The most commonly reported approaches for identifying possible non-adherence were a combined item covering medication electronic monitoring systems, known as MEMS, or pill counts, which 50.8% of respondents said they used at least 75% of the time. Assessing patients’ response to medication was reported by 50.1%, exploring barriers to adherence by 47.5% and reviewing prescription-refill records by 47.2%. The use of a standardized adherence tool, such as the Morisky scale, was reported by 41.7% at least 75% of the time.

Because electronic monitoring and pill counts appeared in one questionnaire item, the survey could not determine their individual frequencies, how either method was performed or how pharmacists interpreted the results. The 50.8% figure therefore should not be interpreted as evidence of widespread use of dedicated electronic adherence-monitoring systems. Both composite scores ranged from 1 to 5, with higher values indicating greater self-reported frequency.

Among the support activities performed at least 75% of the time, patient-friendly labeling was reported by 58.8%, regimen simplification by 57.7%, linking medication use to daily activities by 55.9% and large-font labels by 55.4%. Recommending a medication review was reported by 50.7%, providing dose-administration aids by 45.8%, sending SMS refill reminders by 44.6% and communicating with physicians about adherence by 40.6%. These figures describe reported frequency, not intervention effectiveness, and the survey did not observe consultations or measure whether patients followed the advice they received.

Several activities reported by pharmacists were indirect rather than direct measures of medication-taking behavior. Lung-function testing was performed at least 75% of the time by 35.7% of respondents. Such testing can provide information about disease control or treatment response and may prompt discussion of medication use or inhaler technique, but it does not independently establish whether a patient has taken medicines as prescribed.

Blood-pressure monitoring, blood-glucose monitoring and cholesterol monitoring were also reported as activities performed at least 75% of the time by 48.7%, 50.1% and 45.5%, respectively. The questionnaire did not establish how pharmacists used these clinical measurements to evaluate adherence, illustrating the distinction between monitoring signs or treatment response and determining medication-taking behavior. Pharmacists’ stated attitudes toward adherence support were generally favorable, although responses also reflected uncertainty about professional boundaries.

Among the 345 participants, 65.5% agreed that adherence education was part of the pharmacist’s professional role, 63.2% agreed that pharmacists should promote medication adherence and 62.9% agreed that all pharmacists should identify non-adherence. More than half believed that physicians supported pharmacists’ involvement, at 55.1%, and 55.1% believed patients viewed pharmacists as supporting adherence. Yet 49.6% also agreed that adherence services were primarily the physician’s responsibility.

The survey did not determine whether these attitudes were reflected in consistent service delivery. Its self-administered design also permitted social-desirability and recall bias, meaning responses may overstate the frequency or consistency of positive practices. The most frequently endorsed perceived barriers were a lack of private consultation space, reported by 49.6%, lack of time by 45.8% and limited clinical information by 44.1%.

Insufficient training in adherence services was cited by 41.2%. Difficulty discussing adherence with physicians and poor patient health literacy were each reported by 40.6%, while patient resistance to counseling was reported by 36.5% and language barriers by 35.7%. These were self-reported obstacles rather than experimentally measured effects on service delivery.

Principal-component analysis of the 13 barrier items separated them into role, stakeholder and patient-related barriers, which explained 54.26% of the variance, and practice-resource and communication barriers, which explained another 8.26%. The complete scale had a Cronbach’s alpha of 0.939, indicating strong internal consistency among the survey responses. Adjusted multiple linear regression identified two workplace characteristics associated with the support-strategy composite score.

Pharmacists working at least 40 hours per week had a lower score than those working fewer than 40 hours, with an unstandardized coefficient of −0.30 and a 95% confidence interval of −0.56 to −0.04. Employment in a chain pharmacy was associated with a higher score than employment in an independent pharmacy, with a coefficient of 0.56 and a 95% confidence interval of 0.16 to 0.96. The model was statistically significant, F(27,317) = 2.079, p = 0.002, and explained 15.0% of the variance in support scores, with an adjusted R-squared of 0.078.

No examined predictor was significantly associated with the identification-strategy score at p < 0.05, even though that model was significant overall and explained 13.9% of the variance, with an adjusted R-squared of 0.066. These results are statistical associations in a cross-sectional survey, not evidence that long hours cause lower engagement or that chain-pharmacy employment produces better support. Education level, previous adherence-support training and interest in further training were not significantly associated with either composite score.

That finding does not demonstrate that training has no effect on adherence services, because the cross-sectional design did not test an intervention and previous training was measured only as a participant characteristic. At the same time, 41.2% of respondents perceived insufficient training as a barrier, and 70.4% expressed interest in receiving further training. The survey also did not assess pharmacists’ access to licensed or validated versions of standardized adherence tools, so it could not determine why use of instruments such as the Morisky scale was reported less often than several broader approaches.

Similarly, it did not examine whether the organizational procedures, staffing structures or standardized resources that might distinguish workplaces produced the observed chain-pharmacy association. The sample and recruitment process limit how broadly the results can be generalized. Of 681 pharmacists invited through four community pharmacy chains, 382 responded, producing an initial response rate of 56.1%.

After 37 incomplete or ineligible questionnaires were excluded, the analytical sample represented 50.6% of those invited and 91.3% of the calculated minimum sample of 378. Most participants were men, at 91.6%; held a bachelor’s degree in pharmacy, at 81.7%; worked at least 40 hours per week, at 83.5%; and worked in urban locations, at 68.4%. Chain-pharmacy employees accounted for 93.6% of the sample.

Although licensed pharmacists from all five regions participated, the Western Region contributed 47.0%, compared with 3.2% from the Northern Region. Overall, the survey provides a detailed snapshot of what Saudi community pharmacists said they did to identify medication non-adherence and support medication use. The results show a broad repertoire of reported practices, from refill-record review and direct questioning to self-monitoring, regimen simplification, language-appropriate labels and medication reviews.

They also document perceived organizational, informational, interpersonal and patient-related barriers, while showing that workplace characteristics accounted for some variation in reported support activity. However, the study did not measure patient adherence, clinical outcomes, consultation quality or actual service implementation, and its cross-sectional design cannot establish causal relationships. Questions about the separate use of electronic monitoring and pill counts, the connection between reported strategies and patient-level results, and the organizational factors behind workplace associations therefore remain unanswered by these data.

Subject of Research: Self-reported medication-adherence strategies and perceived barriers among licensed community pharmacists in Saudi Arabia

Article Title: Community pharmacists’ strategies and barriers in supporting medication adherence in Saudi Arabia: a cross-sectional study

Article References: Alzahrani, F., Alnezary, F. S., Saleem, Z., & Almutairi, M. S. (2026). Community pharmacists’ strategies and barriers in supporting medication adherence in Saudi Arabia: a cross-sectional study. Frontiers in Medicine, 13, Article 1962692. https://doi.org/10.3389/fmed.2026.1962692

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1962692

Keywords: medication adherence, community pharmacists, Saudi Arabia, cross-sectional survey, pharmacy practice, health literacy, patient counseling, consultation privacy, clinical information, chain pharmacies, Community, pharmacists

Awareness was highest among pharmacists at 50.8%, compared with 15.0% of physicians and 13.3% of dentists, revealing substantial differences among professionals involved in prescribing, dispensing, and counseling on antibiotic use. The study was conducted from 1 September to 13 October 2025 in public hospitals and specialized dental centers across Karbala Governorate. Researchers used a nonprobability convenience sample with fixed quotas of 120 participants per profession to facilitate comparisons rather than reproduce the local workforce distribution.

Of the final sample, 254 participants completed a self-administered questionnaire face to face and 106 completed an English-language online version distributed through official professional groups with verified identities. The instrument combined 15 five-point knowledge-attitude-practice items—five for each domain—with a binary AWaRe awareness question, a multiple-response item about information sources, and nine perception statements that were completed only by respondents already familiar with the classification. Four subject experts reviewed the questionnaire, and a pilot involving 15 professionals, five from each group, assessed clarity and feasibility.

