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Objectives Pharmacists' contribution to medication therapy management in type 2 diabetes (T2D) is under-reported in Nigeria. This study evaluated the effectiveness of a pharmacy-based intervention on knowledge, pharmacy refills, medication adherence, and glycemic control among patients with T2D. Methods A two-arm prospective, randomized, controlled trial among 309 T2D patients over 25 weeks duration was conducted in a tertiary hospital. The intervention group (n = 155) received weekly health education and follow-up sent as phone-based short message service (SMS), alongside standard care. Control group (n = 154) received only standard care. Primary (HbA1c reduction) and secondary (refill adherence, knowledge, and medication adherence) outcomes were assessed and compared in both groups at baseline and endline. Key findings Intervention improved glycemic control (HbA1c reduction) directly (t = 8.253, P <.001) and indirectly through improved pharmacy refill adherence as 115 (76%) of the intervention group were refill adherent (Proportion of Days Covered [PDC] > 80%). For controls, mean baseline and endline knowledge scores were 2.798 and 2.816, respectively (t = 1.19092, P >.005), while the intervention group had 2.732 and 4.462, respectively (t = 9.76157, P <.005) on a 5-point Likert scale. Baseline and endline adherence scores for control group were 3.41 and 3.50, respectively (t = 0.92477, P >.05), while the intervention group had 3.35 and 6.72, respectively (t = 17.87981, P <.05) on the 8-point Morisky Medication Adherence Scale (MMAS-8). Conclusion Pharmacist-led intervention significantly improved medication refills, glycemic control, knowledge, and medication adherence. Pharmacists should exploit mobile telephony for health education and follow-up services to improve treatment outcomes in medication therapy management of T2D. [ABSTRACT FROM AUTHOR]

Background and Objectives There are growing numbers of older adults with long-term vision impairment who are likely to experience everyday activity challenges from their impairment in conjunction with age-related changes. Technology has potential to support activity engagement. To develop effective technologies and interventions, we need to understand the context of activity challenges and identify unmet support needs. Research Design and Methods The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study is a mixed-method approach to explore everyday challenges of people aging with long-term disabilities. Participants included 60 adults aging with long-term vision impairment (63% female; M age = 67, SD  = 4.6) who completed in-depth, structured interviews exploring the nature of everyday challenges and their unmet support needs for activity engagement. We conducted a content analysis using a deductive and inductive approach to build a detailed coding scheme of challenge codes and subcodes. Results The analyses provided detailed insights about the nature of challenges people aging with vision impairment experience when performing specific instrumental activities of daily living (IADLs) in the context of home maintenance, transportation, shopping/finance, and managing health. Vision-related challenges and participation restrictions were identified for several activities that require reading, navigation, and identification (e.g. shopping, medication management, public transportation). Emergent challenge themes for performing IADLs included personal limitations (e.g. physical, cognitive, financial) and environmental barriers (e.g. accessibility, technology, transportation). Discussion and Implications Contextual examples of IADL challenges among individuals aging with vision impairment highlight opportunities for technology design and innovation to support participation in everyday activities. [ABSTRACT FROM AUTHOR]

Background: Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time‐bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set‐up. Objectives: To explore the safety incident reporting behaviour and the barriers in a hospital set‐up. Methods: The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Results: Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter‐stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication‐related PSE has moderate risk prioritization gradation. Conclusion: Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed. [ABSTRACT FROM AUTHOR]

Following a national multicentre study, two emergency department (ED) screening tools were developed to determine risk of medication-related problems; one for use at ED presentation and another at ED discharge to the community. This study aimed to determine the inter-rater reliability amongst ED health professionals when applying these screening tools to a series of case scenarios. A prospective, cross-sectional study was undertaken in the ED of a major metropolitan hospital. Twelve case scenarios were developed following ED observation of a range of patients, which were incorporated into a questionnaire and distributed to 50 health professionals. Inter-rater reliabilities of each explanatory variable of the screening tools and overall assessment were calculated using Fleiss' multi-rater kappa. The questionnaire was completed by 15 doctors, 19 nurses and 16 pharmacists. Fleiss' kappa showed an overall inter-rater reliability for the ED presentation tool of 0.83 (95% CI 0.83–0.84), indicating near perfect agreement. Fleiss' kappa for the ED discharge tool was 0.83 (95% CI 0.83–0.85), which also showed near perfect agreement. The screening tools produced favourable inter-rater reliability amongst ED health professionals. These results have important implications for ensuring consistency of ED decision-making in screening patients at risk of developing medication-related problems. [ABSTRACT FROM AUTHOR]

This case report describes an exceptionally rare case in which a prior diagnosis of schizophrenia was later determined to be early-onset Fahr's disease, linked to a genetic mutation in the SLC20A2 gene. Initially, the patient exhibited symptoms resembling schizophrenia, including aggression and hostility, and was highly susceptible to medication side effects such as restlessness and Parkinsonism. Despite maintaining independent activities of daily living, his neurological examinations revealed hidden weakness on the left side. Following adjustments to the medication regimen, stability was achieved with residual psychotic symptoms under treatment with Risperidone 1.5mg/day, Valproic acid 1500mg/day, and Quetiapine 37.5mg/day. This case underscores the importance of conducting comprehensive imaging studies at the time of initial psychiatric diagnosis, regardless of the apparent typicality of the presentation. Additionally, it emphasizes the need for patience and adherence to the "Start Low and Go Slow" approach in medication management to minimize the risk of exacerbating psychiatric symptoms and aggression. [ABSTRACT FROM AUTHOR]

