Ensuring the quality use of medicines in clinical trials: A review and perspective on optimising the role of pharmacists.

Evaluation of the Aged Care On-site Pharmacist (ACOP) program in Australian residential aged care homes: Key considerations and next steps.

High-Risk Prescribing in Older People With and Without Dementia in Australia: A Nationwide Cross-Sectional Study.

Sleep disturbance is increasingly recognized as a viable prevention target that could lower dementia risk. While a wide range of pharmacological options exist to manage sleep disturbance in people living with dementia, their use often does not adherent to the quality use of medicine. The complex nature of dementia as a syndrome often requires drugs that target multiple complaints (eg, sleep, cognition, and mood) and thus could produce psychological and physiological side effects that have the potential to do more harm than confer benefits. Therefore, this review first provides an expert narration of the pharmacology of sleep and the mechanisms of agents used to treat sleep disturbance. Then, a systematic scoping review was conducted to analyze evidence from studies over the past 10 years, which examined various pharmacological agents used for sleep disturbance in people living with dementia. SIGNIFICANCE STATEMENT: Sleep disturbances are a common consequence of the neurodegenerative changes occurring in dementia syndromes. They may also be etiologically linked to its development and progression. This review summarizes the pharmacological basis of sleep and collates the impact of medications used for dementia or sedatives on sleep and cognition outcomes. The review highlights gaps in research and will provide clinicians with key information required to make decisions about the quality use of medications to improve sleep health in those with dementia.

To evaluate quality use of medicines (QUM) in patients admitted to the Psychiatric Alcohol and Non-Prescription Drug Assessment (PANDA) Unit through analysis of polypharmacy risk, prescribing safety indicators and national QUM indicators. Retrospective review of electronic medical records for 787 patients (1245 episodes) admitted to PANDA Unit, St Vincent's Hospital Sydney, November 2020-December 2021. We assessed polypharmacy risk using NSW Therapeutic Advisory Group's Inappropriate Polypharmacy Risk Assessment Tool, evaluated nine prescribing safety indicators (PSIs) and assessed four national quality use of medicines indicators (NQUMIs) in a randomly selected subset of 103 patients. Mean age was 40.2years; 67.2% were male. Alcohol-related diagnoses comprised 32.1% of presentations. Medium-risk (43.5%) and high-risk (37.2%) polypharmacy were prevalent, largely reflecting protocol-driven prescribing for acute presentations. Co-prescription of QT-prolonging drugs with antipsychotics affected 17.2% of patients, with 64.7% associated with rapid sedation protocols; only one case of potential QT prolongation was documented. Major gaps were identified in medication reconciliation (40.8% had documented medication history) and discharge documentation (13.1% of discharge summaries contained complete medication information). Patients experiencing homelessness demonstrated poorer outcomes across all QUM indicators, with no discharge summaries meeting quality standards. While PANDA demonstrated appropriate protocol-driven prescribing for acute psychiatric presentations, substantial gaps in medication reconciliation and discharge communication highlight challenges in care transitions for priority populations. Standard polypharmacy and prescribing safety indicators may require adaptation for acute psychiatric settings to distinguish appropriate acute prescribing from potentially inappropriate practices.

Home Medicines Reviews (HMRs) conducted by credentialed pharmacists in response to referrals from medical practitioners are funded by the Australian government to improve the quality use of medicines. In late 2023, a grassroots group of credentialed pharmacists created a Community Service Announcement (CSA) to raise consumer awareness of the HMR program. Community Service Announcements are allocated airtime by mainstream media (e.g. television and radio stations) for promoting messaging in the public interest, such as health services. The HMR awareness CSA was funded by 250 donors through a GoFundMe campaign. Two days of filming with pharmacists, doctors and patients across three rural and regional areas resulted in a 28-s video and corresponding radio sound bites. The CSA aired on major national Australian broadcast networks with coverage during both on-peak and off-peak times across all states and territories. The total value of the television advertising was estimated at AUD1.65 million. Radio messages were aired 36 times over a week on stations nationwide, reaching an estimated 1,911,300 listeners, approximately 8% of the Australian population. This CSA campaign illustrated the potential of health professional initiatives to raise awareness of government health programs. By leveraging crowdfunding and community support, this activity demonstrated a model for other health professionals seeking to promote similar health promotion and awareness initiatives.