Physicians achieved the highest average total KAP score, at 3.713, followed by pharmacists at 3.581 and dentists at 3.489. Physicians also scored higher than pharmacists for knowledge, with means of 3.520 and 3.357, respectively, and higher than both pharmacists and dentists for practice, at 3.707 compared with 3.532 and 3.467. Dentists had the lowest attitude score, 3.632, while physicians and pharmacists scored 3.912 and 3.855.

Bonferroni-adjusted pairwise comparisons confirmed that physicians had higher total scores than both other professions, while pharmacists and dentists did not differ significantly from one another. In a general linear model adjusted for profession, education, gender, age, experience, hospital type, and AWaRe awareness, physicians retained higher total KAP scores than dentists, with an unstandardized coefficient of 0.148 (95% confidence interval 0.039 to 0.256; p = 0.008). Pharmacists did not differ significantly from dentists after adjustment.

Profession was also the main independent predictor of AWaRe awareness. In binary logistic regression, pharmacists had 5.284 times the adjusted odds of awareness compared with physicians (95% confidence interval 2.443 to 11.432; p < 0.001), whereas dentists did not differ significantly from physicians, with an adjusted odds ratio of 0.825 (95% confidence interval 0.338 to 2.014). No other included characteristic—education, experience, age, gender, or hospital type—was independently associated with awareness.

Participants with post-bachelor education had higher unadjusted scores in every KAP domain and in total KAP, but the association disappeared after accounting for profession and other covariates. This pattern is important because 75.0% of physicians held post-bachelor qualifications, compared with 14.2% of pharmacists and 10.8% of dentists, making education and professional group closely intertwined in the sample. Item-level responses showed that some principles were widely endorsed, while several misconceptions and reservations remained.

Agreement was strongest for the statement that correct antibiotic use can help reduce antimicrobial resistance, reported by 92.5%, and for taking culture and sensitivity samples before starting antibiotics, reported by 87.8%. Yet 66.9% agreed that newer and more costly antibiotics are more efficacious, and 60.8% agreed that development of new antibiotics can keep pace with current resistance patterns. The study measured agreement with questionnaire statements rather than directly observed clinical decisions, so these findings describe the respondents’ reported knowledge and attitudes rather than verified prescribing behavior.

Self-reported practice responses were mixed. Most respondents, 74.7%, supported changing an intravenous antibiotic to an oral form after three days when medically appropriate. However, only 51.1% disagreed with the claim that limiting antibiotic use impairs good patient care, and 47.8% disagreed with using broad-spectrum antibiotics when narrower alternatives are effective.

Regarding over-the-counter antibiotic dispensing for minor infections, 43.9% agreed that pharmacists may hand out antibiotics without a prescription. These responses indicate incomplete endorsement of several stewardship principles, but the questionnaire did not record prescriptions, dispensing encounters, patient outcomes, or clinical indications. They therefore cannot establish how often respondents actually selected, dispensed, or administered antibiotics in practice.

Among the 95 participants who reported prior AWaRe awareness, perceptions were generally favorable. Their mean AWaRe perception score was 4.009 out of 5. Pharmacists had the highest score at 4.126, followed by physicians at 3.864 and dentists at 3.729; after Bonferroni adjustment, only the pharmacist–dentist difference was statistically significant.

Among aware respondents, 88.4% agreed that training was needed on antimicrobial resistance, stewardship, and AWaRe, 86.3% believed AWaRe could suggest safe antibiotic choices, and 85.2% believed following the classification could help reduce resistance. By comparison, only 46.3% agreed that hospital regulations and guidelines encourage consideration of AWaRe in practice. Pharmacy or pharmacists were the most frequently reported source of AWaRe information, cited by 64.2% of aware respondents, followed by scientific sources and media, each at 16.8%, the WHO at 14.7%, and physicians at 13.7%; respondents could select more than one source.

Within the aware subgroup, total KAP scores were positively correlated with AWaRe perception scores, with a Spearman’s rho of 0.344 and p = 0.001. This statistical association does not demonstrate that greater stewardship competence causes more favorable views, or vice versa. The cross-sectional design cannot establish causality, and the correlation was calculated in a restricted group of 95 respondents whose prior awareness may itself be related to their perceptions.

The result nevertheless identifies a measurable relationship between general stewardship KAP and engagement with the classification in this sample. It also supports examining broader stewardship education and AWaRe-specific learning together rather than treating awareness of a classification as an isolated subject, while avoiding assumptions about causal effects or changes in clinical behavior. Several limitations constrain the interpretation and generalizability of the results.

Recruitment relied on accessible public hospitals, dental centers, and voluntary professional groups, so the sample may overrepresent respondents who were available, reachable, or especially interested in stewardship. Equal professional quotas supported balanced comparisons but meant that prevalence estimates, including the overall 26.4% AWaRe awareness figure, should not be treated as representative of Karbala’s entire health workforce. Mixing face-to-face and online recruitment may also have introduced selection effects, while voluntary and anonymous participation allowed respondents to present socially desirable answers.

The cross-sectional design could not track practices over time or determine causation. Furthermore, the study was confined to Karbala, the education variable combined different post-bachelor qualifications into one category, and AWaRe perception results were available only for participants who already knew the classification. The favorable perception scores should therefore not be generalized to the 73.6% who reported no awareness.

Within those limits, the survey provides baseline evidence that antimicrobial stewardship education in this setting varied substantially by profession. Physicians reported the strongest overall KAP performance, dentists had the lowest attitude scores, and pharmacists were substantially more likely to know AWaRe despite not having the highest overall KAP mean. The results support profession-tailored education: the study’s authors identified a need for stronger resistance and stewardship content in dental training, while highlighting pharmacists’ potential contribution to AWaRe teaching, dispensing guidance, and prescribing advisory support.

At the institutional level, the low agreement that hospital guidelines encourage AWaRe use indicates that individual awareness alone has not necessarily translated into routine implementation. The survey does not demonstrate that any educational or policy intervention will improve prescribing outcomes, but it identifies specific gaps that future studies and locally tailored stewardship programs can evaluate.

Subject of Research: Antimicrobial stewardship knowledge, attitudes, practices, and WHO AWaRe awareness among physicians, pharmacists, and dentists in Karbala, Iraq

Article Title: Antimicrobial resistance and stewardship knowledge, attitudes, practices, and WHO AWaRe awareness among physicians, pharmacists, and dentists in Karbala, Iraq

Article References: Almubarak, A., & Abdulridha, M. K. (2026). Antimicrobial resistance and stewardship knowledge, attitudes, practices, and WHO AWaRe awareness among physicians, pharmacists, and dentists in Karbala, Iraq. Pharmacia, 73, Article e194858. https://doi.org/10.3897/pharmacia.73.e194858

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e194858

Keywords: antimicrobial resistance, antimicrobial stewardship, WHO AWaRe, physicians, pharmacists, dentists, Iraq, survey, antibiotic use, healthcare education, Antimicrobial, resistance

The study, based on face-to-face interviews conducted from October 2023 to June 2024, reports perceptions and reported practices rather than measured savings, patient outcomes or changes in hospital finances. DRG is a healthcare payment mechanism that has been widely adopted in different countries to encourage cost control and efficiency. By the end of 2024, China had implemented DRG across all national pooling areas, and from 2025 local authorities advanced a version known as DRG 2.0.

The study notes that the reform altered public hospitals’ revenue and expenditure structures, reducing the relative share associated with pharmaceuticals and medical consumables while increasing the share associated with medical services and personnel. Hospitals consequently placed greater emphasis on healthcare quality, resource-use efficiency and the value of medical services. For clinical pharmacists, this did not replace familiar duties involving medication review and pharmaceutical care; instead, it added expectations that recommendations should consider reimbursement conditions, medicine prices, cost-effectiveness and resource use.

Both professional groups agreed that clinical pharmacists had become established members of multidisciplinary teams, or MDTs. Their work included ward rounds, consultations, prescription review, medication reconciliation, therapeutic drug monitoring and the development of individualized medication plans. Physicians recognized pharmacists’ ability to identify duplicate therapies, contraindications, prescribing errors and omissions, as well as their contribution to patient counselling and the dissemination of pharmaceutical knowledge.

