International Journal of Clinical Pharmacy最新文献

{"title":"Quality indicators for pharmacist follow-up of diabetes mellitus: A RAND-modified Delphi method.","authors":"L Christiaens, L Meel, M Buyl, I De Wulf, S Van den Bulck, B Vaes, W Raat, M Van de Putte","doi":"10.1007/s11096-025-01942-y","DOIUrl":"10.1007/s11096-025-01942-y","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus is a complex condition with high morbidity which requires a multidisciplinary approach including pharmacist follow-up. Within primary care medicine, quality indicators combined with audit and feedback are described as quality improvement actions which facilitate change. However, since existing guidelines regarding pharmaceutical care for people living with diabetes mellitus are not validated in Belgium, their recommendations cannot be translated into quality indicators without content validation.</p><p><strong>Aim: </strong>We aimed to define a set of validated and pharmaceutical record extractable quality indicators, to evaluate the quality of care provided by Belgian pharmacists to people living with diabetes.</p><p><strong>Method: </strong>We used a RAND-modified Delphi method. Recommendations from (inter)national guidelines were selected according to the SMART principle. A multidisciplinary Belgian panel (N = 12), consisting of pharmacists, general practitioners, an endocrinologist, a representative of the pharmacists' association, a population manager, a data provider representative, and two diabetes patients, assessed the appropriateness of recommendations for their use as quality indicators. Recommendations received a first preliminary classification after analysis of the median Likert scale scores, prioritization rates, and agreement. Hereafter the recommendations were discussed by the panel in an online consensus meeting. A final validation round resulted in high-potential recommendations which were converted into QIs.</p><p><strong>Results: </strong>A total of 82 recommendations were presented to the panel, which resulted in a set of 24 high-potential recommendations that were merged and modified into 14 recommendations based on the panel members' advice. Three of these, related to influenza and pneumococcal polysaccharide vaccine delivery, and dispensing of blood glucose influencing and sugar-containing medication, could be converted into extractable quality indicators.</p><p><strong>Conclusion: </strong>This study defines a set of 14 quality indicators - covering screening, pharmacological treatment and patient education and lifestyle management - to evaluate the quality of care provided by Belgian pharmacists to people living with diabetes. Based on this quality assessment, the necessary improvement actions can be identified, implemented, and evaluated to strive for the most optimal care provision, aligning with evidence-based recommendations.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1406-1415"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475114","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":"Effect of discrepancy in estimated renal function on vancomycin area under the blood concentration-time curve: a retrospective cohort study comparing serum creatinine and serum cystatin C.","authors":"Yuta Ibe, Tomoyuki Ishigo, Tomohiro Aigami, Satoshi Fujii, Masahide Fukudo","doi":"10.1007/s11096-025-01960-w","DOIUrl":"10.1007/s11096-025-01960-w","url":null,"abstract":"<p><strong>Background: </strong>Accurate estimation of renal function is essential for determining vancomycin (VCM) dosing. Serum creatinine (sCr)-based formulas are used to estimate renal function; however, they may overestimate the glomerular filtration rate (GFR) in patients with reduced muscle mass. Serum cystatin C (cys-C) may provide more accurate estimates of renal function in such populations.</p><p><strong>Aim: </strong>We aimed to investigate the effect of estimated GFR (eGFR) discordance on area under the blood concentration-time curve (AUC) of VCM.</p><p><strong>Method: </strong>Data from 118 patients with simultaneous sCr and cys-C data available at start of VCM therapy were analyzed. Patients were classified into eGFR discordance and concordance groups. eGFR discordance was defined as a case where the sCr-based eGFR was 30% or higher than the cys-C-based eGFR. The primary outcome was the association between eGFR discordance and upward deviation of the VCM AUC.</p><p><strong>Results: </strong>Seventy-two patients with eGFR discordance had significantly higher measurement of VCM AUC than predicted (p < 0.001). Multivariate logistic regression analysis identified age, hospital stay of ≥ 12 days, and eGFR discordance as significant predictors of AUC upward deviation. Factors associated with discordance in the eGFR included these risk factors and intensive care unit (ICU) stay.