.04; p < 0.05). No significant overall effects were observed for time-trial performance, mean power output, heart rate or blood lactate. However, subgroup analyses showed that reboxetine significantly impaired time-trial performance (mean difference 3.62 min, 95% CI 0.18-7.06; p < 0.05) and reduced mean power output (mean difference - 19.97 W, 95% CI - 36.87 to - 3.06; p < 0.05).</p><p><strong>Conclusion: </strong>Short-term antidepressant administration in athletes was associated with a small increase in perceived exertion, without consistent impairment in objective physical performance. As the current evidence derives exclusively from male athletes and acute exposure, further research should clarify its relevance to female athletes and to longer-term antidepressant treatment in athletes with depressive disorders.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1827-1839"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives and experiences of collaborative pharmacist prescribing in the hospital inpatient setting: a cross-sectional survey.","authors":"Hana Amer, Sally Marotti, Jacinta Johnson, Imaina Widagdo, Kirsten Burns, Sharon Goldsworthy, Ramim Hossin, Molly Astley, Lisa Kalisch Ellett","doi":"10.1007/s11096-026-02178-0","DOIUrl":"10.1007/s11096-026-02178-0","url":null,"abstract":"<p><strong>Introduction: </strong>Collaborative pharmacist prescribing in hospitals involves pharmacists, medical doctors, and patients working together to develop medicine plans that support shared decision-making and underpin pharmacist prescriptions. Shared decision-making is a process in which clinicians and patients make treatment decisions together, ensuring they reflect patient preferences and understanding. However, little is known about patient perspectives and experiences with collaborative pharmacist prescribing, particularly related to shared decision-making, in the inpatient hospital setting.</p><p><strong>Aim: </strong>To examine patient perspectives and experiences of collaborative pharmacist prescribing in the hospital inpatient setting.</p><p><strong>Method: </strong>A cross-sectional survey was conducted across four hospitals in South Australia. Eligible inpatients were aged ≥ 18 years and provided informed consent. The primary outcome was patient perspectives of collaborative pharmacist prescribing and experiences during medicine prescribing as an inpatient. Results were stratified by the type of prescribing model (collaborative pharmacist prescribing vs. medical prescribing) received by the patient during their admission. Free-text responses were thematically analysed using Braun and Clarke's framework. Likert scale responses were summarised using descriptive statistics, and sub-group analysis compared categorical variables between groups.</p><p><strong>Results: </strong>Responses were received from 200 patients (100 who received collaborative pharmacist prescribing and 100 who received medical doctor prescribing). Overall, patients had a median age of 72 years and just over half were female. Qualitative analysis found that all respondents trust pharmacists' expertise and ability to collaboratively prescribe. Patients in both groups perceived benefits of collaborative pharmacist prescribing including enhanced interprofessional communication, reductions in medication errors, and a better understanding of their medicines. These findings reinforced the quantitative results, with a higher proportion of patients who received collaborative pharmacist prescribing reporting feeling very or extremely involved in medicine decisions compared to patients who received medical prescribing (60% vs. 14%, p < 0.001).</p><p><strong>Conclusion: </strong>Collaborative pharmacist prescribing enhances shared decision-making by actively involving patients in discussions about their medicines. It improves patients' understanding of their medicines, which supports safer and more informed treatment decisions. These findings support wider adoption of collaborative pharmacist prescribing to improve patient-centered care in hospitals.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1991-2004"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on atrial fibrillation management and pharmacist roles in outpatient clinics: a qualitative study.","authors":"Margaret Dennehy, Anna Seoighe, Cathal Cadogan, Kate Burke, Emma Murtagh, Ronan Collins, Derek Hayden, Christine McAuliffe","doi":"10.1007/s11096-026-02155-7","DOIUrl":"10.1007/s11096-026-02155-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased risk of stroke and mortality. Effective management requires both patient engagement and clear understanding of treatment goals yet evidence suggests persistent gaps in knowledge and involvement in care. Pharmacists are increasingly involved in AF clinics, yet little is known about how patients perceive their role, particularly in the context of potential pharmacist prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To explore patients' perspectives on the management of AF and the role of pharmacists in an Irish outpatient AF clinic, including attitudes toward potential pharmacist prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A qualitative study was conducted using 15 one-to-one semi-structured interviews with adults aged ≥ 65 years attending a specialist AF clinic at Tallaght University Hospital, Dublin, Ireland. Interviews took place between March and May 2025. Participants were purposively sampled to capture a range of clinical and demographic characteristics. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's six-step reflexive thematic analysis. An inductive approach was adopted. Coding and theme development were conducted iteratively, with a subset of transcripts independently reviewed by supervisors to enhance analytical rigour and consistency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five overarching themes were identified relating to understanding of AF, pharmacotherapy, satisfaction with care, perceptions of the pharmacist's role, and views on pharmacist prescribing. Participants demonstrated variable understanding of AF, with limited awareness of stroke risk despite consistent recognition of anticoagulant therapy. Knowledge of anticoagulant safety, particularly bleeding risk, was strong and well retained, whereas understanding of rate-control medicines was limited. Satisfaction with care was high; however, most participants adopted a passive role in decision-making, expressing trust in healthcare professionals. Pharmacists were frequently misidentified as doctors or nurses, reflecting limited role visibility. Once recognised, pharmacist input, particularly in anticoagulant counselling and medication advice, was highly valued. Views on pharmacist prescribing were mixed: while participants acknowledged pharmacists' expertise in medicines, many preferred doctors to retain prescribing responsibility due to established trust.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;While patients spoke positively about pharmacists' input, many struggled to identify the pharmacist within the clinic and were unclear about the scope of their role. Gaps in understanding of stroke risk and broader treatment goals highlight the need for structured patient education. As Ireland considers expanding pharmacist prescribing beyond the current common conditions scheme in community pharmacy, strengthening patient education and f","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1840-1849"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketoproof? A systematic classification of pharmaceutical excipients for ketogenic diet therapy.","authors":"Samir El Abdouni, Manon G den Uil, Zikrullah Kafa, Tatiana Soares Ribeiro, Elles J T M van der Louw, Elisabeth J Ruijgrok, A Laura Nijstad","doi":"10.1007/s11096-026-02156-6","DOIUrl":"10.1007/s11096-026-02156-6","url":null,"abstract":"<p><strong>Introduction: </strong>Ketogenic diet therapy (KDT) is an evidence-based treatment for refractory epilepsy, particularly in children. Strict adherence to carbohydrate restriction is essential to maintain ketosis, yet many medications contain excipients that can disrupt this balance. Pharmacists play a crucial role in evaluating and adjusting medication regimens for patients on KDT, but limited transparency regarding excipient content often makes this process inefficient and inconsistent. Although some regional databases exist, no systematic and comprehensive resources have been developed for broader use.</p><p><strong>Aim: </strong>This study aimed to systematically classify pharmaceutical excipients and label all medications marketed in the Netherlands according to their compatibility with KDT (\"Ketoproof\" status) using a transparent, reproducible framework that can serve as the foundation for safer prescribing and international standardization.</p><p><strong>Method: </strong>A retrospective cross-sectional database analysis was conducted using data from the Dutch G-Standaard (June 2023-March 2024), a national pharmaceutical reference database used in the Netherlands. All excipients authorized in medications marketed in the Netherlands were extracted and classified based on chemical composition, metabolic fate, and administration route. Excipients were assigned a Ketoproof status through a structured decision flowchart, expert consensus, and quality control review. Finally, pharmaceutical products were labeled by cross-referencing their excipient profiles against the classified dataset.</p><p><strong>Results: </strong>A total of 1047 excipients were identified. Of these, 778 (74%) were successfully classified: 590 (56%) as Ketoproof and 188 (18%) as non-Ketoproof. The remaining 269 (26%) were unclassified. Excipients requiring expert consensus included polyols and sugar alcohols, organic acids, and coloring and flavoring agents, which were carefully assessed for clinical relevance. Among 28,721 pharmaceutical products analyzed, 41% (n = 11,781) were labeled as Ketoproof. The full dataset was integrated into KetoMed, a web-based tool designed to support healthcare professionals in reviewing medications for patients on KDT.