One physician recalled that a pharmacist noticed that trihexyphenidyl had been omitted when another clinician prescribed injectable haloperidol, despite the team’s usual practice of combining the medicines to prevent extrapyramidal symptoms. These accounts illustrate medication-safety activities recognized by the interviewees, but they are not estimates of adverse-event reduction. The research did not compare patient outcomes in teams with and without pharmacist involvement.

The clearest disagreement concerned the economic role expected of pharmacists under DRG. Some pharmacists said they analyzed cases whose expenditures exceeded the expected payment, proposed medication substitutions or de-escalation, reconciled medicines and helped develop medication pathways for priority disease groups. They also considered centrally procured medicines, medicines included in national price negotiations and originator products when evaluating treatment options, while continuing to monitor effectiveness and adverse effects.

Several described reviewing medicines across hospital wards and participating in the implementation of clinical pathways. A few also described departmental innovation projects that combined medication reconciliation or substitution with evaluation of patient outcomes and DRG balances. However, the interviews did not provide verified financial totals, controlled comparisons or systematic estimates of savings, so the findings cannot establish the magnitude of any economic effect.

Not every pharmacist had incorporated the new payment environment into daily practice. Some reported that DRG had made little difference to their work, illustrating that changes in professional responsibilities were uneven even within the pharmacy workforce. Physicians were also less likely to recognize the broader activities described by pharmacists.

Many regarded cost control as primarily their own responsibility and described pharmacists as reviewers of indications, contraindications and rational medication use. Some saw a useful economic contribution in a recommendation for a lower-cost alternative, but did not treat expenditure analysis, pathway design or resource allocation as formal pharmacist functions. One described the pharmacist’s contribution chiefly as suggesting a medicine with better cost-effectiveness.

This difference in perception did not necessarily mean that physicians rejected pharmacist expertise; rather, it showed that the teams had not developed a shared description of who should lead cost-related work and how such work should be integrated into clinical decisions. Institutional arrangements constrained pharmacists’ ability to translate their expertise into action. They described having responsibility for cost-related review while retaining limited authority over final treatment decisions, which remained with physicians and clinical departments.

Timely access to DRG grouping and expenditure data was also limited, and poorly integrated information systems forced some pharmacists to move between separate hospital platforms to obtain relevant information. The workload associated with ward rounds, prescription checks, patient education and therapeutic drug monitoring could exceed available staffing, with some tasks carried over to the following day. Pharmacists also described the absence of reimbursement for some pharmaceutical services, meaning expanded responsibilities could remain unpaid.

Patients’ limited familiarity with the clinical pharmacist role added another obstacle, because many continued to direct medication questions primarily to physicians rather than seeking individualized guidance from pharmacists. Physicians were generally positive about collaboration but emphasized practical limits. They often sought pharmacist input for complex, difficult or potentially risky cases while managing routine treatment decisions independently.

Some considered recently employed pharmacists to have limited clinical experience, and the researchers recorded occasional differences in emphasis: a pharmacist might stress adherence to antibiotic guidelines, whereas a physician might focus on the extent of a particular operation and the perceived need for stronger prophylaxis. These observations do not show that pharmacist recommendations were harmful or that either perspective was uniformly correct. Instead, they illustrate differences in clinical reasoning that may arise when multidisciplinary members do not share the same level of specialization.

Physicians proposed that pharmacists develop expertise in selected clinical areas, provide regular training on new medicines and the latest pharmacotherapy evidence, improve communication with patients and clinical teams, and help communicate clinical medication needs to pharmacy and therapeutics committees. Pharmacists emphasized a different set of changes. They called for clearer legal and professional boundaries through a national Pharmacists Law, reimbursement for pharmaceutical care, greater decision-making authority and better digital infrastructure.

Proposed tools included real-time alerts when a case approached a DRG expenditure threshold, integration of pharmacy workstations with other hospital information systems, and direct access to case groupings, departmental costs and medication-use data. Pharmacists also sought more influential roles in medication management and quality governance. Physicians additionally expected them to warn departments about possible budget overruns, support reimbursement appeals and handle medication-related compliance documentation.

The two groups therefore shared a broad desire for closer collaboration, but differed over whether pharmacists should primarily advise clinicians or participate more directly in institutional cost management. Their proposed measures also revealed a shared practical problem: expanded responsibilities require timely data, adequate staffing, professional authority, digital support and resources that permit sustained service rather than unfunded additions to already heavy workloads. The study, reported in Frontiers in Public Health, offers a detailed account of role change in a health system where DRG payment reform, centralized medicine procurement and physician-led decision-making operate together.

It suggests that DRG has encouraged some pharmacists to combine clinical expertise with pharmacoeconomic reasoning without replacing their core role in medication safety and appropriate use. It also shows why a narrow assessment of cost savings may miss much of the work that participants described. Pharmacists’ activities involving therapy evaluation, patient safety, pathway development and expenditure analysis were often retrospective, distributed across cases or embedded in communication, making their contribution less visible than a single prescription substitution.

The interviews nevertheless remain qualitative accounts from a small group rather than measurements of efficiency. The sample was drawn from only two tertiary Grade A hospitals in one city, participants may have been influenced by social desirability, and nurses, hospital administrators and other MDT members were not interviewed. The results therefore describe how these 21 participants understood collaboration and role ambiguity; they do not establish how representative the experience is nationwide or whether expanded pharmacist involvement improves clinical outcomes or reduces costs.

Subject of Research: Clinical pharmacists’ changing roles in multidisciplinary teams under China’s DRG payment reform

Article Title: Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams

Article References: Fu, J., Gao, X., Sun, Q., Xi, X., & Wang, J. (2026). Reconfiguring clinical pharmacists’ roles under China’s DRG payment system: perspectives from clinical pharmacists and physicians in multidisciplinary teams. Frontiers in Public Health, 14, Article 1930532. https://doi.org/10.3389/fpubh.2026.1930532

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1930532

Keywords: clinical pharmacists, DRG payment reform, multidisciplinary teams, healthcare cost management, pharmaceutical care, medication safety, qualitative research, hospital pharmacy, China, Reconfiguring, clinical, pharmacists

The research team evaluated a mobile application called Kelola Obatku, which translates roughly as Manage My Medicines, over a three-month period between August and November 2025. The study recruited 60 adults who managed medicines at home, owned an Android smartphone, and were not healthcare workers or trained in the health sciences. Participants were allocated into two groups of 30 each: an intervention group that used the application for three months, and a control group that received no digital intervention. The setting was Margahusada Pharmacy, a facility owned by the Central Java Provincial Government with ISO-standardized service procedures, and adherence to app use was monitored through door-to-door follow-up every two weeks.

What sets Kelola Obatku apart from a simple health information site is its breadth of functionality. The application bundles eight core features: a drug search tool, stock management for the home medicine supply, documentation of medication use, family member profiles, medication reminders, a locator for the nearest pharmacy, educational content, and direct consultation with a pharmacist. Together, these features cover the full lifecycle of a household medicine, from selection and purchase through use, storage, and eventual disposal. The design reflects a growing consensus in digital health that behavior change requires more than a one-off pamphlet; it needs tools that embed themselves into daily routines.

Before the intervention could be judged on its health outcomes, the researchers tested whether users actually found the app usable. They employed the validated Usefulness, Satisfaction, and Ease of Use questionnaire, which scored an overall eligibility rating of 80.33 percent, comfortably above the 70 percent threshold considered acceptable. The instrument itself showed strong psychometric properties, with an average content validity index of 0.97 across its five domains and a Cronbach’s alpha of 0.973, indicating excellent internal consistency. Users rated the app highly on usefulness, ease of learning, and satisfaction, and most said they would download and continue using it. The weakest signal, tellingly, appeared in a negatively worded item about inconsistencies in the interface, which half of respondents agreed with, suggesting room for polish in future versions.

The core outcome was measured with a validated knowledge, attitude, and practice questionnaire covering 29 knowledge items, 25 attitude items, and 27 practice items related to medication selection, purchasing, use, storage, and disposal. When the researchers compared the change scores between the two groups, the results were striking for two of the three domains. Knowledge improved significantly more in the intervention group, with a between-group difference yielding a p-value of 0.001, and attitudes followed with a p-value of 0.017. Within the intervention group alone, knowledge scores rose from an average of 20.70 to 25.83, and the proportion of respondents classified as having good knowledge climbed from 70 percent to 100 percent. Attitude improvements were similarly pronounced, with the share of good attitudes rising from about a third to nearly two-thirds.

Practice, however, told a more sobering story. Although practice scores trended upward in the intervention group, the between-group difference did not reach statistical significance, with a p-value of 0.688 and a delta score of only 0.9 points. This pattern echoes a well-established finding in health behavior research: knowledge and attitudes are comparatively easy to shift with education, but entrenched habits, such as regularly checking expiration dates, storing medicines away from heat and humidity, and returning unused drugs to pharmacies, take far longer to reform. The authors note that medication management practices are routines woven into everyday life, and that three months may simply be too short an exposure to break and rebuild them. Prior studies of mobile health interventions suggest stronger behavioral effects emerge when tools are sustained over longer periods.

The economic dimension of the study is where the stakes become tangible in rupiah. The researchers calculated the monetary value of leftover, damaged, and expired medicines in each household using the maximum retail price printed on packaging, multiplying remaining quantities by unit price. Within the intervention group, the value of damaged medicines fell significantly, from an average of about 12,293 IDR to 1,300 IDR per household, and the value of expired medicines dropped from roughly 10,330 IDR to 2,667 IDR, with p-values of 0.023 and 0.047 respectively. The control group showed a significant reduction only in damaged medicine value. Intriguingly, the intervention group also showed an increasing trend in the value of remaining medicines, which the authors interpret as a possible sense of confidence and safety in storing and managing a home supply.

Yet when the magnitude of change was compared directly between groups, none of the economic differences reached significance. The between-group p-values for remaining, damaged, and expired medicine values were 0.258, 0.781, and 0.330 respectively. The authors caution that household drug damage often stems from improper storage conditions, such as heat and humidity, and that much of the medicine accumulating in homes has not even expired, pointing instead to problems in purchasing and use patterns. The within-group improvements remain noteworthy as preliminary evidence, but the study’s small sample of 30 participants per group, justified by the Central Limit Theorem, limits statistical power, and the quasi-experimental design restricts causal claims.

One of the more interesting secondary findings concerned who benefited. When the researchers dichotomized demographic variables at their medians and tested associations with outcome changes, almost nothing predicted improvement. Age, gender, education, marital status, employment, and income showed no significant relationship with knowledge, attitude, or practice gains, nor with economic value reductions. The single exception was family size, which was significantly associated with attitude change at a p-value of 0.017. Larger households face more diverse medication needs and more complex decision-making dynamics, a pattern the authors connect to the PRECEDE-PROCEED model of health behavior, in which family characteristics act as predisposing factors shaping health attitudes. The broader implication is encouraging: the app’s benefits did not appear confined to any particular demographic slice.

The study arrives at a moment when Indonesia is grappling with the limits of offline approaches. A national program launched in 2019, Let’s Dispose of Medication Waste Properly, enlisted roughly 1,000 pharmacies to accept returned unused and expired medicines, but its long-term influence on public behavior has remained uncertain, and clear household-level disposal regulations are still lacking. Against that backdrop, the Central Java findings suggest that digital tools can lay the cognitive and attitudinal groundwork that policy alone has struggled to build. The authors are careful about scope: three months is short, the sample is modest, and practice change may demand longer exposure and repeated reinforcement. Still, the combination of strong usability scores, significant knowledge and attitude gains, and meaningful within-group reductions in the value of damaged and expired medicines positions apps like Kelola Obatku as a promising, low-cost complement to pharmacist-led education. Future studies with larger samples, longer follow-up, and more rigorous designs will determine whether a medicine cabinet cleaned up by an algorithm can stay that way.

Subject of Research: A mobile health intervention for improving household medication management, knowledge, attitudes, practices, and economic losses

Article Title: Digital intervention for household drug management: Impacts on knowledge, attitudes, practices, and economic losses

Article References: Fathnin, F. H., Satibi, S., Endarti, D., & Lazuardi, L. (2026). Digital intervention for household drug management: Impacts on knowledge, attitudes, practices, and economic losses. Pharmacia, 73, Article e200091. https://doi.org/10.3897/pharmacia.73.e200091

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e200091

Keywords: mHealth, household medication management, Kelola Obatku, digital health intervention, KAP study, Indonesia, medicine disposal, expired medicines, quasi-experimental study, pharmacists, rational drug use, economic losses

The research team, drawing on pharmacists recruited through professional social networks and pharmacy association groups between March and June 2025, designed the investigation in two phases. The first phase was a cross-sectional survey intended to map who was using AI and why. The second was a quasi-experimental test of whether a single hour of targeted education could soften the attitudes that keep capable professionals away from the technology. Together, the two phases offer one of the most detailed portraits yet of how the digital divide plays out inside a specific health profession in a developing but technologically ambitious country.

The numbers from the first phase are striking. Of the 901 pharmacists surveyed, 75.1 percent reported familiarity with AI, yet only 41.7 percent of the entire cohort said they had actively used AI tools within the previous twelve months. Among those who were familiar with the technology, 55.5 percent had used it. And what they used it for matters: the most common application, cited by 42.3 percent of users, was verifying medication information, while a mere 8.3 percent used AI to analyze patient data or recommend dosages. The researchers suggest this pattern reflects the easy availability of large language models alongside persistent privacy concerns about patient data, a trend consistent with surveys of primary care providers elsewhere.

When the team ran the sociodemographic variables through a multivariable logistic regression, three factors emerged as independent predictors of AI use. Pharmacists who graduated after 2020 had nearly twice the odds of using AI compared with earlier graduates, an adjusted odds ratio of 1.943. Those holding a postgraduate degree had more than twice the odds of diploma holders, at 2.402. And the availability of digital infrastructure in the workplace, meaning reliable internet access, scalable storage, and application hosting, roughly doubled the odds of adoption as well, with an adjusted odds ratio of 2.099. Hospital pharmacists, who benefit from institutional information technology systems, were also significantly more likely to use AI than colleagues in privately owned or chain pharmacies.

The most intriguing finding came from an interaction analysis. The researchers hypothesized that the quality of the digital environment might moderate the apparent generational gap in AI adoption, and the statistics bore this out. Among pharmacists who graduated before 2020 and lacked workplace digital infrastructure, only 16.0 percent used AI. Yet post-2020 graduates maintained a 67.3 percent adoption rate even in low-infrastructure settings, likely by relying on personal mobile devices. When proper digital infrastructure was available, the pre-2020 cohort’s adoption rate jumped to 52.8 percent, shrinking the generational gap from 51.3 percentage points to just 7.1. The authors describe this as a technological friction effect: older pharmacists are not resisting the technology so much as being locked out of environments where it can run.

This framing challenges a common narrative that attributes slow AI uptake in developing countries to generational resistance. The Jordanian data suggest that basic connectivity is an essential leveler, echoing calls from the European Association of Hospital Pharmacists to invest in digital infrastructure, electronic prescribing, and interoperability as prerequisites for AI integration. Comparable studies in Eastern Romania, Switzerland, Greece, and Bulgaria have documented similar structural and educational barriers, indicating that the problem is not confined to the Middle East but mirrors the digitalization struggles of European pharmacy itself.

Income and workload also mattered. Pharmacists earning more than 600 Jordanian dinars per month had higher odds of AI use than the lowest earners, although the wide confidence interval on that estimate suggests some statistical uncertainty. Seeing more than fifty patients a day was independently associated with adoption, perhaps because high patient volumes create pressure to find efficiency tools. Gender, by contrast, dropped out of the picture once other variables were controlled: although the unadjusted chi-square analysis showed slightly higher use among men, the regression model found no meaningful difference between male and female pharmacists.

The second phase of the study addressed a different question: can attitudes be changed cheaply and quickly? Of the original 901 participants, 301 volunteered for a 60-minute educational webinar delivered by an external expert in health informatics and computational pharmacology. The session combined a thirty-minute lecture on AI basics and job-displacement concerns, a twenty-minute live demonstration of AI checking drug interactions, and a ten-minute ethics discussion on data privacy and algorithmic bias. Sessions were repeated bimonthly from April to July 2025 to accommodate different shift patterns, and attitudes were measured immediately before and after using paired categorical analysis with McNemar’s test.

The results were dramatic, at least in the short term. The share of pharmacists who believed AI will replace the need for pharmacists plummeted from 70.0 percent to 24.6 percent, a drop of 45.4 percentage points. Belief that AI involves high operational costs fell from 88.4 percent to 41.5 percent. Concerns about patient data confidentiality dropped by nearly 40 points, while agreement that AI helps provide optimal pharmaceutical care more than tripled, rising from 20.9 percent to 75.4 percent, and trust in AI’s reliability for drug-related information nearly quadrupled, from 15.3 percent to 60.9 percent. Notably, one belief barely moved: agreement that AI requires human oversight rose only from 19.6 percent to 22.9 percent, a change the authors interpret not as resistance but as evidence that the training successfully framed AI as a decision-support aid rather than an autonomous authority, a stance aligned with the Pharmaceutical Group of the European Union’s position that AI should assist, never replace, professional expertise.

The authors are careful about the limits of these findings. The cross-sectional design cannot establish causation, the intervention lacked a control group, and the posttest was administered immediately after the webinar, so only short-term attitudinal shifts are documented, not lasting changes in practice. The volunteers for Phase II may also have been more motivated or technologically adept than their peers, and the online recruitment method may underrepresent pharmacists in remote areas with poor internet access, precisely the population the infrastructure findings highlight. Still, the study’s practical prescriptions are clear: pharmacies need minimum standards for digital infrastructure, continuing education should incorporate AI fundamentals, and mentoring schemes that pair recent graduates’ digital fluency with senior pharmacists’ clinical experience could help close the gap from both directions. Whether a one-hour webinar produces pharmacists who actually use AI years later remains an open question, but the Jordanian data make a strong case that the first barrier to remove is not fear. It is the missing wiring.

Subject of Research: Socioeconomic determinants of artificial intelligence adoption among Jordanian pharmacists and the effect of an educational intervention on their attitudes

Article Title: The digital divide in pharmacy: Socioeconomic determinants of AI adoption and the impact of educational interventions in Jordan

Article References: Al-Tarawneh, A., Abu Dayyih, W., & Abdel-Qader, D. H. (2026). The digital divide in pharmacy: Socioeconomic determinants of AI adoption and the impact of educational interventions in Jordan. Pharmacia, 73, Article e204786. https://doi.org/10.3897/pharmacia.73.e204786

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e204786

Keywords: artificial intelligence, pharmacy, Jordan, digital divide, pharmacists, educational intervention, digital infrastructure, health informatics, cross-sectional survey, technology adoption, job displacement fears, continuing education

A new qualitative study published in Pharmacia has now mapped that territory in detail. Researchers interviewed 27 pharmacists working in Baghdad’s government hospitals using semi-structured, face-to-face interviews conducted in Arabic over two months in late 2025. Recruitment continued until data saturation was reached, the point at which no new themes or meaningful insights emerged from additional interviews. The participants, aged 26 to 48 with a mean of about 31 years, represented a wide range of educational backgrounds, from bachelor’s degrees to clinical pharmacy board certification and postgraduate residency training, and their parenteral nutrition experience ranged from three months to seven years.

The interviews surfaced four major themes: knowledge, complications, the roles of pharmacists, and the challenges and barriers that make their tasks difficult. On the knowledge front, the most common learning activities were institutional lectures and workshops, reported by 21 pharmacists, followed by clinical pharmacy board study, mentioned by 16, and undergraduate education, cited by 12. Eight pharmacists pointed to training during postgraduate residency programs as a crucial stage. Peer-to-peer sharing also played a supporting role, with six participants describing how experienced residents pass practical know-how to colleagues with less exposure to the therapy.

When it comes to information sources, the pharmacists rely on international authorities. Seventeen mentioned the American College of Clinical Pharmacy’s Updates in Therapeutics as their reference for parenteral nutrition, 15 cited the American Society for Parenteral and Enteral Nutrition guidelines, and 14 reported using the European Society for Clinical Nutrition and Metabolism recommendations. Technological platforms such as UpToDate were also mentioned. Nineteen pharmacists reported complete adherence to these guidelines, while seven admitted only partial adherence, often because resources such as line filters were simply unavailable. Most participants, 23 in total, expressed a strong commitment to lifelong learning, emphasizing that old information cannot be trusted in a field that evolves as rapidly as clinical nutrition.

The complications the pharmacists encounter read like a checklist of metabolic hazards. Fluid and electrolyte abnormalities were the most frequently reported problem, mentioned by 12 pharmacists, including imbalances such as hyperkalemia, hypokalemia, and hypocalcemia, often at the initiation of therapy when baseline electrolyte measurements are skipped or the patient has renal dysfunction. Refeeding syndrome, the dangerous rapid intracellular electrolyte shift that occurs when a malnourished patient is fed too quickly, was identified by eight pharmacists, some of whom noted that pretreatment with electrolyte correction has reduced its likelihood. Hepatobiliary disorders, including liver injury linked to soybean-based lipid emulsions, were reported by seven participants, while hyperglycemia, hypoglycemia, and hypertriglyceridemia each appeared in the accounts of five pharmacists.

Infectious complications were the second major concern, mentioned by ten pharmacists, who traced them to problems with line handling, aseptic technique, and patient status. One described a patient who appeared completely normal with no signs of infection, only for an infection to appear after two days on parenteral nutrition, indicating that something in the conditions or handling had not been sterile. Opportunistic infections, especially in neonates, were also flagged. Mechanical and technical issues, such as line access problems, drug administration through the same line, and pump or catheter failures, rounded out the picture for four participants.

The pharmacists’ roles emerged as far broader than traditional compounding and dispensing. Before therapy begins, 26 pharmacists calculate the dosage and requirements for calories, amino acids, lipids, and electrolytes, and 25 prepare and compound the solutions. Twenty integrate biochemical data with clinical conditions to detect complications early, examining laboratory results and nutritional status before initiation. Eighteen assess prescriptions and indications to ensure the patient genuinely needs the therapy rather than starting it improperly. During and after administration, all 27 pharmacists emphasized educating patients or caregivers on what the intravenous solution contains and why it matters, while 26 described regular monitoring and follow-up, usually daily at first, with adjustments such as changing glucose concentrations or stopping lipids or amino acids depending on the patient’s condition. Twenty-two described managing complications as a shared responsibility of the nutrition support team, and ten reported setting infusion pump rates as part of their duties.

But the barriers are formidable. The most common obstacle, reported by 26 participants, was the shortage of parenteral nutrition components. One pharmacist described the problem with phosphorus replacement: because intravenous phosphorus is unavailable, the team prepared an oral phosphate solution that causes gastrointestinal disturbances in addition to its bad taste. Twenty pharmacists cited a shortage of compounding facilities, noting that basic supplies such as syringes of various sizes are frequently unavailable. Eleven reported that the availability and functionality of infusion pumps sometimes jeopardize precise administration, and five noted that some laboratory tests needed for follow-up, such as phosphorus levels, are not always accessible.

Human resources present their own set of challenges. Thirteen pharmacists called for continuing education programs to improve clinical competence, noting that seminars should be held for nursing staff, doctors, and both board-certified and non-certified pharmacists. Eleven identified the shortage of experienced staff as a main challenge to effective monitoring, with some describing situations where on-call staff lack strong experience, forcing patients to wait for the morning shift when problems occur. Communication issues hampered cooperation among healthcare professionals for five participants, and burnout and staff turnover increased task demands for two. Organizational barriers included the lack of consistent institutional rules, with seven pharmacists urging the Iraqi Ministry of Health to establish a comprehensive national protocol that all health departments must follow. The absence of computerized prescribing systems, cited by seven, results in lengthy manual calculation times for what is a delicate and error-prone process. Nine pharmacists also mentioned that limited patient or caregiver health literacy and negligence affect therapy management.