</p><p><strong>Conclusion: </strong>This study highlights the importance of measuring cys-C levels at initiation of VCM therapy identifying patients at risk of renal function overestimation and subsequent VCM overdosing. Older with extended hospitalization or ICU stay may benefit from measuring cys-C levels of optimize VCM therapy and reduce drug-induced toxicity risk.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"1458-1466"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591111","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":"ESCP Best Practice: Development, implementation and evaluation of a practical risk assessment process for the introduction of new medicines to clinical practice at an Acute Hospital.","authors":"Chloe Lewis, Dale Weerasooriya, Caroline Cheng, Melanie Dalby","doi":"10.1007/s11096-025-02011-0","DOIUrl":"https://doi.org/10.1007/s11096-025-02011-0","url":null,"abstract":"<p><strong>Introduction: </strong>Incorporating new medications into clinical practice can present potential risks to staff and patients. Risk assessment of new medicines procured into acute hospitals in the United Kingdom varies between organisations and national guidance is lacking. Existing processes required risk assessment of all new medicines, consuming considerable pharmacist resource.</p><p><strong>Aim: </strong>To rationalise the risk assessment of new medicines at an acute hospital.</p><p><strong>Setting: </strong>A 1300 bed, multi-site tertiary-referral teaching hospital, London, United Kingdom.</p><p><strong>Development: </strong>A pharmacy working group, including formulary, governance, medication safety, and clinical leads, developed a rationalised risk assessment process. An initial triage was proposed to evaluate whether a risk assessment was required. Existing risk assessment tools were combined and adapted for use. A New Drug Panel (NDP) of pharmacy leaders was formed to review risk assessments.</p><p><strong>Implementation: </strong>The process was piloted for 6 months; minor modifications were made and it was fully introduced in May 2022. Implementation included governance sign off and training of members of the NDP on utilisation of the tools.</p><p><strong>Evaluation: </strong>Two years after introduction, 646 requests for new medicines were triaged and 196 (30%) required risk assessment. Fourteen requests were cancelled, so 182 risk assessments were reviewed by the NDP. The NDP recommended an additional 46 mitigations. Trends identified issues with unlicensed medicines, safe administration practices, communication and electronic prescribing.</p><p><strong>Conclusion: </strong>A practical risk assessment process reduced risk assessments by 70%, releasing clinical pharmacist time. An expert NDP identified additional mitigations, reducing patient harm and ensuring safe incorporation of medicines into clinical practice.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199351","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":"ESCP best practice: development of the national methodology for the provision of clinical-pharmaceutical care and its implementation in the healthcare system of the Czech Republic.","authors":"Jan Miroslav Hartinger, Ivana Tašková, Jana Gregorová, Ondřej Slanař, Daniela Fialová","doi":"10.1007/s11096-025-02009-8","DOIUrl":"https://doi.org/10.1007/s11096-025-02009-8","url":null,"abstract":"<p><strong>Introduction: </strong>In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important which led to extension of pharmacy practice beyond merely drug-oriented pharmacy-based services.</p><p><strong>Aim: </strong>To outline the development, implementation and outcomes of the methodology that established standards for CP practice in the Czech Republic and which contributed to establishing CP as an independent postgraduate specialization with its own workplaces and full-time employment positions.</p><p><strong>Setting: </strong>Inpatient and outpatient healthcare settings in the Czech Republic.</p><p><strong>Development: </strong>Legislative changes in 2011 incorporated CP care into the healthcare system and the national CP methodology was published in 2014. Proactive screening of the medication lists and patient healthcare documentation was introduced. Results of CMRs are discussed with attending physicians and the plans for drug therapy adjustment are added to patient documentation. Clinical pharmacists have become standard partners for physicians on medical wards and outpatient facilities. A comprehensive clinical postgraduate training program (fully interlinked with accredited CP wards) has been established to maintain high standards of CP care.