Publications | Pharmacists & Patient Outcomes
Pharmacist & Outcomes – ALL
Pharmacists are among the most accessible and trusted healthcare professionals and are uniquely positioned to serve as medication experts within integrative medicine teams. This narrative review synthesizes the literature describing pharmacist contributions to integrative medicine, with a focus on chronic disease management. Evidence highlights pharmacist involvement in diverse practice settings-including [...]
CONCLUSIONS: For patients with recently diagnosed HFrEF, pharmacist- and/or nurse practitioner-led medication management is cost-effective, supporting the expansion of this care to improve GDMT uptake and patient outcomes. [...]
CONCLUSION: Most instruments demonstrated acceptable reliability. However, few studies assessed sources of validity evidence, often with methodological limitations. Further studies employing rigorous methods for assessing validity evidence are needed to develop an instrument that is both valid and reliable for use in hospital pharmacy clinical practice. [...]
INTRODUCTION: Older adults with cancer are at greater risk of experiencing drug therapy problems (DTPs), often related to multiple comorbidities, advanced age, and cancer treatments. Increasing evidence demonstrates the value of a pharmacist in geriatric oncology clinics, but little information exists on their practical integration. Our objective is to evaluate [...]
CONCLUSION: Collaborative pharmacist prescribing enhances shared decision-making by actively involving patients in discussions about their medicines. It improves patients' understanding of their medicines, which supports safer and more informed treatment decisions. These findings support wider adoption of collaborative pharmacist prescribing to improve patient-centered care in hospitals. [...]
CONCLUSION AND PRACTICE IMPLICATIONS: Recruiting older adult participants and conducting the P3iD in a tertiary primary care clinic was feasible. Incorporating deprescribing into routine practice through periodic medication reviews provides a structured, safer, and more effective approach to managing polypharmacy and improving patient outcomes, subsequently optimizing health management and strengthening [...]
The inappropriate use of surgical antibiotic prophylaxis (SAP) remains a common issue in Vietnam, posing a significant risk of surgical site infections (SSIs) and other adverse outcomes. This study aimed to evaluate the impact of a pharmacist-led audit-feedback (A&F) intervention, as part of an antimicrobial stewardship (AMS) program, on improving [...]
CONCLUSIONS: The consistency of effectiveness and safety findings across studies, showing either no significant difference (indicating equivalence of care and outcomes) or significant improvement in pharmacist prescribing groups, suggests it is a potential policy option. Future research on implementation, public and patient preferences and cost-effectiveness would provide valuable insights into [...]
CONCLUSION: Ambient AI documentation tools were associated with reduced documentation time among ambulatory care clinical pharmacists and may enable increased clinical capacity. These findings provide early implementation evidence supporting the use of ambient AI documentation tools in pharmacy practice, demonstrating feasibility and measurable workflow impact in the ambulatory care setting. [...]
CONCLUSION: This scoping review identified patient health outcomes used to evaluate pharmacist-led primary care. Although studies on pharmacist-led clinical services have increased, the most assessed services may not reflect current practice. These findings should inform health system metrics grounded in outcomes that matter to patients to ensure safe, effective pharmacist-led [...]
CONCLUSIONS: A data-driven, pharmacist-led pathway was associated with significant LDL-C reduction. Among those who engaged, target attainment was similar across sex, ethnicity and IMD quintile, although low engagement from the most deprived quintile highlights that equitable reach has not yet been achieved. Further work is required to address upstream barriers [...]
CONCLUSIONS: Clinical pharmacist-led AMS achieves substantial cost containment and prescribing optimization in county-level hospitals without compromising clinical safety. These findings support expanding clinical pharmacy services as a cost-effective strategy for antimicrobial resistance containment in resource-limited settings. [...]
CONCLUSION: This study used bibliometric analysis to examine the past and current trends in the scope of pharmacy practice globally. The results show that the scope of pharmacists is expanding beyond traditional dispensing roles, while also showing emerging practice areas in recent years that align with the current changes in [...]
PurposeUK oncology services face increasing demand alongside workforce constraints. This study evaluated the impact of a pharmacist-led breast cancer clinic on consultant workload and clinic utilisation in a UK district general hospital.MethodsThis was a prospective service evaluation conducted over 11 months following implementation of an independent prescribing pharmacist-led breast cancer [...]
This single-center retrospective cohort study assessed whether pharmacist-led recommendation and management was associated with effectiveness and safety outcomes of mirogabalin for cancer-related neuropathic pain. Among 143 patients prescribed mirogabalin, 85 adults with malignancy were included. Patients were classified into a pharmacist-led recommendation and management group (n = 18), in which [...]
CONCLUSIONS: Among AYAs newly diagnosed with cancer, pre-diagnosis pharmacist continuity was associated with higher patient-reported satisfaction with pharmacist consultations, particularly in the MISS-21J domains of distress relief and rapport. These findings highlight the potential value of accessible, continuous relationships with pharmacists in improving patients' perceived pharmaceutical care experience during the [...]
CONCLUSION: Increased prescribing of SGLT2i therapy in hospitalized patients with heart failure was observed following pharmacist-led education and prospective reviews with feedback. [...]
Purpose: This study evaluated the impact of pharmacist-initiated versus provider-initiated patient enrollment in the Meds to Beds program. The primary objective was to compare the number of high-risk readmission patients enrolled through pharmacist-initiated versus provider-initiated processes. Secondary objectives included comparing 30-day all-cause and heart failure readmission rates, number of prescriptions [...]
Introduction: A patient's understanding, implementation of, and adherence to hospital discharge instructions are important in keeping them from being readmitted to the hospital within 30 days of discharge. The understanding of and ability to follow these instructions after the transition from hospital to home may be significantly supported by additional [...]
Background: The Minnesota Community Measurement assesses health system performance for diabetes care based on five measures: blood glucose (A1c), blood pressure (BP), cholesterol (LDL), tobacco use, and aspirin use, aggregated and known as a "GAP score." Rural areas are negatively impacted by inadequate diabetes care. The positive impact of direct [...]
Background: Hypertension and diabetes are prevalent chronic disease states. Pharmacists and dietitians collaborated to develop and implement employee benefit programs for hypertension and diabetes at a regional grocery store. The hybrid program included virtual education modules and check-in calls to monitor participants. Objectives: The primary objective of this study is [...]
Background: United States Veterans are disproportionately impacted by homelessness. Substance use, mental health conditions, and trauma increase the risk for homelessness and contribute to challenges in maintaining housing. Street Medicine utilizes a trauma-informed approach to provide low-barrier health and social services for those at risk for and experiencing homelessness. Limited [...]
Background: Clinical pharmacists are a limited resource in British Columbia (BC). Few studies have been conducted to explore hospital clinical pharmacist allocation. It is unclear how pharmacy leaders prioritize the allocation of their pharmacist staff to provide clinical services at their sites. Objectives: To characterize how hospital pharmacy leaders allocate [...]
