International Journal of Clinical Pharmacy最新文献

{"title":"Development of an interpretable machine learning model to predict short-term bleeding risk in patients receiving dual antithrombotic therapy following cardiac surgery.","authors":"Haolong Han, Jifan Zhang, Xia Wang, Weihong Ge, Jason Z Qu","doi":"10.1007/s11096-025-02016-9","DOIUrl":"https://doi.org/10.1007/s11096-025-02016-9","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding is a serious complication in cardiac surgery, especially among patients receiving combined anticoagulant and antiplatelet therapy. Current prediction models rarely include those undergoing both valve surgery and coronary artery bypass grafting (CABG) or account for postoperative factors and dual antithrombotic therapy, limiting their clinical utility.</p><p><strong>Aim: </strong>This study aimed to develop and validate machine learning models for the individualized prediction of bleeding events within three months after discharge in patients receiving warfarin plus aspirin following combined CABG and valve surgery.</p><p><strong>Method: </strong>Data from 499 adult patients who underwent cardiac surgery and received combined anticoagulant and antiplatelet therapy between June 2019 and December 2023 were retrospectively analyzed. Patients were randomly assigned to training (70%) and internal validation (30%) cohorts. Eleven key bleeding predictors were selected using the least absolute shrinkage and selection operator (LASSO) method. Seven machine learning algorithms, logistic regression, decision tree, random forest (RF), support vector machine, eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM) and k-nearest neighbors, were subsequently trained using these predictors. The model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and Brier score. External validation was performed in a temporally independent cohort of 93 patients. Model interpretability was assessed through Shapley Additive Explanations (SHAP), which were used to visualize both global and individual risk contributions.</p><p><strong>Results: </strong>Eleven clinical variables, including anemia, diabetes, heart failure, atrial fibrillation, age, postoperative drainage, previous bleeding, stroke, body mass index, estimated glomerular filtration rates and intraoperative bleeding, were identified as predictors. Among the models, the RF algorithm demonstrated the best performance (internal validation: AUC = 0.85, accuracy = 0.80, sensitivity = 0.75, specificity = 0.82, PPV = 0.64, NPV = 0.89 and F1-score = 0.69). In the external validation, the RF model maintained strong performance (AUC = 0.82, accuracy = 0.73, sensitivity = 0.76, specificity = 0.72, PPV = 0.44, NPV = 0.92 and F1-score = 0.56). Decision curve analysis confirmed the clinical utility of the model, and SHAP visualizations provided a transparent interpretation of individualized bleeding risks.</p><p><strong>Conclusion: </strong>This study demonstrates the feasibility and clinical utility of ML-based prediction of short-term bleeding risk in cardiac surgery patients on dual antithrombotic therapy. The RF model enables individualized risk assessment, with SHAP interpretation supporting clinical ","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130693","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":"Climate conscious pharmacy practice: a qualitative interview study with pharmacists in the context of respiratory health care.","authors":"Rabia Cameron, Yasir Alhazmi, Philip Chi Lip Kwok, Bandana Saini","doi":"10.1007/s11096-025-02005-y","DOIUrl":"https://doi.org/10.1007/s11096-025-02005-y","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change negatively impacts millions of people with respiratory conditions. On the other hand, respiratory health care negatively impacts climate change given that mainstay inhaler treatment poses its own environmental risk. Pharmacists are frequently involved in managing chronic respiratory conditions including counselling on inhaler use, thus they are well-positioned to reduce associated environmental impacts, however this role is unexplored.</p><p><strong>Aim: </strong>This study aimed to investigate Australian pharmacists' perceptions on the impact of climate change on respiratory health and the impact of respiratory health care provision or treatment use on the environment. We also aimed to explore pharmacists' views about their potential roles in promoting sustainable respiratory health care.</p><p><strong>Method: </strong>Following approval from an institutional ethics review committee, qualitative semi-structured interviews were conducted with consenting pharmacists who had at least one year of post-registration experience and were currently working in any clinical setting. The interviews explored pharmacists' general perspectives on climate change before delving specifically into respiratory health care. Interviews were recorded, transcribed verbatim and subjected to an inductive thematic analysis within a constructivist paradigm.