Open research questions in Pharmaceutical Practices and Patient Outcomes

What the literature leaves open

• Literature supports the interprofessional collaboration of pharmacists and PA students within the didactic phase of learning, but this relationship has not yet been evaluated in clinical year.

  Integration of Clinical Pharmacy into PA Education · 2026 · DOI

• This study is limited by the small sample size, length, and assessment of perceived increased knowledge, however, demonstrates promise that small amounts of dedicated learning with a CP can positively influence pharmacological learning.

  Integration of Clinical Pharmacy into PA Education · 2026 · DOI

• R and R2 were calculated as 0.423 and 0.179, respectively, sug- gesting a weak positive linear relationship between the number of drugs taken by insurants and the number of CP recommen- dations (Fig. 1). The equation of the regression line was deter- mined as Y = 0.21 × X + 1.15 (p-value of the model < 0.001).

  Clinical-pharmacological medication reviews for insurants of a German statutory health insurance fund (Kaufmännische Krankenkasse (KKH)): a 5-year retrospective analysis (2019–2023) · 2026 · DOI

• Brief SummaryMost SNF residents with hyperlipidemia had relevant medication orders; non-statin use was rare, and differences observed in prescribing patterns by sex and payer warrant further study.

  Hyperlipidemia Pharmacotherapy in Skilled Nursing Facilities: A Real-World Evidence Study · 2026 · DOI

• The limitations of this study include its single- center nature and the inclusion of a limited number of surgical wards, which may affect the representa- tiveness of the study population and the possibility of generalizing the results to other clinical centers with different work organization, patient profiles, or local therapeutic practices.

  Impact of Clinical Pharmacist Interventions on Optimizing Antibiotic Therapy in Surgical Ward Patients: A Retrospective Study · 2026 · DOI

• This study had several limitations. Its retrospective design limited causal inference and relied on the completeness of forensic records. The dataset included only cases referred for medico-legal evaluation and therefore did not reflect the overall incidence of pharmacy-related errors in routine practice. In addition, detailed system-level variables, such as staffing patterns, workload intensity, and safety culture, could not be assessed.

  Evaluation of Medical Practice Allegation Cases Within the Scope of Pharmacy Services and Applications · 2026 · DOI

• The strengths of this study include its population-based design, comprehensive four-year statistical analysis of temporal trends, and use of a validated European PIM assessment tool.

  Potentially Inappropriate Prescribing Among Older Adults in Slovakia: A Population-Based Study of Pre-Pandemic Trends · 2026 · DOI

• low- and middle-income uneven, particularly infrastructure, countries, where experiential and workforce integration can hinder effective curriculum delivery (WHO, 2013; Buabeng & Amo-Darko, 2025). As a result, discrepancies may arise between intended educational outcomes and students’ actual learning experiences. capacity, In Algeria, pharmacy education has evolved within a distinct historical and institutional context. Following independence in 1962, the pharmaceutical sector became largely state-controlled, with an emphasis on ensuring equitable access to medicines and developing national production capacity (Meklat & Kandi, 2025). Pharmacy training during this period was primarily oriented toward theoretical knowledge and industrial applications. Economic reforms in the 1990s led to increased private sector participation, expanding professional opportunities and creating demand for pharmacists with more diverse and practice-oriented (Benkedidah & competencies Hadada, 2024) introduced graduates To align with international developments, Algeria introduced (PharmD) the Doctor of Pharmacy programme in 2011 (Azzouz, 2019). This reform aimed to strengthen clinical training, pharmacotherapeutic knowledge, and practical skills in order to better prepare roles. Nevertheless, several challenges have been reported, limited availability of structured clinical including placements, variability training quality, and in difficulties in integrating experiential learning into the curriculum. Similar implementation challenges have in other educational contexts been documented undergoing curricular transition (Al-Worafi, 2024). patient-centred for The Department of Pharmacy at the University of Batna 2 represents a key institution for pharmacy education in eastern Algeria. Established in 2001, it enrolled 1,651 students during the 2024–2025 academic year. The programme offers a comprehensive curriculum covering pharmaceutical sciences, biological sciences, and emerging clinical components. However, as in many comparable settings, the integration of practical constrained by and clinical infrastructural and including logistical restricted access to training sites and evolving partnerships with healthcare institutions (Al-Worafi, 2024). limitations, remains training In this context, examining students’ perceptions provides valuable insight into how educational reforms are experienced at the ground level. This study explores the perceptions of PharmD students at the University of Batna 2 regarding the quality and structure of their learning and assessment education, preferred methods, and future career aspirations. By focusing on a single institutional setting, the study aims to offer a contextualised understanding of pharmacy education in Algeria while contributing to broader discussions on aligning educational outcomes with professional expectations. Ultimately, the findings may inform efforts to enhance curriculum design, strengthen experiential learning opportunities, and support students’ transition into evolving professional pharmaceutical landscape.

