搜索结果：Exploratory research in clinical and social pharmacy

Despite the critical need for effective healthcare in internally displaced persons (IDP) camps in Ethiopia, a significant gap exists between the demand for and the actual provision and management of essential medicines. This challenge is rooted in systemic failures across the medicine supply chain and utilization practices, directly compromising the health and well-being of a highly vulnerable population. This study, therefore, explored the challenges and best practices related to essential medicines supply and use in IDP camps in Ethiopia. An exploratory qualitative study was conducted among key informants, including healthcare providers, IDP site coordinators, representatives from donor organization and health bureue, and patients from selected IDP camps. Participants were purposively selected to capture diverse perspectives relevant to essential medicine supply and use. The contact information of all potential key informants was obtained through official camp records, IDP camp team leaders, and referrals from key stakeholders. Data were collected through in-depth interviews and analyzed thematically using OpenCode software. The investigator conducted in-depth interviews with 17 key informants. Analysis identified 22 sub-themes grouped under 13 main themes. Key challenges identified included fragile supply chains and procurement process, persistent stock-outs, limited availability, inadequate storage and transportation, weak information management and reporting practices, financial constraints, donor-driven priorities, irrational prescribing and dispensing, fragmented service delivery, poor supervision and accountability mechanisms, and patient and community-level practices such as medicine sharing, self-medication, and incomplete adherence. Best practices that mitigated these challenges included patient identification initiatives, medicine-shifting systems, centralized distribution and cluster-level coordination, structured reporting, strategic allocation, and partnerships between humanitarian actors. Ensuring sustainable access to essential medicines in IDP camps requires integrated strategies that strengthen supply chain resilience, promote rational medicine use, and actively engage communities. Contextually adapted best practices can enhance equitable access, improve treatment adherence, and support the resilience of health systems in protracted IDP camps.

Patients' perceptions of medication significantly influence therapeutic outcomes, particularly among individuals with Acute Coronary Syndrome (ACS). The Beliefs about Medicines Questionnaire (BMQ) is a widely utilized instrument for evaluating patients' beliefs regarding their medications. However, a validated, culturally relevant, and linguistically accurate Indonesian version of the BMQ is currently unavailable. The absence of such adaptation restricts the tool's effectiveness in assessing beliefs among post-ACS patients in Indonesia, where these beliefs may substantially impact treatment adherence and clinical outcomes. Therefore, translation, validation, and cultural adaptation of the BMQ are essential to ensure its accuracy in evaluating patient beliefs within the Indonesian context. To develop and validate an Indonesian version of the BMQ questionnaire, ensuring its linguistic and cultural appropriateness for use specifically among post-ACS patients in Indonesia. This validated version is crucial for regions with a high burden of cardiovascular disease, where belief patterns can inform tailored adherence interventions. This cross-sectional study was conducted with post-acute coronary syndrome (ACS) patients who received treatment in June and July 2025 at two hospitals in Makassar, South Sulawesi, Indonesia. We adhered to the established guidelines for forward-backward translation and recruited 96 post-ACS outpatients. The inclusion criteria encompassed individuals aged ≥18 years who had been diagnosed with ACS, had undergone therapy for a minimum of six months, and had provided written consent to participate. The psychometric evaluation by Horne et al., comprised confirmatory factor analysis, item-total validity assessed through Pearson correlation, internal consistency measured using Cronbach's alpha, and inter-rater reliability. The Indonesian-translated BMQ instrument was tested for validity and reliability among 96 post-ACS patients. All 18 items demonstrated strong validity with r-count values exceeding the r-table threshold (0.1996). Cronbach's alpha values were all ≥0.750 across domains, indicating high overall reliability. Pilot feedback prompted minor wording refinements to enhance clarity and cultural resonance. These results confirm that the instrument reliably measures patient beliefs about medicine in this population. The psychometric properties of the Indonesian version of the BMQ align with those documented in the original study. Our findings indicate that the Indonesian adaptation of the BMQ is a valid and reliable instrument for evaluating treatment-related beliefs in patients with post-acute coronary syndrome (ACS) in South Sulawesi, Indonesia. However, further psychometric assessments are necessary to confirm its broader applicability across different regions and patient populations, particularly in population-based studies and routine pharmacy practice settings.