Background: The role of community pharmacists has evolved beyond the dispensing of medicines. The aim of this scoping review was to describe the interventions that expand the pharmacist's scope of practice within a community pharmacy setting and assess their effectiveness. Methods: We performed a scoping review to identify randomised controlled trials (RCTs), published worldwide from 2013 to 2024, which focused on interventions designed to expand pharmacists' scope of practice in the community. The review was undertaken in accordance with the Joanna Briggs Institute methodology for scoping reviews. To address the aim of this scoping review, the included RCTs were mapped to themes influenced by the Professional Practice Standards 2023 as developed by the Pharmaceutical Society of Australia: medication management, collaborative care and medication adherence. Results: Twelve studies demonstrated the potential to expand community pharmacists' scope of practice. Two RCTs resulted in no effect of the intervention. One RCT (conducted in Italy) led to an actual change to community pharmacists' scope of practice, with a statistically significant improvement in the proportion of patients with controlled asthma. Conclusions: On the whole, this scoping review synthesised the findings of peer-reviewed RCT studies that revealed expanding community pharmacists' scope of practice may result in improved patient outcomes, a reduced burden for the healthcare system, and greater productivity. [ABSTRACT FROM AUTHOR]

Purpose: To implement the Age-Friendly Health Systems (AFHS) 4Ms framework, focusing on Medication and its impact on Mobility, Mentation, and What Matters, within Hamad Medical Corporation in Qatar. Method: A quality improvement approach was used to implement, extend, and sustain the AFHS 4Ms framework at Hamad Medical Corporation. The Medication "M" was described as the use case to illustrate the impact of high-risk medications on Mobility, Mentation, and What Matters, using an evidence-based, interdisciplinary approach. Results: Implementation of the AFHS 4Ms framework revealed success in aligning multidisciplinary teams to prioritize patient-centered care and caregiver engagement. Through this collaboration, a process map, modified medication screening tool, documentation templates, and educational efforts were developed. Conclusion: Applying the AFHS 4Ms framework into health care settings is crucial to improve the care of older adults. Medication management is a cornerstone, involving interdisciplinary team input during screening and act phases to ensure proper medication prescribing and use in older adults. [Journal of Gerontological Nursing, 50(6), 6–9.] [ABSTRACT FROM AUTHOR]

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Identify the collaborations between authors, countries, and institutions, respectively, and explore the hot issues and prospects for research on hospital medication management. Materials and Methods: Publications on hospital medication management were retrieved from the Web of Science Core Collection. Bibliometric analyses were performed using CiteSpace 6.1.R3, HistCite 2.1, and VOSviewer 1.6.16. The network maps were created between authors, countries institutions, and keywords. Results: A total of 18,723 articles related to hospital medication management studies were identified. Rapid growth in the number of publications since 2017. The high papers were published in AM J HEALTH-SYST PH, while JAMA-J AM MED ASSOC was the most co-cited journal. Manias E and WHO ranked first in the author and cited author. There were active collaborations among the top authors. Bates DW was the key author in this field. The authors have active collaborations in adverse drug events, acute coronary syndrome, in-hospital major bleeding, and so on. The US was the leading contributor in this field. The UK, Australia, and China are also very active. Active cooperation between countries and between institutions was observed. The main hot topics included matters related to outcome indicators, hospital pharmacy service behaviors, and medication use in pain management. More recent keywords focus on chronic disease medication management and clinical medication management. Conclusion: Hospital medication management studies have significantly increased after 2017. There was active cooperation between authors, countries, and institutions. The application of hospital medication management in the emergency department and the relationship between medication management and medication adherence are current research hotspots. In addition, with the continuous progress of society, chronic diseases have become an important factor affecting people's health, and medication management is becoming more and more subdivided, so the direction of chronic disease medication management as well as precise medication may become the development direction of future research. [ABSTRACT FROM AUTHOR]

Introduction: Obesity and ADHD have become increasingly common diagnoses. In the last decade, research has found that there is a high prevalence of obesity in patients with ADHD. The mainstays of management in the general population include lifestyle modifications, pharmacotherapies, and/or bariatric surgery. However, there is a lack of understanding of appropriate management of patients with both ADHD and obesity. Methods: We identified those with obesity for at least five consecutive years (BMI > 30) in the TriNetX database before separating into two groups based on the presence or absence of ADHD. We assessed both the distribution of treatment modalities and the change in average BMI over time in each of our four groups across 5 years. Results: Average BMI decreased over time in all groups, with the smallest change seen in the ADHD Pharmacology cohort (− 0.366 kg/m2) and the largest in the ADHD Surgery group (− 8.532 kg/m2). Average BMIs at the 5-year mark were significantly different. Conclusion: Our research found that pharmacological management of individuals with ADHD was only half as effective for individuals with ADHD than our control. Though surgical management of patients with ADHD is roughly 20 times more effective in managing obesity, it was not used as frequently in comparison to medication for management of weight. [ABSTRACT FROM AUTHOR]

Connected healthcare is a form of health delivery that connects patients and providers through connected health devices, allowing providers to monitor patient behavior and proactively intervene before an adverse event occurs. Unlike the costs, the benefits of connected healthcare in improving patient behavior and health outcomes are usually difficult to determine. In this study, we examine the efficacy of a connected health system that aimed to reduce readmissions through improved medication adherence. Specifically, we study 975 patients with heart disease who received electronic pill bottles that tracked medication adherence. Patients who were nonadherent received active social support that involved different types of feedback, such as text messages and calls. By integrating data on adherence, intervention, and readmission, we aim to (1) investigate the efficacy of connected healthcare in promoting medication adherence, (2) examine the relationship between medication adherence and readmission, and (3) develop a dynamic readmission risk-scoring model that considers medication adherence and use the model to better target nonadherent patients. Our findings suggest that patients are more likely to become adherent when they or their partners receive high levels of intervention that involve personalized feedback and when the intervention is escalated quickly and consistently. We also find that long-term adherence to three common heart medications is strongly associated with reduced readmission risk. Lastly, using counterfactual simulation, we apply the dynamic readmission risk-scoring model to our setting and find that, when using an intervention strategy that prioritizes high-risk patients, we obtain 10% fewer readmissions while using the same effort level from the patient support team. This paper was accepted by Jayashankar Swaminathan, operations management. Funding: The randomized, controlled trial was funded by the Center for Medicare & Medicaid Innovation [Healthcare Innovation Award 1C1CMS331009]. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.4865. [ABSTRACT FROM AUTHOR]