Australian pharmacists' experiences and perspectives in implementing a chronic kidney disease screening service in community pharmacies: A qualitative study

Antifungal stewardship is important for promoting quality care and tackling the emergence of drug resistance. Evaluation of the quantity and appropriateness of common antifungal prescriptions like fluconazole is essential in the development of these programmes. To perform a clinical audit of fluconazole prescribing and explore whether involvement of pharmacy students in this process was feasible and meaningful from both pharmacy student and health system perspectives. An audit was conducted of all fluconazole prescriptions from January 2024 to March 2024 at two Sydney hospitals. Trained pharmacy students, under the supervision of antimicrobial stewardship pharmacists and physicians, completed the audit using the Antifungal National Antimicrobial Prescribing Survey audit tool. Prescriptions were assessed for their compliance to guidelines and appropriateness. Data on pharmacy students’ educational experience was collected by a 5-point Likert scale survey. A total of 145 fluconazole prescriptions were audited: 34 for empiric therapy, 56 for directed therapy, and 56 for prophylaxis. A total of 91 (62.8%) prescriptions were assessed as appropriate, 46 (31.7%) were inappropriate, and 8 (5.5%) were not assessable. Potential drug–drug interactions were identified in 17 patients receiving fluconazole doses of 200 mg or greater, of which three were clinically significant, requiring intervention. Students had positive experiences contributing to quality use of medicines, in terms of enjoyment, support, and education. Inappropriate fluconazole use was common. Pharmacy students made a positive contribution to the antifungal audit, promoting good stewardship practises for the hospital while accessing enhanced learning and development opportunities.

The escalating global burden of chronic diseases necessitates innovative approaches to enhance medication adherence and quality use of medicines (QUM), particularly in underserved rural populations. This study developed and evaluated Impak Sihat, a telehealth system tailored to address systemic healthcare barriers in rural Malaysia through a three-phase mixed-methods design. Phase 1 involved qualitative interviews with 15 villagers, revealing smartphone ownership, inconsistent internet connectivity, high social media engagement, and limited critical appraisal of online health information. Phase 2 utilised these insights to create a dual-component system: a public portal with Malay-language educational materials, appointment booking, and a practitioner platform featuring secured patient data management. Phase 3 assessed feasibility via community demonstrations with 77 participants (mean age 53.4 ± 11.8 years), showing high acceptance scores (73-87%) across six domains. Key findings included strong usability (87.0 ± 16.3) and interface design (74.8 ± 23.9), though older adults scored significantly lower on interface design for learnability (ρ=-0.29, p < 0.01). The system's offline functionality and WhatsApp integration mitigated rural connectivity constraints, yet challenges persisted in data confidentiality (lowest score: 73.1 ± 26.7). Healthy participants consistently rated the system significantly higher across multiple domains (Interface Design: p = 0.003, User Experience: p = 0.018, Healthcare Delivery: p = 0.002, and Overall Satisfaction: p = 0.003). These results underscore the potential of context-specific telehealth systems to bridge urban-rural health disparities while highlighting critical implementation barriers. This work highlights the importance of engaging key stakeholders, such as healthcare providers and community leaders, to ensure system sustainability and scalability. Overall, the study demonstrates that digital health interventions, when appropriately tailored to the specific needs of rural populations, can significantly contribute to reducing healthcare disparities and promoting patient empowerment.