Irrational antibiotic use remains a critical challenge in clinical pharmacy practice, driving antimicrobial resistance. Large language models (LLMs) are increasingly explored as tools to support medication use processes, yet their practical utility in antimicrobial stewardship-particularly in prescription evaluation-remains underexamined. This cross-sectional study aimed to explore the potential of three mainstream Chinese LLMs (DeepSeek, DouBao, Qwen) as auxiliary tools in rational antibiotic use, focusing on their performance in both knowledge-based and practice-based pharmacy tasks. A dual-framework evaluation was conducted. First, a standardized 100-point examination based on national antimicrobial guidelines assessed the models' foundational knowledge relevant to clinical pharmacy. Second, 20 real-world outpatient antibiotic prescriptions with documented irrational issues were analyzed by each model. Responses were independently evaluated by two clinical pharmacists using a five-point scoring scale. Inter-rater agreement was assessed using Cohen's weighted Kappa. In the standardized examination, the models achieved an average score of 86.0 ± 2.0 points, with relatively lower performance in empirical therapy modules. In the clinical prescription analysis, the average score was 92.3 ± 3.5 points (range: 89-96), with good inter-rater consistency (Cohen's weighted Kappa = 0.89). All models demonstrated stronger performance in identifying clinical logic contradictions than in handling institution-specific compliance rules. Mainstream Chinese LLMs show promising potential as exploratory AI in antimicrobial stewardship, particularly in supporting prescription logic review within the medication use process. Their stronger real-world performance supports human-AI collaboration. Future work should focus on integrating these tools into clinical workflows as auxiliary screening aids.

Polypharmacy is common in older adults and, independent of underlying multimorbidity, is associated with adverse drug events, reduced quality of life, and increased healthcare use. Deprescribing can help address these issues. Pharmacists can identify deprescribing opportunities during clinical medication reviews (CMRs), and guidelines may support this process. However, their impact depends on successful implementation. To identify determinants relevant for the implementation of this deprescribing guideline based on CPs' experiences with its use in clinical practice. Online focus groups were held with community pharmacists from the intervention group of a cluster randomized trial evaluating guideline-assisted deprescribing during CMRs in older patients with hyperpolypharmacy (≥10 medications). Pharmacists received training on the guideline and its drug-specific fact sheets. The topic guide was informed by the Tailored Implementation for Chronic Diseases (TICD) checklist. Transcripts were deductively coded and analysed thematically. Nineteen of 24 eligible pharmacists participated in three focus groups. Across seven TICD domains, 26 determinants were identified. There were few barriers related to the guideline itself, with pharmacists appreciating the layered structure and summaries and applicability of recommended interventions. At personal level, their ability to identify deprescribing opportunities and to monitor clinical outcomes was considered relevant. . At patient level, barriers included limited knowledge and ambivalent attitudes. Key influences regarding professional interaction included general practitioners' familiarity with deprescribing, clarity of task allocation, and interprofessional trust. Regarding resources insufficient reimbursement, and lack of integrated decision support were reported as barriers. Drug-specific fact sheets support deprescribing but do not fully address the complexity of decision-making in practice. Implementation is influenced by clinical uncertainty, experience, interprofessional collaboration, and organisational factors. Strengthening decision support, collaboration, and organisational conditions is essential for sustainable implementation.