The advancement of human space exploration presents unprecedented healthcare challenges, and heightens the need for specialized pharmaceutical care across the distinct timelines of a space mission. Despite growing interest in integrating pharmacists into space healthcare, their roles remain largely generalized, not tailored to the specific demands of pre-mission preparation, in-mission [...]
Rates of unintended pregnancy continue to remain high in the United States. Pharmacist-prescribed hormonal contraception offers an accessible option for preventing mistimed or unintended pregnancies, leading to better reproductive health outcomes. Specifically in Indiana, studies show patient interest in this service, however, overall pharmacy implementation and patient awareness has been [...]
CONCLUSION: This study demonstrated improved access and improved guideline directed therapy outcomes for rural Veterans seen by a CPP. Integration of the CPP with a focus on the management of COPD can increase access to CMM and increase overall quality. [...]
CONCLUSION: Taken together, the findings indicate that involving pharmacists more directly in the medication management of individuals with chronic conditions leads to better clinical results and more favorable economic outcomes. These findings support the idea of involving pharmacists more closely within chronic-care teams. [...]
CONCLUSION: Through increased medication adherence, better patient awareness, and support for lifestyle adjustment, pharmacist-led educational programs greatly reduce the risk of CVD and enhanced lipid profiles. To enhance the management of chronic diseases, clinical chemists must be integrated into multidisciplinary care teams. To optimise advantages, future research should focus on [...]
CONCLUSION: A bibliometric analysis of pharmacist-related outcomes describes pharmacist involvement in outcome-based practice at patient, system, and population levels. The research on pharmacist outcomes continues to grow and is clinically focused. Opportunities to address global and system-level health needs remain. [...]
CONCLUSION: This grid-based precision ASP was associated with sustained reductions in antimicrobial use and costs, and improved clinical outcomes. It was also associated with changes in the temporal relationship between AUD and MDRO detection rates. These alterations suggest this approach may mitigate selective pressure driving resistance, although causality cannot be [...]
CONCLUSION: This pilot service demonstrates that a pharmacist-led holistic smoking cessation model can be feasibly integrated into psychiatric care in a provincial Thai hospital. Further controlled studies are warranted to evaluate long-term effectiveness and scalability. [...]
Immune checkpoint inhibitors (ICIs) have significantly advanced cancer treatment, and their clinical indications continue to expand. At the same time, the importance of managing immune-related adverse events (irAEs) has been increasing, along with growing expectations for pharmacist involvement. Herein, we report a case in which prompt pharmacist intervention prevented the [...]
CONCLUSION: This meta-synthesis of the evidence regarding the perceptions of healthcare professionals on the role of pharmacists in aged care provides contextual information for individuals, organisations and policy-makers for future implementation. Pharmacists are perceived to improve stakeholder confidence, staff capacity and capability, and overall person-centred care. Embedded roles that foster [...]
CONCLUSION: Pharmacist-led interventions at an FQHC substantially improved access to CGM devices for patients with uncontrolled diabetes. Through direct education, payor navigation, and device coordination, pharmacists mitigated common financial and logistical barriers to care. This model offers a potential scalable strategy to advance health equity in access to diabetes technology. [...]
The design and implementation of antimicrobial stewardship programs for patients admitted to intensive care units must consider the specific characteristics of this population, including infection severity, organ dysfunction, and pharmacokinetic/pharmacodynamic alterations. The creation of a multidisciplinary team and the establishment of clear, targeted objectives are essential to improve treatment appropriateness, [...]
CONCLUSIONS: The development and adoption of PPEAPSOP policies depend on alignment amongst policy actors, navigation of systemic constraints, strategic foresight of policy implications, and a narrative grounded in robust evidence, =contextualised to the policy environment. Current approaches to the development and adoption of PPEAPSOP policies highlight gaps, underscoring the need [...]
The gut microbiome, a complex ecosystem of microorganisms, is now recognized as a key determinant of drug efficacy and toxicity, giving rise to the field of pharmacomicrobiomics. This review decodes the profound influence of the gut microbiome on treatment outcomes for hematologic malignancies. We explore the tripartite mechanistic pathways through [...]
CONCLUSIONS: These results suggest that a pharmacist-led GAIN approach improves patients' insight and medication attitudes, facilitating both the initiation and long-term maintenance of LAI therapy. In the context of burdened clinical settings, pharmacist involvement via task shifting represents an effective strategy for optimizing psychiatric pharmacotherapy. [...]
Patients with renal dysfunction are highly susceptible to drug-related problems (DRPs) due to altered pharmacokinetics and polypharmacy. Clinical pharmacists(CP) play a key role in optimising pharmacotherapy and preventing medication errors in this vulnerable population. To evaluate the prevalence of DRPs in patients with renal dysfunction and to compare the effectiveness [...]
BackgroundImmune checkpoint inhibitor (ICI) eligibility is primarily guided by tumor-centric biomarkers that do not fully account for the host's systemic immune competence. Emerging evidence suggests that readily available hematologic indices absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratio (NLR) are associated with treatment outcomes in patients receiving ICIs, yet these markers [...]
CONCLUSION: Inpatients demonstrated clear preferences for attributes of IPC, with variations by income, residence, and chronic disease status. Greater involvement of clinical pharmacists, tailored adjustment of consultation frequency and duration, and integration into hierarchical diagnosis and treatment and chronic disease management were encouraged. Price has limited influence on choices. We [...]
CONCLUSIONS: Integrating pharmacists into care teams can enhance GLP-1 RA PA turnaround times while improving medication access, safety, and continuity of care. These findings support further research and policy development in pharmacist interventions in PA process and GLP-1 RA management. [...]
CONCLUSIONS: Pharmacist-led interventions may contribute to quality indicators, specifically treatment adherence and persistence in oral anticancer therapy management. While these improvements are associated with patient safety and treatment effectiveness, current evidence is insufficient to confirm a direct translation into superior clinical endpoints. Further studies are needed to confirm the effectiveness [...]
CONCLUSIONS: Pharmacist-led education on diabetic retinopathy did not increase ophthalmology visits or improve diabetes-related outcomes. Effective strategies to encourage ophthalmology visits are required. [...]
CONCLUSION: The pharmacist-led DEMO program was non-inferior to standard physician consultation in achieving a BP target of 140/90mmHg within six months, with high usability and modest WTP. [...]
CONCLUSION: The majority of antithrombotic interventions in critically ill children were in the PCICU and involved anticoagulation for thromboembolism treatment and prevention. Further research is warranted to evaluate pediatric pharmacist-driven clinical services and the impact on antithrombotic outcomes in critically ill children, particularly those with cardiac disease. [...]
CONCLUSIONS AND RELEVANCE: In this quality improvement study, pharmacist-led outreach was associated with increased initiation of SGLT2 inhibitors; however, limited intervention reach may have constrained the overall impact. Strategies to improve uptake are needed to enhance impact and inform broader SGLT2 inhibitor implementation in patients with CKD and type 2 [...]