  PharmD students’ perceptions of their education and future career: A cross-sectional study in Batna, Algeria · 2026 · DOI

• Community pharmacies are the most accessible health facility in Indonesia and a central interface of the BPJS Kesehatan Program Rujuk Balik (PRB) for chronic disease pharmaceutical care, yet empirical evidence on patient safety culture in this setting remains sparse.

  Patient Safety Culture in Community Pharmacies Serving the Indonesian Chronic Disease Referral Programme (BPJS Program Rujuk Balik): A Sequential Exploratory Mixed-Methods Study · 2026 · DOI

• Board certification is the established professional standard for CCPs but its impact on ICU patient outcomes, including its relationship between CCP characteristics and workload, remain unclear.

  Impact of pharmacist board certification on health outcomes of critically ill patients: An analysis of the Optimizing Pharmacist-Team Integration for ICU patient Management (OPTIM) study · 2026 · DOI

• Our study has several strengths. It leverages data from a large, nationally generalizable population-based cohort of community-dwelling adults aged 45–85 years, enabling age-stratified analyses across middle-aged and older adults. Regularly used medications presented by participants were documented by trained interviewers during home visits. Physical functioning was assessed through clinically meaningful, standardized performance-based tests. There are several limitations to this study. The cross-sectional design precludes the assessment of temporality. In the LPA analysis, profiles with the lowest physical function were associated with less favorable covariate characteristics, whereas the opposite was observed for profiles with the best function. Despite rigorous adjustment for confounders, residual confounding related to underlying health status cannot be excluded. The fully adjusted LPA was conducted in 78.5% of participants, with findings consistent with a model adjusted for education, comorbidities, and depression symptoms in 97.6% of participants. Additionally, daily dose was imputed for 8.4% of medications and as needed medications were assigned a DBI score of 0, which may have led to underestimation of exposure.

  Association between anticholinergic and sedative medications and physical functioning: data from the Canadian longitudinal study on aging (CLSA) · 2026 · DOI

• 4 Strengths and limitations The current study employed the SP methodology, which pro- vides an objective, unbiased assessment of actual practice and phar- macist behavior, further avoiding the social desirability bias associated with self-reported surveys.

  Evaluating community pharmacists’ practices in managing insomnia in Saudi Arabia: a cross-sectional study using simulated patient visits · 2026 · DOI