Background Patient-related factors and limited medication adherence in patients with chronic diseases, are associated with poor clinical outcomes, long-term complications, and increased overall disease costs. Many methods have been tested with mixed results, and innovative approaches are needed to encourage patients to adhere to their prescribed drug regimens. Methods This randomised controlled trial examined a new multifactorial pharmacist-led intervention protocol (MPIP), including a medication therapy management (MTM) program with face-to-face counselling, patient-specific medication booklets, and a mobile application, from July 2021 to September 2022 in the Oud Al Touba diagnostic and screening ambulatory centre in 192 patients with type 2 diabetes in the United Arab Emirates. Medication adherence was assessed using the fixed medication possession ratio of medication refills and the medication adherence questionnaire. Results At 12 months follow-up, participants in the MPIP showed significant improvement in overall medication adherence with total (composite) medication possession ratio (MPRt) of mean (±SD) 0.95 (±0.09) compared to 0.92 (± 0.09) in the control group with mean difference of 0.03 (95%, CI 0.01–0.06), P =0.02. In addition, improvement trend was evident in the MPIP group for all medication regimens with P value

The article discusses a pilot study on collaborative management of specialty medications by a dermatologist and pharmacist. The study found that patients prescribed medications post-implementation were more likely to have their first-choice medication approved in a shorter time, with a decrease in time to first fill by almost a week. The close collaboration between the dermatologist and pharmacist, along with enhanced patient support, played a key role in the success of the program, showing potential benefits for clinical outcomes, patient satisfaction, and healthcare costs. The study acknowledges limitations in generalizability due to the focus on a single dyad and suggests further research to explore the program's impact on clinical outcomes. [Extracted from the article]

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

ObjectiveLanguage barriers during inpatient medication management can occur during medication reconciliation on admission and discharge, and during the hospitalization. Understanding inpatient clinicians' experiences with language barriers and use of interpreters can help inform interventions aimed at improving medication management with Limited English Proficient (LEP) patients. Our objective was to examine clinicians' experiences with language barriers around inpatient medication management.MethodsWe used semi-structured interviews with pharmacist technicians, pharmacists, nurses, and physicians working in a tertiary care hospital. We used the constant comparison method to guide data collection and analysis.ResultsWe interviewed 14 providers. Nurses and physicians perceived lack of time to use formal interpreters, particularly during busy or night shifts. Clinicians strongly preferred virtual and in-person interpreter services over telephonic services, and highlighted communication challenges with patients with low health literacy, concerns about the quality of interpretation, and inconsistencies in the use of translated materials.ConclusionsEnsuring access to formal interpreters during all shifts, translation of materials into the patient/caregiver's language, and access to in-person/virtual services would improve quality of care for LEP patients.Practice implicationsCurrent laws require use of interpreters, but do not provide for their reimbursement, resulting in suboptimal use. Reimbursement for interpreter services may increase their availability.

Saskia Herrmann,1,2 Jana Giesel-Gerstmeier,1 Thomas Steiner,3,4 Florian Lendholt,5 Dominic Fenske1 1Hospital Pharmacy, Helios Kliniken GmbH, Berlin, Berlin, Germany; 2Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, Jena, Thuringia, Germany; 3Department of Urology, Helios Klinikum Erfurt, Erfurt, Thuringia, Germany; 4Medicine, HMU Health and Medical University Erfurt, Erfurt, Thuringia, Germany; 5Management, Helios Klinikum Erfurt, Erfurt, Thuringia, GermanyCorrespondence: Dominic Fenske, Hospital Pharmacy, Helios Kliniken GmbH, Friedrichstraße 136, Berlin, Berlin, 10117, Germany, Tel +49 361 781 71100, Fax +49 361 781 71105, Email dominic.fenske@helios-gesundheit.dePurpose: The shortage of nursing staff as well as the slow progress in the German health care system’s digitalisation has gained much attention due to COVID-19. Patient-specific medication management using the unit-dose dispensing system (UDDS) has the potential for a lasting and positive influence on both digitalisation and the relief of nursing staff.Methods: Nursing staff UDDS-acceptance was determined via a validated online survey. For the evaluation of stock keeping on the wards, the delivery quantities were determined for a comparative period before and after the introduction of the UDDS. The time required for on-ward medication-related processes on ward before and after the introduction of UDDS was recorded based on a survey form and the nursing relief in full-time equivalent (FTE) was calculated using the data obtained.Results: We show that nurses appreciate the UDDS and confirm a significant reduction in drug stocks on the wards. The UDDS reduces the time needed to dispense medications from 4.52 ± 0.35 min to 1.67 ± 0.15 min/day/patient. In relation to the entire medication process, this corresponds to a reduction of 50% per day and per patient. Based on 40,000 patients/year and a supply of 1,125 beds with unit-dose blisters, 7.36 FTE nursing staff can be relieved per year. In contrast, 6.5 FTE in the hospital pharmacy are required for supplying the hospitals.Conclusion: UDDS is well accepted by nurses, reduces stock levels on ward, and fulfils criteria as a nursing-relief measure.Keywords: unit dose drug distribution systems, medication therapy management, nursing staff