CONCLUSION: This study indicates that in patients treated with vancomycin under TDM, pharmacist interventions can promote the standardization of vancomycin TDM, reduce the incidence of acute kidney injury, and improve clinical outcomes. [...]
CONCLUSION: Community pharmacies are well positioned to expand CRC screening access. Addressing reimbursement, training, workflow, and coordination barriers through evidence-based strategies and supportive policy can enable pharmacist-delivered CRC screening to reduce disparities and improve population health outcomes. [...]
Patients with low health literacy are at risk for comorbidities, including obesity. Pharmacists offer a unique position to improve health literacy amongst all patients, including those with obesity. The primary aim of this study was to assess change in health literacy using the HELIA assessment pre and post pharmacist intervention. [...]
INTRODUCTION: Despite limited evidence of efficacy, opioid analgesics are frequently used by patients for chronic pain while awaiting total hip or knee arthroplasty (THA or TKA). Preoperative use of opioids is problematic as it increases the likelihood of postoperative opioid-related adverse drug events and postoperative complications and is the strongest [...]
Background: Treatment-related problems (TRPs), including patient adherence, knowledge, and medication errors, affect hospitalized patients' outcomes worldwide. Effective clinical pharmacist communication is essential for proper patient counselling and medication safety. However, the effect of clinical pharmacist communication skills on TRPs has not been adequately studied. Objective: This study aimed to assess [...]
CONCLUSION: In patients with HM3 LVADs receiving warfarin, pharmacist-managed warfarin led to a higher TTR compared with UC. [...]
CONCLUSIONS: Further research is needed to validate these ratios in various pediatric clinical pharmacy settings. [...]
CONCLUSIONS: Pharmacist-led assessment of Y-site compatibility in pediatric TPN is essential for medication safety and good outcomes. The high proportion of drugs with unknown or conflicting information about compatibility highlights the need for further research to support clinical decision-making. [...]
INTRODUCTION: Pharmacist prescribing has been introduced to alleviate pressures on hospital services and improve timely access to treatment. However, implementation in inpatient settings remains highly variable, with pockets of excellent practice alongside areas where prescribing roles are limited or absent. Traditional effectiveness reviews have demonstrated positive impacts of pharmacist prescribing [...]
CONCLUSION: This workflow demonstrated that pharmacist interventions within the nurse BP workflow can contribute to improvement in BP without requiring a comprehensive pharmacist visit. [...]
CONCLUSIONS: This study presents the validation of the first pharmacist-specific tool to measure engagement. The POWER Engagement Framework demonstrated good reliability and conceptual coherence to assess pharmacist engagement. Refinement for Well-being and Resources constructs could improve the model. [...]
Polypharmacy in older adults is associated with medication-related harm, including adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalization-related outcomes. This systematic review evaluated the effectiveness and safety of pharmacist-led deprescribing interventions in adults aged ≥65 years. The review was reported according to the Preferred Reporting Items for Systematic Reviews [...]
CONCLUSION: Connect AF demonstrates how pharmacists can address SDOH-related care gaps and provides a scalable model for cross-sector collaboration to enhance patient care coordination. [...]
CONCLUSION AND RELEVANCE: A collaborative pharmacist care model in RHCs significantly improved glycemic control and increased utilization of guideline-directed medication therapy for diabetes and cardiometabolic comorbidities. These findings add to the growing body of literature demonstrating positive clinical outcomes of pharmacist services in rural clinics and underscore the need for [...]
CONCLUSION: Pharmacist-led interventions in hematology-oncology care improve medication management processes and may contribute to better adherence and medication safety. However, evidence for effects on clinical and economic outcomes remains limited and heterogeneous, highlighting the need for well-designed prospective studies using standardized outcome measures. [...]
IntroductionThe complexity of chemotherapy protocols and the narrow therapeutic index of anticancer drugs make the risk of medication errors particularly high in oncology. This study analyzed and categorized pharmaceutical interventions related to chemotherapy prescriptions in a clinical hematology center.MethodsThis study was conducted in a specialized clinical hematology center over a [...]
INTRODUCTION: Potentially inappropriate prescriptions (PIPs) in older adults, such as long-term use of benzodiazepines, proton pump inhibitors without indication or antipsychotics in dementia, are associated with adverse events and increased healthcare utilisation. Despite clinical guidelines discouraging their use, PIPs remain frequent in primary care. An audit and feedback (A&F) intervention [...]
Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on [...]
CONCLUSIONS: In this pilot implementation of same-day telemedicine PPMM, high rates of MOAD receipt were seen among referred Veterans. However, most Veterans with AUD/OUD seen in participating clinics were not referred. Further evaluation of barriers and/or facilitators to referral are needed to increase program uptake. [...]
BACKGROUND: Migraine is a prevalent neurological disorder and a leading cause of disability worldwide. Despite effective medications, many patients experience underdiagnosis, suboptimal medication use, and poor adherence. Pharmacists are well-positioned to provide medication counselling, yet their role in structured migraine counselling services within community pharmacy practice remains underexplored. OBJECTIVE: This [...]
CONCLUSION: This pharmacist-led risk assessment tool has strong potential for accurately identifying high-risk β-lactam allergy patients and optimising antimicrobial stewardship in Chinese hospitals. Further large-scale validation is warranted. [...]
CONCLUSION: In this MTAC-supported cohort, polypharmacy and full GDMT were not associated with increased burden or reduced adherence. A modest positive association between medication count and QOL was observed. SGLT2i use was associated with lower adherence and QOL, although these findings are exploratory and may reflect differences in disease severity [...]
CONCLUSION: Inpatient and TOC pharmacist clinical review is associated with improved optimization of GDMT and may enhance value-based outcomes such as hospital readmissions. [...]
CONCLUSION: Pharmacists' interventions exert a positive effect on asthma and COPD management outcomes, though improved research design and quality are still needed. [...]
CONCLUSION: Our study established the feasibility, acceptability and implementation outcomes of a new pharmacist-led model of care for carvedilol dose optimisation. We provide practical insights to inform the implementation of similar technology enabled multidisciplinary models of care at scale for patients with cirrhosis. [...]
Chronic insomnia is a prevalent disorder that negatively impacts Veterans’ health. The first-line intervention is cognitive behavioral therapy for insomnia (CBT-I); however, sleep medications, which have unreliable effectiveness and pose risks for adverse events, are the most commonly used intervention. Pairing CBT-I with deprescribing (the supervised reduction of medications) can [...]
CONCLUSION: A clinical pharmacist-led multimodal ASP intervention significantly improved the appropriate use of perioperative antimicrobial prophylaxis for Class I incision surgeries, reducing unnecessary use and costs without increasing SSI risk. This approach represents an effective and replicable stewardship model for routine surgical care. [...]