</p><p><strong>Implementation: </strong>Based on the CP care methodology approved by professional medical and pharmaceutical societies and accepted by the Ministry of Health and health insurance companies, three inpatient procedures and one outpatient procedure became eligible for reimbursement thus facilitating the further development of CP practice and independent CP departments. Currently, the Czech Republic has 58 CP facilities and nearly 200 specialized clinical pharmacists.</p><p><strong>Evaluation: </strong>The provision of CP care according to current national guidelines was shown to provide an effective and cost-effective approach by the results of two extensive studies; the calculated economic cost-benefit ratio was determined at 1:3-4.2. The number of clinical pharmacy specialists and facilities is steadily increasing.</p><p><strong>Conclusion: </strong>The development of methodological approach accompanied by changes concerning reimbursement in the Czech Republic have led to the establishment of a stable and well-defined environment for clinical pharmacists to become full-time experts in both inpatient and outpatient settings. Clinical pharmacists are now recognized as skilled experts who are respected for their valuable contribution to inter-professional cooperation within medical teams.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199362","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":"Impact of Australian home medicines reviews on continuous polypharmacy and associated costs among older women: a cohort study.","authors":"Kaeshaelya Thiruchelvam, Nicholas Egan, Syed Shahzad Hasan, Julie Byles","doi":"10.1007/s11096-025-02018-7","DOIUrl":"https://doi.org/10.1007/s11096-025-02018-7","url":null,"abstract":"<p><strong>Introduction: </strong>Medication misadventure is associated with the use of polypharmacy and is highly prevalent in the older population living in the community, especially among women.</p><p><strong>Aim: </strong>This study aimed to determine the impact of Home Medicines Reviews (HMRs) on continuous polypharmacy, the prevalence of continuous polypharmacy, and inflation-adjusted differences in costs among women who did and did not receive HMRs.</p><p><strong>Method: </strong>The study included 9347 participants from the Australian Longitudinal Study on Women's Health who fulfilled the eligibility criteria from 77-82 years in 2003 to 91-96 years in 2017. Generalised estimating equations were used to estimate the association between HMRs and continuous polypharmacy. Out-of-pocket costs and benefits paid to government were presented as median costs for each participant from 2003 to 2017, alongside interquartile ranges.</p><p><strong>Results: </strong>Only a small percentage of women received HMRs in 2003 (1.14%) but this percentage increased over time to 2017 (3.95%). The prevalence of continuous polypharmacy in 2017 was 39.06% amongst women who received an HMR and 28.05% amongst women who did not receive an HMR. There was evidence for an association between the use of HMRs and continuous polypharmacy in the following calendar year (OR 1.12; 95% CI 1.03, 1.21). There was an increase in out-of-pocket (OOP) medication costs in both women with and without HMRs, with the HMR group demonstrating higher OOP medication costs (AUD$26 to AUD$57) than the non-HMR group (AUD$22 to AUD$50).</p><p><strong>Conclusion: </strong>HMRs were associated with a modest increase in the odds of continuous polypharmacy in the subsequent year. Increase in OOP medication costs over time highlights the need to further optimise cost-effective medications for individuals.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199306","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":"Impact of a pharmacist-led elective caesarean section pre-admission clinic on efficiency of pharmacist workflow and patient preparedness for post-operative discharge medication supply: a retrospective observational study.","authors":"Charis Lau, Rita Wardan","doi":"10.1007/s11096-025-02015-w","DOIUrl":"https://doi.org/10.1007/s11096-025-02015-w","url":null,"abstract":"<p><strong>Introduction: </strong>Rapid patient throughput on maternity wards results in pharmacist resources being directed towards discharge processes, primarily focused on patients who have undergone caesarean section (CS) due to their discharge medication requirements. This occurs at the expense of admission processes, including best possible medication history (BPMH) documentation.