The study’s authors argue that these findings carry implications for healthcare policy, pharmacist training, and the establishment of multidisciplinary nutrition support teams in Iraq. The results can prompt the Ministry of Health to create a national parenteral nutrition protocol, target budget allocations to areas of highest clinical need, and mandate strict compounding standards. They also support updating university pharmacy curricula and requiring continuing education workshops in nutrition support. The researchers acknowledge limitations, including possible social desirability bias from self-reported experiences and the restriction to government hospitals in Baghdad, which may limit generalizability to private hospitals or other governorates. However, they note that the inclusion of pharmacists with varied educational backgrounds and practice environments provided a wide range of perspectives, and that because Iraq’s healthcare infrastructure and supply of parenteral nutrition components are highly centralized under the Ministry of Health, the operational barriers identified reflect systemic rather than isolated local issues. Given the scarcity of published literature on parenteral nutrition practices in Iraq, the study offers a critical baseline perspective that highlights gaps relevant to other healthcare settings facing similar resource constraints, and it underscores that pharmacists are essential at every step of the process, from nutritional assessment and customized calculations to monitoring, complication management, and patient education.

Subject of Research: A qualitative study of 27 pharmacists in Baghdad's government hospitals maps how parenteral nutrition is prepared, monitored, and managed, revealing both the breadth of pharmacists' roles and the shortages of components, facilities, and trained staff that hamper the therapy.

Article Title: Exploring the current practices of parenteral nutrition from pharmacists’ perspectives: a qualitative study

Article References: Ibrahim Saleh, O., Jabbar Kadhim, D., & Faris Nassir, K. (2026). Exploring the current practices of parenteral nutrition from pharmacists’ perspectives: a qualitative study. Pharmacia, 73, Article e208575. https://doi.org/10.3897/pharmacia.73.e208575

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e208575

Keywords: parenteral nutrition, clinical pharmacy, qualitative research, Iraq, nutrition support, medication safety, pharmacists, Exploring, current, practices, parenteral, nutrition

The distinction between knowing something in general and being able to apply it at a specific moment is central to interpreting the Taiyuan findings. The mean knowledge-risk score of 59.78 and behavior-risk score of 57.22 both fell within the prespecified good category, which suggests that the women surveyed had absorbed a reasonable amount of medication-safety information and reported generally sensible practices. Yet the attitude-risk score, averaging 37.34 and landing only in the pass category, tells a different story. Nearly six in ten participants were classified as pass on attitude risk, while one in six fell into the fail range and only about a quarter reached the good or excellent tiers. In practical terms, this means that a substantial share of women held beliefs or concerns about medication use that were less well aligned with safety guidance than their knowledge or reported behavior would suggest.

This pattern is not merely a statistical curiosity. Attitudes toward medication during pregnancy often carry an emotional dimension that factual knowledge alone does not resolve. A woman may know that untreated gestational hypertension poses serious risks, yet still feel deep reluctance to take an antihypertensive drug because of lingering fears about fetal harm. The weak positive correlation between attitude risk and behavior risk (r = 0.118) observed in the study hints that beliefs and actions were only loosely coupled in this sample, while the moderate inverse correlation between knowledge risk and attitude risk (r = −0.258) suggests that women with better factual knowledge tended to hold somewhat more favorable attitudes. The positive correlation between knowledge risk and behavior risk (r = 0.275) is more counterintuitive at first glance, since higher knowledge-risk scores mean less favorable knowledge, and these were associated with less favorable behavior. Taken together, the correlation structure implies that the three domains move in related but imperfect ways, and that improving one domain does not automatically improve the others.

The study’s measurement approach deserves some attention for readers unfamiliar with survey methodology. Risk-oriented scoring reverses the usual convention of KAP questionnaires: instead of higher scores indicating better outcomes, higher scores on the knowledge, attitude, and behavior domains indicate greater risk or less favorable profiles. This design choice keeps all unfavorable responses pointing in the same numerical direction, which simplifies interpretation of correlations across domains. The internal consistency of the questionnaire, assessed with Cronbach’s alpha, ranged from 0.808 to 0.957 across the scales, values generally considered acceptable to excellent for survey instruments. This indicates that the items within each domain tended to measure a coherent underlying construct rather than a grab bag of unrelated questions.

The statistical methods also reflect careful attention to the realities of survey data. Welch’s analysis of variance, which does not assume equal variances across groups, was followed by Games-Howell post hoc tests, a combination appropriate when group sizes and spreads differ. The multivariable regression models used ordinary least squares with HC3 robust standard errors, a technique that guards against misleading conclusions when the variability of residuals is not uniform across the range of predictor values. These choices do not change the cross-sectional nature of the design, which limits causal inference, but they do strengthen confidence in the associations that were reported.

Among the demographic findings, the elevated behavior-risk scores among women aged 35 to 49 years stand out. This age group encompasses women who may have more chronic health conditions, more prior medication experience, and potentially more entrenched habits around self-medication. It also includes women who may face higher-risk pregnancies by virtue of age alone. The finding that participants with other insurance types or self-payment showed higher behavior risk points to a possible structural dimension: access to consistent pharmaceutical counseling may vary with insurance status, and women paying out of pocket may face different incentives around seeking professional advice before using a medicine. The income analysis illustrates the hazards of overinterpreting isolated contrasts. Although the comparison between women earning 4,000 to 6,000 yuan per month and those earning below 2,000 yuan reached nominal statistical significance, the overall test of income across all groups did not (Wald p = 0.098). The researchers appropriately labeled the isolated contrast as exploratory, a decision that reflects sound statistical practice when a global test fails but a single pairwise comparison appears significant by chance or through a fragile pattern in the data.

The familiarity scores deserve particular emphasis because they reveal something that aggregate domain scores cannot. Across five pregnancy- and lactation-specific medication topics, self-rated familiarity ranged only from 2.46 to 2.60 on a five-point scale. These values sit just above the midpoint, indicating that women felt only moderately familiar with topics that are directly relevant to the decisions they face. The narrow range across topics suggests that no single area of medication knowledge stood out as well covered; instead, familiarity was uniformly modest. This is precisely the kind of finding that broad KAP totals can obscure. A woman might score well on general medication knowledge while feeling uncertain about, for example, which analgesics are compatible with breastfeeding or how to manage a chronic medication during the transition from pregnancy to lactation.

The pharmacological backdrop helps explain why such uncertainty matters. Pregnancy alters gastric emptying, plasma volume, hepatic metabolism, and renal clearance, all of which can change how much of a drug reaches maternal circulation and how quickly it is eliminated. These changes evolve across gestation, meaning that a dose that was appropriate in the second trimester may require adjustment later or after delivery. Medications taken while breastfeeding add another layer of complexity, since infant exposure depends on drug properties, milk composition, and feeding patterns. The study’s authors note that avoiding medication altogether can itself cause harm when necessary treatment is delayed or inadequate, a point that deserves emphasis because excessive caution is a common and underrecognized medication-safety problem in pregnancy. Untreated asthma, epilepsy, depression, hypertension, and infections can carry risks to both mother and fetus that exceed the risks of appropriately chosen therapy.

The treatment decisions women face also shift across the maternity timeline. During pregnancy, questions may center on managing nausea, heartburn, anemia, or chronic disease. Around delivery, analgesia and anesthesia choices come to the fore. After discharge, women may confront lactation suppression, postpartum pain management, wound care, mental health treatment, and the resumption or adjustment of pre-pregnancy medications. A single educational session delivered at one point in this sequence cannot address all of these questions. The study’s recommendation to integrate medication-safety counseling broadly into antenatal and postpartum care reflects this reality, suggesting repeated touchpoints rather than one-time instruction. The additional suggestion of proactive medication review for women aged 35 to 49, those with other insurance or self-payment, and those with complex medication needs represents a targeted approach that concentrates resources where the adjusted models indicated higher risk.