Pharmacist prescribing in cardiology is influenced by clinical expertise, organizational structures, and expanding scopes of practice. Although international models highlight the value of pharmacist prescribers, limited evidence describes how prescribing is experienced within cardiology pharmacy practice. This study examined the prescribing potential, contextual conditions, and motivations of clinical pharmacists as part of continuing professional development. An interview-based qualitative design informed by collective autoethnography was used to situate researchers' professional experiences and reflections. Data were derived from retrospective reflections of clinical pharmacists and a pharmacy student working within an academic health system in the United Arab Emirates (UAE). Reflexive thematic analysis, guided by Braun and Clarke's six-phase approach, was conducted with iterative reflexivity and theoretical integration. Twelve themes were generated from 155 coded excerpts and grouped into three domains: what pharmacists do when prescribing, when prescribing occurs, and why prescribing is undertaken. Prescribing activities included patient assessment, dose adjustment, and initiation of evidence-based cardiovascular therapies. Key enabling conditions were specialized training, interprofessional trust, and collaborative care structures. Motivations centered on enhancing autonomy, improving timely medication optimization, and achieving meaningful patient outcomes. Pharmacist prescribing in cardiology is a clinically grounded and collaborative practice that suggests potential to support timely therapeutic decisions and reduces treatment inertia. Insights from this insider perspective underscore the need for structured prescribing pathways, advanced training, and supportive regulatory frameworks to enable pharmacists to practice at their full scope.

Tuberculosis (TB) and diabetes mellitus (DM) are major global health concerns that frequently coexist, particularly in low- and middle-income countries. This dual burden negatively affects disease progression and outcomes. The patient care interventions have demonstrated benefits in chronic disease management. However, interventions designed specifically for individuals with TB-DM co-morbidity remain poorly understood. To systematically review the impact of patient care interventions on clinical, humanistic, and treatment outcomes among TB-DM patients. A comprehensive literature search was conducted in PubMed, Embase, and Scopus from inception to April 2025. Interventional studies evaluating the effects of patient care interventions in adults with TB-DM comorbidity were included. Outcomes were categorized as clinical (e.g., glycemic control), humanistic (e.g., patient knowledge, adherence), and treatment-related (e.g., TB treatment success). The risk of bias was assessed using the Cochrane risk of bias tool. A narrative synthesis was performed due to heterogeneity in interventions and outcomes. Three randomized controlled trials (RCTs) conducted in Malaysia and Indonesia between 2021 and 2023 met the inclusion criteria. Interventions included structured patient educational counselling, glucose monitoring, and medication adherence support. Two studies observed improved glycemic control, while all reported enhanced patient knowledge and adherence. Only one study reported TB treatment outcomes, showing improved cure and success rates following the intervention. The overall risk of bias was low to moderate. The evidence suggests that patient care interventions may improve clinical and humanistic outcomes, as well as potentially treatment outcomes, in patients with TB-DM comorbidity. These findings support the integration of structured patient support strategies into multidisciplinary care models for TB-DM comorbidity. Further large-scale, multicenter trials are needed to validate these findings and assess long-term impact.

Independent Prescribing Practice (IPP) by pharmacists has been internationally recognized as an effective strategy to improve healthcare access, optimize medication use, and reduce physician workload. This review aimed to examine pharmacists' awareness, readiness, attitudes systematically, and perceived barriers and facilitators toward implementing IPP in selected Middle Eastern countries. A systematic review followed the PRISMA 2020 guidelines for conducting and reporting systematic reviews and the Cochrane Handbook guidelines. PubMed, Web of Science, regional journals, and the grey literature published between 2015 and 2025 was systematically searched using predefined keywords related to pharmacist prescribing. Eligible studies were quantitative, peer-reviewed (qualitative studies were excluded), and focused on pharmacists' readiness or perceptions of IPP in the Middle East. Data on study characteristics, awareness, readiness, barriers, and facilitators were extracted and synthesized descriptively. Nine cross-sectional studies from Saudi Arabia, Jordan, and the United Arab Emirates (UAE), involving pharmacists, were included in this analysis. Pharmacists demonstrated high readiness and positive attitudes toward IPP, acknowledging its potential to enhance patient access and improve healthcare efficiency. However, implementation remains limited by the absence of legal frameworks, insufficient diagnostic training, and weak interprofessional collaboration. Identified facilitators included national health reforms, professional development initiatives, and institutional support for expanding clinical roles. Pharmacists in Saudi Arabia, Jordan, and the UAE demonstrate readiness to adopt independent prescribing; however, evidence is limited to these countries and cannot be generalized to the wider Middle East. Structural, regulatory, and educational barriers persist, highlighting the need for context-specific policy and training frameworks.