BackgroundPeople living with Alzheimer's disease and other types of dementia are vulnerable to medicine-related problems. More research is needed to support achieving quality use of medicines in people living with dementia.ObjectiveTo determine the top 10 unanswered quality use of medicines questions for people living with dementia, as prioritized by Australians living with dementia, their carers, and healthcare professionals.MethodsThe James Lind Alliance Priority Setting Partnership method was used. This manuscript reports the second half of the priority setting process. Using a quantitative survey, consumers (people living with dementia, their carers and family and friends) and healthcare professionals selected up to ten research questions about quality use of medicines that they felt were most important. The research questions were informed by a previous national qualitative survey and evidence checking process to identify those that were unanswered. An online workshop was then conducted with consumers and healthcare professionals to prioritize the unanswered questions, resulting in a top 10 list.Results171 consumers and 67 healthcare professionals completed the survey and the workshop included 17 participants. The top 10 priorities related to shared decision making, education of healthcare professionals, communication between healthcare professionals, reducing the use of unnecessary and harmful medicines, managing medicines safely at home, medicine reviews, residential aged care facilities and managing pain, behavioral changes, depression and anxiety.ConclusionsTargeting research efforts towards these identified consumer and healthcare professional priorities will ensure research funds are being directed to the most urgent areas of need in practice.

Introduction: Healthcare for patients in pasung is often neglected. Limited data is available on the roles of Primary Health Centres (PHCs) as the main providers of primary care in Indonesia. This research aims to explore health services provided for patients in pasung at PHCs and to identify the roles of pharmacists. Methods: This descriptive qualitative research used in-depth interviews with a range of stakeholders [i.e., patients in pasung (n=14) or the representative family caregivers (n=12), mental health nurses (n=5), pharmacists (n=5)] at 5 PHCs in Trenggalek, Indonesia from May to July 2023. Inductive thematic analysis was used to address the research questions. Ethical approval was obtained from the Research Ethics Committee of Universitas Surabaya (number 130/KE/V/2023), and participants provided written informed consent. Results: Patients in pasung have generally had adequate access to PHCs with no charge for their treatments. Health services provided for patients in pasung at PHCs were categorised into two main themes: outpatient services (i.e., medication supply, and home-care), and referral to inpatient services. Pharmacists’ roles have largely related to drug supply, while clinical pharmacy services have been very limited (e.g., providing drug information when patients obtained their medications at the pharmacy units). Conclusion: In conclusion, findings in this study have provided a baseline for future development of mental healthcare for patients in pasung. Pharmacists have the potential to take up more clinical roles to ensure quality use of medicines among patients in pasung. Supporting policy and resources should be allocated for PHCs to expand pharmacist’s services.

Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets.

Acute coronary syndrome is a major global disease burden with high morbidity and mortality. This study aims to assess the impact of clinical pharmacy interventions on improving the quality use of medicines and drug-related problems in acute coronary syndrome patients. An open, prospective, controlled, nonrandomised clinical trial was conducted at the Teaching Hospital, Peradeniya, Sri Lanka. Consenting patients were recruited and divided into control and intervention groups. Medication history, medication adherence and drug-related problems were assessed. The intervention group received clinical pharmacy interventions for six months. Improvements in medication adherence, discharge medication appropriateness, reduction of hospital readmissions for six months, and responses from the healthcare team's awareness and perception on clinical pharmacy services were recorded. Both groups (control - 180 patients, intervention - 185 patients) showed poor medication adherence at baseline. Medication adherence improved significantly after 6-months post-discharge in the intervention group compared to the control group (49.3% vs 18.8%). The clinical pharmacists successfully identified drug-related problems and provided suggestions for resolving them. The treating team accepted the majority (60%) of these suggestions. Discharge medication appropriateness in the intervention group was significantly higher compared to the control group. There was no significant difference in hospital readmissions related to cardiovascular disorders between the groups. Most doctors and nurses were aware of clinical pharmacists but none of them had previously worked with one. Clinical pharmacist-led interventions significantly improved medication adherence and appropriateness, underscoring the added value of clinical pharmacists in a multidisciplinary healthcare team. While most doctors and nurses were aware of clinical pharmacists, none of them had prior experience working with them, emphasising an opportunity to foster greater multidisciplinary integration for improved health outcomes. Overall findings highlight the potential role of clinical pharmacists in enhancing good patient outcomes and improving real-world patient care.