• A major strength of this study is the use of nationwide Korean National Health Insurance Service (NHIS) data to examine longitudi- nal patterns of psychotropic use in LTC hospitals before and during the COVID-19 pandemic. By capturing both prescription days and dose-based measures (DDDs) at the national level within a single- payer system, our findings provide insight into psychotropic steward- ship needs in Korea’s medicalized LTC hospital model. However, some limitations should be considered. The NHIS data lacked information on the frequency and severity of BPSD, non-phar- macological care delivery, or the clinical appropriateness of psychotro- pic prescribing in LTC hospital residents. Psychotropic prescribing may be clinically indicated when symptoms become unresponsive to non- pharmacological approaches and/or pose a substantial risk of harm to self and/or others (2). Also, we lacked staff-related information that may influence prescribing, including staff knowledge of BPSD care and appropriate psychotropic use, burnout, and distress levels (46, 47). Although we adjusted for facility-level bed-to-RN and bed-to-NA ratios, these structural staffing measures may not fully capture actual staffing availability, shift-level deployment, workload, or care processes relevant to non-pharmacological responses to BPSD. In addition, while physicians are routinely present and responsible for psychotropic pre- scribing in Korean LTC hospitals, physician staffing was not included as a covariate in the present analyses. The inclusion of random intercepts for LTC hospitals accounted for clustering within facilities and partially captured unmeasured between-facility heterogeneity, but it could not fully address unmeasured facility-level factors. Future studies incorpo- rating workforce capacity, staff competencies, and care-process mea- sures are needed to better understand prescribing trends and identify targets for improvement.

  Trends in psychotropic use among older adults with dementia in Korean long-term care hospitals across the COVID-19 pandemic: a national longitudinal study · 2026 · DOI

• There are limitations to the study. Only the most common administration line materials and those most readily available to clinicians were considered to ensure real-world guidance. New medications may be introduced, while established medications may be withdrawn, and the evidence base for their administration requirements is changing. Line material is also JMIR Hum Factors 2026 | vol. 13 | e88333 | p.

  Good Clinical Practice Guidance for Line Materials, Filtration, and Light Protection in Intravenous Medication Administration: Modified Delphi Consensus Study. · 2026 · DOI

• This study is limited by the range of stakeholder perspectives, largely composed of nursing and medical staff, and lack of allied health and consumer perspectives. It is further limited by the method; triangulation of qualitative data through the analysis of quantitative survey data may strengthen findings. As grey literature was not searched, selection bias for only published literature is also a limitation. As English language only was included in the search, this may have missed key perspectives from international literature not published in English.

  Healthcare professionals’ perspectives of pharmacist roles in residential aged care: a qualitative systematic review and meta-synthesis · 2026 · DOI

• Future primary research may benefit from gathering more diverse perspectives from allied health professionals, as perspectives within the identified papers primarily involved nursing staff, prescribers, and pharmacists. This is particu- larly important given the crossover between allied health professionals and pharmacists and potential for collaboration (such as speech pathologists or physiotherapists, managing swallowing difficulties and pain respectively). Investigations on improving interdisciplinary collaboration with visiting pharmacist models of care should also be undertaken. Future literature reviews should investigate the perspectives of resi- dents, informal caregivers, and non-health professional staff to complement these findings. Although we did not evalu- ate the outcomes of pharmacist roles in aged care, this has been explored previously with mixed findings in aged care specifically [24] and care of older persons broadly [105]; future research could employ methodologies such as realist evaluation to identify why and in what contexts such out- comes occur.

  Healthcare professionals’ perspectives of pharmacist roles in residential aged care: a qualitative systematic review and meta-synthesis · 2026 · DOI

• cannot verify whether such advisories are effectively communicated to or accurately relayed by patients when they consult physicians for prescription adjustments (C2).” “The pharmacist team provides highly professional medication counseling to patients. However, when patients arrive at my consultation room, the information for example: “The they relay is often vague and imprecise, pharmacist mentioned that the white pill might not be suitable” or “Someone said taking this medication excessively could harm the kidneys.” In such cases, it is typically unclear which pharmacist provided the advice, what specific concerns were raised, or on what clinical evidence or rationale the recommendations were based (D2).” “I typically inform the physician immediately of a patient’s medication-related reactions. However, regarding pharmacist recommendations, due to the inconsistent presence of pharmacists across departments and the lack of a standardized information is often relayed schedule for pharmacy rounds, indirectly through messages left for the attending physician (N1).” 3.2.2 The erosion of trust in the doctor-patient relationship In the collaborative effort to streamline prescribing practices, pharmacists and nurses perceive that patients place trust primarily in their attending physicians, whereas physicians observe that patients tend to place greater confidence in senior and renowned specialists. This divergence in perceptions regarding the attribution of trust creates a climate of caution among all parties, who remain hesitant to advance streamlining initiatives in the absence of strong authoritative endorsement. “Most patients tend to adhere to physicians’ recommendations, whereas deprescribing proposals put forward by pharmacists are often not readily accepted. This disparity stems from the prevailing perception among patients that physicians possess greater professional authority and clinical credibility compared to pharmacists (C3).” “Patients are generally more inclined to follow physicians’ recommendations and may perceive nursing staff as having less authority in clinical decisionmaking.