As in adult care, pediatric patients experience transitions in their care trajectory, such as transfers to intensive care units (ICUs) during episodes of clinical deterioration. In pediatric onco-hematology, the administration of Chimeric Antigen Receptor (CAR) T-cell therapy often necessitates several days of ICU admission for post-infusion monitoring. As a result, systematic collaboration between pediatric onco-hematology and intensive care teams is becoming standard for these advanced therapies. This study aimed to explore healthcare professionals' perceptions, experiences, and practices related to medication management during transitions of care between pediatric onco-hematology and ICU settings. Semi-structured interviews were conducted with healthcare professionals from both specialties. Transcripts were analyzed using a manual inductive approach. Twenty-four healthcare professionals participated (14 ICU, 10 onco-hematology). Themes emerged: (1) the clinical complexity of onco-hematology patients, (2) technical and logistical barriers (e.g., software incompatibility, clinical transfers, medication transfer), (3) the specific involvement of parents in pediatric care. Emergency ICU admissions were identified as the highest-risk transfer for medication-related adverse events. Improvements included three essential areas: information diffusion especially improving written one and verbal nursing transmissions, implementing trainings and practices standardization by instance for intravenous medications. Clinical pharmacists can help in those improvement areas and so need to be implemented in pediatric ICU and work on those transitions to reduce medication errors. These findings underscore the need to optimize medication safety during care transitions. Strategic efforts such as interdisciplinary collaboration, standardized protocols, and pharmacist involvement can help reduce risks and improve outcomes.

Scholarly productivity is central to academic advancement, institutional benchmarking, and accreditation in pharmacy education. This study evaluated the national scholarly productivity among non-pharmacy practice (NPP) faculty in U.S. schools and colleges of pharmacy and assessed variation in publication output across faculty and nppinstitutional characteristics. A retrospective bibliometric analysis was conducted between January 2019 and December 2023. Faculty were identified using the American Association of Colleges of Pharmacy Roster of Faculty and Professional Staff and classified as biomedical and pharmaceutical sciences (BPS) or social and administrative sciences (SAS). Publications were retrieved from Web of Science and characterized by type and scope. The analysis included 1613 NPP faculty from 142 U.S. schools and colleges of pharmacy. The mean annual publication rate was 3.43 ± 4.35 per faculty member (median 2; IQR 0.8-4.6). Publication productivity was skewed, with 15% of faculty producing 50% of all publications. BPS faculty demonstrated higher productivity (median 2.8; IQR 1.0-7.8) than SAS faculty (median 1.8; IQR 0.6-4.2). Original research articles comprised 67.7% of publications, followed by meeting abstracts/proceedings (16.6%) and narrative reviews (8.9%). Most publications were BPS-focused (72.5%), followed by SAS/health economics and outcomes research/clinical trials (25.5%) and scholarship of teaching and learning (2.1%). Increased publication productivity was noted among senior academic ranks, at public institutions, within health science center-affiliated schools, and at institutions offering graduate programs and receiving higher levels of extramural funding. These findings provide contemporary national benchmarks for NPP scholarly productivity and highlight the influence of faculty and institutional characteristics on publication output.