Sickle cell disease (SCD) is a common genetic disorder with potentially serious sequelae that can be effectively treated with hydroxyurea. Despite its favorable benefit‐risk profile, hydroxyurea uptake in patients with SCD is low. A pilot study was conducted at the Southern Alberta Rare Blood and Bleeding Disorders (SARBBDs) Comprehensive Care Program between January 2020 and September 2023 to assess the implementation of a pharmacist‐led protocol for supporting the uptake of hydroxyurea among eligible patients with SCD and optimizing its dosing. The protocol standardized the prescription, monitoring, dose titration, and patient counselling by a clinic pharmacist. The number of patients enrolled in the SARBBDs program increased from 98 in January 2020 to 168 in 2023. During this period, the proportion of patients on hydroxyurea increased from 37.8% to 62.5%, the proportion of patients on hydroxyurea who were at a maximum tolerated dose (MTD) increased from 35.1% to 63.8%, and the average hemoglobin F level increased from 13.9% to 19.7%. The mean time to reach MTD was 10 months and required eight pharmacist interventions, six laboratory assessments, and three dose increases. Hydroxyurea continuation rates were high, with most discontinuations resulting from loss to follow‐up or transition to a transfusion management strategy. This real‐world pilot study demonstrated that implementation of a pharmacist‐led prescribing and monitoring protocol nearly doubled hydroxyurea uptake and achievement of MTD in patients with SCD managed in a rare blood disorders clinic. [ABSTRACT FROM AUTHOR]

Aims. This study aimed to identify and analyze the factors significantly influencing long‐term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self‐efficacy were assessed, respectively, using self‐developed questionnaires, MMAS‐8, C‐DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re‐evaluated. Results. After excluding lost‐to‐follow‐up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self‐efficacy, and medication beliefs (P < 0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self‐efficacy, knowledge, or medication beliefs between intervention and control groups (P > 0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self‐efficacy, knowledge, and medication beliefs (P < 0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self‐efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444. [ABSTRACT FROM AUTHOR]

Background: Patients on hemodialysis (HD) often uses several medications, making them highly susceptible to medication-related problems (MRP) thereby leading to medication nonadherence. Therefore, an innovative pharmaceutical care strategy incorporating drug therapy optimization (DTO) and motivational interviewing (MI) can mitigate medication-related problems and optimize patient care. Aims and objective: The objective of this study is to assess the efficacy of pharmacist led interventions in utilizing DTO and MI techniques in managing medication related problems among patients undergoing hemodialysis. Method and design: A12-months, cross sectional prospective study was conducted among 63 End Stage Renal Disease (ESRD) patients on HD. DTO was conducted by the pharmacist to identify the MRP by reviewing complete medication list gathered from patient interview and medical records. All MRPs was classified using the PCNE classification version 9.00 and medication issues, that require patient involvement were categorized as patient-related, while those that necessitate physician intervention were classified as physician-related. The DTO was performed at the baseline, 6-month and at the final month of the study. Identified medication issues were communicated to the site nephrologist and was tracked during next follow up. Whereas MI was conducted physically at Month-3 and via telephone on month-6 and month-9 to address patient related medication issues. Results: Mean age of the study population was 48.5±14 years. While the mean number of prescribed medications was 8.1±2 with 57% of the patients taking more than 5 types of medication. After 12 months of pharmacist intervention using DTO and MI, a mean reduction in MRP was observed for both patient-related and physician-related MRPs across three time series. However, further analysis using repeated measure ANOVA revealed that the reduction in patient-related MRPs was statistically significant [F(1.491, 92.412) = 60.921, p < 0.05], while no statistically significant difference was detected in physician-related MRPs [F(2, 124) = 2.216, P = 0.113]. Conclusion: Pharmaceutical care service through DTO and MI can effectively reduce and prevent drug-related issues to optimize medication therapy among HD patients. [ABSTRACT FROM AUTHOR]

Background: Ensuring equal access to medicines and their appropriate and safe use at reasonable costs are core functions of health systems. Despite that, few descriptions of national medicines policies' development processes and implementation strategies have been published. This study aimed to describe the government program-based development of the Rational Pharmacotherapy Action Plan in Finland as a part of the undergoing major health and social service system reform, also covering the implementation of rational pharmacotherapy in the reformed system and processes. Methods: The data of this qualitative study consisted of public reports and Steering Group meeting memos related to the development of the national Rational Pharmacotherapy Action Plan that the Ministry of Social Affairs and Health coordinated. Qualitative content analysis applying systems theory and the conceptual framework of integrated services as theoretical frameworks was used as an analysis method. Results: The national Rational Pharmacotherapy Action Plan covering 2018–2022 was created in a bottom-up development process involving a wide range of stakeholders. Rational pharmacotherapy was redefined by adding equality as the fifth pillar to complement the previously defined pillars of being effective, safe, high-quality, and cost-effective. The Action Plan formed a normative framework for long-term development, with a vision and principles focusing on people-centeredness, better coordination and management of the medication use processes, the continuity of treatment paths and the flow of patient and medicines information through partnerships, and evidence-informed policies and practices. Conclusion: Through intensive stakeholder participation, the bottom-up approach created a national vision and principles of rational pharmacotherapy along with strong commitment to implementing the goals and measures. The concern lies in ensuring the continuity of the Action Plan implementation and achieving a balanced long-term development aligned with the integrated and reformed national social and health services system. The development of the pharmaceutical system has several national and EU-level dependencies requiring political long-term commitment. While the Action Plan differs from the national medicines policy, it forms a good basis for long-term development covering important parts of medicine policy at the micro, meso, and macro levels of the service system. [ABSTRACT FROM AUTHOR]

Background: Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. Methods: Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. Results: Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. Conclusions: The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities. [ABSTRACT FROM AUTHOR]

Intravenous therapy is the standard medical procedure that is used for administering medications directly into the vein. The automated drug infusion devices are designed in such a way that they provide exact medication doses with safety measures included. On the other hand, this is why they must be regularly watched by healthcare providers. This paper introduces a cloud-based IoT drug infusion system that was developed to address remote patient care needs. This system enables remote, accurate, and secure management of medication delivery. Its key contributions include allowing healthcare providers to control and monitor IV infusions remotely while maintaining safety features. The system consists of a microcontroller that is responsible for data processing, a control system that oversees infusion rate regulation, and an IoT-based framework that allows for remote monitoring and alerts via a user-friendly web interface. This new approach to care will therefore improve patient care by providing remote management of medications. [ABSTRACT FROM AUTHOR]