It is worth situating these findings within the broader Chinese policy context. The Healthy China 2030 strategy frames maternal care within a life-course approach to health services, and national policy calls for integrated care spanning pregnancy and the postpartum period. Medication safety fits naturally within this framework, since pharmacies, community health services, antenatal clinics, and maternity wards all encounter women at moments when medicines can be reviewed. The Taiyuan study provides local evidence that can inform how such integration is designed, though the authors are careful to note that a single-hospital convenience sample cannot represent all women in Taiyuan or elsewhere in China. Convenience sampling, by definition, recruits participants who are accessible rather than randomly selected, which can introduce selection effects that are difficult to quantify.

Comparisons with other settings reinforce the value of examining knowledge, attitudes, and practice separately. Research in western Uganda found that 42.6 percent of pregnant women had adequate knowledge and 34.5 percent demonstrated rational medication practice despite generally positive attitudes, illustrating that these domains can diverge in different populations and different directions. National health-insurance database studies in mainland China have documented which medications are actually used during pregnancy, including some potentially higher-risk exposures, but such data do not reveal how women understood the risks or reached their decisions. The KAP approach addresses this complementary question, probing the reasoning and beliefs that underlie observed behavior.

For clinicians and public health planners, several practical implications emerge from this work. First, counseling should not assume that favorable knowledge translates into confident decision-making; the attitude-risk findings suggest that addressing fears and beliefs directly may be as important as conveying facts. Second, topic-specific familiarity assessments could become a routine part of antenatal visits, helping clinicians identify which specific decisions a woman feels unprepared to make. Third, the demographic correlates point to groups who might benefit from proactive outreach, particularly older pregnant and postpartum women and those navigating the healthcare system without standard insurance coverage. Finally, the authors’ call for multicenter prospective studies is a reminder that this cross-sectional survey describes a snapshot at one hospital and one moment in time. Prospective designs could follow women across pregnancy and the postpartum period, tracking how knowledge, attitudes, and behavior evolve as treatment decisions change, and could evaluate whether integrated counseling services actually improve medication safety outcomes for mothers and infants alike.

Subject of Research: Medication-related knowledge, attitudes, and practices among pregnant and postpartum women in Taiyuan, China

Article Title: Medication-related knowledge and behavior profiles are generally favorable, but counseling needs remain among pregnant and postpartum women in Taiyuan, China: a cross-sectional study

Article References: Zhang, C., He, Y., Yang, Y., Zhang, L., Zhang, W., Yang, L., & Ma, M. (2026). Medication-related knowledge and behavior profiles are generally favorable, but counseling needs remain among pregnant and postpartum women in Taiyuan, China: a cross-sectional study. Frontiers in Public Health, 14, Article 1969907. https://doi.org/10.3389/fpubh.2026.1969907

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1969907

Keywords: medication safety, pregnancy, postpartum, lactation, Knowledge-Attitude-Practice, counseling, pharmacists, Taiyuan, China, antenatal care, self-medication, cross-sectional study

The study, conducted from June to November 2025, used a structured online questionnaire distributed through pharmacy-related social media groups and professional pages across Kosova. Participants included pharmacists and pharmacy technicians directly involved in dispensing medicines and counseling patients. The 29-item instrument covered demographic and professional background, awareness of opioid abuse and misuse, attitudes toward counseling and harm reduction, reported practices, and self-reported confidence related to naloxone administration. Most participants were female (75.8 percent), aged 19 to 30 (57.7 percent), and held a Master of Pharmacy degree (65.4 percent). More than half reported one to four years of work experience, and most worked full time in urban pharmacies.

The results paint a picture of a workforce that is well informed on paper. A striking 93.5 percent of respondents reported understanding the difference between opioid abuse and opioid misuse, terms that carry distinct clinical meanings: misuse refers to using prescription opioids in a manner other than prescribed, while abuse refers more broadly to harmful or non-medical opioid use. Familiarity with naloxone and its mechanism of action was reported by 81.5 percent of participants. Internal consistency of the awareness items was good, with a Cronbach’s alpha of 0.81, suggesting the questions reliably captured a coherent construct of self-reported knowledge.

Attitudes toward professional involvement were similarly encouraging. Three quarters of respondents (75.8 percent) agreed that pharmacies are appropriate settings for counseling individuals suspected of opioid abuse, and 75.1 percent said they were willing to provide such counseling. Support for dispensing opioids only with a valid medical prescription was nearly universal at 93.5 percent, and 94.6 percent agreed that pharmacy professionals should not sell medications to individuals who appear to be abusing them. Almost all respondents (95.0 percent) agreed that pharmacy staff should be trained to recognize individuals with substance misuse, and 98.5 percent said staff should be informed about medications with abuse potential. The attitude scale showed acceptable internal consistency with a Cronbach’s alpha of 0.76.

Yet beneath these positive surface indicators, the survey exposed significant vulnerabilities. Only 56.2 percent of participants reported feeling either confident enough or very confident in administering naloxone in their pharmacy setting, while 43.8 percent reported not feeling confident at all. This is a substantial proportion of a workforce that, in many countries, is increasingly expected to serve as a frontline response to opioid overdose. More than half of respondents (54.2 percent) also expressed concern that administering naloxone would require more time than they could provide in routine pharmacy practice, pointing to workflow pressures as an additional barrier beyond knowledge alone.

Work experience emerged as a meaningful variable across multiple measures. Chi-square tests revealed statistically significant associations between years of practice and several responses, including views on prescription-only opioid dispensing (p = 0.013), training in recognizing substance misuse (p = 0.040), naloxone-related education (p = 0.001), and time constraints around naloxone administration (p = 0.027). Most notably, self-reported confidence in administering naloxone was significantly associated with work experience (p = 0.017), and familiarity with naloxone showed an even stronger association (p = 0.001). These findings align with previous international research suggesting that more experienced pharmacists often report greater comfort when addressing opioid-related situations and engaging in patient counseling.

The regulatory context in Kosova adds a layer of complexity that the authors emphasize. Although national legislation governs medicinal products and retail pharmacy services, the current framework does not explicitly provide community pharmacists or pharmacy technicians with the authority to administer naloxone. This means that participants’ responses regarding confidence in naloxone administration should be understood as perceptions of a potential role rather than reflections of established practice. The authors note that this regulatory uncertainty is particularly relevant when assessing pharmacy professionals’ willingness and confidence to participate in opioid overdose management, and that clearer professional and regulatory guidance may be needed to address the gap.

Not all findings were uniformly positive. While 78.1 percent of respondents reported suggesting safer alternatives when misuse was suspected, only 31.9 percent reported contacting nearby pharmacies to inform them of an individual suspected of opioid misuse. This pattern, in which pharmacists feel comfortable with individual counseling but hesitate when broader professional collaboration is required, has been observed in other studies and may reflect barriers to inter-professional communication that were not directly examined in the present research. Additionally, 38.5 percent of participants agreed that the sale of controlled medications without a prescription represents an important source of pharmacy income, a finding the authors say should be interpreted cautiously as it reflects perceptions rather than dispensing practices.

The study has several limitations that shape how the results should be read. The cross-sectional design captures attitudes at a single point in time and cannot establish causality. Responses were self-reported rather than directly observed, meaning actual behavior and practical competence may differ from what participants described. Social desirability bias may have influenced answers to questions about professional responsibility and ethical practice. The voluntary online recruitment through social media may have attracted pharmacy professionals with a stronger interest in public health, potentially skewing responses toward more positive attitudes. The questionnaire was developed specifically for this study without formal pilot testing, and confidence in naloxone administration was assessed using a single item. Pharmacists and pharmacy technicians were also analyzed together without separate analysis by professional qualification.

Despite these limitations, the findings carry practical weight for a region where empirical evidence on pharmacy involvement in opioid harm reduction has been scarce. The authors conclude that strengthening the role of community pharmacy professionals in opioid abuse prevention will require more than awareness alone. Practice-oriented training, clear professional guidance, and supportive regulatory frameworks are needed to translate positive attitudes and self-reported knowledge into genuine confidence at the counter. International evidence suggests that successful pharmacist involvement in opioid harm reduction is most likely when training, regulatory clarity, and institutional support are aligned, and in settings where access to specialized addiction services is limited, community pharmacies may represent one of the most promising settings for early identification of opioid-related concerns and overdose prevention.