Ketamine has been previously administered as an anesthetic but recently gained importance as an analgesic in pediatric oncology. Despite its efficacy, continuous intravenous administration to children with cancer is interrupted when other essential drugs require infusion. This occurs because its compatibility with many drugs and lipid emulsions is unknown, causing inadequate pain management and patient discomfort. This study has assessed the physicochemical compatibility and stability of ketamine with selected drugs, based on usage frequency data, and lipid emulsion formulations administered to pediatric cancer patients at tertiary hospitals. Physicochemical compatibility of ketamine involved admixture with selected concentrations of drugs, for physical incompatibility. Admixtures of ketamine with lipid emulsions and the other drugs included determining ketamine's chemical concentration using high performance liquid chromatography (HPLC). Particle size analysis investigated lipid stability. The HPLC assay was linear over a range of concentrations (0.05 mg/mL - 0.5 mg/mL), validated under forced degradation conditions causing no interferences and an intra- and inter-day precision less than 2%. Ketamine was highly stable with all drugs and lipid emulsions tested, retaining >90% of its concentration for all systems investigated for two hours. No additional physical incompatibility occurred., but amoxicillin incompatibility was confirmed. Lipid emulsion stability was maintained, with no system exceeding particle size limits. Ketamine is safe to co-administer with AmBisome®, cyclizine, hydromorphone, Intralipid®, magnesium sulfate, metoclopramide, micafungin, potassium dihydrogen phosphate, sodium dihydrogen phosphate and vancomycin. Our findings are significant for improving pain management in vulnerable patients simultaneously administered the tested drugs with ketamine.

Inappropriate antibiotic use is a major driver of antimicrobial resistance and adverse clinical outcomes. Evidence on its pooled prevalence and determinants among hospitalized patients in Ethiopia remains scarce. Therefore, this study aimed to estimate the pooled prevalence of inappropriate antibiotic use and associated factors among hospitalized patients in Ethiopia. This systematic review and meta-analysis was reported in accordance with the PRISMA statement and registered in PROSPERO (CRD420261379594). A comprehensive literature search was conducted from December 5 and December 19, 2025. Electronic databases including PubMed/MEDLINE, Embase, ScienceDirect, Scopus, and PsycINFO were systematically searched. In addition, supplementary platforms and grey literature sources including Google Scholar, ResearchGate, and HINARI were explored to identify relevant studies. Data were extracted using Microsoft Excel and analyzed using Stata version 14.0. A random-effects model was employed to estimate the pooled prevalence, and heterogeneity was assessed using the I2 statistic. Subgroup analysis, sensitivity analysis, and assessment of publication bias were also performed. Twelve primary studies were included. The pooled prevalence of inappropriate antibiotic use among hospitalized patients in Ethiopia was estimated at 40.50% (95% CI: 24.88-56.16). However, this estimate should be interpreted with caution due to the very high heterogeneity observed across studies (I2 = 99.5%). Inappropriate indication (26.2%) and incorrect duration of therapy (24.65%) were the most common forms of inappropriateness. Comorbid conditions (OR = 3.46; 95% CI: 2.79-4.28) and multiple medication co-prescription (OR = 2.98; 95% CI: 2.31-3.84) were significantly associated. The pooled prevalence of antibiotic utilization among hospitalized patients was 59.42% (95% CI: 48.76-70.07). Empirical therapy accounted for 93.26% of prescriptions, while culture and sensitivity testing was performed in only 17.7% of cases. The mean number of antibiotics prescribed per patient was 1.95. Metronidazole, cephalosporin, and penicillin were the most commonly prescribed antibiotics. Inappropriate antibiotic use among hospitalized patients in Ethiopia appears to be high and may be associated with empirical prescribing, limited diagnostic confirmation, comorbidities, and polypharmacy. Strengthening antimicrobial stewardship, and adherence to treatment guidelines is urgently needed.