The high prevalence of chronic diseases, workforce challenges, and growing polypharmacy adversely impact the quality use of medicines (QUM) and health outcomes in Saudi Arabia (SA). The SA Ministry of Health (MOH) has initiated several programs and policies to enhance QUM including a National Medication Safety Program, national clinical guidelines, and technology-based strategies. To assess the published literature on the range, quality, and effectiveness of QUM methods in the SA health system. Comprehensive search of electronic databases Scopus, Medline, and PubMed for papers reporting evaluation of QUM interventions or programs in SA. QUM programs involving medication reconciliation, interventions by hospital pharmacists, antibiotics stewardship, technology and staff training are the most commonly used programs reported in SA. Evaluations of several QUM interventions found a significant positive impact on health outcomes, prescribing patterns, chronic disease management, medication safety, and healthcare costs. Medication reconciliation programs reduced discrepancies by up to 20% in some studies. Hospital pharmacist interventions showed high acceptance rates (up to 92%) and improved medication safety. Antibiotic stewardship programs effectively reduced antimicrobial use and costs. Health information technology implementations like electronic health records (EHR), and computerized physician order entry (CPOE) showed mixed results but generally improved medication safety and efficiency. Staff training initiatives enhanced healthcare professionals' knowledge and skills in medication management. While SA has national QUM policies and programs, and evidence that individual QUM interventions have significant positive local impact, more large-scale, multi-center studies are needed to provide a comprehensive view of QUM practices.More rigorous evaluations of existing programs and expansion of the range of QUM programs to align with international ones could further improve medication safety and patient outcomes in Saudi Arabia.

Applications of artificial intelligence in current pharmacy practice: A scoping review.

Investigate the impact of recent notified medicine shortages on dispensing patterns of 30, 40, 50, and 60 mg strengths of lisdexamfetamine for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Australia. Pharmaceutical Benefits Scheme (PBS) aggregate dispensing data for 2022-2024 were analysed. Monthly dispensings and Defined Daily Doses (DDDs) for lisdexamfetamine were calculated overall and by product strength. From January 2022 to August 2023, there was a constant increase in overall dispensing and volume of lisdexamfetamine likely due to expansion of PBS prescribing restrictions allowing subsidy of this medicine for patients 18 years and older in February 2021. Dispensings of the 30 mg strength decreased from August 2023 corresponding with shortages of this product. Dispensings of the 50 mg peaked in October 2023 then decreased. During the shortage of the 30 and 50 mg strengths, dispensings of the 40 and 60 mg strengths increased, however, by December 2023 dispensings of these strengths were also decreasing. Dispensings of 70 mg strengths grew steadily throughout 2024. DDDs changed substantially during the shortage period suggesting that people likely transitioned to different strengths of lisdexamfetamine to maintain their dose. Dispensing patterns of lisdexamfetamine, by strength, changed significantly during the medicines shortages periods revealing potential changes in prescriber and patient behaviours, such as switching to higher strength products or using medicines intermittently, to maintain continuity of care. To facilitate quality use of medicines during shortages, dispensing patterns must be monitored so that inequities of access can be identified and addressed.

New onset insomnia is often experienced by patients during hospitalization due to environmental disruptions, pain and increased patient care activities. Patient distress arising from poor sleep quality and quantity often results in the prescribing of hypnotics. Melatonin use in hospital settings is common and is increasingly used for off label indications including primary insomnia in those aged < 55 years, prevention of delirium and to facilitate benzodiazepine discontinuation. A literature review was conducted to evaluate the efficacy, effectiveness, safety, tolerability, and cost-effectiveness of melatonin for various off-label indications in inpatient hospital settings. The review found limited high quality evidence demonstrating a clinically meaningful benefit from melatonin in improving sleep, delirium, or facilitating benzodiazepine discontinuation in the inpatient setting. Study findings were inconsistent, and those that did show statistical improvement were of uncertain clinical benefit. The review also found a paucity of data on the safety of melatonin when used in hospitalized patients, and no evidence to support cost-effectiveness. Non-pharmacological interventions are recommended as first-line treatment of insomnia and for the prevention of delirium in inpatient settings. The use of interventions without evidence for efficacy or effectiveness is contrary to the quality use of medicines principles in Australia's National Medicines Policy. Context-specific evidence on the efficacy and effectiveness of a medicine should guide clinician decision-making and prescribing, to improve the quality use of medicines.