Subject of Research: Community pharmacists' awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova

Article Title: Community pharmacists’ awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova: A cross-sectional survey

Article References: Ibraimi, Z., Haxhiu, A., Shabani, D., Qeriqi, V., Bresa, A., & Haliti, D. (2026). Community pharmacists’ awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova: A cross-sectional survey. Pharmacia, 73, Article e204449. https://doi.org/10.3897/pharmacia.73.e204449

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e204449

Keywords: opioid abuse, naloxone, community pharmacists, Kosova, harm reduction, cross-sectional survey, Community, pharmacists, awareness, attitudes, confidence, regarding

The numbers on medication burden are striking. In the Saudi National Survey for Elderly Health, 51.5 percent of 2,946 community-dwelling older adults were taking five or more therapeutic classes—the common definition of polypharmacy. Across Saudi studies, polypharmacy prevalence ranges from 34 to 76 percent, and potentially inappropriate medications from 43 to 80 percent, depending on setting and definitions. The stakes are not abstract: adverse drug reactions account for an estimated 8.7 percent of hospital admissions among older adults, and polypharmacy is linked to falls, cognitive impairment, hospitalization, and higher healthcare spending. Yet medication count alone does not determine whether a regimen is appropriate—a complex regimen may be fully justified, while a shorter one can still contain a drug whose likely harm outweighs its benefit.

Enter deprescribing: a planned, supervised process of reducing or stopping medications that no longer fit a patient’s treatment goals or benefit–harm balance. Researchers emphasize that it is not the withdrawal of care but a continuous part of good prescribing, revisited as health status, priorities, and treatment burden change. The classic five-step framework—establish the complete medication list, assess overall medication-related harm, weigh each drug’s benefits and harms, prioritize what to stop, and implement with follow-up—has gained international backing through the World Health Organization’s Medication Without Harm challenge. But deprescribing carries its own risks: symptom recurrence, disease relapse, physiological withdrawal effects, and patient anxiety can all follow cessation, which is why tapering and active monitoring are built into the intervention rather than treated as afterthoughts.

Pharmacists sit at the center of this effort for a structural reason: they see the whole regimen across diseases and care settings, not just one condition. Repeated community-pharmacy contact lets them discuss prescription and nonprescription drugs alike, while home medication inventories have shown that older adults often possess over-the-counter products that never appear in the electronic record. The usual workflow starts with a Best Possible Medication History checked against records, followed by a structured review of indication, duplication, benefit–harm balance, and patient goals. The hard part often comes after the review. Among non-hospitalized older adults, acceptance of pharmacist recommendations ranged from 42 to 93 percent, but actual implementation ranged from just 27 to 88 percent. A recommendation without a named prescriber, a route to modify the prescription, and clear responsibility for monitoring is unlikely to change anything.

When the full pathway is implemented, the results can be dramatic. In the Canadian D-PRESCRIBE trial, 489 older adults across 69 community pharmacies received pharmacist-led education plus a pharmaceutical opinion sent to their prescriber; 43 percent discontinued the targeted medication compared with 12 percent under usual care. The EMPOWER study showed that even a patient-directed brochure prompted 27 percent of long-term benzodiazepine users to quit, versus 5 percent with usual care. The hospital-initiated Shed-MEDS program, continued through post-acute care, produced 14 percent fewer medications at discharge and 15 percent fewer at 90 days. But here is the uncomfortable truth the evidence reveals: deprescribing interventions change medication counts far more consistently than they change how patients actually function or feel. A recent systematic review found moderate-certainty evidence for only a small reduction—roughly one fewer medication per seven patients treated—and no significant reduction in the proportion with at least one potentially inappropriate medication. Mortality, hospitalization, and quality-of-life findings remain inconsistent, largely because trials are underpowered and follow-up is short.

The tools pharmacists use to spot problematic prescriptions come in two flavors. Explicit tools like the American Geriatrics Society Beers Criteria and the European STOPP/START criteria apply predefined rules that can be readily built into electronic health systems. Implicit tools like the Medication Appropriateness Index require clinicians to judge each medication against ten criteria—indication, effectiveness, dosage, interactions, duration, cost, and more—offering nuance at the price of time. Both families have a problem in Saudi Arabia: neither has a validated Arabic adaptation, and both were built on American or European evidence and formularies that may not match medications registered by the Saudi Food and Drug Authority. Moreover, explicit tools generally offer limited guidance on tapering or managing withdrawal, and different tools can classify the same medication differently. They identify candidates for review; they do not constitute a deprescribing plan, which must still account for frailty, comorbidities, patient preferences, and goals of care.

Pharmacist authority varies enormously worldwide, and this determines what is actually possible. In England, clinical pharmacists are embedded in general practice and qualified independent prescribers can alter treatment without separate authorization for each change. In the United States, collaborative practice agreements can delegate defined medication-management functions within state law. Canada’s RxACTION study showed community pharmacist prescribing improved blood pressure control, though it addressed hypertension rather than deprescribing. Saudi Arabia currently lacks this clarity: pharmacists there report adequate knowledge and positive attitudes but identify limited training, time, and authority as key barriers. Without defined authority, a pharmacist can identify a deprescribing candidate but cannot prescribe, monitor, or own the change.

Saudi intervention evidence remains thin. Only one small ambulatory-care pilot has tested a deprescribing intervention; most published studies are attitudinal surveys of healthcare professionals’ knowledge and readiness. No Saudi study has evaluated economic or patient-reported outcomes, and long-term effectiveness has never been assessed. Reported barriers include limited consultation time, heavy clinical workload, fear of withdrawal symptoms, absence of a national framework, and unclear institutional guidance. Willingness is not the problem—international evidence suggests many patients will consider deprescribing when a trusted professional recommends it. The gap is between attitude and infrastructure.

Paradoxically, Saudi Arabia’s digital health transformation may be the opening deprescribing advocates have been waiting for. NPHIES, launched in 2022 by the Council of Health Insurance, aims to unify health records across private and government sectors, potentially reducing fragmentation and letting providers review a patient’s complete medication list with standardized coding. Wasfaty, the Ministry of Health’s e-prescription platform introduced in 2019, connects primary care centers and hospitals with selected community pharmacies and lets patients collect medications free of charge—placing community pharmacists in an ideal position to spot potentially inappropriate medications and raise deprescribing conversations. The expansion of pharmacy colleges from three in 2008 to roughly 28 may help build the workforce, though geriatric training capacity will need deliberate investment.

Researchers behind the review lay out a concrete roadmap: the Saudi Geriatric Society should develop a validated Arabic tool and national deprescribing guidelines; pharmacist-led initiatives should be built in collaboration with geriatricians; the Saudi Society of Clinical Pharmacy should embed core deprescribing competencies into PharmD curricula; and multicenter interventional studies must replace the current survey-based literature. The global evidence shows pharmacists can identify inappropriate medications, engage patients and prescribers, and monitor withdrawal—but also that clinical benefits remain uncertain and implementation hinges on authority, workflow, and record access. Saudi Arabia has the demographic momentum, the digital infrastructure, and a young pharmacy profession. What it lacks is the evidence and the rules. The coming decade of aging will test whether it builds both in time.

Subject of Research: Pharmacist-led deprescribing of potentially inappropriate medications in older adults in Saudi Arabia

Article Title: Pharmacist-led deprescribing of potentially inappropriate medications in older adults in Saudi Arabia: a narrative review

Article References: Alamer, K. A., & Alotaibi, F. M. (2026). Pharmacist-led deprescribing of potentially inappropriate medications in older adults in Saudi Arabia: a narrative review. Pharmacia, 73, Article e211525. https://doi.org/10.3897/pharmacia.73.e211525

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e211525

Keywords: deprescribing, polypharmacy, pharmacists, older adults, Saudi Arabia, potentially inappropriate medications, geriatric pharmacotherapy, medication safety, Pharmacist-led, potentially, inappropriate, medications

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