Growing medicine use raises environmental concerns due to pharmaceutical residues, which can be mitigated through proper household disposal. This study investigated household practices and background factors related to the proper disposal of unnecessary and expired medicines in Finland. Using the extended Theory of Planned Behavior (TPB), the study also explored psychosocial factors influencing individuals' intention and behavior regarding proper medicine disposal. An online survey was conducted among loyalty customers of the University Pharmacy in 2023. The data were analyzed using frequencies, Chi-Square tests, and Structural Equation Modeling (SEM) based on the extended TPB. The final data included 5004 respondents. Most households reported returning unnecessary (84.7%) and expired (97.6%) medicines to pharmacies or designated collection points, while 33.5% retained unnecessary medicines for potential future use. Key factors influencing disposal practices included age, education, chronic illness, and recycling habits. SEM revealed that personal norms, perceived behavioral control, situational factors, and subjective norms significantly influenced disposal intentions, while intention, situational factors, and perceived behavioral control directly affected disposal behavior. While proper medicine disposal is common in Finnish households, further improvement is needed, particularly regarding unnecessary medicines. The findings highlight the need for ongoing communication and easy-to-use and time-effective disposal solutions. Communication should be designed to engage both the rational and emotional dimensions of medicine users and appeal to moral values, such as sense of duty and responsibility. Communication should specifically target groups less engaged in proper disposal, such as younger individuals and those without chronic conditions.

Effective verbal medication counselling is crucial for patients' understanding, medication adherence, and treatment outcomes. In linguistically diverse populations, language barriers can pose a significant challenge, when older patients prefer to receive information in languages other than English. To assess pharmacy staff's self-efficacy in providing medication counselling to older adults in Singapore's four official languages (English, Mandarin [Chinese], Malay and Tamil) and other Chinese dialects. We conducted a cross-sectional survey among 121 pharmacy staff working in public primary care clinics. Respondents reported the languages or dialects they used when counselling older patients (aged 60 and above) and completed a six-item self-efficacy scale (1-5, higher scores indicate greater self-efficacy) for each language or dialect, covering aspects of greeting patients, explaining medication information and explaining serious health risks. Mean (± standard deviation) self-efficacy scores were 4.5 ± 0.6 for English, 3.7 ± 1.0 for Mandarin, 3.4 ± 1.3 for Malay, 4.5 ± 0.9 for Tamil, and between 3.0 and 3.1 (±0.9-1.0) for other Chinese dialects. Across all languages or dialects, the least self-efficacy was in explaining serious health risks. Pharmacy staff exhibited lower self-efficacy counselling in official languages other than English and in other Chinese dialects, highlighting a potential care gap. The findings underscore the need for targeted language support for pharmacy staff to enhance communication among ageing, multilingual populations, such as in Singapore.

Cancer genome medicine grounded in genetic alterations is advancing worldwide, with comprehensive genome profiling (CGP) now routinely implemented in Japan. Although the role of pharmacists in cancer genome medicine remains unclear, they may serve as trusted sources of CGP-related information, potentially enhancing patient health literacy and supporting informed decision making. This study evaluated whether pharmacists providing CGP information earlier than the completion of standard therapy affects patient decision making. Using treatment intent as a stratification factor, participants were randomly allocated 1:1 to nonintervention or intervention groups, in which pharmacists delivered only standard medication counseling as in usual practice or additionally provided structured information regarding CGP, respectively. The primary endpoint was the proportion of patients demonstrating reduced Decisional Conflict Scale (DCS) scores before and after pharmacist interviews, 2-6 weeks follow-up interval. Secondary endpoint analysis explored factors associated with patient decision making. Data from 180 patients were included in the final analysis. The proportion of patients with decreased DCS scores did not differ significantly between the intervention and non-intervention groups (49.4% vs. 41.9%; p = 0.31). However, while decisional conflict regarding treatment selection increased in both groups, the amplitude of this increase was significantly lower in the pharmacist intervention group, with mean DCS scores rising by only 1.98 ± 16.5 compared to 3.61 ± 17.3 in the non-intervention group (p = 0.0261). In conclusion, although early pharmacist-led information provision did not change the overall proportion of improved patients, it successfully limited the rise of decisional conflict amplitude. These findings demonstrate that pharmacists can play an active, valuable role in supporting patients for cancer genome medicine-related patient decisions.