</p><p><strong>Aim: </strong>To evaluate the impact of a pharmacist-led elective caesarean section (ELCS) pre-admission clinic (PAC) on efficiency of pharmacist workflows, BPMH documentation, and patient preparedness for analgesic supply on discharge.</p><p><strong>Method: </strong>A retrospective observational study was undertaken at an Australian tertiary obstetric public hospital where an ELCS PAC was introduced through reallocation of clinical pharmacist resources. The PAC pharmacist attempted telephone contact with all patients scheduled for ELCS, within 1 week before surgery. The pharmacist obtained and documented a BPMH, and where appropriate, encouraged patients to purchase paracetamol and ibuprofen pre-operatively. Data were collected from electronic medical records and dispensing records for 1 month pre- and 2 months post-implementation, including: CS classification (elective or emergency); whether PAC was completed and timing of completion before CS; number of BPMH documented per day; timing of BPMH completion after CS; pharmacist staffing levels; and whether paracetamol and ibuprofen were dispensed on discharge.</p><p><strong>Results: </strong>During the 3-month study period, 1863 patients were admitted to the maternity wards, with 654 patients birthing via CS. Elective CS accounted for 43.3% (283/654) of CS deliveries, with 57.2% (162/283) of these patients reviewed in ELCS PAC. Post-implementation, workflow efficiency increased, with 19.9% more BPMH documented per pharmacist per day (3.87 vs 4.64, p = 0.012). Overall BPMH completion increased for all patients who underwent CS (83.7% vs 93.3%, p < 0.001). Timeliness of BPMH documentation improved for ELCS patients, with higher BPMH completion on the day of surgery (19.8% vs 34.5%, p = 0.019). Patients reviewed in PAC were less likely to require discharge supply of paracetamol (52% vs 37.1%, p = 0.031) and ibuprofen (80% vs 56.4%, p < 0.001).</p><p><strong>Conclusion: </strong>Reallocation of resources to introduce the ELCS PAC enhanced workflow efficiency and BPMH completion. Patient preparedness improved, with reduced reliance on hospital supply of simple analgesics on discharge.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185849","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":"Pharmacovigilance assessment of drug-induced aplastic anemia: analysis of the FDA adverse event reporting system.","authors":"Fan Zhang, Peng Wang, Xin Liu, Yuanmu Chen, Jie Yang","doi":"10.1007/s11096-025-02010-1","DOIUrl":"https://doi.org/10.1007/s11096-025-02010-1","url":null,"abstract":"<p><strong>Introduction: </strong>Aplastic anemia is a rare but life-threatening disorder often triggered by drug exposure. Given its low incidence, identifying drug-associated risks requires large-scale real-world data. The FDA Adverse Event Reporting System (FAERS) is a valuable pharmacovigilance resource for detecting rare and serious drug reactions.</p><p><strong>Aim: </strong>This study aimed to evaluate the association between a broad range of medications and the risk of drug-induced aplastic anemia using FAERS data obtained through disproportionality analysis, regression modeling, time-to-onset analysis, and predictive modeling.</p><p><strong>Method: </strong>A retrospective pharmacovigilance study was conducted using FAERS reports from January 1, 2004, to December 31, 2024. Aplastic anemia cases were identified using five Preferred Terms from the Medical Dictionary for Regulatory Activities. Signal detection was performed using ROR, PRR, BCPNN, and MGPS. Logistic regression analyses with weighted LASSO variable selection identified the independent risk factors. A predictive model was developed and validated using receiver operating characteristic (ROC) curve analysis. Time-to-onset (TTO) and pharmacological classification were also conducted.</p><p><strong>Results: </strong>A total of 4493 drug-related aplastic anemia cases were identified. Disproportionality analysis revealed 593 significant drugs, of which 16 met stringent inclusion criteria for multivariate analysis. Temozolomide was most frequent (n = 148), followed by methotrexate (n = 126), busulfan (n = 100), and linezolid (n = 90). Other common drugs included ribavirin, nivolumab, pembrolizumab, fludarabine, carboplatin, etoposide, and cyclophosphamide. Male sex was a significant risk factor (OR = 1.63), while older age (> 42 years) and higher weight (> 60 kg) were protective. The predictive model showed good discrimination (AUC = 0.777). Median TTO was 299 days, with most cases occurring within six months. The 16 implicated drugs fell into categories including antineoplastics, antibacterials, antivirals, antiepileptics, and antigout agents.