</p><p><strong>Results: </strong>Thirty-two participants (72% female, 28% male) were interviewed. Three key themes were derived from the analysis: (1) environment considerations as an afterthought, (2) linking environment to respiratory care, and (3) working towards sustainable practice. Patient health was expressed as the main concern in clinical practice, with environmental considerations reported as lower priority. Most participants saw their role as being the management of patients 'respiratory symptom control'. Barriers to climate action described by participants included prescriber and patient acceptance of recommendations and concerns about counselling patients on switching to low carbon footprint inhalers being beyond their current scope of practice. Participants recommended multi-stakeholder collaboration and inclusion of this topic in pharmacy curricula as key factors to address to build sustainable respiratory health care provision.</p><p><strong>Conclusion: </strong>Pharmacists' main focus in respiratory health care provision is on clinical rather than environmental change issues. Many barriers such as concerns about patients' acceptance of sustainability related advice or counselling, and limited training on the topic were cited. Further research should explore best ways to address these issues, preferably in co-design practices with stakeholders.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124756","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":"Economic evaluation of hepatitis B screening in low- and middle-income countries: a systematic review.","authors":"Ha Thi Nguyen, Phuong Thi Lan Nguyen, Trinh Viet Ngo, Anh Hoang Chau Dang, Huyen Thanh Nguyen","doi":"10.1007/s11096-025-02003-0","DOIUrl":"https://doi.org/10.1007/s11096-025-02003-0","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis B virus (HBV) causes significant morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with intermediate to high endemicity. Screening interventions are essential for reducing infection rates.</p><p><strong>Aim: </strong>To synthesize economic evaluation evidence of hepatitis B (HBV) screening strategies in LMICs.</p><p><strong>Method: </strong>A comprehensive search of PubMed, Embase, and Scopus was conducted up to August 08, 2024. All types of economic evaluations comparing HBV screening strategies in LMICs were included. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 and the Consensus Health Economic Criteria (CHEC) extended checklists. The protocol was registered in PROSPERO (CRD42023472855).</p><p><strong>Results: </strong>Twenty-four studies were included, with 11 focusing on pregnant women, 7 on adults, and others on children or infants. Most studies were from Asia, primarily China, using model-based analyses and a provider cost perspective. Regarding antenatal screening, adding tenofovir prophylaxis for HBsAg-positive pregnant women was more cost-effective than intervention solely targeting infants. In adults, a combination of screening and treating eligible cases or immunizing non-infected individuals was more cost-effective than no screening, particularly among young adults aged 21 to 39. Notably, expanding HBV screening to the general population was more cost-effective than limiting screening to high-risk groups. In children, screening plus re-vaccination of infants or 10-year-olds born to HBV-infected mothers was cost-effective compared to no re-vaccination.</p><p><strong>Conclusion: </strong>Overall, more comprehensive interventions were generally cost-effective across all populations. The most cost-effective strategies included tenofovir prophylaxis for HBV-infected pregnant women, screening with treatment and/or vaccination in adults, and screening combined with re-vaccination in children.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113136","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":"Tele-triaging: a qualitative study exploring pharmacists' clinical decision-making in a Poisons Information Centre using interviews and a clinical vignette.","authors":"Qi Xuan Koh, Sarah Wise, Deborah Debono, Darren M Roberts, Jane E Carland","doi":"10.1007/s11096-025-02000-3","DOIUrl":"https://doi.org/10.1007/s11096-025-02000-3","url":null,"abstract":"<p><strong>Introduction: </strong>Specialists in Poisons Information (SPIs), most of whom are pharmacists, work in Australian Poisons Information Centres (PICs) and provide telephone-based triage (tele-triage) and management advice for poison exposures. Australian PICs answer calls from the public and healthcare practitioners and are considered an emergency telephone service. While tele-triaging and clinical decision-making have been explored in other health professions, limited studies are available exploring how pharmacists apply their knowledge to make clinical decisions in a busy tele-triage emergency setting.</p><p><strong>Aim: </strong>To explore how SPIs apply clinical judgement in tele-triage and to understand the factors that shape their decision-making.</p><p><strong>Method: </strong>This study represents the second, qualitative phase of an exploratory sequential mixed-methods design examining calls related to unintentional poisoning exposures in older adults (≥ 75 years) to the New South Wales PIC. Semi-structured interviews with 12 SPIs were conducted, supported by clinical vignettes and analysed using an inductive approach. Thematic analysis was combined with process mapping to describe the decision-making process.</p><p><strong>Results: </strong>SPIs followed a flexible, three-phase process of information gathering, risk stratification, and management decision-making. This process was iterative, shaped by experience, clinical knowledge, and the urgency of the call. Decision-making relied on the ability to balance known and uncertain risks, interpret caller information, and assess social and clinical context. While structured guidelines supported consistency, SPIs emphasised the importance of clinical autonomy, particularly in complex cases. A strong collegial culture and peer learning were central to developing decision-making skills. Time pressure and documentation requirements created tensions, highlighting the need to align workflows with clinical priorities.</p><p><strong>Conclusion: </strong>SPI decision-making is a dynamic, context-dependent process that combines clinical expertise, guideline use, and real-time judgement. Findings have implications for SPI training, documentation systems, and the design of telehealth services involving complex risk assessment.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091660","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":"Optimising end-of-life geriatric pharmacotherapy: a hospital-based retrospective cohort study of deprescribing early in the care trajectory before hospice transition.","authors":"Tahani Alwidyan, Carole Parsons, Abdelrahim Alqudah, Abdel-Ellah Al-Shudifat, Abdel-Rahman N Al-Lozi, Muna Riziq Khader","doi":"10.1007/s11096-025-02001-2","DOIUrl":"https://doi.org/10.1007/s11096-025-02001-2","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy and potentially inappropriate medications (PIMs) are common among terminally ill older people and often persist until death, undermining comfort-focused care. While deprescribing is an effective strategy to optimise medicines use at the end of life, its timing is crucial. Delaying deprescribing until after hospice admission may diminish opportunities for comprehensive medication review during hospital-based care, when a full multidisciplinary team (MDT) and complete clinical records are available. Timely deprescribing during the final days of hospital-based care before hospice transition may better align pharmacotherapy with end-of-life goals and facilitate transition.</p><p><strong>Aim: </strong>This study aimed to evaluate the impact of an MDT-led intervention delivered during the final days of hospital-based care before hospice transition on medication burden, PIM use, and symptom control prescribing.</p><p><strong>Method: </strong>This retrospective cohort study was conducted at a Jordanian tertiary hospital. Patients aged ≥ 65 years with life-limiting illnesses who were transitioned to hospice care between January and December 2022 were included. Medication data were extracted at baseline (seven days before MDT review) and post-intervention (in the final 24 h of hospital-based care). Deprescribing was categorised as proactive (planned discontinuation to prevent future harm) or reactive (triggered by an immediate clinical issue). Medication appropriateness was assessed using STOPPFrail version 2. Regimen complexity was evaluated using the Medication Regimen Complexity Index (MRCI).</p><p><strong>Results: </strong>Among 165 patients, polypharmacy (use of ≥ five medications) prevalence declined from 63.0% to 14.5% (P < 0.001), and the proportion receiving ≥ one PIM decreased from 91.6% to 34.0% (P < 0.001). The mean number of chronic medications declined by 4.5 (± 3.2), and MRCI scores decreased by 4.8 points (P < 0.001). Of 736 medications discontinued, 65.9% were proactively deprescribed. Use of symptom control medications, particularly opioids, increased significantly (from 5 to 64 prescriptions; P < 0.001). Regression analysis identified baseline polypharmacy, high MRCI, and dyslipidaemia as predictors of greater PIM reduction.</p><p><strong>Conclusion: </strong>MDT-led deprescribing, implemented during the final days of hospital-based care before hospice transition, was associated with reduced medication burden and PIM use, alongside increased symptom-focused prescribing. These findings support the integration of structured, proactive deprescribing into hospital-based care to improve medication safety, enhance patient comfort, and facilitate continuity across care settings.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040040","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":"Experiences and challenges of implementing clinical medication reviews in daily practice: a mixed-methods study.","authors":"Sek Hung Chau, Petra J M Elders, Jacintha Domić, H J Marjorie G Nelissen-Vrancken, François G Schellevis, Jacqueline G Hugtenburg","doi":"10.1007/s11096-025-01992-2","DOIUrl":"https://doi.org/10.1007/s11096-025-01992-2","url":null,"abstract":"<p><strong>Introduction: </strong>Organisational problems still prevent widespread implementation of clinical medication reviews. The Opti-Med2 method was developed to facilitate the process of performing clinical medication reviews. The method includes patient involvement by means of a questionnaire and expert teams of community pharmacists and general practitioners (GPs) to perform pharmacotherapeutic analyses, providing the patients' own GP with pharmacotherapeutic advice. There is a supporting role of community pharmacy technicians and general practice nurses/assistants in the process.</p><p><strong>Aim: </strong>To gain insight into the implementation of the Opti-Med2 method within the framework of pharmacotherapeutic audit meeting groups in the Netherlands.</p><p><strong>Method: </strong>A mixed-methods implementation study in seven groups of primary care healthcare providers. Quantitative data were collected using study forms. Semi-structured interviews with 8 GPs, 5 community pharmacists and 2 community pharmacy technicians were held. Interviews were transcribed verbatim and were analysed using the extended Normalization Process Theory.</p><p><strong>Results: </strong>Only one group provided sufficient quantitative data for analysis. Of the pharmacotherapeutic advice given by the expert team, 72% was adopted by the GPs of which 85% resulted in an intervention with the patient. In general, the healthcare providers were satisfied with using the Opti-Med2 method. The use of expert teams was appreciated by most GPs and community pharmacists. All healthcare providers were very satisfied with the use of the patient questionnaire.</p><p><strong>Conclusion: </strong>Although full implementation of Opti-Med2 method as a whole was not achieved, the structured organisation of conducting CMRs and the use of questionnaires was deemed successful.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023262","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":"Evaluating the quality, feasibility and patient satisfaction of medication history taking by telephone for patients with scheduled admissions: a pilot study.","authors":"Theresa Terstegen, Janina A Bittmann, Luise Kauk, Marietta Kirchner, Sebastian Krug, Annika Gauss, Ute Chiriac, Benedict Morath, Walter E Haefeli, Hanna M Seidling","doi":"10.1007/s11096-025-02002-1","DOIUrl":"https://doi.org/10.1007/s11096-025-02002-1","url":null,"abstract":"<p><strong>Introduction: </strong>Medication history taking at hospital admission is still prone to errors. Despite numerous quality improvement initiatives, new strategies to improve medication history taking are still sought and evaluated. Unfortunately, the gold standard research methodology for evaluation is resource-intensive, as it requires each patient to complete two medication history interviews. Therefore, a new study design and quality parameter were developed.</p><p><strong>Aim: </strong>We aimed to pilot our newly developed study design and quality parameter in a study on medication history taking by telephone.</p><p><strong>Method: </strong>In this prospective interventional study, patients with scheduled admissions had their medication histories taken either by telephone before admission (intervention) by a pharmacist or in-person by physicians or medical interns upon admission (control). Following the newly developed design, we compared a patients' new medication histories to the respective pre-visit medication lists available in the medical records to calculate the new endpoint: the difference in the number of updates per patient. Further, we surveyed patients and staff on their satisfaction.