INTRODUCTION: To optimize pharmacist engagement in antimicrobial stewardship (AMS), this study assessed general surgeons' knowledge, practices, and perspectives on AMS and pharmacist interventions. Although antibiotic utilization density has decreased consistently over three years following the involvement of clinical pharmacists, challenges to AMS persist. [...]
Antimicrobial resistance (AMR) poses a major global public health threat. The effective implementation of antimicrobial stewardship (AS) is essential for optimizing antimicrobial use and improving clinical outcomes. In this context, pharmacists play a central role by managing pharmacotherapy across multiple clinical practice domains. This narrative review summarizes evidence on pharmacist-driven [...]
CONCLUSION: These findings suggest that pharmacist-led PEN-FAST implementation is a feasible strategy to identify low-risk penicillin allergies, but allergy delabeling and oral challenge rates remain low. Further efforts are needed to integrate PEN-FAST into clinical workflows and enhance antimicrobial stewardship. [...]
CONCLUSION: Pharmacist participation in multidisciplinary antifungal stewardship teams may be associated with improved antifungal utilization and adherence to guidelines in hospitalized adults. The findings support that pharmacists are important members of multidisciplinary teams in antifungal stewardship. [...]
CONCLUSION: Clinical pharmacist-led antimicrobial stewardship programs (ASPs) significantly reduced antimicrobial exposure and healthcare utilization, improving the appropriateness of antimicrobial prescriptions and clinical outcomes. These findings highlight the importance of ASPs as an evidence-based strategy to address antimicrobial resistance and optimize patient care in HAP. [...]
CONCLUSION: Pharmacist-led interventions in COPD may improve selected medication-related and patient-centered outcomes; however, the available evidence is heterogeneous and limited by study quality and inconsistent effects across outcomes. These findings should be interpreted cautiously, and well-designed, adequately powered trials with standardized outcomes are needed before robust conclusions regarding clinical effectiveness [...]
CONCLUSION: The pharmacist-led telehealth TOC program significantly reduced hospital readmission rates. These findings support the implementation of pharmacist-led TOC programs and suggest the importance of risk stratification in targeting interventions. [...]
CONCLUSION: Successful implementation of the TOC program enabled continuity of care and optimized medication management following discharge, with the goal of improving patient outcomes. [...]
CONCLUSIONS: Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx community pharmacy pilot randomised controlled trial successfully achieved key progression criteria. If found to be effective and cost-effective in a subsequent definitive randomised controlled trial, it offers promise as an adaptable (United Kingdom and internationally) model of integrated care provision for [...]
CONCLUSIONS: Many studies documented improvements in clinically relevant outcomes because of the care provided by a CCP. QM/KPI derived from CCP activities performed in these studies may be useful in standardizing CCP practice and workflow and further establish CCP value. [...]
CONCLUSION: EMP involvement in patient care during anticoagulation reversal of acute hemorrhages improved time to anticoagulation reversal agent administration. Larger scale, higher-quality studies are necessary to assess the value of EMPs in improving patient-centered outcomes. [...]
CONCLUSION: The Pharm.D. resident on-call program was well-received and perceived to enhance physician resident education. Future efforts should focus on increasing program visibility, targeted specialty outreach, and enhancing pharmacists' responsibility and integration in physician residency training and education. [...]
CONCLUSIONS: The implementation of the LOW-TOC approach to CV team-based lipid management was associated with significantly increased optimizations compared with the standard process typically utilized in many health systems. These findings support the utility of pharmacists leading the CV team in optimizing lipid management using a population health model in [...]
CONCLUSIONS: The cost-utility analyses indicated that pharmacist-led deprescribing interventions are generally a cost-effective option compared with usual care. While these interventions appear promising from an economic standpoint, more long-term, population-based studies are needed to validate these findings. [...]
The American College of Clinical Pharmacy (ACCP) advocates for board certification of clinical pharmacists in one of the recognized specialties as a fundamental qualification and requirement for providing and supervising trainees in the provision of direct patient care. However, data linking pharmacist board certification to patient outcomes are limited, and [...]
CONCLUSION: CPPs provided MOUD care that was safe and effective, with outcomes comparable with those of physicians and nurse practitioners. Their increased use of risk mitigation tools such as PDMP underscores the value of CPP integration into MOUD programs, which can increase access to SUD care. [...]
CONCLUSION: Integration of a clinical pharmacist into a interprofessional audit and feedback process significantly improved antimicrobial appropriateness and reduced antimicrobial-related problems. An associated reduction in 30-day mortality was observed after adjustment for illness severity; however, this finding warrants confirmation in larger prospective studies. [...]
Psychotropic medicines are essential in managing mental illness but are associated with complex challenges, including off-label use, polypharmacy, drug interactions, adverse effects, and diverse safety profiles. Effective decision-making requires access to reliable, evidence-based, and context-specific medicines information. Medicines Information (MI) services, particularly those led by pharmacists, provide tailored, evidence-informed advice [...]
CONCLUSION: The pharmacist-led intervention more than doubled the pharmacologic treatment rate for AUD in primary care. [...]
It is challenging to generate data sufficient to assess the complex relationships between pharmacist workload and patient outcomes. The purpose of this paper is to describe innovative methods of recruitment and retention in engaging health professionals as study participants in a multicenter effort to collect workload data for a large [...]
CONCLUSIONS: This scoping review demonstrates an integral and direct role for pharmacists in improving outcomes for patients with CKM conditions in interprofessional settings. However, there is a need for more robust studies that investigate cardiovascular, kidney, and metabolic outcomes in these patients. [...]
CONCLUSION: Pharmacist stewardship intervention significantly increased the appropriateness of prescribed antibiotics at discharge by 60% without compromising patient care. Because most antibiotics are meant to be completed post-discharge, these findings highlight that inpatient antimicrobial stewardship efforts overlook a significant number of patients on antibiotics. [...]
CONCLUSIONS: Pharmacist-guided rapid titration accelerated attainment of therapeutic methadone doses and did not increase adverse events. Although the adjusted increase in the proportion achieving ≥60 mg TDD by discharge was not statistically significant, these findings demonstrate how inpatient clinical pharmacists can modernize inpatient OUD care. [...]
CONCLUSION: In this retrospective study, the presence of unresolved drug-related problems following pharmacist-led comprehensive medication reviews was independently associated with four-fold higher odds of hospital readmission within 6 months. These findings highlight unresolved drug-related problems as a strong, independent marker of increased readmission risk. Prospective studies are needed to determine [...]
CONCLUSIONS: While ICIs have substantially improved survival outcomes, their immunomodulatory effects may amplify drug-specific dermatologic toxicities when used in combination regimens. Shared inflammatory pathways and immune cell recruitment to the skin likely underlie this interaction, underscoring the importance of anticipatory monitoring and optimized management strategies in combination therapy. [...]
This methods paper describes the development and implementation of a pharmacist-led, workplace-based diabetes prevention intervention tailored to hospitality workers in New Orleans. Grounded in the Social Ecological Model (SEM) and the Health Belief Model (HBM), this study integrated onsite diabetes risk screening, brief lifestyle education, provision of health-promoting tools, and [...]
Pharmacist & Outcomes – Open Acess (Free PDF)
The inappropriate use of surgical antibiotic prophylaxis (SAP) remains a common issue in Vietnam, posing a significant risk of surgical site infections (SSIs) and other adverse outcomes. This study aimed to evaluate the impact of a pharmacist-led audit-feedback (A&F) intervention, as part of an antimicrobial stewardship (AMS) program, on improving [...]
CONCLUSIONS: The consistency of effectiveness and safety findings across studies, showing either no significant difference (indicating equivalence of care and outcomes) or significant improvement in pharmacist prescribing groups, suggests it is a potential policy option. Future research on implementation, public and patient preferences and cost-effectiveness would provide valuable insights into [...]
CONCLUSIONS: A data-driven, pharmacist-led pathway was associated with significant LDL-C reduction. Among those who engaged, target attainment was similar across sex, ethnicity and IMD quintile, although low engagement from the most deprived quintile highlights that equitable reach has not yet been achieved. Further work is required to address upstream barriers [...]
CONCLUSIONS: Among AYAs newly diagnosed with cancer, pre-diagnosis pharmacist continuity was associated with higher patient-reported satisfaction with pharmacist consultations, particularly in the MISS-21J domains of distress relief and rapport. These findings highlight the potential value of accessible, continuous relationships with pharmacists in improving patients' perceived pharmaceutical care experience during the [...]
Purpose: This study evaluated the impact of pharmacist-initiated versus provider-initiated patient enrollment in the Meds to Beds program. The primary objective was to compare the number of high-risk readmission patients enrolled through pharmacist-initiated versus provider-initiated processes. Secondary objectives included comparing 30-day all-cause and heart failure readmission rates, number of prescriptions [...]
Introduction: A patient's understanding, implementation of, and adherence to hospital discharge instructions are important in keeping them from being readmitted to the hospital within 30 days of discharge. The understanding of and ability to follow these instructions after the transition from hospital to home may be significantly supported by additional [...]
Background: The Minnesota Community Measurement assesses health system performance for diabetes care based on five measures: blood glucose (A1c), blood pressure (BP), cholesterol (LDL), tobacco use, and aspirin use, aggregated and known as a "GAP score." Rural areas are negatively impacted by inadequate diabetes care. The positive impact of direct [...]
Background: Hypertension and diabetes are prevalent chronic disease states. Pharmacists and dietitians collaborated to develop and implement employee benefit programs for hypertension and diabetes at a regional grocery store. The hybrid program included virtual education modules and check-in calls to monitor participants. Objectives: The primary objective of this study is [...]
Background: United States Veterans are disproportionately impacted by homelessness. Substance use, mental health conditions, and trauma increase the risk for homelessness and contribute to challenges in maintaining housing. Street Medicine utilizes a trauma-informed approach to provide low-barrier health and social services for those at risk for and experiencing homelessness. Limited [...]
Background: Clinical pharmacists are a limited resource in British Columbia (BC). Few studies have been conducted to explore hospital clinical pharmacist allocation. It is unclear how pharmacy leaders prioritize the allocation of their pharmacist staff to provide clinical services at their sites. Objectives: To characterize how hospital pharmacy leaders allocate [...]
The advancement of human space exploration presents unprecedented healthcare challenges, and heightens the need for specialized pharmaceutical care across the distinct timelines of a space mission. Despite growing interest in integrating pharmacists into space healthcare, their roles remain largely generalized, not tailored to the specific demands of pre-mission preparation, in-mission [...]
CONCLUSION: Taken together, the findings indicate that involving pharmacists more directly in the medication management of individuals with chronic conditions leads to better clinical results and more favorable economic outcomes. These findings support the idea of involving pharmacists more closely within chronic-care teams. [...]
CONCLUSION: Through increased medication adherence, better patient awareness, and support for lifestyle adjustment, pharmacist-led educational programs greatly reduce the risk of CVD and enhanced lipid profiles. To enhance the management of chronic diseases, clinical chemists must be integrated into multidisciplinary care teams. To optimise advantages, future research should focus on [...]
CONCLUSION: This pilot service demonstrates that a pharmacist-led holistic smoking cessation model can be feasibly integrated into psychiatric care in a provincial Thai hospital. Further controlled studies are warranted to evaluate long-term effectiveness and scalability. [...]
CONCLUSION: This grid-based precision ASP was associated with sustained reductions in antimicrobial use and costs, and improved clinical outcomes. It was also associated with changes in the temporal relationship between AUD and MDRO detection rates. These alterations suggest this approach may mitigate selective pressure driving resistance, although causality cannot be [...]
Immune checkpoint inhibitors (ICIs) have significantly advanced cancer treatment, and their clinical indications continue to expand. At the same time, the importance of managing immune-related adverse events (irAEs) has been increasing, along with growing expectations for pharmacist involvement. Herein, we report a case in which prompt pharmacist intervention prevented the [...]
The design and implementation of antimicrobial stewardship programs for patients admitted to intensive care units must consider the specific characteristics of this population, including infection severity, organ dysfunction, and pharmacokinetic/pharmacodynamic alterations. The creation of a multidisciplinary team and the establishment of clear, targeted objectives are essential to improve treatment appropriateness, [...]
CONCLUSIONS: The development and adoption of PPEAPSOP policies depend on alignment amongst policy actors, navigation of systemic constraints, strategic foresight of policy implications, and a narrative grounded in robust evidence, =contextualised to the policy environment. Current approaches to the development and adoption of PPEAPSOP policies highlight gaps, underscoring the need [...]
The gut microbiome, a complex ecosystem of microorganisms, is now recognized as a key determinant of drug efficacy and toxicity, giving rise to the field of pharmacomicrobiomics. This review decodes the profound influence of the gut microbiome on treatment outcomes for hematologic malignancies. We explore the tripartite mechanistic pathways through [...]
Patients with renal dysfunction are highly susceptible to drug-related problems (DRPs) due to altered pharmacokinetics and polypharmacy. Clinical pharmacists(CP) play a key role in optimising pharmacotherapy and preventing medication errors in this vulnerable population. To evaluate the prevalence of DRPs in patients with renal dysfunction and to compare the effectiveness [...]
CONCLUSION: Inpatients demonstrated clear preferences for attributes of IPC, with variations by income, residence, and chronic disease status. Greater involvement of clinical pharmacists, tailored adjustment of consultation frequency and duration, and integration into hierarchical diagnosis and treatment and chronic disease management were encouraged. Price has limited influence on choices. We [...]
CONCLUSIONS: Integrating pharmacists into care teams can enhance GLP-1 RA PA turnaround times while improving medication access, safety, and continuity of care. These findings support further research and policy development in pharmacist interventions in PA process and GLP-1 RA management. [...]
CONCLUSIONS: Pharmacist-led education on diabetic retinopathy did not increase ophthalmology visits or improve diabetes-related outcomes. Effective strategies to encourage ophthalmology visits are required. [...]
CONCLUSION: The pharmacist-led DEMO program was non-inferior to standard physician consultation in achieving a BP target of 140/90mmHg within six months, with high usability and modest WTP. [...]
CONCLUSIONS AND RELEVANCE: In this quality improvement study, pharmacist-led outreach was associated with increased initiation of SGLT2 inhibitors; however, limited intervention reach may have constrained the overall impact. Strategies to improve uptake are needed to enhance impact and inform broader SGLT2 inhibitor implementation in patients with CKD and type 2 [...]
CONCLUSION: This study indicates that in patients treated with vancomycin under TDM, pharmacist interventions can promote the standardization of vancomycin TDM, reduce the incidence of acute kidney injury, and improve clinical outcomes. [...]
CONCLUSION: Community pharmacies are well positioned to expand CRC screening access. Addressing reimbursement, training, workflow, and coordination barriers through evidence-based strategies and supportive policy can enable pharmacist-delivered CRC screening to reduce disparities and improve population health outcomes. [...]
Background: Treatment-related problems (TRPs), including patient adherence, knowledge, and medication errors, affect hospitalized patients' outcomes worldwide. Effective clinical pharmacist communication is essential for proper patient counselling and medication safety. However, the effect of clinical pharmacist communication skills on TRPs has not been adequately studied. Objective: This study aimed to assess [...]
INTRODUCTION: Despite limited evidence of efficacy, opioid analgesics are frequently used by patients for chronic pain while awaiting total hip or knee arthroplasty (THA or TKA). Preoperative use of opioids is problematic as it increases the likelihood of postoperative opioid-related adverse drug events and postoperative complications and is the strongest [...]
INTRODUCTION: Pharmacist prescribing has been introduced to alleviate pressures on hospital services and improve timely access to treatment. However, implementation in inpatient settings remains highly variable, with pockets of excellent practice alongside areas where prescribing roles are limited or absent. Traditional effectiveness reviews have demonstrated positive impacts of pharmacist prescribing [...]
CONCLUSION: This workflow demonstrated that pharmacist interventions within the nurse BP workflow can contribute to improvement in BP without requiring a comprehensive pharmacist visit. [...]
CONCLUSIONS: This study presents the validation of the first pharmacist-specific tool to measure engagement. The POWER Engagement Framework demonstrated good reliability and conceptual coherence to assess pharmacist engagement. Refinement for Well-being and Resources constructs could improve the model. [...]
Polypharmacy in older adults is associated with medication-related harm, including adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalization-related outcomes. This systematic review evaluated the effectiveness and safety of pharmacist-led deprescribing interventions in adults aged ≥65 years. The review was reported according to the Preferred Reporting Items for Systematic Reviews [...]
CONCLUSION: Connect AF demonstrates how pharmacists can address SDOH-related care gaps and provides a scalable model for cross-sector collaboration to enhance patient care coordination. [...]
CONCLUSION: Pharmacist-led interventions in hematology-oncology care improve medication management processes and may contribute to better adherence and medication safety. However, evidence for effects on clinical and economic outcomes remains limited and heterogeneous, highlighting the need for well-designed prospective studies using standardized outcome measures. [...]
INTRODUCTION: Potentially inappropriate prescriptions (PIPs) in older adults, such as long-term use of benzodiazepines, proton pump inhibitors without indication or antipsychotics in dementia, are associated with adverse events and increased healthcare utilisation. Despite clinical guidelines discouraging their use, PIPs remain frequent in primary care. An audit and feedback (A&F) intervention [...]
Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on [...]
CONCLUSION: This pharmacist-led risk assessment tool has strong potential for accurately identifying high-risk β-lactam allergy patients and optimising antimicrobial stewardship in Chinese hospitals. Further large-scale validation is warranted. [...]
BACKGROUND: Migraine is a prevalent neurological disorder and a leading cause of disability worldwide. Despite effective medications, many patients experience underdiagnosis, suboptimal medication use, and poor adherence. Pharmacists are well-positioned to provide medication counselling, yet their role in structured migraine counselling services within community pharmacy practice remains underexplored. OBJECTIVE: This [...]
CONCLUSION: In this MTAC-supported cohort, polypharmacy and full GDMT were not associated with increased burden or reduced adherence. A modest positive association between medication count and QOL was observed. SGLT2i use was associated with lower adherence and QOL, although these findings are exploratory and may reflect differences in disease severity [...]
CONCLUSION: Pharmacists' interventions exert a positive effect on asthma and COPD management outcomes, though improved research design and quality are still needed. [...]
CONCLUSION: A clinical pharmacist-led multimodal ASP intervention significantly improved the appropriate use of perioperative antimicrobial prophylaxis for Class I incision surgeries, reducing unnecessary use and costs without increasing SSI risk. This approach represents an effective and replicable stewardship model for routine surgical care. [...]
INTRODUCTION: To optimize pharmacist engagement in antimicrobial stewardship (AMS), this study assessed general surgeons' knowledge, practices, and perspectives on AMS and pharmacist interventions. Although antibiotic utilization density has decreased consistently over three years following the involvement of clinical pharmacists, challenges to AMS persist. [...]
Antimicrobial resistance (AMR) poses a major global public health threat. The effective implementation of antimicrobial stewardship (AS) is essential for optimizing antimicrobial use and improving clinical outcomes. In this context, pharmacists play a central role by managing pharmacotherapy across multiple clinical practice domains. This narrative review summarizes evidence on pharmacist-driven [...]
CONCLUSION: Pharmacist-led interventions in COPD may improve selected medication-related and patient-centered outcomes; however, the available evidence is heterogeneous and limited by study quality and inconsistent effects across outcomes. These findings should be interpreted cautiously, and well-designed, adequately powered trials with standardized outcomes are needed before robust conclusions regarding clinical effectiveness [...]
CONCLUSION: Clinical pharmacist-led antimicrobial stewardship programs (ASPs) significantly reduced antimicrobial exposure and healthcare utilization, improving the appropriateness of antimicrobial prescriptions and clinical outcomes. These findings highlight the importance of ASPs as an evidence-based strategy to address antimicrobial resistance and optimize patient care in HAP. [...]
CONCLUSIONS: While ICIs have substantially improved survival outcomes, their immunomodulatory effects may amplify drug-specific dermatologic toxicities when used in combination regimens. Shared inflammatory pathways and immune cell recruitment to the skin likely underlie this interaction, underscoring the importance of anticipatory monitoring and optimized management strategies in combination therapy. [...]
This methods paper describes the development and implementation of a pharmacist-led, workplace-based diabetes prevention intervention tailored to hospitality workers in New Orleans. Grounded in the Social Ecological Model (SEM) and the Health Belief Model (HBM), this study integrated onsite diabetes risk screening, brief lifestyle education, provision of health-promoting tools, and [...]
CONCLUSION: Clinical pharmacist-led antimicrobial stewardship can reduce the antibiotic use intensity among patients undergoing VATLS in thoracic surgery, decrease the use of broad-spectrum antibiotics and shorten the duration of antibiotic therapy. [...]
Background Patients receiving maintenance hemodialysis experience a high burden of infectious morbidity, and vaccination is a key preventive strategy in this population. Despite international guideline recommendations, vaccination uptake and immune response in this population remain suboptimal. Aims The study aimed to evaluate hepatitis B virus (HBV) vaccination completion and seroprotection, [...]
CONCLUSION: Low-dose slow and ultraslow alteplase thrombolytic regimens demonstrated favorable clinical outcomes in patients with symptomatic PVT within a real-world clinical setting. Despite limitations inherent to a retrospective observational design and small sample size, these findings support pharmacologic thrombolysis as a potential alternative to surgery in selected patients. Larger prospective [...]
CONCLUSION: This prediction model effectively identifies MHD patients with pneumonia at high risk of developing IPFI, demonstrating robust predictive performance. This tool can facilitate early risk stratification by clinical pharmacists in ward decision-support and stewardship consultations, optimizing the prophylactic and targeted use of antifungal agents and promoting rational drug therapy. [...]
CONCLUSION: The intervention was associated with a significant improvement in the perception and willingness to pay for adult vaccines among the participants. Infodemic management interventions can effectively improve uptake of adult vaccines. [...]
BACKGROUND Patients with acute ischemic stroke receiving intravenous thrombolysis require intensive secondary prevention; however, poor medication adherence and inadequate lipid control in real-world practice often compromise long-term outcomes. This study evaluated the effects of a clinical pharmacist-led medication management program on medication adherence, lipid control, and functional outcomes in patients [...]
CONCLUSIONS: In a setting where HAV and HBV vaccination guidelines remained consistent over time, the pharmacist-led MMC model was associated with higher vaccination and screening rates compared with the traditional care model, and these associations remained robust after adjustment for age, sex, genotype, and fibrosis stage. The model may have [...]
INTRODUCTION: With health systems facing increasing challenges, it is important to define new care models that may release some of the burden on the workforce, whilst maintaining quality and improving patient convenience. The objective of this study was to create a taxonomy of pharmacist-led interventions aimed at supporting improved health [...]
CONCLUSION: The closed-loop stewardship model effectively improved meropenem target concentration attainment by systematically reducing drug loss through degradation and metabolism. This optimized exposure profile correlated with improved eradication rates of Gram-negative sensitive bacteria. [...]
(1) Background: Medication-related problems (MRPs) are a significant burden on health care systems. Pharmacists play an important role in preventing and reducing MRPs through clinical review, education, and policy governance. This study analyzed pharmacist interventions within a 92-bed neonatal clinical care unit to better understand MRPs and guide targeted medication [...]
CONCLUSION: Clinical pharmacist interventions can significantly enhance the rational use of perioperative antimicrobial drugs in hysteroscopic surgery, leading to notable clinical outcomes and economic benefits. [...]
CONCLUSION: This case demonstrates that a full-course pharmaceutical care model enables timely detection and management of complex ADRs, optimizes therapeutic outcomes, and supports multidisciplinary decision-making. The model illustrates the pivotal role of the clinical pharmacist in improving medication safety and efficacy in ABPA, offering a replicable framework for promoting integrated, [...]
CONCLUSION: This trial will evaluate the effectiveness of pharmacist-led education in improving DOAC adherence and treatment outcomes over a 6-month follow-up period. The findings will inform the development and implementation of future pharmacist-led care models. [...]
CONCLUSIONS: The DCC program was associated with directional improvements in clinical, health care utilization, and cost outcomes and was cost-neutral due to savings and associated revenue. With approximately one-third of participants having Medicaid insurance, the sustainability of such programs increases through leveraging the 340B program to enhance care for economically [...]
CONCLUSIONS: A post-discharge nurse-pharmacist telehealth service is a feasible and well-accepted MoC. The inclusion of a routine MedRec post-discharge may enhance continuity of care, improve medication safety, and support HF management. [...]
CONCLUSIONS AND RELEVANCE: Among older adults with polypharmacy, no reduction overall in 30-day unplanned hospital and ED utilization from a pharmacist-led TOC intervention was detected, but a reduction was found among patients with low medication adherence and literacy, suggesting benefit for this subgroup. [...]
CONCLUSIONS: A primary care embedded virtual intervention involving pharmacist-led tapering and mindfulness-informed CBT sessions to support benzodiazepine deprescribing is feasible, acceptable, may reduce older adults' benzodiazepine use, and warrants multi-site testing. [...]
CONCLUSIONS: These findings suggest that the physician-pharmacist collaborative model could improve the long-term quality and efficiency of T2D management and reduce medical costs in underresourced areas globally. Patients with T2D, especially those with central obesity or high cardiovascular risk, may benefit more from collaborative clinics. [...]
CONCLUSIONS: This underpowered study found no evidence of pain differences between ABI-MTM and SMC, tentatively suggesting possible alcohol-opioid co-use improvements associated with the intervention without worsening pain. [...]
CONCLUSIONS: This evaluation furthers what is understood regarding barriers to implementing care bundles within rural healthcare contexts. Our findings suggested that clinicians in rural settings felt constrained in their ability to take on new tasks and expand their practice models due to staffing shortages and heavy workload demands. Some clinicians [...]
CONCLUSIONS: This study identified priority outcomes for evaluating the impact of pharmacist prescribing and their measurability, encompassing clinical, safety, economic, and patient perspectives. [...]
CONCLUSION: Spanish-speaking patients exposed to clinical pharmacist care observed significant improvements in glycemic control and timely preventative care screening. [...]
Despite the broad coverage offered by Taiwan's National Health Insurance system, attention-deficit/hyperactivity disorder (ADHD) care continues to face a critical "leaky pipeline" problem. There is a clear gap between diagnostic prevalence and long-term treatment retention. This perspective article applies the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework [...]
CONCLUSIONS: This pilot study underscores the critical role of pharmacist-led education for patients with primary open-angle glaucoma in improving treatment outcomes, particularly in achieving IOP targets and therby reducing the risk of vision loss. Future research involving larger cohorts and longer follow-up is necessary to further validate these findings. [...]
CONCLUSIONS: The brief pharmacist-led intervention was effective in improving attitudes toward medication and behavioral adherence among patients receiving antipsychotic treatment in our study group. These findings underscore the importance of active pharmacist engagement for supporting medication adherence. [...]
CONCLUSIONS AND RELEVANCE: This cluster randomized trial found that a centralized consultant pharmacist model was feasible, integrated well into primary care workflows, and resulted in high practitioner acceptance of recommendations; however, it did not significantly reduce opioid or benzodiazepine prescribing or falls within 1 year. These results suggest that more [...]
CONCLUSION: Pharmacist-led interventions in interprofessional primary care settings contributed to the appropriateness of pharmacotherapy and satisfaction of older adults under evaluation for or living with a NCD after a 6-month follow-up. [...]
CONCLUSION: This evaluation demonstrated the impact of clinical pharmacists serving as prescribers in improving COPD management in rural settings. The sustainment factors identified can be utilized to inform the expansion of similar, team-based healthcare programs across rural settings. [...]
CONCLUSIONS AND RELEVANCE: This large-scale cohort study found that the use of an FPS was not associated with lower risk of death or hospitalization from any cause. However, the results generated a clinically important hypothesis that FPS use may be associated with slightly lower risk of death among older patients [...]
CONCLUSIONS: Our study demonstrates that comprehensive machine learning optimization can achieve strong predictive performance for identifying patients who would benefit from pharmacist intervention. The clinical prediction model, trained exclusively on clinical variables, provides a robust framework for personalized TB treatment resource allocation. Supportive transcriptomic analyses provide biological context but are [...]
CONCLUSIONS: Pharmacist-developed educational leaflets can support short-term knowledge acquisition and are perceived positively by women across age groups. These findings highlight the potential role of community pharmacies in delivering accessible written health education, while underscoring the need for future studies to assess long-term knowledge retention, behavioral outcomes, and topic-specific, targeted [...]
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, adding proactive, protocol-driven clinical pharmacist outreach into collaborative team-based care improved medication optimization and patient outcomes. This approach provides an evidence-based strategy for reducing the risk of developing severe hypoglycemia in individuals with T2D at high risk, enhancing patient safety, and potentially [...]
Background/Objectives: Older adults with chronic kidney disease (CKD) are particularly vulnerable to polypharmacy-related adverse outcomes due to altered pharmacokinetics, multimorbidity, and increased susceptibility to medication-related harm. Polypharmacy in CKD is associated with falls, hospitalizations, and functional decline. Clinical pharmacist-led medication reviews may mitigate these risks; however, access barriers limit their [...]
CONCLUSIONS: The clinical pharmacist-led MDT model enhances carbapenem-prescribing appropriateness and fosters interprofessional collaboration. Its implementation was associated with shorter hospital stays and improvements in key clinical indicators, including reduced ICU admission and mortality. However, the observed shifts in resistant pathogen epidemiology underscore that antimicrobial stewardship strategies must be integrated with [...]
Antimicrobial resistance (AMR) undermines clinical care. Thus, ensuring appropriate antimicrobial therapy is crucial in global and national AMR countermeasures. This narrative review aimed to summarize pharmacist-led antimicrobial stewardship interventions in Japan and discuss their practical and clinical significance across inpatient, outpatient, and community settings. In inpatient care, antimicrobial stewardship programs [...]
BACKGROUND: Venous thromboembolism (VTE) is a common and potentially fatal complication in orthopedic trauma patients, particularly following lower limb and hip-related fractures. While pharmacological prophylaxis is the cornerstone of prevention for patients at moderate to high risk, its use is a balance between efficacy and bleeding risk. Clinical pharmacists play [...]
CONCLUSIONS: A pharmacist-led PST intervention with ongoing education and counselling led to improved TTR and clinical outcomes in patients with MHV in China. [...]
BACKGROUND: Drug-related problems (DRPs) and polypharmacy are common among older adults with multimorbidity and limited functional capacity. These issues are associated with adverse outcomes and require targeted interventions. However, evidence regarding their prevalence and associated factors in home-based primary care settings—such as the ATDOM program in Catalonia—is still limited. METHODS: [...]
CONCLUSION: This scoping review highlighted emerging but heterogeneous use of CGM metrics in CGM-integrated pharmacists' services in diabetes care. While reported outcomes were consistently positive, most studies focused on clinical parameters, particularly A1C. Future research should place greater emphasis on evaluating humanistic and economic outcomes of CGM on pharmacist-involved diabetes [...]
CONCLUSIONS: PADL delivered by non-allergy nurses in the outpatient setting is safe and effective at removing low-risk penicillin allergy records. [...]
CONCLUSION: The factors identified in this study can be used to develop potential strategic plans to improve existing PMAC services and extend their implementation across the country. Future research should aim to quantify the effectiveness of PMAC services on patients' clinical/non-clinical outcomes. Positive findings could provide further evidence of the [...]
Piperacillin/tazobactam (PIPC/TAZ) and vancomycin (VCM) are frequently used in combination (PTV) to manage severe healthcare-associated infections, but are also associated with an increased risk of acute kidney injury (AKI). In 2019, Ogaki Municipal Hospital implemented pharmacist-led interventions aimed at reducing PTV use and mitigating AKI. This study evaluated the impact [...]
CONCLUSION: Preparing pharmacists for prescribing roles in the Netherlands requires integrating several new or expanded competencies into pharmacy education. Regardless of the prescribing model to be introduced, assuming responsibility for prescribing decisions and outcomes appears essential. [...]
CONCLUSION: Integrating The DBI Calculator© into pharmacist-led medication reviews supported deprescribing efforts and was effective at reducing the DBI score in older hospital inpatients. Further research is required to explore widespread implementation and sustainability. [...]
CONCLUSION: Pharmacists' activities, the extent of collaboration and outcomes of collaborative care varied. This information may help to support the implementation of new COPD-focused services. Further rigorously designed research is needed to explore the effect of collaborative community pharmacist-physician care in COPD management. [...]
BACKGROUND: Cancer pain remains a prevalent and debilitating symptom among patients with advanced malignancies, significantly compromising quality of life. While clinical guidelines for pain management exist, real-world challenges such as polypharmacy, poor adherence, and drug-related problems (DRPs) hinder effective treatment. Pharmacist-led Medication Therapy Management (MTM) offers a structured approach to [...]
CONCLUSION: The KTA framework was a useful tool for implementing the pharmacist-led post-discharge medication review clinic, adapting and monitoring processes and improving knowledge of key stakeholders. Identified barriers and facilitators are relevant to implementing future clinic models. [...]
CONCLUSIONS: In this outpatient pain and palliative-care population, benzodiazepine-related dependence phenomena were common: 59.7% of patients met the criteria for dependence based on the pharmacist-led EMR review. The involvement of the pharmacist was essential, as this systematic evaluation would have been difficult to perform within routine medical consultations. The pharmacist's [...]
The management of hyperphosphatemia is of critical significance given its high prevalence among hemodialysis (HD) patients and its strong association with worse outcomes. Clinical pharmacists can play a crucial role in medication management, but there is a critical shortage. Currently, there is rarely study evaluating how pharmacists in different roles [...]
CONCLUSION: Patients and clinicians were generally supportive of potential pharmacist prescribing in the hemodialysis unit, contingent on several considerations for implementation. Interviews with additional stakeholders in other dialysis care settings could further inform strategies for broader adoption. [...]