Background: Hospital pharmacy services support quality use of medicines and medication safety through clinical pharmacy activities such as medication reviews and patient education. These activities can be measured and monitored using evidence-based and standardised key performance indicators (KPIs), which highlight the value of pharmacy services. Standardisation of KPIs supports long-term benchmarking and inter- and intra-site comparisons to target key areas for improvement in clinical pharmacy services. Aim: To describe the type and frequency of clinical pharmacy activity across five hospitals within one metropolitan hospital district. Methods: Key Performance Indicator data were collected by pharmacists from five hospital sites at one metropolitan hospital district, in Queensland Australia. Data were collected over one week for the following clinical settings: inpatient, discharge, outpatient clinic, and the dispensary. Data were collected using a manual, paper-based data collection tool previously developed using a co-design process. Results: Across 11,215 inpatient encounters, hospital pharmacy services provided: best possible medication history (BPMH) within 24 h of admission: 69.5%; daily medication chart review: 57.2%; discharge education: 82.7%, discharge reconciliation: 88.2%; and provision of discharge medication record: 82.4%. Across 1,092 outpatient encounters, pharmacists documented BPMH for 33.3% of patients. Pharmacists identified a total of 5,009 drug-related problems (DRPs) across the data collection period, with the rate of identification highest in the outpatient clinic setting (64.8 per 100 patient reviews) followed by discharge (52.6 per 100 patient reviews) and then inpatient (48.1 per 100 patient reviews). Almost 20% of DRPs identified (n = 975) were high risk. Conclusion: Reporting and benchmarking clinical pharmacy activity through standardised KPIs supports opportunities to identify service improvements. Future research should focus on larger scale studies using routinely recorded data to monitor clinical pharmacy KPIs across all care settings.

Abstract Older adults are at high risk of drug‐related problems during hospitalisation for surgery. Pharmacists play a key role in the multidisciplinary health care team to improve the safety and quality use of medicines in hospitals. The aims of this prospective study were to examine the frequency, type, associated factors, and acceptance rates of pharmacist consultations in a cohort of 302 consecutive patients aged ≥65 years admitted to a tertiary vascular surgery unit. Data collected included frequency and type of pharmacist consultations, patient and clinical characteristics, and the rate of acceptance of pharmacist recommendations. There was a total of 299 pharmacist consultations, with 159 (52.6%) patients being reviewed at least once by a pharmacist. Of the 299 pharmacist consultations, the most common reason for consultation was a medication order review (38.8%). Pharmacist consultation was more likely if the patient had an emergency admission (p = 0.045), had admission to intensive care unit during the hospitalisation (p &lt; 0.001), or had a long‐stay admission defined as &gt;14 days (p &lt; 0.001). Older age, frailty status, cognitive impairment, polypharmacy, and operative management were not associated with having a pharmacist review. Of these pharmacist consultations, 190 (63.5%) included recommendations for the care team to implement, and 166 (87.4%) of the 190 recommendations were addressed. These findings provide insight into the roles played by hospital pharmacists and suggest an unmet need for proactive pharmacist consultation for older surgical patients with polypharmacy, frailty, and cognitive impairment. Ethical approval was granted by the Sydney Local Health District Human Research Ethics Committee — Concord Hospital (Reference no: CH62/6/2018–170) and the study conforms to the Australian National statement on ethical conduct in human research.

Acute care provided in the hospital's emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as "choosing suitable medicines and using them safely and effectively", remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED.