Participants were enrolled in two pre-existing sections of a management course. One section received a 14-week problem-based learning intervention based on authentic community pharmacy scenarios, while the other received conventional lecture-based instruction covering the same core content. The researchers assessed critical thinking disposition and social problem-solving at baseline and after the intervention using validated instruments. Quantitative data were examined with mixed-design analysis of variance, which accounted for change over time and the interaction between time and group. The study did not randomly allocate students, and the groups were not equivalent at baseline on the critical thinking disposition measure, limiting interpretation of the between-group pattern.

The researchers also conducted semi-structured interviews with students in the intervention group and analyzed the accounts using reflexive thematic analysis. Students described problem-based learning as an active, experience-based process that increased their engagement and supported the transfer of theoretical knowledge to community pharmacy practice. They also reported developing more systematic and multifaceted approaches to problem-solving. These accounts provided qualitative context for the pre-test and post-test results, but they did not establish that the teaching method alone produced the measured improvements. The authors characterized the quantitative findings as an association between the structured intervention and gains in critical thinking disposition and social problem-solving.

The study’s scope was limited to a modest sample of final-year students in two intact class sections at one institution, and its findings were confined to a semester-long management course and authentic community pharmacy scenarios. The researchers said larger studies with more comparable groups are needed to evaluate the comparative effectiveness of problem-based learning in pharmacy curricula. Within those limits, the combined results suggest that a sustained, scenario-based course may engage students and help them connect classroom knowledge with problem-solving in community pharmacy contexts. The authors associated these experiences with areas relevant to patient counselling, decision-making and practice readiness, while emphasizing that the study does not demonstrate improved patient outcomes or prove that problem-based learning was superior to conventional instruction.

Subject of Research: A mixed-methods study of problem-based learning and pharmacy students’ critical thinking and social problem-solving

Article Title: Enhancing critical thinking and social problem-solving through problem-based learning: a mixed-methods study among pharmacy students

Article References: Ulutas Deniz, E., & Kürüm, F. A. (2026). Enhancing critical thinking and social problem-solving through problem-based learning: a mixed-methods study among pharmacy students. BMC Medical Education. https://doi.org/10.1186/s12909-026-10420-6

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10420-6

Keywords: pharmacy education, problem-based learning, critical thinking, social problem-solving, community pharmacy, mixed-methods research, student engagement, quasi-experimental study, Enhancing, critical, thinking, social

The study, led by Şeyma Halaç of the Turkish Ministry of Health alongside colleagues from İstanbul University-Cerrahpaşa and the University of Health Sciences, set out to answer a deceptively simple question: how do the academics who train future pharmacists actually perceive public health, and do they believe pharmacy education equips graduates to deliver it? To find out, the team conducted in-depth, semi-structured online interviews with eleven pharmacy academics drawn from eight universities across Istanbul, four public and four private, between November 2024 and January 2025.

The participant pool was deliberately diverse. It spanned clinical pharmacy, pharmacognosy, pharmaceutical technology and pharmaceutical toxicology, and ranged from assistant professors to full professors, with a mean age of 38 years. Recruitment followed a maximum-variation sampling strategy and closed after eleven interviews, when the researchers judged that the information gathered had reached sufficient depth and that new interviews were producing few substantively fresh ideas. Interviews lasted roughly forty minutes each, were audio-recorded with consent, transcribed verbatim, and analysed using reflexive thematic analysis, with reporting structured according to the Consolidated Criteria for Reporting Qualitative Research, the international standard checklist for qualitative studies.

The analysis produced a framework of fifteen codes organised into four domains under a single overarching theme: the strategic role and perceptions of pharmacists in public health. Those domains covered how academics conceptually define public health, their emphasis on preventive healthcare, the individual and societal awareness elements that underpin it, and the concrete points of contact between community pharmacy and population health. Across all four, one message dominated: prevention, not treatment, is where pharmacists could make their greatest difference.

The single most intensively discussed topic in the interviews was the idea of taking precautions before diseases occur. Academics framed public health as a protective, preventive and multidimensional enterprise that extends far beyond individual patients to encompass social welfare, equitable access to services and even psychological wellbeing. One participant described public health as all efforts to protect and improve the general health of society, stressing that improving health conditions at the societal level and providing equal access to health services are as much a part of the field as treating the sick. Another emphasised that physicians, pharmacists, nurses, government and companies all carry a share of responsibility, and that community pharmacists have a distinct duty within that shared model.

That preventive framing has concrete technical implications. Participants repeatedly pointed to screening, early guidance, immunisation and infectious disease follow-up as activities where pharmacy’s accessibility gives it an edge over conventional clinic-based services. Community pharmacies are, in many neighbourhoods, the healthcare settings people visit most often, and that repeated, low-barrier contact creates natural opportunities for early intervention, counselling and referral. One academic noted that pharmacists’ daily practice can be preventive and prophylactic while also supporting treatment, positioning the pharmacy as the first link in a chain of information, monitoring and referral that relieves pressure on the wider health system.

International models featured prominently in the academics’ reasoning. Several pointed to the United States, where pharmacists actively participate in vaccination campaigns, as evidence that pharmacies can function as genuine public health delivery points rather than mere dispensing outlets. The idea of turning pharmacies into vaccination centres was offered as a concrete example of public health practice that could plausibly be transferred to Türkiye. This aligns with a growing body of international evidence, cited in the study, showing pharmacist-led interventions improving vaccination coverage, screening uptake and chronic disease monitoring in a range of health systems.

Yet the academics were equally clear about why this potential remains unrealised in Türkiye. Three barriers emerged. First, pharmacy education itself was judged insufficient: public health competencies are not adequately embedded in undergraduate curricula, and one participant argued that public health should be part of all courses because the field draws on every discipline. Second, societal health literacy is perceived as low, which undermines the effectiveness of any preventive service. Participants described patients self-treating with information from hearsay or television rather than reliable sources, and one academic lamented that health literacy in the country is not at very high levels, directly linking this deficit to the impact of public health services.

The third barrier is systemic. Although Ministry of Health Circulars No. 2019/10 and 2019/18 formally recognised community pharmacies as providers of primary healthcare services in Türkiye, participants said pharmacists’ public health potential remains underused and that services are not sufficiently standardised. Without policies that formally recognise pharmacists as frontline public health practitioners, the academics argued, the profession’s accessibility advantage cannot be converted into measurable population health gains. One participant summarised the frustration bluntly: the potential role of pharmacists in public health in Türkiye is not sufficiently evaluated, but with the right training, empowerment and support, this situation can change.

The study’s authors conclude that strengthening public health education within pharmacy curricula, supported by postgraduate and continuing professional development, and establishing policies that formally recognise pharmacists as frontline public health practitioners could substantially enhance the profession’s contribution to population health. The findings carry caveats: all participants were Istanbul-based academics, so the views may not transfer to other regions or to community pharmacists themselves, who were not interviewed. Future research, the team notes, should include geographically diverse participants and additional professional groups, and should examine how the proposed roles can be operationalised and evaluated in real-world practice. Even so, the message from the educators who shape the profession is unambiguous: the pharmacy on the corner is already a public health asset, and the systems around it have yet to act like it.

Subject of Research: Pharmacy academics' perceptions of pharmacists' public health roles and barriers in Türkiye

Article Title: Pharmacy academicians’ perception towards public health: a qualitative study

Article References: Halaç, Ş., Bektay, M. Y., Eker, H. H., & Öztürk, M. (2026). Pharmacy academicians’ perception towards public health: a qualitative study. International Journal of Public Health, 71, Article 1608594. https://doi.org/10.3389/ijph.2026.1608594

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1608594

Keywords: public health, community pharmacy, pharmacists, pharmacy education, health literacy, preventive healthcare, qualitative study, Türkiye, vaccination, chronic disease management, thematic analysis, primary healthcare

The study, published in the Journal of Pharmacy and Pharmaceutical Sciences, analyzed records from 36,340 outpatients treated at a single Japanese hospital between 2016 and 2021. Rather than relying on patient questionnaires, which are notoriously unreliable when it comes to adherence, the researchers tapped into something far more objective: a protocol-based pharmacotherapy management system, known as PBPM, in which community pharmacists physically count and report leftover medications back to prescribing physicians. Under this standardized leftover drug adjustment protocol, pharmacists interview patients during dispensing, verify unused pills, and send objective reports that allow doctors to fine-tune prescription durations. Any patient with at least one such report during the five-year window was classified as having leftover drugs.

The headline number is deceptively modest: 9.6 percent of patients—3,472 individuals—had leftover drugs reported at least once. But the distribution across the lifespan is anything but uniform. The prevalence climbed steadily from just 0.4 percent in children under ten to a peak of 15.9 percent among patients in their eighties, before dipping back to 10.5 percent in those aged ninety and older. Patients in the leftover group were, on average, nearly seventeen years older than those without leftovers, and they carried roughly twice as many medications, received prescriptions lasting nearly twice as long, and visited significantly more prescribing departments.

What makes the study genuinely novel is its decade-by-decade dissection of risk. Using multivariate logistic regression with interaction terms, the team demonstrated that age does not merely add risk on its own—it fundamentally rewrites which prescription characteristics matter most. The statistical model, which achieved an area under the curve of 0.858, revealed significant interactions between age and three of the four primary factors examined: drug count, prescription duration, and the number of prescribing departments. Sex, by contrast, dropped out as an independent predictor once these prescription complexities were accounted for, suggesting that the fundamental drivers of leftover drug risk are structural features of the prescription itself rather than demographic attributes.

The most striking finding concerns young adults. For patients in their twenties, prescriptions lasting sixty days or longer carried an adjusted odds ratio of 102.15 compared with prescriptions under thirty days—a number so extreme that the researchers themselves caution it comes with wide confidence intervals and sparse event counts. Yet the pattern held across the twenties, thirties, and forties: long-term prescriptions were the single most potent risk factor for younger adults, dwarfing the influence of polypharmacy or multi-department care in these age groups. The researchers interpret this through the lens of episodic non-adherence. Among younger patients, single occurrences of leftover drugs predominated—nearly seventy percent of cases in the teenage group involved just one report—consistent with situation-dependent lapses, such as lifestyle disruptions or treatment changes, rather than chronic mismanagement.

Older patients tell a very different story. For those in their sixties through eighties, the dominant risks were polypharmacy—defined as five or more concurrent medications—and visits to three or more prescribing departments. The predicted probability models revealed a synergistic amplification: when patients on five or more drugs also received prescriptions lasting sixty days or longer, the probability of leftover drugs remained above 0.3 from the thirties through the eighties, eventually approaching 0.6 when multi-department care was added. This cumulative burden structure, the authors argue, reflects the reality that medication-related risks in older adults rarely stem from a single factor but emerge from the interaction of multiple components of pharmacotherapy.

Amid this complexity, one finding cut across every age group: keeping the drug count below five was consistently associated with a lower likelihood of leftover drugs, even when prescription duration or department count was unfavorable. In profiles where all factors sat at baseline levels—fewer than five drugs, prescriptions under thirty days, and a single prescribing department—the predicted probability of leftover drugs stayed below 0.05 across all ages. This suggests that deprescribing, the deliberate process of reducing inappropriate polypharmacy guided by tools such as the Beers Criteria and the STOPP/START criteria, may be the single most transferable strategy across the lifespan.

The middle decades present their own vulnerability. For patients in their forties and fifties, the sensitivity of risk to an increasing drug count was more pronounced than in any other age band. The researchers speculate that this cohort, often juggling employment and family responsibilities, is uniquely exposed when polypharmacy collides with extended prescription durations. For them, suppressing the medication count below five may serve as a practical buffer between the demands of work and the burden of treatment.

The study’s methodology deserves attention because it sidesteps a chronic weakness in adherence research. Self-reported surveys tend to overestimate compliance, and pharmacy refill records can conflate adherence with access issues. By contrast, the PBPM data capture what community pharmacists actually observed and reported—clinical facts negotiated between pharmacist and physician. The approach is not without blind spots: patients who concealed their leftovers, discarded them at home, or had prescriptions adjusted during the medical exam never entered the leftover group. The authors also acknowledge that leftover drugs do not exclusively signal non-adherence; dose adjustments, hospitalizations, treatment completion, and deprescribing can all produce surplus medication, making the indicator multifactorial rather than a direct measure of non-adherence.

Even so, the practical implications are hard to ignore. For younger adults, the data argue for starting with shorter prescriptions to gauge management capability, then using refills and pharmacist follow-up—potentially supported by information and communication technology—to maintain contact. For older adults, the priority shifts toward simplifying regimens and building information-sharing systems between medical institutions, since fragmented care across departments can breed duplicate prescriptions and inappropriate additions. Japan’s medical fee system already requires pharmacies to confirm leftover drugs and adjust prescriptions accordingly, and pharmacists there are legally obligated to monitor medication status throughout treatment. Whether the specific magnitude of risk seen in young Japanese adults—particularly that eye-watering odds ratio above 100—translates to other healthcare systems remains an open question, and the authors call for multicenter prospective studies combined with qualitative research into patient behavior. But the core message travels well: the recipe for leftover medication changes dramatically with age, and one-size-fits-all adherence interventions are doomed to miss half their audience. The future of medication management, this study suggests, belongs to strategies tailored to each decade of a patient’s life—with the number of pills in the regimen as the common denominator of safety.

Subject of Research: Age-stratified risk factors for leftover medications identified through community pharmacy pharmacotherapy management data

Article Title: Age-related risk factors for leftover drugs: a lifespan analysis in community pharmacies

Article References: Hirai, T., Hanaoka, S., Terakado, Y., Seki, T., Hayashi, H., & Watanabe, F. (2026). Age-related risk factors for leftover drugs: a lifespan analysis in community pharmacies. Journal of Pharmacy & Pharmaceutical Sciences, 29, Article 16879. https://doi.org/10.3389/jpps.2026.16879

Image Credits: AI Generated

DOI: 10.3389/jpps.2026.16879

Keywords: medication adherence, leftover drugs, polypharmacy, community pharmacy, prescription duration, pharmacists, older adults, deprescribing, medication safety, PBPM, healthcare costs, Japan

The research team, headed by Wael Y. Khawagi and Abdullah A. Alshehri of Taif University’s Department of Clinical Pharmacy, surveyed 188 licensed pharmacists working in community pharmacies between January and April 2026. Using a structured online questionnaire, the researchers asked respondents about the availability and frequency of 26 distinct professional pharmacy services, grouped into three domains: core pharmacy services, clinical and public health services, and advanced and access services. Participants rated how often each service was provided, from not available at all to daily delivery, and the researchers converted these responses into summary scores for service breadth and overall utilization. The team then used Spearman correlation and multivariable logistic regression to identify which demographic, professional, and operational factors were associated with higher service provision.

The results paint a picture of a profession with one foot in the traditional dispensing model and the other hesitating at the threshold of expanded clinical practice. Prescription dispensing was reported as available by 97.9 percent of respondents, and medication counselling by 97.3 percent, with more than half of pharmacists reporting that they delivered these core services at high frequency. Management of minor ailments was available to 80.9 percent of respondents. But the picture changed dramatically for extended services. Vaccination was the least available clinical service of all, with 80.9 percent of pharmacists reporting that it was simply not offered in their pharmacy. Blood glucose and blood pressure screening were available to only 44.1 percent and 42.0 percent of respondents respectively, despite the kingdom’s high and growing burden of diabetes and cardiovascular disease.

The gradient was even steeper for advanced and access services, many of which depend on physical infrastructure or digital integration rather than clinical skill alone. Home delivery was the most prevalent service in this category, available to 72.9 percent of respondents, though only 17.6 percent provided it daily. Digital adherence monitoring was available to 53.2 percent, and pharmacovigilance and adverse drug reaction reporting to 51.6 percent, yet high-frequency adverse drug reaction reporting was uncommon at just 12.8 percent. The infrastructure-dependent services fared worst of all: 65.4 percent of respondents said their pharmacy could not prepare dosette or blister packs, 66.5 percent had no access to electronic health records, 72.3 percent offered no drive-thru dispensing, and 75.0 percent reported having no private consultation room. Only 4.8 percent of pharmacists used a consultation room daily, a figure that underscores how difficult confidential patient conversations can be in a retail pharmacy environment.

Perhaps the most statistically compelling finding concerned prescription volume. In the fully adjusted multivariable model, each category increase in daily prescription volume was associated with 3.52-fold higher odds of high service utilization, by far the strongest independent predictor in the analysis. Years of professional experience also mattered, with each category increase associated with 1.56-fold higher odds of higher utilization. Spearman correlations told a consistent story: prescription volume correlated moderately with both service availability and utilization, while experience showed smaller but significant positive associations. Intriguingly, the number of pharmacists per shift, daily opening hours, and urban versus rural workplace setting showed no significant association with either outcome, suggesting that raw patient throughput and individual professional engagement matter more than staffing levels or geography.

The qualification effect was one of the study’s more counterintuitive results. Pharmacists holding a PharmD degree, the more clinically oriented doctoral qualification, actually had 0.29 times the odds of high service utilization compared with BPharm holders after adjustment. Increasing age was also associated with lower odds of higher utilization, at 0.91 per year. The authors caution that these observational associations cannot establish causation and may reflect unmeasured factors such as workplace type, employer expectations, or the roles younger and older pharmacists occupy within organizations. The postgraduate subgroup was too small, with only eight respondents, to draw meaningful conclusions. A sensitivity analysis using the continuous utilization score rather than a median-based dichotomization produced broadly consistent results, lending some robustness to the primary findings.

When asked what stood in the way of providing more services, pharmacists pointed overwhelmingly to the system around them rather than to their own capabilities. Unclear regulations topped the list, cited by 55 percent of respondents, followed closely by high workload and time constraints at 53 percent, and administrative burden associated with the Wasfaty electronic prescribing system at 51 percent. More than a third also flagged limited training and continuing professional development, technical or software problems, and the absence of financial incentives. Notably, perceived barriers did not correlate significantly with the provision of core or clinical services, suggesting that pharmacists who already deliver expanded services do not necessarily perceive fewer obstacles, or that barriers operate uniformly across the profession.

Satisfaction with the current scope of practice was lukewarm at best. Only 42.0 percent of respondents reported being satisfied or very satisfied with the range of services they could offer, while 15.4 percent expressed dissatisfaction and the largest single group, 42.6 percent, sat squarely on the fence. That ambivalence may itself be informative: it suggests a workforce that recognizes the potential of expanded practice but sees the gap between what is expected of them and what the regulatory, financial, and physical environment actually permits. The Wasfaty system, which connects prescriptions electronically between prescribers and pharmacies and has been praised by patients for convenience, appears to have introduced its own administrative friction for the pharmacists operating it.

The study’s implications extend beyond Saudi borders, because the tension it documents is playing out in healthcare systems worldwide. International evidence from Europe, Australia, and other Middle Eastern countries has similarly found that introducing new pharmacy services does not guarantee their routine integration into practice, and that availability frequently outpaces actual utilization. In countries where community pharmacists have become established immunization providers, supportive legislation, reimbursement mechanisms, and clear role definitions preceded the expansion. The Saudi findings suggest that the kingdom’s reform agenda will need to address these structural enablers if community pharmacies are to relieve pressure on primary healthcare centers and hospitals as intended.

The authors are candid about the limitations of their work. The cross-sectional design cannot establish cause and effect, the convenience sampling strategy and the concentration of 75 percent of respondents in the Makkah region limit generalizability, and a response rate could not be calculated because the number of pharmacists who received the invitation was unknown. Self-reported service provision is vulnerable to recall and social desirability bias, the questionnaire was pilot-tested but not previously validated, and pharmacy-level clustering could not be accounted for because individual pharmacies were not identified. Future research, the team argues, should use nationally representative samples and objective service records, track changes longitudinally as Vision 2030 reforms unfold, and test interventions such as reimbursement models, workforce expansion, and digital integration. For now, the study offers a clear diagnosis: Saudi community pharmacists have mastered the dispensing core, but the clinical, preventive, and advanced services that could redefine their profession remain locked behind regulatory ambiguity, heavy workloads, and missing infrastructure.

Subject of Research: Availability and utilization of professional pharmacy services in Saudi Arabian community pharmacies

Article Title: Availability, utilization, and factors associated with professional pharmacy services in community pharmacies in Saudi Arabia: a cross-sectional study

Article References: Khawagi, W. Y., Al-Sharif, O. N., Al-Zahrani, T. A., Alghamdi, S. S. A., Alruqayb, W. S., & Alshehri, A. A. (2026). Availability, utilization, and factors associated with professional pharmacy services in community pharmacies in Saudi Arabia: a cross-sectional study. Journal of Pharmacy & Pharmaceutical Sciences, 29, Article 17413. https://doi.org/10.3389/jpps.2026.17413

Image Credits: AI Generated

DOI: 10.3389/jpps.2026.17413

Keywords: community pharmacy, Saudi Arabia, pharmaceutical care, pharmacist services, vaccination, health screening, Wasfaty, Vision 2030, cross-sectional study, pharmacovigilance, medication counselling, healthcare transformation

If annual funding is approved at the first-year level, the initiative represents nearly $25 million in investment in rural Colorado over five years. Approximately $1.42 million of the first-year award is budgeted to support CU Anschutz Pharmacy’s role in the project, an investment that could total more than $7 million over the full five-year span, making STREAM one of the largest awards in the history of the Skaggs School. Denver Recovery Group serves as the lead grantee, working in partnership with CU Anschutz Pharmacy, The Steadman Group, and community and healthcare partners across the state to develop and implement the new model. The scale of the collaboration reflects a deliberate design choice: rather than building new infrastructure from scratch, STREAM aims to connect the healthcare resources and trusted relationships that already exist in Colorado’s small communities into a single coordinated network of care.

The scale of the problem the initiative confronts is stark. Nearly 722,000 Coloradans live in rural communities, and 47 of the state’s 64 counties are classified as rural or frontier. Many residents face chronic healthcare provider shortages, long travel distances and limited access to specialty and behavioral health services. Those barriers become particularly consequential for people seeking treatment for opioid use disorder, a condition for which rural communities often have few treatment providers and limited behavioral health resources, and where transportation difficulties and fragmented care can make it hard for patients to begin and remain in treatment. At the same time, rural populations carry significant burdens from chronic conditions such as diabetes, hypertension and cardiovascular disease, illnesses that demand consistent monitoring, careful medication management and ongoing clinical follow-up that distant clinics struggle to provide.

Colorado STREAM’s answer to this geography of scarcity is a hub-and-spoke architecture built around the local pharmacy. The model will create connections among regional treatment hubs, community pharmacy networks, telehealth services and coordinated whole-person care. Concretely, the initiative will work to expand access to evidence-based medications and support for opioid use disorder; connect patients and rural pharmacy teams with treatment specialists and other clinicians through telehealth and coordinated referrals; increase access to medication management for chronic diseases such as diabetes, hypertension and cardiovascular disease; and build rural healthcare workforce capacity by training pharmacists, pharmacy technicians, students, preceptors and collaborating healthcare professionals. The program will also develop sustainable models that allow community pharmacies to play a larger role in delivering and coordinating healthcare, and it will use data and evaluation to measure outcomes, improve care and refine a model that can be sustained and expanded over time.

The logic of placing pharmacies at the center of the network is grounded in both trust and logistics. Community pharmacists are among the most accessible healthcare professionals in rural America, often the only clinically trained providers physically present in a town, and they already hold medication expertise and established relationships with the patients they serve. By connecting them with treatment specialists, technology and coordinated care networks, the initiative aims to bring critical services closer to patients rather than asking patients to travel long distances to find care. Telehealth links and structured referral pathways are intended to extend the reach of regional treatment centers into communities where recruiting physicians and behavioral health clinicians has proven persistently difficult, converting existing pharmacy counters into access points for a far broader continuum of care.

The partnership behind the project is deliberately broad. Denver Recovery Group, led on the ground by Regional Director Denise Vincioni, served as the lead applicant and brings evidence-based treatment expertise for opioid use disorder, including medications for opioid use disorder, counseling, case management and care coordination. The Steadman Group, led on the project by JK Costello, MD, MPH, contributes program design and evaluation capacity, while the CU Anschutz team, led by Rob Valuck, PhD, RPh, Wes Nuffer, PharmD, and Dean Brian Tsuji, PharmD, adds academic depth in pharmacy practice, addiction science and experiential training. The collaboration also includes national and regional pharmacy operators Albertsons-Safeway and Kroger/City Market, independent rural pharmacies such as Downtown Drug in Glenwood Springs and Buena Vista Drug, and CPESN Colorado, a statewide network focused on expanding community pharmacy-based patient care. Emily Zadvorny, PharmD, Executive Director of the Colorado Pharmacists Society, brings additional statewide pharmacy leadership to the effort, a roster designed to ensure the model is informed by the realities of delivering care in communities of very different sizes and regions.

Leaders involved in the project have framed it as a rethinking of how healthcare can reach places the traditional system has left behind. Dean Brian Tsuji has described the investment as an extraordinary opportunity to rethink rural care delivery, noting that community pharmacists are already trusted professionals embedded in these communities and that connecting them with treatment specialists, technology and coordinated networks can bring services to patients instead of forcing patients toward services. Denise Vincioni has emphasized that people in rural Colorado should be able to receive high-quality treatment and coordinated healthcare closer to home, and that STREAM connects treatment expertise with trusted community pharmacies, academic partners, technology and local care resources so that distance is less of a barrier to recovery and better health. Rob Valuck has argued that where a person lives should not determine whether they can get the care they need, and that the strength of the hub-and-spoke model lies in not trying to recreate an entire healthcare system in every rural community, but in connecting regional expertise with pharmacists already caring for patients close to home.

Wes Nuffer has added a practical dimension to that vision, observing that for many rural Coloradans the community pharmacy may be one of the most accessible points of healthcare in their community, and that STREAM builds on that existing relationship rather than creating entirely new infrastructure. From the university’s perspective, the initiative also carries an educational mission: preparing future pharmacists to practice in rural and frontier settings and demonstrating how pharmacists can contribute more broadly to the healthcare team. Tsuji has noted that pharmacists have always been medication experts but that their potential contribution to rural healthcare extends much further, and that STREAM offers a chance both to improve access today and to train the next generation of pharmacists to become an integral part of the rural healthcare workforce, a tangible example of combining education, innovation, clinical expertise and community partnerships to tackle complex healthcare challenges.

The award sits within a much larger wave of federal investment. Colorado’s Rural Health Transformation Program is supported through the federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services, a five-year initiative authorized under Section 71401 of H.R. 1, Public Law 119-21, which provides grants totaling $50 billion in federal funding nationwide from Federal Fiscal Year 2026 through FFY 2030. Colorado is directing $169,587,181 in RHTP grants to rural healthcare providers across the state, and through a highly competitive application process, 91 applicants and approximately 250 projects were selected to receive funding across 52 rural or frontier counties and three rural census tract counties. Colorado’s first-year award totals $200,105,604.17 and is 100 percent funded by CMS. The state program’s priorities include expanding the rural healthcare workforce, strengthening rural healthcare networks, increasing preventive care capacity, integrating telehealth and technology, and developing new approaches to rural care delivery, priorities that STREAM touches on nearly every front.

For the communities involved, the measure of success will be practical: whether a person with opioid use disorder in a frontier county can start evidence-based medication without a multi-hour drive, whether a diabetic patient can get consistent medication management from a pharmacist they already know, and whether the network can sustain itself financially beyond the grant period. The award remains subject to execution of the Grant Agreement and annual funding is subject to continued approval, so the five-year horizon is not yet guaranteed. But if the model performs as its architects hope, Colorado STREAM could offer a template for a national question: how to convert the most trusted and most accessible healthcare professionals in rural America into the connective tissue of a system that has long struggled to reach them. The initiative’s own data and evaluation work will determine whether that template is ready to travel beyond the Rockies.

Subject of Research: Pharmacy-based rural healthcare access and opioid use disorder treatment in Colorado through the Rural Health Transformation Program

Article Title: $4.9M RHTP award will expand pharmacy-based healthcare access across rural Colorado

Article References: $4.9M RHTP award will expand pharmacy-based healthcare access across rural Colorado. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: rural health, community pharmacy, opioid use disorder, telehealth, Colorado, Rural Health Transformation Program, CU Anschutz, medication management, hub-and-spoke model, healthcare workforce, chronic disease, CMS

The study, led by Sara M. Hanning of the University of Auckland’s School of Pharmacy with colleagues from the university and Middlemore Hospital, set out to answer three practical questions: how unwanted medicines are currently disposed of in community pharmacies, how many metered-dose inhalers are actually returned for disposal, and whether pharmacists would support a dedicated, low-carbon return scheme for inhalers. Between December 2023 and January 2024, an anonymous online questionnaire was emailed to 1,043 community pharmacies across New Zealand, drawn from the Medsafe pharmacy licence register. After reminders and data cleaning, 102 responses were complete enough for analysis, a response rate of roughly ten percent.

The headline finding was encouraging: 98 percent of responding pharmacies already collect unwanted or expired medicines for disposal, and most reported receiving returns at least weekly, with nearly 16 percent receiving them daily. The dominant disposal route was a dedicated pharmaceutical waste bin collected by a third-party contractor. In New Zealand, non-cytotoxic pharmaceutical waste is steam sterilised by autoclave and then sent to a dedicated landfill, because the country no longer operates any high-temperature incinerators for pharmaceuticals or other waste. Cytotoxic medicines are the exception, exported offshore for incineration.

But the survey also uncovered practices that fall short of the official pathway. Some pharmacies reported pouring liquid medicines down the sink, a method that introduces pharmaceutical compounds into wastewater, where they can persist through treatment plants and reach rivers and coastal waters. A handful of respondents said they returned unopened, in-date medicines to stock for re-dispensing, a practice the researchers warn against, since pharmacies cannot verify how medicines were stored once they left the premises. Others mentioned giving sealed, in-date medicines to medical aid charities or destroying controlled drugs by dissolving them into kitty litter. The variety of reported methods, the authors suggest, reflects a deeper problem: most pharmacists simply do not know what happens to waste after it leaves their premises. Only 15.7 percent felt informed or well informed about the fate of pharmaceutical waste, and 67.4 percent said they were not at all informed about the environmental impact of inhaler disposal.

The inhaler numbers were stark. Respondents estimated their pharmacies dispensed an average of 214 metered-dose inhalers per month, but received only about eight back for disposal, a return rate of under four percent. This aligns with earlier research showing that most consumers toss empty inhalers into household rubbish, despite consumer information leaflets instructing them to bring devices back to a pharmacy. Passive information channels, the authors conclude, are clearly not enough to change behaviour.

The climate stakes are considerable. Pressurised metered-dose inhalers accounted for 66 percent of inhalers prescribed in New Zealand in 2020, largely because they are cheaper than dry-powder or soft mist alternatives and better suited to patients who cannot generate the inspiratory force needed for powder devices, including children, older people and those with severe symptoms. The hydrofluorocarbon propellants they contain were introduced to replace ozone-destroying chlorofluorocarbons after the Montreal Protocol, but they are powerful greenhouse gases. A common propellant, HFA134a, has a heat-trapping potential roughly 1,300 times that of carbon dioxide, and a typical 200-puff salbutamol inhaler carries a footprint equivalent to 28 kilograms of carbon dioxide, comparable to driving a petrol car more than 120 kilometres. Because manufacturers fill canisters with excess propellant to guarantee every dose, gas remains even after all the medicine is used, and it lingers in the atmosphere for an average of 15 years.

When asked whether they would be interested in a dedicated recycling scheme for metered-dose inhalers, 42.7 percent of pharmacists said yes and 39.3 percent said maybe, with only 18 percent declining. The two biggest barriers, ranked by a weighted scoring method, were the administrative load on pharmacy staff and the financial cost to the pharmacy. The small number of inhalers returned by consumers ranked lowest among the barriers. Free-text comments captured the tension: one pharmacist wrote that they would want to know the procedure and full rationale first, since delivering medication was the priority and environmental concerns secondary; another noted that pharmacies spend significant staff time on returned medicines with no financial reimbursement, calling it yet another service community pharmacies provide for free.

Pharmacists also had clear views on what would motivate patients. Media advertisements promoting the scheme and financial incentives for returning inhalers ranked highest, while reminders at the point of dispensing ranked lowest, echoing the finding that passive advice has little effect. International evidence suggests such schemes can work. A 12-month postal pilot in one English region collected more than 20,000 inhalers, 77 percent of them pressurised devices, and recycled the propellant gases for refrigeration, the aluminium canisters into smelting bricks and the plastic casings into pellets, preventing an estimated minimum of 119 tonnes of carbon dioxide equivalent from entering the atmosphere. Yet scale matters: the UK’s Complete the Cycle scheme, which recycled two million inhalers over nine years, closed in 2020 because its creator concluded that a standalone scheme could not achieve adequate scale without industry-wide cooperation. In New Zealand, a six-month inhaler recycling trial began in the Bay of Plenty in June 2025, and a refrigerant destruction facility using plasma arc technology is under construction in the North Island, potentially offering a domestic route for capturing and destroying propellant gases.

The researchers argue that a product stewardship model, in which responsibility is shared across manufacturers, importers, distributors, pharmacies and consumers, may be the fairest path forward, with pharmacies forming one link in a larger technological chain. New Zealand already has precedent for such schemes with synthetic refrigerants, and the regulatory and administrative infrastructure exists. To ease the burden on pharmacies, the authors propose a scheme that integrates seamlessly with existing medicine return systems, supported by centralised automated administration, government funding, space-conscious collection containers and regular scheduled pick-ups. Consumer-side measures could range from money-back incentives on prescription costs, as trialled in Sweden, to low-cost local prize draws like one running at a general practice on Vancouver Island, Canada.

The study has limitations the authors acknowledge candidly. The ten percent response rate, likely worsened by staffing shortages, pharmacist burnout and the timing of invitations over the Christmas and New Year holiday period, means the sample may over-represent pharmacists already interested in sustainability, potentially inflating estimates of willingness to participate. Still, the direction of the findings is clear: pharmacies overwhelmingly accept returned medicines, most feel responsible for safe disposal, and most are open to an inhaler scheme if cost and paperwork are addressed. The next phase of the research will use semi-structured interviews with pharmacists and inhaler users to map barriers and encouragers in more detail, alongside work to establish cost-effective pathways for emptying and decontaminating canisters so that aluminium and plastic components can re-enter the circular economy. With New Zealand committed to cutting net carbon dioxide emissions to 50 percent below 2005 levels by 2030 and reaching net zero for most greenhouse gases by 2050, capturing the greenhouse gases hiding in medicine cabinets and rubbish bins may prove one of the quieter but more achievable wins in healthcare’s climate transition.

Subject of Research: Pharmaceutical waste disposal practices in community pharmacies and the feasibility of a low-carbon return scheme for metered-dose inhalers in New Zealand

Article Title: Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers

Article References: Hanning, S. M., Barnes, M., Burrell, R., & Aspden, T. J. (2026). Disposal practices for unwanted medicines in New Zealand community pharmacies and their willingness to support a low-carbon return scheme for metered-dose inhalers. Clean Technologies and Environmental Policy, 28(10), Article 262. https://doi.org/10.1007/s10098-026-03622-5

Image Credits: AI Generated

DOI: 10.1007/s10098-026-03622-5

Keywords: community pharmacy, pharmaceutical waste, metered-dose inhalers, hydrofluorocarbons, greenhouse gas emissions, inhaler recycling, New Zealand, planetary health, medicine disposal, product stewardship, environmental sustainability, asthma