Journal of Pharmaceutical Policy and Practice最新文献

{"title":"Systemic evaluation and optimisation strategies for the synergy of high-value medical consumables policies in China.","authors":"Huitong Yang, Shuzhen Chu","doi":"10.1080/20523211.2026.2673696","DOIUrl":"10.1080/20523211.2026.2673696","url":null,"abstract":"<p><strong>Background: </strong>The excessively high prices of High-Value Medical Consumables (HVMCs) and the substantial financial burden on patients are core issues in China's healthcare reform. Although the Volume-Based Procurement (VBP) policies have significantly reduced prices, insufficient policy coordination has led to frequent implementation deviations, constraining the effectiveness of reforms.</p><p><strong>Methods: </strong>Guided by a three-dimensional framework encompassing policy intensity, measures, and objectives, this study employed an integrated analytical process. Text mining facilitated initial thematic identification, which was then iteratively refined and validated through the Delphi method to establish quantifiable indicators within the framework. These indicators were analysed using a synergy degree model to evaluate policy alignment. 21 national-level policies from 2004 to 2024 are analysed.</p><p><strong>Results: </strong>Based on the constructed synergy indices, policy development underwent three stages: 'initial exploration, gradual development, and stable optimization'. As indicated by the model, the synergy degree showed an evolutionary trend, moving from early dispersion, to mid-term leap, and later differentiation. According to the indices, planning guidance and administrative measures showed relatively high synergy over the long term but appeared to squeeze the synergy space for other measures. The results also indicated that imbalances existed among policy objectives, with contradictions between cost control and innovation goals, and insufficient adaptation between medical insurance payment and industry development. Based on these model-based findings, optimisation strategies such as classified coordination mechanisms, dynamic weight adjustment, and closed-loop feedback for quality and supply are proposed.</p><p><strong>Conclusion: </strong>Theoretically, this study is the first to systematically quantify the degree of synergy of high-value medical consumables policies by developing a framework-based coordination analysis model using constructed indices. Practically, it provides a scientific basis for optimising policy combinations, balancing short-term cost control with long-term industrial innovation, and improving medical insurance support mechanisms.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2673696"},"PeriodicalIF":2.6,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of pricing, availability, and affordability of essential medicines in a resource-limited setting.","authors":"Faiza Inayat, Nasir Mahmood, Bashir Ahmad, Muhammad Sheeraz Ahmad","doi":"10.1080/20523211.2026.2701916","DOIUrl":"10.1080/20523211.2026.2701916","url":null,"abstract":"<p><strong>Background: </strong>Access to essential medicine is a worldwide issue, driven by high prices, low affordability and limited availability. Under funded health systems, weak local production, poor supply chain governance, and discriminatory policies are the main hurdles. Low and middle-income countries are continuously making efforts to improve healthcare services. To evaluate the extent to which the intended objectives have been met, the present study undertakes an investigation into the pricing, availability, and affordability of selected essential medicines in Pakistan.</p><p><strong>Methods: </strong>A survey of 50 essential medicines, including 14 from the global core list and 36 selected from the national essential medicine list, was carried out from November 2025 to February 2026, using an adaptation of WHO/HAI methodology in five geographical areas of Pakistan. Data were acquired from 9 pharmacies of government hospitals and 18 retail pharmacies of the private sector. Prices were evaluated on the basis of the Median Price Ratio (MPR); affordability was determined by estimating how many days a minimum salaried employee of the government must spend to buy the prescribed regimen.</p><p><strong>Results: </strong>In the public sector mean availability was 12.65% (IB), 36.2% (LPG) and in private sector it was 45.7% (IB) and 55.2% (LPG). In private retail pharmacies, 13.61% were stocked with oncology medicines. Median price ratios in the private sector varied between 0.11-6.85 for LPG and 0.17-23.37 for IB. Median price ratio of 12 medicines (out of 36 calculated for MPR) was approximately similar between LPG and IB. However, prices for cardiovascular and antidiabetic medicines increased.</p><p><strong>Conclusion: </strong>Availability of LPGs has improved in the private sector. Median price ratios have decreased over time, but medicines are still unaffordable, especially for diabetes, viral, fungal and bacterial infectious diseases.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2701916"},"PeriodicalIF":2.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring pharmaceutical waste management in Southern Africa: a scoping review.","authors":"Tessa Moleman, Aukje K Mantel-Teeuwisse, Raffaella Ravinetto, Fatima Suleman, Jennie Lates, Saleh Aljadeeah","doi":"10.1080/20523211.2026.2700215","DOIUrl":"10.1080/20523211.2026.2700215","url":null,"abstract":"<p><p>Pharmaceutical waste management is an emerging health and environmental concern, particularly in low- and middle-income countries with limited waste infrastructure. This scoping review examined pharmaceutical waste practices and policies in Botswana, Eswatini, Lesotho, Namibia and South Africa at the healthcare facility and household levels. We systematically searched databases and grey literature sources from 2004 to 2024. Out of 729 research studies and 129 reports identified, we included 28 publications. The results were synthesised to show segregation, treatment and disposal practices. Regulatory frameworks existed in most countries, but often lacked detailed guidance and effective enforcement. Definitions of pharmaceutical waste varied, and documentation practices were inconsistent. Inappropriate practices of pharmaceutical waste management, such as inadequate incineration and landfilling conditions, were frequently reported. These findings are concerning and indicate a need for clearer, context-appropriate policies, stronger implementation mechanisms, improved segregation systems and further research, particularly at the household level.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2700215"},"PeriodicalIF":2.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy inventory management practices and constraints in Asia-Pacific hospitals: a systematic review and qualitative synthesis.","authors":"Wuan Shuen Yap, Wing Loong Cheong, Li Ling Yeap","doi":"10.1080/20523211.2026.2701922","DOIUrl":"10.1080/20523211.2026.2701922","url":null,"abstract":"<p><strong>Background: </strong>Persistent medicine shortages across the Asia-Pacific region suggest variability in hospital inventory management capacity. Despite available guidelines, variations exist across hospitals in adopting recommended inventory management practices. Thus, this study aimed to identify existing inventory management methods, evaluate related challenges, and highlight recommendations for improvement.</p><p><strong>Methods: </strong>Searches were performed to identify relevant sources from 39 countries on CINAHL, Cochrane, Embase, PubMed, Scopus, Business Source Complete, and Emerald Insight. Non-indexed literature was retrieved through Google Scholar and general Google searches. Backward and forward citation searching was conducted. Data were extracted based on an initial framework comprising three components: planning and procurement, storage and stock management, and staff management. The framework was later expanded through inductive coding to include 12 subcomponents. Findings were narratively synthesised to describe inventory management methods and their impact on medicine supply. Methodological quality of the included empirical publications was assessed using the Mixed Methods Appraisal Tool (MMAT).</p><p><strong>Results: </strong>Seventy-two publications from 20 countries were included. Practices varied between hospitals even within the same country. Hospitals shared common inventory management challenges that weakened medicine supply systems. A conceptual framework was developed to outline three key themes: systemic constraints, infrastructural limitations, and staff skill gaps. Overcoming systemic constraints requires streamlining expenditure and enhancing central distribution systems. Implementing multi-supplier contracts may be effective at stabilising supply. Infrastructural improvements in storage space and inventory tracking systems may bolster medicine availability. Addressing staff skill gaps requires significant investment in training programmes to strengthen adherence to effective inventory management methods.</p><p><strong>Conclusion: </strong>This study mapped key determinants of medicine availability in hospitals, providing guidance on priority areas for intervention to policymakers, hospital leadership, and inventory personnel. Securing medicine supplies in hospitals requires practical inventory management guidelines that account for systemic constraints and infrastructural limitations while empowering staff to optimise pharmacy inventory management practices.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2701922"},"PeriodicalIF":2.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13417656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-utility and budget impact analysis of herpes zoster vaccines in Thai patients with end-stage renal disease.","authors":"Nattanichcha Kulthanachairojana, Pattheera Phothong, Pitch Promkladphanao, Chollakarn Singharerg, Jatapat Hemapanpairoa","doi":"10.1080/20523211.2026.2701918","DOIUrl":"10.1080/20523211.2026.2701918","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage renal disease (ESRD) are increased risk of herpes zoster (HZ). The economic value of HZ vaccines in Thai patients with ESRD has not been assessed. This study evaluated the cost-utility and budget impact of two HZ vaccination strategies - zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV) - compared with no vaccination in Thailand.</p><p><strong>Methods: </strong>A Markov model was developed to estimate lifetime health and economic outcomes in patients with ESRD. Cost-utility analysis was conducted from a societal perspective, while budget impact analysis was performed from a payer perspective over a 5-year time horizon. Model inputs were derived from published literature and Thai data sources. Uncertainty was assessed using deterministic, probabilistic, and scenario sensitivity analyses.</p><p><strong>Results: </strong>In the base-case analysis, both ZVL and RZV were cost-effective compared with no vaccination, with incremental cost-effectiveness ratios (ICER) of USD 1,599.14 (THB 51,912.56) and USD 2,920.09 (THB 94,794.30) per quality-adjusted life year (QALY) gained, respectively - both below Thailand's willingness-to-pay threshold. RZV generated greater health benefits but was associated with higher costs. Sensitivity analyses confirmed the robustness of cost-effectiveness results across key assumptions. Over a 5-year period, the estimated budget impact ranged from USD 4.99-9.55 million (THB 161.86-310.02 million) for ZVL and USD 28.92-55.42 million (THB 938.95-1,799.09 million) for RZV, depending on vaccine uptake assumptions, with expenditures largely concentrated in the first year due to vaccination of prevalent patients.</p><p><strong>Conclusion: </strong>Both HZ vaccines are cost-effective options for preventing HZ in Thai patients with ESRD. While RZV provides greater health gains, it requires substantially higher budgetary investment. These findings support prioritising HZ vaccination for patients with ESRD and initiating pilot implementation within dialysis care settings to assess system-level impact and feasibility.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2701918"},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practices and attitudes of Thai community pharmacists in managing diabetic peripheral neuropathy using neurotropic B vitamins.","authors":"Kitiyot Yotsombut, Thanompong Sathienluckana, Sirinoot Palapinyo, Naeti Suksomboon","doi":"10.1080/20523211.2026.2701910","DOIUrl":"10.1080/20523211.2026.2701910","url":null,"abstract":"<p><strong>Background: </strong>Diabetic peripheral neuropathy (DPN) affects approximately half of individuals with diabetes. Community pharmacists play a pivotal role in the early management of DPN. This exploratory study examined community pharmacist practices in DPN assessment and management, with particular focus on attitudes toward and factors influencing neurotropic B vitamin recommendations.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among a convenience sample of community pharmacists in Bangkok, Thailand. The questionnaire focused on pharmacists' attitudes and practices in managing patients presenting with negative symptoms, positive symptoms, or diagnosed DPN.</p><p><strong>Results: </strong>Ninety community pharmacists participated in this study. Most patients presented with mild symptoms. Symptom severity was primarily assessed based on patient history and pain scales. Among patients presenting with negative symptoms and overt DPN, the most frequently recommended medication was a combined neurotropic B vitamin (48.11% and 44.73%, respectively). The factor associated with likelihood of recommending combined neurotropic B vitamins was reasonable product price, while guideline recommendation, package labelling, and brand reputation showed inverse association with recommendation behaviour.</p><p><strong>Conclusion: </strong>Community pharmacists frequently recommend neurotropic B vitamins for early-stage and painless DPN - presentations not addressed in current clinical guidelines. The inverse associations between guideline endorsement and recommendation behaviour likely reflect these guideline gaps rather than inappropriate practice. Pharmacy-specific clinical guidelines and clearer product labelling addressing both painful and painless DPN are needed. Given the exploratory design and convenience sampling from Bangkok, findings should be interpreted as hypothesis-generating.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2701910"},"PeriodicalIF":2.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australian pharmacist immunisers in vaccine conversations with patients: a qualitative study to explore communication support needs.","authors":"K T Bolsewicz, M S Steffens, L S Cox, E Hazelwood, J Andreatta, Y Bae, M Bushell","doi":"10.1080/20523211.2026.2694236","DOIUrl":"10.1080/20523211.2026.2694236","url":null,"abstract":"<p><strong>Background: </strong>Since the COVID-19 pandemic, uptake of childhood and adolescent vaccines recommended under the National Immunisation Program (NIP) in Australia has declined, while adult NIP vaccine uptake remains stable but suboptimal. Over the past 10 years, pharmacists have taken on a larger role in NIP vaccination, yet their communication and information needs are not well understood. Supportive vaccine conversations are key to improving uptake, but can be difficult, especially with hesitant patients. This study explored Australian pharmacist immunisers' experiences and support needs around vaccine conversations with patients, aiming to inform evidence-based communication resources.</p><p><strong>Methods: </strong>Qualitative interviews from 12 community, 7 aged care and 3 general practice pharmacist immunisers from across metropolitan, regional and rural Australia were analysed thematically. Most participants reported vaccinating adults and older adults.</p><p><strong>Results: </strong>Key themes include: 1. The usual practice; 2. What works well; 3. The gaps and challenges; 4. Addressing the gaps: perspectives and recommendations from pharmacist immunisers. We found that pharmacists - especially in regional areas - are known to the community, offer valued advice and accessible vaccinations. While many reported using effective vaccine communication, they identified a need for further clinical guidance, scenario-based training and tools to address misinformation and emotional concerns. Other needs included tailored support for aged care, accessible vaccine resources for older adults, culturally and linguistically diverse communities, and those with limited literacy and peer forums for rural and sole pharmacists.</p><p><strong>Conclusion: </strong>The study offers insights into practices and information and communication support needs of Australian pharmacist immunisers, especially in underexplored areas like aged care and sole pharmacist rural practice. It highlights the need to better disseminate existing communication supports and develop new ones. Further research should explore sector-specific and systemic challenges, and communication needs with younger populations and their carers.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2694236"},"PeriodicalIF":2.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A point prevalence survey on antibiotic dispensing practices identifies targets for quality improvement of antimicrobial stewardship in community pharmacies in Dar es Salaam, Tanzania.","authors":"Mary Migiro, Mtebe Majigo, Agricola Joachim, Doreen Kamori, Salim Masoud, Upendo Kibwana, Bjørn Blomberg, Joel Manyahi","doi":"10.1080/20523211.2026.2691452","DOIUrl":"10.1080/20523211.2026.2691452","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate antibiotic use is a major driver of antimicrobial resistance (AMR), especially in low- and middle-income countries (LMICs), where over-the-counter antibiotics are readily available without a prescription. This study assessed antibiotic dispensing practices in community pharmacies in Dar es Salaam, Tanzania.</p><p><strong>Methodology: </strong>From February to March 2025, a point prevalence survey was conducted in 100 community pharmacies in Dar es Salaam. Researchers approached existing customers, obtained consent, and conducted confidential interviews. Five participants were enrolled per pharmacy, for a total of 500 participants.</p><p><strong>Results: </strong>Overall, 64% (320/500) of community pharmacy attendees were dispensed antibiotics, of whom 71% (227/320) received them without a prescription. Access-group antibiotics were most frequently dispensed (56%, 201/356), followed by Watch (32%, 115/356) and Reserve groups (3%, 10/356), with metronidazole (15%, 53/356) and azithromycin (12%, 44/356) being the most commonly dispensed antibiotics. Urinary tract infection (UTI) was the leading indication (37%, 119/320), mainly treated with azithromycin (25%, 35/138), ciprofloxacin (12%, 16/138), and nitrofurantoin (7%, 9/138). Among antibiotic recipients, 44% (140/320) received antibiotics based on dispensers' recommendations. Ceftriaxone was commonly dispensed with prescriptions, while all Reserve antibiotics were dispensed without prescriptions. Participants with technical/vocational education (adjusted prevalence ratio [aPR], 1.38, 95% CI: 1.13-1.68, <i>p</i> = 0.001) were more likely to be dispensed antibiotics than those with no formal education or primary and secondary education, and a borderline association was found for college/university education (aPR, 1.22, 95% CI: 0.99 - 1.48, p = 0.05). The presence of an underlying medical condition was an independent protective factor against antibiotic dispensing (aPR, 0.70; 95% CI: 0.49-0.88; <i>p</i> = 0.005).</p><p><strong>Conclusion: </strong>Most clients attending community pharmacies in Dar es Salaam receive antibiotics without prescriptions, often based on dispensers' recommendations. The widespread use of Watch and Reserve antibiotics without oversight highlights major regulatory gaps and the urgent need for stronger policy enforcement and antimicrobial stewardship.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2691452"},"PeriodicalIF":2.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on systemic anti-cancer therapy in patients with breast cancer: a systematic review and meta-analysis.","authors":"Dana Karasneh, Mohammed Patel, Syed Shahzad Hasan, Barbara R Conway, Ahmed A Sadeq, Mamoon A Aldeyab","doi":"10.1080/20523211.2026.2684148","DOIUrl":"10.1080/20523211.2026.2684148","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic caused significant disruptions in oncology services worldwide. Breast cancer care depends on timely and coordinated treatment pathways. This review assessed changes in systemic anti-cancer therapy, including chemotherapy, endocrine therapy, targeted therapy, and immunotherapy. Secondary outcomes included treatment delays, short-term mortality, and hospital admissions.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis following PRISMA guidelines. The protocol was registered with PROSPERO (CRD42024542702). We searched PubMed, Scopus, Web of Science, and CINAHL for studies published between March 2020 and August 2024. We included original studies comparing adult breast cancer patients treated before and during the pandemic. Patients of any stage and sex were eligible. We assessed risk of bias and used a random-effects model to present pooled proportions and odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Forty-eight studies were included in the review, and 35 in the meta-analysis. Chemotherapy use increased from 35% before the pandemic to 42% during the pandemic. This rise was driven by an increase in neoadjuvant chemotherapy, from 18% to 22%, while adjuvant chemotherapy remained stable. Endocrine therapy increased from 35% to 42%. Neoadjuvant endocrine therapy rose from 2% to 10%, whereas adjuvant endocrine therapy declined from 46% to 43%. Targeted therapy and immunotherapy showed minimal change. The pooled OR for short-term mortality was 0.81 (95% CI: 0.56-1.15). Hospital admission estimates showed wide confidence intervals, reflecting heterogeneity.</p><p><strong>Conclusion: </strong>The pandemic led to notable shifts in systemic treatment patterns, particularly an increase in the use of neoadjuvant strategies. Short-term mortality did not significantly differ between periods. The study findings should be interpreted with caution due to variability in studies. Health systems require robust pharmaceutical policies and resilient triage frameworks to ensure continuity of cancer treatment during future crises.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2684148"},"PeriodicalIF":2.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13307381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of technological acceptance on application-based engagement among type 2 diabetes patients: local insights and implications for developing countries.","authors":"Afeefa Tahira, Mohamad Haniki Nik Mohamed, Mohamed Hassan Elnaem, Furqan Khurshid Hashmi, Nadeem Irfan Bukhari","doi":"10.1080/20523211.2026.2682340","DOIUrl":"10.1080/20523211.2026.2682340","url":null,"abstract":"<p><strong>Background: </strong>Acceptability and sustained engagement of mobile health (mHealth) applications in resource-limited settings for chronic disease management are suboptimal. Research on mHealth applications overlooks contextual factors affecting the translation of their acceptance to long-term usage.</p><p><strong>Methods: </strong>This study examined contextual factors using questionnaire developed by Technological Acceptance Models (TAM) and Expectation Confirmation Theory (ECT), to study the influence of technology acceptance (TA) on Sustained App-based Engagement and Use (ABEU) among Type 2 Diabetes Mellitus (T2DM) patients. Data were collected through purposive sampling from 397 T2DM patients across public and private hospitals in four provinces of Pakistan. Exploratory factor analysis, confirmatory factor analysis, and structural equation modelling validated hypothesised relationships.</p><p><strong>Results: </strong>Model depicted a strong, positive effect of TA on ABEU (<i>β</i> = 0.65, <i>p</i> < 0.001), indicating acceptance led to sustained use of mHealth. Based on <i>β</i> ≥ 0.50 for acceptance and engagement, Social image boost, Confidence boost, Better health through app use, and Doctors' recommendations were important cultural factors. Satisfaction, Better sugar levels, Confidence in App use, Search and download ability, and Easy access to reliable information were critical contextual factors. Better health facilities, Time-saving, and Internet speed and connectivity were key infrastructural factors. Improved health facilities, faster internet speeds, and reliable connectivity were boosted through users' confidence and enhanced self-image, encouraging them to engage, supported by increased satisfaction and perceived health benefits.</p><p><strong>Conclusion: </strong>TA significantly impacted ABEU through contextual, cultural and infrastructural factors in mHealth adoption, underscoring the need for actionable insights to improve mHealth adoption and retention.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"19 1","pages":"2682340"},"PeriodicalIF":2.6,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}