Telepharmacy has the potential to improve access to pharmacy services in both rural and urban settings. However, limited studies have examined differences in patients' perspectives between these populations. This study assessed patients' expectations, willingness to use (WTU), and willingness to pay (WTP) for telepharmacy, and identified determinants of expectations. A cross-sectional survey was conducted among patients attending community pharmacies in rural and urban areas in Indonesia. Data were collected using a validated self-administered questionnaire assessing sociodemographic, expectations, WTU, WTP, and preferred telepharmacy services. Expectation scores were compared using the Mann-Whitney U test, and determinants were examined using multiple linear regression. A total of 405 patients were included (204 rural; 201 urban). Rural patients reported significantly higher expectations toward telepharmacy than urban patients (mean rank 223.08 vs. 182.62, p&#xa0;<&#xa0;0.001). No sociodemographic factors were associated with expectations in rural areas. In urban areas, older age (B&#xa0;=&#xa0;-0.14, p&#xa0;<&#xa0;0.001) and lower household income (B&#xa0;=&#xa0;3.41, p&#xa0;=&#xa0;0.007) were associated with lower expectations. WTU was reported by 68.1% of rural and 91.5% of urban patients (p&#xa0;<&#xa0;0.001). WTP was higher in rural areas (99.3%; most common amount IDR 10,000 [USD 0.64]) than in urban areas (92.4%; most common amount IDR 15,000 [USD 0.96]). Drug counseling was the most preferred service in both groups. Urban patients showed greater willingness to use telepharmacy, whereas rural patients demonstrated higher expectations and willingness to pay. These findings highlight the need for patient-centered and financially sustainable telepharmacy models tailored to population differences.

The global shift toward patient-centered clinical pharmacy services is governed by Good Pharmacy Practice (GPP) standards. However, implementing these in low-middle income countries (LMICs) remains challenging due to resource and infrastructure constraints. This study aimed to implement GPP standards at a central tertiary hospital using the Plan-Do-Study-Act (PDSA) cycle. A prospective, interventional quality improvement study was conducted at a tertiary care central hospital over five months. Intervention included functional decentralization of services, development of 21 Standard Operating Procedure (SOPs) using the ALCOA+ framework, and staff training. Four longitudinal audits were performed using an expanded 125-indicator Department of Drug Administration (DDA) checklist. Root cause analysis (RCA) via the "5 Whys" technique addressed implementation barriers. Overall median GPP compliance increased from 57.1% (IQR: 25.0%-77.8%) to 100.0% (IQR: 100.0%-100.0%) by final audit (p&#xa0;<&#xa0;0.0001). High-compliance domains rose from 17.6% to 88.2%. The Hodges-Lehmann estimator indicated a median improvement of 43.7% (95% CI: 22.2% - 62.5%). Qualitative analysis revealed that documentation gaps were rooted in ergonomic friction rather than incompetence; relocating logbooks to dispensing counters resolved these issues. A ceiling effect was observed in store management (91.7% compliance) due to fixed architectural constraints. The PDSA model is an effective framework for driving rapid quality improvement in resource-limited pharmacy settings. Success was achieved not only through procedural changes but by transitioning staff culture from a "money-driven" mindset to "professional ownership". This study provides a scalable roadmap for GPP implementation and suggests that national audit tools should adopt tier-specific indicators for tertiary facilities.

Advances in hematologic malignancy treatment have improved survival, but patients often experience treatment-related toxicities. Traditional clinical follow-up often overlooks the patient's subjective experience, highlighting the need for integrated patient-reported outcome measures (PROMs). The primary objective of this study was to describe the design and implementation of the SiMON-PRO-Hematology&#xae; system, a comprehensive information tool supporting the pharmacotherapeutic follow-up of patients with hematological malignancies. A secondary objective was to detail the process for PROM collection. SiMON-PRO-Hematology was designed by a multidisciplinary team of pharmacists, hematologists, nurses, and software engineers. This group defined the functional requirements of the system, as well as the demographic, clinical, laboratory, and pharmacotherapeutic variables and disease-specific PROMs relevant to hematologic malignancies. The system was structured into three main areas: Clinical care (assistance), management, and research. No primary data were collected; therefore, ethical approval was not required. SiMON-PRO-Hematology automates PROM collection via tablet devices completed independently by patients. The platform integrates PROMs with baseline clinical data and laboratory results, generates real-time alerts, and supports structured pharmaceutical interventions. Business intelligence tools enable analysis of patient evolution, treatment adherence, and cohort comparisons. Implementation allows standardized, longitudinal follow-up, enhancing detection of safety and effectiveness signals while streamlining workflows and minimizing documentation duplication. Unlike existing tools, SiMON-PRO-Hematology integrates independently reported PROMs within a broader, adaptable monitoring system tailored to diverse hematologic malignancies. This approach ilustrates how a fully integrated digital platform is designed to potentially enhance the quality and efficiency of pharmaceutical care, providing a technical framework to support proactive interventions, longitudinal monitoring, and patient-centered outcomes.

The global pharmacy workforce is witnessing a transition from focusing on medication dispensing to patient-centered clinical care. This transition demands a similar change in the workforce, especially in leadership. However, leadership in pharmacy relies significantly on role-based management instead of evidence-based behavioural models. This narrative review synthesized contemporary behaviour focused leadership models - transformational, authentic, servant and distributed leadership, and their effects on pharmacy workforce motivation, innovation and professional performance. A narrative literature review was conducted by integrating interdisciplinary evidence extracted from pharmacy, healthcare and leadership literature. Two models are suggested for empirical testing in future studies to replace existing valid frameworks. A narrative literature review was conducted by searching published literature from 2000 to the present in MEDLINE, PsycINFO, Web of Science and Scopus. It's no longer sufficient for pharmacy leadership to continue to engage in a transaction - based management approach. Contemporary leadership behaviour has exhibited a tendency to fulfil pharmacy workers basic psychological needs (autonomy, competence, relatedness), as defined by self-determination theory (SDT). Evidence suggests that contemporary leadership behaviours are associated with reduced burnout, increased resilience, and enhanced climates of innovation. The pharmacy profession should view leadership as more than a soft skill or a management position and instead frame it as a primary behavioural competency. Two conceptual heuristic models are offered here to further guide empirical research, education and leadership training, given the current lack in evidence.

This study investigated the practices of community pharmacists regarding two minor ailments, headache and insomnia, using a simulated patient (SP) method in Karaj, Iran. A trained pharmacy student, acting as an SP, visited pharmacies presenting with complaints of either headache or insomnia. Each simulation consisted of three steps: in Step 1, the SP explained the symptoms and waited for the pharmacist's recommendations; in Step 2, the SP requested medications; and in Step 3, the SP insisted on obtaining prescription-only drugs. A total of 200 pharmacies were surveyed; 100 were assigned to the headache scenario and 100 to the insomnia scenario. In the headache scenario, which required a referral to a physician, the pharmacists asked 26.4% of the patient history questions and addressed 9.4% of the physician referral criteria. Only 29 pharmacists (29.0%) referred the SP to a physician/imaging. Male pharmacists dispensed more prescription-only medications than female pharmacists (p&#xa0;=&#xa0;0.03), whereas females were more likely to refer the SP to a physician (p&#xa0;=&#xa0;0.02). In the insomnia scenario, which could be treated with nonprescription medications, the pharmacists asked 11.6% of the patient history questions and addressed 11.0% of the referral criteria. The most common recommendations in the first step were melatonin (52.0%), nonpharmacological interventions (18.0%), and herbal medicines (10.0%). Most pharmacists failed to obtain an adequate patient history, including physician referral criteria. In addition, the dosage, duration of therapy, and potential adverse drug reactions were not communicated to patients in most cases. The community pharmacists in this study demonstrated substantial deficiencies in history taking, contraindication screening, and patient counseling. These findings underscore the urgent need for targeted educational, regulatory, and practice-based interventions to enhance the quality and safety of over-the-counter care in Iran.