Time of prescribing

The gap

Evidence profile

Sourced from the recommendations and limitations of the source papers, classified as general, spanning 3 journals.

Supporting evidence — 3 representative gaps

• PHARMACIST-LED DEPRESCRIBING FOR HOSPITALIZED OLDER ADULTS: CURRENT EVIDENCE, IMPLEMENTATION BARRIERS, AND FUTURE DIRECTIONS (2026) · Zenodo (CERN European Organization for Nuclear Research) · doi

  acceptance, medicine discontinuation, PIM count, DBI score, or anticholinergic burden. Mortality, readmission, falls, and quality of life are influenced by frailty, disease severity, indication, follow-up duration, post-discharge adherence, and the medicine withdrawn. Small single- centre and before-and-after studies are therefore poorly suited to detect reliable differences in these endpoints. In pooled evidence, Carollo et al.[11] reported a small reduction in readmission without a mortality benefit, whereas Tesfaye et al.[12] found no significant pooled effect on total medicine count or effective deprescribing across mixed substantial heterogeneity. settings noted and There were nevertheless clinically relevant signals: fewer reported adverse drug reactions after hip fracture, better functional recovery in rehabilitation, less inappropriate insulin exposure, no withdrawal events in one DBI programme, and preserved sleep quality after hypnotic discontinuation.[7,14,18,21,22] Larger controlled studies with standard outcomes and longer follow-up are needed to determine whether these signals are reproducible. The pharmacist's role within a multidisciplinary model The evidence favours a pharmacist-led, not pharmacist- only, model. Pharmacists are well placed to find high- risk patients, verify histories, assess PIMs and interactions, review benefit and harm, propose tapering and monitoring, and communicate across settings.

  generalrecommendations
  Keywords: medicine pharmacist discontinuation count mortality readmission quality follow small pooled evidence reported benefit across settings
• Prespecified High-Risk Medication Combinations and Gastroprotection Gaps Among Hospitalized Adults with Type 2 Diabetes and Polypharmacy: A Cross-Sectional MedicationSafety Study at a Tertiary Hospital in Nasiriyah, Iraq (2026) · International Journal of Drug Delivery Technology · doi

  time of prescribing. This knowledge further relies on the availability of either an electronic prescribing system or a clinical pharmacist reviewing the entirety of patients' medication records, neither of which was accessible at this hospital during the data collection period (16). Consequently, the policy significance of this work arises from its comparative evidence foundation. Measuring the disparity between established guidelines and actual prescriptions in a low- and middle-income the country provides high-income experts with necessary data to reevaluate their approach to guideline implementation in low-income environments (58). This should not involve diminishing the quality of rather pharmacotherapy adapting the implementation strategies to be effective in contexts with distinct resource limitations compared to those where the majority of existing evidence is produced (59). Committees responsible for guideline development at NICE and ADA should recognise from this study that their commendable recommendations regarding the monitoring of NSAIDs versus metformin, the precise prescribing of clopidogrel and PPIs, and the risk stratification of patients for NSAID prescriptions are not effectively reaching the intended patient population (60).

  generalrecommendationsevidence 5/5
  Keywords: prescribing income patients evidence prescriptions guideline implementation time knowledge further relies availability either electronic system
• Trajectories of antidepressant dispensing among privately insured transgender people in the United States (2026) · Scientific Reports · doi

  ARTICLE IN PRESSARTICLE IN PRESS ACCEPTED MANUSCRIPT This study is not without limitations. We acknowledge that our method for measuring medication dispensing is a proxy, as we will not have access to data detailing whether a patient took their medication as dispensed or used the right dosage and frequency. However, this measure is endorsed by the Pharmacy Quality Alliance (PQA), utilized by the Centers for Medicare and Medicaid Services (CMS), and influences 41% of Medicare Star Ratings (70,71). Proportion of Days Covered is known as the “foundation for enabling optimal results,” as it is the strongest available measure within claims data and critical for economic evaluations, policy decision-making, and insights for clinical outcomes of interest (72). We also assumed that medications were interchangeable if there was a dispensing switch within 30 days, which could potentially overestimate a patient’s PDC. We also did not have medication strength or dosage information for a patient’s antidepressant, which could vary by individual. Without this information, there may be differences in medication dispensing by dosage strength that we are not able to measure in this study. We were unable to determine if the length of antidepressant days’ supply was directed by one’s health provider, which is why we move away from describing the individual as “non-adherent” and towards discussing dispensing so as to understand larger barriers and facilitators that may influence antidepressant medication taking. Further, previous studies evaluating medication dispensing have also found early discontinuers to have similar health to long-term users, as this group may have improved symptoms where medication was no longer necessary (73). Future research should explore medication use with data that includes measurement of symptoms and reasons for discontinuation of antidepressant use. Additionally, this claims dataset may not capture all psychiatric-related claims as it is possible to receive psychiatric-related care outside of insurance coverage, such as ARTICLE IN PRESSARTICLE IN PRESS ACCEPTED MANUSCRIPT psychotherapy. We also do not have information on symptom severity of depressive disorders and anxiety in claims data, which could be major time-varying factors impacting dispensing pattern trajectories. Claims databases also do not obtain patient- reported outcomes and therefore we are not able to measure side effects and the potential impact of side effects on treatment discontinuation. We also did not assess second-line treatment of antidepressants for TGD people with recurrent depression or anxiety. Future research should consider including evaluating antidepressant dispensing trajectories among TGD people using tricyclics and monoamine oxidase inhibitors antidepressants as a second-line treatment for a recurrent mental health condition. Seasonal differences, particularly in depressive disorders, may have occurred for patients especially during winter months in the US (October to March), which could affect dispensing levels. As our measure was descriptive, we did not adjust for seasonal differences, especially as past findings found longer term exposures were more likely to cause confounding than short term exposures (74). As we assessed dispensing patterns over 6 months, we did not anticipate this to be a major issue in our measurement. MarketScan does not report income or racial demographic information of enrollees, which precludes our study from assessing potential differences by socio- economic status or race, which are important drivers of health inequities within the US (75). Additionally, this claims dataset only contains claims from private insurance providers, limiting our results from being generalizable to the entire TGD patient population, although previous studies have found most TGD people have private health insurance (>50%) (76,77). Finally, as there is no gold standard within claims data of gender identity, we cannot measure how many additional TGD people were not identified in the claims dataset who did not seek gender-affirming medical care. ARTICLE IN PRESSARTICLE IN PRESS ACCEPTED MANUSCRIPT However, previous research using claims data applied TGD-related diagnosis codes alone and were able to obtain a sensitivity of 89% and specificity of 99%, suggesting that conservative CPs have high accuracy in identifying TGD people who receive gender-affirming care (78).

  generallimitationsevidence 5/5
  Keywords: claims dispensing medication article press measure patient antidepressant health people within information differences accepted manuscript

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