</p><p><strong>Results: </strong>We enrolled 76 intervention and 75 control patients. In the intervention group, a mean of 4.93 (± 4.45, 0-18) updates were found vs. 3.40 (± 3.75, 0-21) in the control group. Accordingly, the incident rate of number of updates per patient was 1.34 times higher in the intervention group (p = 0.044). The distribution of the types of updates was similar with the most common type of update being newly initiated medicines in both groups. Medication history taking by telephone took 15.7 ± 9.8 min (mean ± SD), including preparation, interview, and documentation. Survey results showed that intervention patients felt positive about the telephone interviews. Both groups were open to other digital approaches, e.g., online platforms.</p><p><strong>Conclusion: </strong>The new study design proved feasible to evaluate medication history taking by telephone with comprehensible results. The telephone approach delivered more updates compared to standard care, however, the proposed endpoint needs to be validated against the gold standard before widespread application Patient acceptance for this and other digital approaches was high in both groups.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023239","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 pharmacy clinical service redesign on quantity and quality of pharmacy interventions in a tertiary teaching hospital: a pre-post cohort study.","authors":"Adriana J Chubaty, Carly Wills, Kingston Yeung, Harsheen K Saran, Aagam S Bordia, Gabrielle Widjaja, Jonathan Penm","doi":"10.1007/s11096-025-01967-3","DOIUrl":"https://doi.org/10.1007/s11096-025-01967-3","url":null,"abstract":"<p><strong>Background: </strong>Pharmacists are integral to the multidisciplinary team; however, staffing and resource challenges limit pharmacists' impact. Aligning pharmacists by admission specialty teams, rather than traditional ward-based models, may address these challenges.</p><p><strong>Aim: </strong>This study aimed to evaluate whether a pharmacy redesign, which included aligning pharmacists to a specialty-based model from a ward-based model, increased the number and quality of interventions made per full-time equivalent pharmacist in hospitalised patients.</p><p><strong>Method: </strong>The pre-post observational cohort study was conducted at a 550-bed tertiary teaching hospital. The redesign of the clinical pharmacy service was conceived and implemented using redesign methodology. Implemented solutions involved alignment of pharmacists to a specialty team-based model, multidisciplinary teamwork, pharmacist clinical specialisation, an emphasis on clinical documentation, and prioritisation of patients requiring medication review. Pharmacist interventions documented pre- and post-clinical redesign were compared. Two independent reviewers classified the intervention type and determined the impact and significance.</p><p><strong>Results: </strong>In total, 226 patients were included in the pre-cohort and 468 post. Age (mean 70 vs 69, p-value = 0.404) and other demographics were similar between the cohorts. Pharmacist interventions increased after the clinical pharmacy redesign (n = 310 vs n = 1,106). After the implementation of the clinical pharmacy redesign, there was a significant increase in the median number of clinical interventions per Full-time Equivalent pharmacist (13.5 [0-64] vs 81.5 [3-166], p = 0.004). The redesign showed a positive impact and increase in all interventions.</p><p><strong>Conclusion: </strong>The redesign of pharmacy services increased pharmacist impact without increasing resource requirements or using screening tools, resulting in improved prioritisation of patients, identifying drug-related problems and increased interventions.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000497","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 provincial survey of patient experiences while receiving care from pharmacists in team-based primary care in British Columbia, Canada.","authors":"Peter J Zed, Anita I Kapanen, Arwa Nemir, Peter S Loewen, Anupama Salil","doi":"10.1007/s11096-025-01999-9","DOIUrl":"https://doi.org/10.1007/s11096-025-01999-9","url":null,"abstract":"<p><strong>Introduction: </strong>The Pharmacists in PCN Program integrated primary care clinical pharmacists as a core members of the interprofessional team in Primary Care Networks (PCNs) across British Columbia (BC), Canada. Patient experiences after receiving care from pharmacists in a team-based primary care setting have not been extensively studied.</p><p><strong>Aim: </strong>To describe patient experiences while receiving care from a pharmacist as a member of the interprofessional team in PCNs across BC.</p><p><strong>Method: </strong>A survey was conducted over a 66-week period between May 30, 2022 and September 1, 2023, and was administered online through Qualtrics®. A questionnaire was distributed to 2714 patients who completed their initial patient appointment with a pharmacist and had a valid e-mail in their health record.</p><p><strong>Results: </strong>We analyzed responses from 787 questionnaires (29.0% response) representing all 23 PCN communities (42 PCNs) active during the survey period. The mean (SD) age of respondents was 65.3 (14.7) years, 60.5% were female and 81.5% identified as White. Patients reported a high overall satisfaction (strongly agree/agree) with their experience of care provided by their pharmacist. Patients felt listened to during their appointment (93.2%, 703/754), that conditions, medications and their treatments were explained in a manner that was easy to understand (92.4%, 697/754), and that they were given an opportunity to ask questions (92.4%, 697/754). Pharmacists were highly acknowledged for showing sensitivity to patient values, needs and preferences (88.7%, 669/754), and that patients were treated with dignity and respect (94.6%, 713/754). Patients reported improved understanding of their medications and their health as well as increased confidence and motivation regarding their health and medication. Nearly all patients (95.3%, 714/749) wanted to see the same pharmacist again and 94.9% (711/749) would recommend their pharmacist to a friend/family member. Patients felt engaged with the decision-making process around their medications, and valued the process pharmacists used when helping them make decisions.</p><p><strong>Conclusion: </strong>Patients reported an overall high degree of satisfaction with their experiences of care provided by pharmacists in a team-based primary care model in BC. Patients reported improved understanding and confidence of the medications and their health and reported positive experiences with the shared decision-making process.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000541","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-led anticoagulation model based on early active consultation optimizes perioperative venous thromboembolism management in orthopedic surgery: a retrospective cohort study.","authors":"Yalan Wang, Qian Du, Songqing Liu, Jun Xiao, Xuejiao Tang, Jun Feng, Dongxuan Li, Jun Zhu, Jinghui Gou, Rui Zhang, Fan Wu, Jie Dong","doi":"10.1007/s11096-025-01997-x","DOIUrl":"10.1007/s11096-025-01997-x","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) is a common and preventable complication in orthopedic surgery, yet adherence to prophylaxis guidelines remains suboptimal. A pharmacist-led anticoagulation care model based on the Pharmacist Early Active Consultation (PEAC) framework may enhance the quality and safety of VTE prevention in surgical patients.</p><p><strong>Aim: </strong>This study aimed to evaluate the impact of a pharmacist-led Venous Thromboembolism Clinical Pharmaceutical Care (VTE-CPC) model, derived from the PEAC framework, on VTE prevention and anticoagulation quality in orthopedic surgery patients.</p><p><strong>Method: </strong>A retrospective cohort study was conducted at a tertiary hospital in China. Patients admitted between December 2023 and May 2024 received routine care (no VTE-CPC group), while those admitted between June and November 2024 received additional pharmacist-led interventions (VTE-CPC group). Multivariate logistic regression was used to identify independent risk factors for VTE. Propensity score matching (PSM) was performed to control baseline differences, resulting in a balanced cohort of 812 patients. Outcomes included VTE incidence, pharmacological prophylaxis practices, and safety endpoints.</p><p><strong>Results: </strong>A total of 959 patients were included (no VTE-CPC: n = 531; VTE-CPC: n = 428). The incidence of VTE was significantly lower in the VTE-CPC group (3.74%) compared to the no VTE-CPC group (7.53%, p = 0.020). VTE-CPC remained an independent protective factor in multivariate analysis (OR = 0.45; 95% CI 0.23-0.84; p = 0.015). In the PSM matched cohort, patients in the VTE-CPC group had higher rates of postoperative pharmacological prophylaxis (22.66% vs. 16.26%, p = 0.027) and improved dosage appropriateness across all perioperative phases (p < 0.05). No significant differences were observed between groups in rates of bleeding events, thrombocytopenia, or hepatic/renal dysfunction.</p><p><strong>Conclusion: </strong>A pharmacist-led anticoagulation management model based on the PEAC framework significantly reduced perioperative VTE incidence without increasing adverse events. These findings support broader implementation of proactive, pharmacist-driven strategies to improve thromboprophylaxis quality in orthopedic surgery.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953114","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}