</p><p><strong>Conclusion: </strong>This study presents the first systematic classification of pharmaceutical excipients for KDT compatibility. The transparent, evidence-informed framework enables structured labeling of medications and supports safer prescribing for patients undergoing KDT. Broader adoption and international collaboration are recommended to establish consensus on excipient classification, enhance regulatory transparency, and integrate Ketoproof labeling into clinical decision-support systems to optimize ketogenic therapy management.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1850-1857"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors related to community pharmacists' intention to provide collaborative deprescribing service for fall-risk medications in older adults: a factorial and theory-based cross-sectional study.","authors":"Zeynep Sayın, Ilgın Asena Cebeci, Mesut Sancar, Betul Okuyan","doi":"10.1007/s11096-026-02173-5","DOIUrl":"10.1007/s11096-026-02173-5","url":null,"abstract":"<p><strong>Introduction: </strong>Collaborative deprescribing of fall-risk-increasing medication by community pharmacists and family physicians can reduce falls in older adults. No such exists in Türkiye.</p><p><strong>Aim: </strong>To identify factors related to community pharmacists' intention (1) to provide collaborative deprescribing service for fall-risk medications in older adults, and (2) to discuss older adults' potential fall-risk medications with the family physician.</p><p><strong>Method: </strong>In this cross-sectional study, a web-based survey was conducted between November 2023 and February 2024 among Turkish community pharmacists recruited using convenience sampling. The questionnaire included items at the respondent level (including a theory of planned behaviour-based questionnaire) and the vignette level (including factorial vignettes). The factors related to their intention to perform two behaviours were evaluated: (1) providing collaborative deprescribing service and (2) discussing older adults' potential fall-risk medications with the family physician. Multilevel linear mixed-effects models were used.</p><p><strong>Results: </strong>Based on responses from 398 community pharmacists (response rate of 93.2%), the intention to provide collaborative deprescribing service was related to their knowledge test score, self-reported rate of older adults served in the community pharmacy (61-80% category), their scores of subjective norm, self-efficacy, and perceived behavioural control (p < 0.05). Community pharmacists' intention to discuss older adults' potential fall-risk medications with the family physician was related to being male, younger age, their experience on patient-centred services, their higher scores of subjective norm, self-efficacy, and perceived behavioural control, and lower scores of attitude (p < 0.05). At vignette level, both intentions were linked to having a history of falls and the number of patients waiting in the community pharmacy (p < 0.05).</p><p><strong>Conclusion: </strong>A collaborative deprescribing service for fall-risk-increasing medications in older adults could be implemented by addressing key determinants of community pharmacists' intention at both respondent and vignette levels, including subjective norm, self-efficacy, perceived behavioural control, attitude, workload-related factors, and patient clinical history.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1957-1966"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritising medication management criteria to identify emergency department patients with potential medication-related harm: Nominal Group Technique workshops with clinicians.","authors":"Amber Franich, Kate Hill, Gary Grant, H Laetitia Hattingh","doi":"10.1007/s11096-026-02199-9","DOIUrl":"10.1007/s11096-026-02199-9","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacist involvement in the emergency department (ED) and early in a patient's hospital stay improves clinical outcomes and reduces medication errors. Because EDs are high-pressure settings with limited pharmacist staffing, pharmacists cannot review every patient. Instead, they must focus on identifying and prioritising patients who may be at risk of potential medication-related harm.</p><p><strong>Aim: </strong>To establish and prioritise consensus-based medication management criteria to identify patients with potential medication-related harm within the ED setting for early pharmacist review.</p><p><strong>Method: </strong>We used Nominal Group Technique (NGT) methodology to rank the most important criteria for identifying whether a patient's presentation may be due to medication-related harm or whether they may be at risk of developing medication-related harm in the ED. Participants were purposively recruited ED clinicians including pharmacists, doctors and nurses who worked at the ED of either the Gold Coast University Hospital or Robina Hospital on the Gold Coast, Queensland, Australia, during May-June 2025.</p><p><strong>Results: </strong>A total of 14 participants comprising six pharmacists, five nurses and three doctors participated in two 1-h NGT workshops. Participants ranked 12 criteria from a list of 34 during NGT Round 1. They subsequently ranked six criteria from the list of 12 during NGT Round 2. The weighted rankings of the criteria across both groups were combined to determine the top six criteria which were, in order from 1 to 6 (1 = most relevant): (1) medication-related admission or thinks medicine responsible for admission; (2) bleeding and falls; (3) poor historian (unable to provide reliable history)/suspected non-adherence or poor compliance; (4) carbidopa/levodopa (entacapone), co-beneldopa; (5) unverified medicines; and (6) medicines requiring therapeutic drug monitoring/medicines with narrow therapeutic index. The first four criteria were ranked within the top six in both NGT workshops.</p><p><strong>Conclusion: </strong>This study has provided a concise list of six medication-related criteria that expert consensus agreed were the most important for prioritising patients with potential medication-related harm. This forms the basis for the development of information gathering strategies to be incorporated into clinicians' workflows early in patients' ED journey.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2139-2148"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient health outcomes for evaluation of pharmacist-led primary care: a scoping review.","authors":"Claire Keenan, Amy Grant, Andrea Bishop, Kristy Hancock, Natalie Kennie-Kaulbach, Hannah MacConnell, Alex Robart, Noel Guscott, Charmaine Cooke, Rachel Giacomantonio, Mina Tadrous, Lisa Woodill, Jennifer E Isenor","doi":"10.1007/s11096-026-02179-z","DOIUrl":"10.1007/s11096-026-02179-z","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacists' role in primary care has rapidly evolved in recent years, driven by pressures on primary care and supported by increased government funding, further enabling full scope of practice while reducing patient costs. To optimize healthcare delivery, the patient outcomes of pharmacist-led primary care in community settings must be evaluated.</p><p><strong>Aim: </strong>This scoping review aimed to identify and explore the breadth of patient health outcomes used to assess the quality, effectiveness, and safety of pharmacist-led primary care.</p><p><strong>Method: </strong>A comprehensive search was conducted in four databases and Google for articles published from 1997 to July 2023, updated in February 2025. Database records were screened independently by two reviewers at two stages in Covidence. Google search results were screened by one reviewer, with selections verified by a second reviewer. Studies were included if they involved pharmacist-led primary care and reported patient health outcomes related to quality, effectiveness, and/or safety. Extracted data on study design, disease state, clinical services, and patient outcomes were categorized by two reviewers. Data are reported descriptively (frequencies, percentages) and are displayed using heat maps. Results were reported using PRISMA-ScR guidelines.</p><p><strong>Results: </strong>A total of 299 studies (297 peer-reviewed, 2 grey literature) were included from 10,498 database records and 300 grey literature search results. Experimental study designs were the most common (61%) and increased in prevalence over the study period. Patient populations primarily comprised those with chronic diseases, primarily endocrine (27%) and cardiovascular (26%), with the volume of studies focused on these groups also increasing over time. Studies often evaluated multiple types of clinical service, with more focusing on education or counselling (29%) and chronic disease management (23%). A wide variety of outcomes were measured, with more than 70% being positive. The number of studies reporting outcomes increased markedly after 2002, particularly those examining clinical measures (29%), resource use (19%), and laboratory measures (14%).</p><p><strong>Conclusion: </strong>This scoping review identified patient health outcomes used to evaluate pharmacist-led primary care. Although studies on pharmacist-led clinical services have increased, the most assessed services may not reflect current practice. These findings should inform health system metrics grounded in outcomes that matter to patients to ensure safe, effective pharmacist-led care.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1800-1811"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative dual antiplatelet therapy vs. aspirin monotherapy on perioperative outcomes in carotid endarterectomy patients: a retrospective cohort study.","authors":"Wenjun Yang, Wei Hu, Yifeng Pan, Xiangkun Meng, Leilei Tang, Jie Chen, Huimin Xu","doi":"10.1007/s11096-026-02160-w","DOIUrl":"10.1007/s11096-026-02160-w","url":null,"abstract":"<p><strong>Introduction: </strong>The preoperative use of dual antiplatelet therapy (DAPT) in patients undergoing carotid endarterectomy (CEA) is controversial.</p><p><strong>Aim: </strong>This study aimed to compare perioperative major bleeding and major adverse cardiovascular events (MACEs) between patients receiving aspirin alone and those receiving DAPT (clopidogrel plus aspirin).