The demand for digital platforms in managing heart failure (HF) is expected to increase with promising effects on readmission and health expenditure. The study aims to explore current post-discharge management strategies and identify the need and acceptance of digital platforms, to ensure the development of a user-friendly mobile application for HF patients. Using a cross-sectional analytical research design, 90 consecutive patients diagnosed with HF who were discharged from a Tertiary Care Center were enrolled. Tele-interview was conducted using a self-developed and validated tool. The mean age of participants was 55.54 ± 10.33 years. The participants' adherence to HF management strategies was low in terms of physical exercise and weight monitoring. More than one-third were willing to self-record their measurements and use a mobile application. The common mobile application features requested were medication information/reminder (88.6%), health education (84.3%), chat with nurses (84.3%), physical activity (81.4%), symptoms (78.6%), diet (78.6%) and weight management (72.9%). The findings from this initial phase of mobile development are expected to help leverage better development of digital interventions for HF patients. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease is a neurodegenerative disease, and many patients are cared for at home by nurses. Parkinson's disease nurse specialists have been certified in several countries. This study aimed to provide an overview of what is known about the role of nurses in the care of patients with Parkinson's disease at home and to determine the differences between nurses and Parkinson's disease nurse specialists. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched (keywords: Parkinson's disease AND nurse AND [community OR home]) for studies published in English up to September 2023 describing the nurse's role in caring for patients with Parkinson's disease at home. Studies without abstracts were removed, along with protocols, systematic reviews, and studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases. Roles were described and organized by category. Results: A total of 26 studies were included. The nurses' roles were categorized as overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Medication management and education of care home staff were identified as roles of nurse specialists. Conclusions: This study revealed the role of nurses caring for patients with Parkinson's disease at home. Because of the complexity of the patients' medication regimens, nurse specialists provide assistance, especially with medication management and the provision of education to care staff. This study will facilitate the preparation of nurses to acquire the knowledge and skills necessary to help patients with Parkinson's disease, even in countries where Parkinson's disease nurse specialists are not officially certified, and will help patients feel comfortable with the care they receive. [ABSTRACT FROM AUTHOR]

The management of medications is a crucial component of healthcare, and pharmaceutical errors can have detrimental effects on patients, healthcare professionals, and healthcare systems. By utilizing patient-specific data and cutting-edge technology like the Internet of Medical Things (IoMT) and machine learning, customized drug management systems have the potential to increase patient safety and healthcare effectiveness. In this study, we reviewed a large body of literature on the subject of medication management in healthcare and the potential advantages of personalized medication management. We then assessed how IoMT and machine learning might be used to enhance medication management in smart hospitals. Then, we created a framework for assessing how personalized medication management utilizing IoMT and machine learning affects patient safety and healthcare effectiveness. Our study's findings demonstrate that in smart hospitals, tailored medication management with IoMT and machine learning can drastically lower medication errors while also enhancing patient safety and healthcare effectiveness. Our findings have important ramifications for the future of medication administration in smart hospitals, and we advise healthcare professionals and policymakers to give priority to integrating cutting-edge technology like IoMT and machine learning for customized medication management. [ABSTRACT FROM AUTHOR]

Background: Audit and feedback (A/F), which include initiatives like report cards, have an inconsistent impact on clinicians' prescribing behavior. This may be attributable to their focus on aggregate prescribing measures, a one-size-fits-all approach, and the fact that A/F initiatives rarely engage with the clinicians they target. Methods: In this study, we describe the development and delivery of a report card that summarized antipsychotic prescribing to publicly-insured youth in Philadelphia, which was introduced by a Medicaid managed care organization in 2020. In addition to measuring aggregate prescribing behavior, the report card included different elements of care plans, including whether youth were receiving polypharmacy, proper medication management, and the concurrent use of behavioral health outpatient services. The A/F initiative elicited feedback from clinicians, which we refer to as an "audit and feedback loop." We also evaluate the impact of the report card by comparing pre-post differences in prescribing measures for clinicians who received the report card with a group of clinicians who did not receive the report card. Results: Report cards indicated that many youth who were prescribed antipsychotics were not receiving proper medication management or using behavioral health outpatient services alongside the antipsychotic prescription, but that polypharmacy was rare. In their feedback, clinicians who received report cards cited several challenges related to antipsychotic prescribing, such as the logistical difficulties of entering lab orders and family members' hesitancy to change care plans. The impact of the report card was mixed: there was a modest reduction in the share of youth receiving polypharmacy following the receipt of the report card, while other measures did not change. However, we documented a large reduction in the number of youth with one or more antipsychotic prescription fill among clinicians who received a report card. Conclusions: A/F initiatives are a common approach to improving the quality of care, and often target specific practices such as antipsychotic prescribing. Report cards are a low-cost and feasible intervention but there is room for quality improvement, such as adding measures that track medication management or eliciting feedback from clinicians who receive report cards. To ensure that the benefits of antipsychotic prescribing outweigh its risks, it is important to promote quality and safety of antipsychotic prescribing within a broader care plan. [ABSTRACT FROM AUTHOR]

Fungal infections in HIV-positive patients present a major challenge, despite advances in antiviral treatments. With an incidence of around 37%, these infections go beyond simple benign mycoses to include serious and potentially fatal forms. The management of these infections requires an individualised approach, taking into account the severity of the infection, drug sensitivity, co-morbidities and drug interactions, as these patients are often on a combination of antibacterial, antifungal and antiviral treatments. Candidiasis, particularly of the oropharynx, is the most common. Initial treatment involves local antifungal agents such as nystatin, followed by systemic treatments such as fluconazole in the event of resistance. Oesophageal candidiasis requires a broad-spectrum antifungal agent, principally fluconazole. Vaginal candidiasis is treated locally with imidazoles. Cryptococcosis, caused by Cryptococcus neoformans, is treated in three phases with a combination of amphotericin B, flucytosine and fluconazole, with close monitoring of the patient's response. Histoplasmosis, caused by Histoplasma capsulatum, can affect various organs. Initial treatment is with liposomal amphotericin B, followed by itraconazole if there is improvement, with particular attention to plasma levels due to variable absorption. Aspergillosis, although rare, has a high mortality rate. Voriconazole is the treatment of choice, requiring rigorous monitoring of plasma concentrations to avoid drug interactions. In summary, the management of fungal infections in HIV-positive patients requires a strategic approach, combining local and systemic treatments, with close monitoring to adjust therapies according to the patient's individual response. [ABSTRACT FROM AUTHOR]

Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease–specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality. A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management. Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05). How a nurse-led multidisciplinary team implemented a quality improvement project to identify patients with Parkinson disease and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. [ABSTRACT FROM AUTHOR]

Systemic autoimmune rheumatic diseases (SARDs) in pregnancy represent a complex challenge for both patients and healthcare providers. Timely preparation for pregnancy enables adequate disease control, thereby reducing the risk of disease flare and pregnancy complications. Interdisciplinary care starting from the pre-pregnancy period throughout pregnancy and during breastfeeding ensures better fetal and maternal outcomes. This review provides a comprehensive guide to pre-pregnancy counselling in SARDs, an overview of medication management strategies tailored to pregnancy, disease activity and pregnancy monitoring in patients, and the promotion of shared decision making between healthcare providers and patients. Guidelines from international organizations were selected to provide a basis for this review and guidance through the quintessential discussion points of care. [ABSTRACT FROM AUTHOR]

Malignancies are a difficult to treat disease in clinical practice. At present, there are many cases of differentiation and treatment based on qi and yin deficiency, the coagulation of phlegm, blood stasis and cancer toxin, there are few theories on the treatment of yang deficiency and yin excessiveness, as well as the coagulation of cold and dampness. On the basis of inheriting the cancer toxin theory of Chinese medicine master ZHOU Zhongying, combined with the theory of promoting yang and our own practice, we believe that malignancy is caused by yang deficiency as the foundation, cold dampness, phlegm-turbidity stagnation and toxin transformation as the manifestation, and the key pathogenesis can be summarized as yang deficiency and yin binding. Based on this, it is proposed to differentiate and treat malignancies from promoting yang and eliminating yin. The method of promoting yang and eliminating yin is people-oriented, with harmony as the value, based on the whole, with a focus on adjusting harmony, constantly promoting yang and timely eliminating yin. The specific differentiation and treatment strategies are as follows: in the early stages of malignancy, it is important to seize the opportunity to warm and dredge, or eliminate yin; malignancy is already present, balancing deficiency and excess, supplementing, eliminating, and harmonizing appropriately; after malignancy surgery, it is important to strengthen the foundation and regulate the spleen and kidney, and strengthen both congenital and acquired constitution; treating the zang-fu organs accordingly, elevating and lowering, and conforming to the physiology of the organs. Unlike simple malignancy treatment and detoxification, promoting yang and eliminating yin is a method of examining symptoms and identifying etiology and pathogenesis. It involves macroscopic regulation of yin and yang, dynamic management of medication, and orderly treatment, which can significantly improve the quality of life of patients and increase long-term survival rates. Exploring the theory and strategy of promoting yang and eliminating yin in the differentiation and treatment of malignancy can provide new ideas and references for the clinical differentiation and treatment of malignancies. [ABSTRACT FROM AUTHOR]

Along with the degree of population ageing, the proportion of the elderly is increasing in patients with type 2 diabetes mellitus ( T2DM) year by year. Elderly patients with T2DM are prone to drug-related problems (DRPs) due to complications or comorbidities, a large and complex number of medications, and low medication compliance, which poses a severe challenge to medication management in the elderly with T2DM. Drug Therapy Management (MTM) is a kind of pharmaceutical care project, which is widely used in many countries in the treatment of chronic diseases. The core mission of MTM is to promote the correct use of medicines by patients, prevent medication errors, enhance the effectiveness of treatment, and reduce the waste of healthcare costs. This paper introduces MTM and DRPs in the elderly with T2DM, then summarizes and evaluates the construction and application of MTM service system in the elderly with T2DM, which probably provides suggestions and references for the development of MTM service in the elderly with chronic diseases in China. [ABSTRACT FROM AUTHOR]

Due to variability in pharmacokinetics and pharmacodynamics, clinical outcomes of antimicrobial drug therapy vary between patients. As such, personalised medication management, considering both pharmacokinetics and pharmacodynamics, is a growing concept of interest in the field of infectious diseases. Therapeutic drug monitoring is used to adjust and individualise drug regimens until predefined pharmacokinetic exposure targets are achieved. Minimum inhibitory concentration (drug susceptibility) is the best available pharmacodynamic parameter but is associated with many limitations. Identification of other pharmacodynamic parameters is necessary. Repurposing diagnostic biomarkers as pharmacodynamic parameters to evaluate treatment response is attractive. When combined with therapeutic drug monitoring, it could facilitate making more informed dosing decisions. We believe the approach has potential and justifies further research. [ABSTRACT FROM AUTHOR]

Purpose: To assess the failure modes and effects of clinical application of breviscapine-based traditional Chinese medicine injection (TCMI). Methods: 229 reports on clinical application errors, medication errors or management measures relating to breviscapine injection were collected by searching various databases. A clinical application and safety evaluation questionnaire was formulated for use in the failure mode and effects analysis (FMEA) of breviscapine injection. The questionnaire survey was then distributed to 100 doctoral, nursing and pharmaceutical personnel in Xinxiang Central Hospital who were randomly chosen to participate. Results: A total of 81 (83.5 %) valid questionnaires were retrieved. A total of 29 potential failure types, failure causes and failure effects were identified. Mean values of all risk priority numbers (RPN) of the 29 failure modes were ranked comprehensively. The failure modes identified as top 10 risk factors include; detailed information regarding the patient's medical, allergy and family disease history not being provided to physicians (75.22); incorrect choice of drug manufacturer and lot number (74.95), drugs not being dispensed on the spot (72.16); inappropriate choice of solvent (71.31); drugs not suitable for combination therapy (70.81); inappropriate choice of solvent dosage (69.14); individual patient differences not taken into consideration (67.07); infusion rate too fast (67.00); off-label drug use (65.32); and age of the patient not taken into consideration (64.96). Conclusion: As a risk management tool, the FMEA conducted in this study reduces potentially dangerous clinical application of high-risk TCMI, standardizes the medication process and significantly reduces occurrence of adverse reactions to TCMI. Future studies are required to validate these claims. [ABSTRACT FROM AUTHOR]

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic resulted in decreased access to routine diabetes care in rural areas and adversely affected self-management of diabetes. Methods: This article describes a descriptive pretest-posttest study conducted to assess efficacy in managing hemoglobin A1C (A1C) among patients with type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring (CGM) system for 1 year. Results: A total of 14 participants completed the Diabetes Mellitus Self-Efficacy Scale survey. Of those 14, 11 used CGM for 1 year; of the 11 who maintained CGM use, A1C levels improved in 9. Conclusions: Results indicate that CGM combined with medication management positively impacts self-efficacy in managing A1C levels among patients with T2DM. Interdisciplinary collaboration optimizes patient outcomes. The COVID-19 pandemic resulted in decreased access to routine diabetes care in rural areas and adversely affected diabetes self-management. This article describes a descriptive pretest-posttest study conducted to assess efficacy in managing hemoglobin A1C (A1C) among patients with type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring (CGM) system for 1 year. Results indicate that CGM combined with medication management positively impacts self-efficacy in managing A1C levels among patients with T2DM. Interdisciplinary collaboration optimizes patient outcomes. [ABSTRACT FROM AUTHOR]

As part of our series on medicines optimisation in people with additional needs, this article considers the health challenges that Deaf and hard of hearing patients face, and discusses how to improve healthcare access and tailor consultations to optimise health outcomes. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the administration of intravenous (IV) fluids and medicines • To enhance your ability to identify and resolve issues that may occur with the administration of IV fluids and medicines • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Managing intravenous (IV) access is a standard proficiency for UK nurses, enabling them to administer IV injections and IV infusions and to manage injection equipment and infusion pumps and devices. In this article the author describes various types of venous access devices that are commonly seen in practice and details the preparation, checking and administration of IV fluids and medicines, including some complications that may arise. The author also discusses the calculation of fluid requirements, types of IV fluids, displacement values and ongoing care of venous access devices. [ABSTRACT FROM AUTHOR]

Background Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary care is ad hoc and opportunistic, but there has been little focus on the challenges of frailty management, particularly within the context of recent introduction of primary care networks and an expanding allied health professional workforce. Aim Explore the views of primary care clinicians in England on the management of frailty. Design and setting Semi-structured interviews were conducted with clinicians across England, including general practitioners (GPs), physician associates, nurse practitioners, paramedics and clinical pharmacists. Thematic analysis was facilitated through NVivo (Version 12). Results A total of 31 clinicians participated. Frailty management was viewed as complex and outside of clinical guidelines with medication optimisation highlighted as a key example. Senior clinicians, particularly experienced GPs, were more comfortable with managing risk. Relational care was important in prioritising patient wishes and autonomy, for instance to remain at home despite deteriorations in health. In settings where more formalised multidisciplinary frailty services had been established this was viewed as successful by clinicians involved. Conclusion Primary care clinicians perceive frailty as best managed through trusted relationships with patients, and with support from experienced clinicians. New multidisciplinary working in primary care could enhance frailty services, but must keep continuity in mind. There is a lack of evidence or guidance for specific interventions or management approaches. [ABSTRACT FROM AUTHOR]

Background An updated time-trend analysis of anti-dementia drugs (ADDs) is lacking. The aim of this study is to assess the incident rate (IR) of ADD in individuals with dementia using real-world data. Setting Primary care data (country/database) from the UK/CPRD-GOLD (2007–20), Spain/SIDIAP (2010–20) and the Netherlands/IPCI (2008–20), standardised to a common data model. Methods Cohort study. Participants: dementia patients ≥40 years old with ≥1 year of previous data. Follow-up: until the end of the study period, transfer out of the catchment area, death or incident prescription of rivastigmine, galantamine, donepezil or memantine. Other variables: age/sex, type of dementia, comorbidities. Statistics: overall and yearly age/sex IR, with 95% confidence interval, per 100,000 person-years (IR per 105 PY (95%CI)). Results We identified a total of (incident anti-dementia users/dementia patients) 41,024/110,642 in UK/CPRD-GOLD, 51,667/134,927 in Spain/SIDIAP and 2,088/17,559 in the Netherlands/IPCI. In the UK, IR (per 105 PY (95%CI)) of ADD decreased from 2007 (30,829 (28,891–32,862)) to 2010 (17,793 (17,083–18,524)), then increased up to 2019 (31,601 (30,483 to 32,749)) and decrease in 2020 (24,067 (23,021–25,148)). In Spain, IR (per 105 PY (95%CI)) of ADD decreased by 72% from 2010 (51,003 (49,199–52,855)) to 2020 (14,571 (14,109–15,043)). In the Netherlands, IR (per 105 PY (95%CI)) of ADD decreased by 77% from 2009 (21,151 (14,967–29,031)) to 2020 (4763 (4176–5409)). Subjects aged ≥65–79 years and men (in the UK and the Netherlands) initiated more frequently an ADD. Conclusions Treatment of dementia remains highly heterogeneous. Further consensus in the pharmacological management of patients living with dementia is urgently needed. [ABSTRACT FROM AUTHOR]

Background Community pharmacists potentially have an important role to play in identification of frailty and delivery of interventions to optimise medicines use for frail older adults. However, little is known about their knowledge or views about this role. Aim To explore community pharmacists' knowledge of frailty and assessment, experiences and contact with frail older adults, and perceptions of their role in optimising medicines use for this population. Methods Semi-structured interviews conducted between March and December 2020 with 15 community pharmacists in Northern Ireland. Interviews were transcribed verbatim and analysed thematically. Results Three broad themes were generated from the data. The first, 'awareness and understanding of frailty', highlighted gaps in community pharmacists' knowledge regarding presentation and identification of frailty and their reluctance to broach potentially challenging conversations with frail older patients. Within the second theme, 'problem-solving and supporting medication use', community pharmacists felt a large part of their role was to resolve medicines-related issues for frail older adults through collaboration with other primary healthcare professionals but feedback on the outcome was often not provided upon issue resolution. The third theme, 'seizing opportunities in primary care to enhance pharmaceutical care provision for frail older adults', identified areas for further development of the community pharmacist role. Conclusions This study has provided an understanding of the views and experiences of community pharmacists about frailty. Community pharmacists' knowledge deficits about frailty must be addressed and their communication skills enhanced so they may confidently initiate conversations about frailty and medicines use with older adults. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical implications of antimicrobial resistance (AMR) amid the global challenges posed by population growth, environmental changes, and technological advancements. It discusses AMR as not just a medical issue but also an ethical challenge affecting individuals, communities, and ecosystems, highlighting the complex consequences for patients, including prolonged treatment, stigma, and reduced access to healthcare interventions.

Ritonavir is a potent inhibitor of the cytochrome P450 3A4 enzyme and is commonly used as a pharmacokinetic (PK) enhancer in antiviral therapies because it increases bioavailability of concomitantly administered antivirals. Decades of experience with ritonavir-enhanced HIV therapies and, more recently, COVID-19 therapies demonstrate that boosting doses of ritonavir are well tolerated, with an established safety profile. The mechanisms of PK enhancement by ritonavir result in the potential for drug–drug interactions (DDIs) with several classes of drugs, thus making co-medication management an important consideration with enhanced antiviral therapies. However, rates of DDIs with contraindicated medications are low, suggesting these risks are manageable by infectious disease specialists who have experience with the use of PK enhancers. In this review, we provide an overview of ritonavir's mechanisms of action and describe approaches and resources available to mitigate adverse events and manage concomitant medication in both chronic and short-term settings. [ABSTRACT FROM AUTHOR]

Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management. To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes. A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia. In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes. Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making. • Varied medication policies across settings were associated with adverse effects. • Older patients were not often given information about changes to their regular medications. • Older patients were informed about new medications after decisions were made. • Health professionals had rigid views about their own roles in medication decisions. • Shared decision-making was rarely observed during medication changes. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home. Objective: To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence. Design: Exploratory study. Setting: Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence. Participants: Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications. Outcomes and Measures: Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test–Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month. Results: Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home. Conclusions and Relevance: There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence. The study findings reveal a gap between patient-reported outcomes and performance-based assessments in the context of medication management at home. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative drug therapy management (CDTM) allows pharmacists to assess patients, administer medications, manage and adjust medication regimens, and order laboratory tests within a defined protocol. Pharmacist CDTM may aid in preventative care and chronic condition management. Objectives: The primary objectives were to identify CDTM services provided by pharmacists in the state of Georgia, examine factors associated with the provision of CDTM services, and identify barriers and facilitators to CDTM service provision. The secondary objective was to assess differences in CDTM practice between pharmacists who completed a Registered Pharmacist (R.Ph.)/Doctor of Pharmacy (Pharm.D.), postgraduate year one (PGY1), or postgraduate year two (PGY2) residency. Methods: Using the Dilman method, this cross‐sectional study invited all 134 CDTM‐licensed pharmacists in Georgia to complete a 30‐min electronic survey. Data included demographics, training, services offered, disease states managed, and perceptions regarding CDTM implementation. Descriptive statistics, Welchs analysis of variance (ANOVA), and chi‐square were conducted using SPSS v28. Results: A total of 36 (26.9%) pharmacists completed the survey. Participants offered a median of three CDTM services. A majority offered medication therapy management (86.1%) and chronic care management (66.7%). A majority offered services for diabetes (58.3%), hyperlipidemia (55.6%), and hypertension (55.6%). There were differences in the mean ranked number of CDTM services offered between R.Ph./Pharm.D. and PGY2 groups (−11.667, p = 0.019), and the mean ranked number of disease states covered between R.Ph./Pharm.D. and PGY1 (−10.990, p = 0.029) and R.Ph./Pharm.D. and PGY2 (−12.640, p = 0.010, adjusted p‐value) groups. Reported CDTM facilitators were job requirements, expanding patient care, job satisfaction/personal advancement, and expanding professional practice. Reported challenges were continuing education, clinical/interprofessional concerns, administration issues with the board of pharmacy or individual practice site, and regulations differing from other states. Conclusion: Of those with CDTM licensure, a majority offer medication therapy management and chronic care management services covering diabetes, hypertension, and hyperlipidemia. Postgraduate training may help prepare pharmacists to engage in CDTM services. [ABSTRACT FROM AUTHOR]

Background: Comprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health‐related goals. Objective: The objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs). Design: Semistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC. Key Results: Thirty‐nine codes were identified across all CFIR constructs, including the addition of a new construct, "Patient characteristics." Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy‐in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput. Conclusions: Identifying early‐stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes. [ABSTRACT FROM AUTHOR]