</p><p><strong>Conclusion: </strong>This study identified key drugs and patient factors associated with aplastic anemia, providing a data-driven framework for pharmacovigilance. These findings support early detection and informed clinical and regulatory decision making, but prospective studies are required to confirm causality and refine individualized risk predictions.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185921","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":"Pharmacists' views on potential non-medical prescribing for pharmacists in Sweden: a nationwide survey study.","authors":"Nicole Ljungdahl, Sofia Kälvemark-Sporrong, Albin Tranberg, Thomas Kempen","doi":"10.1007/s11096-025-02006-x","DOIUrl":"https://doi.org/10.1007/s11096-025-02006-x","url":null,"abstract":"<p><strong>Introduction: </strong>The role of pharmacists in healthcare has evolved, and in several countries, they have prescribing rights. Currently, pharmacists in Sweden do not have the right to prescribe. Exploring their views on pharmacist prescribing may be a critical step toward advancing the profession and improving patient care.</p><p><strong>Aim: </strong>To explore pharmacists' views on potential pharmacist prescribing in Sweden.</p><p><strong>Method: </strong>An online questionnaire about pharmacist prescribing was distributed via email to Swedish pharmacists who are members of the Swedish Pharmacists Association (n = 5597). The questionnaire covered demographic information and statements about predefined prescribing models, preconditions, benefits, and risks associated with pharmacist prescribing. Each statement had a 4-point agreement Likert scale response option with additional \"Don´t know/no opinion\" option. Data were collected in May 2024. Closed-ended questions were analyzed descriptively, while open-ended questions were categorized and summarized.</p><p><strong>Results: </strong>Of the 395 respondents (7% response rate), 75.2% (n = 297) agreed with introducing at least one model of pharmacist prescribing. The two models that received the most support were \"Prescribing based on an agreement or collaboration with one or more independent prescribers\" (50.1%; n = 198) and \"Independent, but limited prescribing rights\" (48.1%; n = 190). All predefined preconditions were important for the respondents; their education (97.2%, n = 384) was identified as the most important factor. Overall, respondents agreed more with the benefits than the risks of introducing pharmacist prescribing. Most frequently (somewhat) agreeing that an enhanced professional position of pharmacists in health care was a key benefit (91.1%; n = 369), and the risks that respondents most (somewhat) agreed with included increased workload (80.8%; n = 319) and the conflict of interest involved in pharmacists acting as both prescribers and dispensers (60.8%; n = 240).</p><p><strong>Conclusion: </strong>The majority of respondents supported introducing at least one pharmacist prescribing model in Sweden. These findings provide valuable insights for policymakers considering an expanded role for pharmacists in Sweden, which may include a variety of extended professional roles in different settings.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174872","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":"Implementation fidelity of a pharmacist-led intervention program to improve a high serum phosphate concentration in haemodialysis patients: a mixed-methods study.","authors":"F J van den Oever, E C Vasbinder, Y C Schrama, T van Gelder, P M L A van den Bemt, J G Hugtenburg","doi":"10.1007/s11096-025-01995-z","DOIUrl":"https://doi.org/10.1007/s11096-025-01995-z","url":null,"abstract":"<p><strong>Introduction: </strong>The PIDO-P (Pharmacist Intervention and Dose Optimization of Phosphate-binding medication) was designed to improve high serum phosphate concentration (SPC) in haemodialysis patients with a high pill burden of phosphate-binding medication (PBM). This intervention consisted of three pharmacist-patient consultations, in which barriers to adherence to PBM were addressed and PBM dose was reduced. Although this intervention improved PBM adherence, SPC remained high.</p><p><strong>Aim: </strong>To determine the implementation fidelity (IF) of the PIDO-P intervention.