</p><p><strong>Method: </strong>This retrospective cohort study included patients with carotid artery stenosis who underwent CEA between January 2020 and December 2024. Patients were grouped according to preoperative antiplatelet therapy (DAPT vs. aspirin), and inverse probability of treatment weighting (IPTW) was applied to adjust for baseline imbalances. The primary outcome was 30-day post-CEA major bleeding (neck hemorrhage requiring reoperation or intracranial hemorrhage). The secondary outcome was 30-day post-CEA MACEs (ischemic stroke, myocardial infarction, or death). Multivariate logistic regression was performed to identify the predictors of major bleeding.</p><p><strong>Results: </strong>A total of 741 patients were included (aspirin, n = 504; DAPT, n = 237). Patients in the DAPT group had a higher prevalence of symptom, prior stroke, coronary artery disease, hyperlipidemia, and prior revascularization. After IPTW adjustment, DAPT was associated with a higher risk of major bleeding than Aspirin (OR 4.21, 95% CI 1.81-9.78), with no significant difference in MACEs (OR 1.49, 95% CI 0.57-3.85). Multivariate analysis confirmed DAPT as an independent predictor of major bleeding (OR 3.40, 95% CI 1.42-8.19, p = 0.006), whereas preoperative statin use was independently associated with a reduced risk (OR 0.13, 95% CI 0.03-0.51, p = 0.003).</p><p><strong>Conclusion: </strong>Compared with aspirin monotherapy, preoperative DAPT was associated with an increased risk of perioperative major bleeding without a reduction in perioperative MACEs in patients undergoing CEA. Larger multicenter prospective studies are needed to confirm these findings.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1884-1892"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of existing polypharmacy measures to a measure incorporating all modes of administration: an observational study using routinely collected data.","authors":"David Lim, David Youens, Rachael Moorin, Andrew Stafford","doi":"10.1007/s11096-026-02194-0","DOIUrl":"10.1007/s11096-026-02194-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Polypharmacy is often associated with adverse clinical outcomes and increased medication management complexity. However conventional analyses of medicine burden and polypharmacy using administrative data are limited to oral medicines (i.e. tablets and capsules), potentially underestimating overall medicine exposure. These products may significantly increase the burden of medication management and therefore risk to patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study compared traditional measures of polypharmacy with a measure incorporating all modes of medicine administration and examined how these differences impacted estimates of polypharmacy prevalence among adults aged &gt; 65 years in Western Australia (WA) from 2012/13 to 2018/19, between two independent cohorts: community-dwelling and residential aged care home populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Linked medication dispensing data were used to classify and compare medicines between community-dwelling and residential aged care populations in Western Australia. Conventional medicine capture was extended to include medicines via various modes of administration, including creams, ointments, patches, and eye and ear drops. Medicines were classified into five categories: 0, 1, 2-4, 5-8, 9 + medicines, and counts were compared across care settings to assess changes in observed medicine burden and measures of polypharmacy. Comparative analysis was performed between two methods: Method 1 (conventional medicine capture) and Method 2 (all medicines including non-oral preparations).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Inclusion of medicines via mode of administration increased observed medicine burden in both subpopulations, with a greater relative increase in residential aged care. This approach notably contributed to total medicine counts, revealing previously unrecognised medicine exposure. This resulted in absolute increases in the 5 + medicine category of 4.0% in 2012/13 and 3.4% in 2018/19. Among aged care residents, opioid analgesics previously ranked as the most common medicine class using Method 1, was reclassified as separate oral and patch formulations using Method 2, ranking 4th and 5th. Drugs for dry eyes also emerged as the 7th most common medicine class, with only minor ranking changes observed for the other top medicine classes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Incorporating all modes of medicine administration into a polypharmacy measure substantially altered estimates of medicine burden and identified previously unrecognised exposure, particularly among residential aged care populations. The impact was greatest in higher polypharmacy categories, indicating that conventional approaches may underestimate medicine use in individuals with more complex therapeutic regimens. These findings highlight the importance of accounting for formulation diversity and support the inclusion of mode-of-administration-based measures to provide a more comprehensive assessm","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"2158-2168"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}