</p><p><strong>Method: </strong>This mixed-methods implementation study had a convergent design using the intervention mixed-methods framework. Data from all patients included in the PIDO-P study (n = 75) were used to assess IF using Carroll's Framework for IF. Six key components were identified [A: identifying barriers, B: assessing medication-related health literacy; C: providing information and advice, D: discussing patient preferences, E: providing a summary/dose reduction advice, F: performing a follow-up consultation]. Two researchers independently rated the extent to which the different aspects of the key intervention components were carried out as planned. Data sources were research administration (quantitative and qualitative), oral surveys from patients (quantitative and qualitative) and pharmacists (quantitative), semi-structured interviews with six patients, two pharmacists, and three prescribers (qualitative), and electronic medical records (quantitative). Data from semi-structured interviews were thematically analysed according to Braun and Clarke with Atlas.ti, quantitative data were analysed using descriptive statistics in SPSS. Where possible, data integration was performed.</p><p><strong>Results: </strong>The adherence to the intervention was moderate to high, except for the screening process. The written summary was delivered to a moderate degree (65.3%). Facilitation strategies were helpful, and pharmacists considered the intervention not too complex. The quality of delivery and participant responsiveness were good. Four IF themes could be identified: (1) patient knowledge and understanding, (2) correct use of PBM, (3) PBM treatment individualisation, (4) relationship between pharmacist and patient. To increase its feasibility, the intervention should be targeted at patients with SPC > 2.0 mmol/L, and patient selection should be improved.</p><p><strong>Conclusion: </strong>The lack of effect of the PIDO-P intervention on SPC cannot be explained by low IF. Targeting patients with higher SPC and improving patient selection may increase its effectiveness.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148684","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 of potentially inappropriate medications with rehospitalisation and death within three months in older patients: a systematic review and meta-analysis.","authors":"Isabella Muzzarelli, Vera Isabel Neumeier, Michael Gagesch, Wiebke Rösler, Andrea Rahel Burch","doi":"10.1007/s11096-025-02013-y","DOIUrl":"https://doi.org/10.1007/s11096-025-02013-y","url":null,"abstract":"<p><strong>Introduction: </strong>Potentially inappropriate medications (PIMs) are medications with an unfavourable risk-benefit profile for patients aged ≥ 65 years. Currently, several screening tools are available and are used in clinical practice to identify PIMs.</p><p><strong>Aim: </strong>Our objective was to systematically synthesize the available evidence on the association between potentially inappropriate medications (PIMs), as identified by various screening tools including STOPP/START and the Beers Criteria, and the outcomes of rehospitalization and mortality within three months in older patients.</p><p><strong>Method: </strong>Adhering to Cochrane standards, we conducted a systematic review and meta-analysis to investigate the outcomes of patients aged 65 years and older, comparing those with at least one PIM identified by any explicit screening tool to those without PIMs. Primary outcomes were readmission and/or death within three months. The databases of Embase, MEDLINE, and CENTRAL were searched for retrospective as well as prospective observational studies published between 1991 and May 17 2024. The risk of bias was assessed for all included studies.</p><p><strong>Results: </strong>In total, 1,642 studies were identified through the systematic search. Nine observational studies were included in this review. Our analysis revealed a statistically significant association between the overall presence of PIMs and rehospitalisation; odds ratio (OR) 1.47 [95% confidence interval (CI) 1.02 to 2.13, p = 0.045]. While stratification according to STOPP/START criteria yielded a statistically significant OR of 1.84 [CI 1.08 to 3.12, p = 0.024; n = 5], no statistically significant difference was seen according to Beers list [OR 1.25, CI 0.86 to 1.81, p = 0.235; n = 5]. Furthermore, no significant association was found between PIMs and mortality in either the overall analysis or the stratification according to the Beers and STOPP/START criteria. The risk of bias in the included studies was moderate to serious, and the certainty of evidence was very low.</p><p><strong>Conclusion: </strong>The use of PIM screening tools during medication evaluations may reduce the risk of rehospitalisation and potentially lower mortality in older patients. However, further studies are warranted to confirm the association with adverse outcomes.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136837","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}