  A qualitative study on the challenges in deprescribing for elderly patients with polypharmacy · 2026 · DOI

• It is important to promote optimal medication-taking behavior among patients with chronic diseases receiving polypharmacy, as it can improve treatment outcomes Measures may involve both individual and systemic actions. To start with, patients should be provided with educational booklet containing easy-to-understand information on the general principles of medication-taking behavior while being counseled to read it thoroughly to clarify any misunderstandings. Family members should also be educated as this may help the patients in their medication-taking behavior. Use of supplemental measures such as reminders and alarms may help enhance the effectiveness of educational inputs. Pharmacists and nurses are also able to provide osmotic health education regarding prescribed medications. In addition, non-pharmacological treatment should be introduced for chronic diseases that warrants health education delivery.

  Challenges in understanding dosing instructions among polypharmacy patients with chronic illnesses in Iraq · 2026 · DOI

• Strength and The Limitations of the Study To the best of an our knowledge, this study was the first of its type about misunderstanding of the dosing regimen instructions among patients with chronic diseases taking multiple medications. It highlighted “misunderstanding” of the dosing regimen instructions include all patients with chronic diseases who were receiving polypharmacy in Iraqi hospitals. The strengthening points of this study included the use of a validated questionnaire as the data collection tool. Another strength was that the sampling showed diversity with regard to patients’ demographics and health status. The limitation of this study was the cross-sectional self-reporting design, meaning that causal inferences cannot be made. Besides, there may still be unaddressed confounding factors within the control of the researcher. Moreover, the survey was conducted in public hospitals only. Private hospitals may have a different view of the problem, so the ability to generalize the study conclusions and recommendations to private hospitals is limited. Also, the representativeness of all patients with chronic diseases taking polypharmacy who come to Iraqi hospitals is limited. Consequently, multi- national and multi-center studies with larger sample sizes are recommended to address these limiting factors.

  Challenges in understanding dosing instructions among polypharmacy patients with chronic illnesses in Iraq · 2026 · 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).

  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 · DOI

• vast and dynamic for any single prescriber to monitor effectively without computational decision support (25). If each patient in the DDI+ group is prescribed an in average of 10.7 medications, approximately 57 potential drug pairs, calculated as 10.7 × (10.7 - 1) / 2, illustrating how prescribing increases. complexity rises as medication count Consequently, with a clinically significant interaction rate of 5% for those pairs, a prescribing physician would need to monitor nearly three potential major drug interactions per patient during each admission encounter, without computerised assistance.

  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 · DOI

• Declarations Page 7 of 8 The main limitation of this study is that participants were recruited exclusively from informal caregiver self-help groups, thereby capturing a population already actively engaged in support networks. Informal caregivers who do not participate in such groups, due to lack of inter- est, access, or awareness, may experience different pat- terns of burden and healthcare engagement. In addition, the distribution of questionnaires within the groups was not standardized, raising the possibility of selective dis- tribution by group leaders. Finally, although the number of participating support groups was sufficient to provide an overview of this population, the overall sample of 180 informal caregivers remains relatively small in relation to the total population of dementia caregivers in Germany, which may limit generalizability.

  Medication process-related burden among informal caregivers of people with dementia: a nationwide cross-sectional survey in Germany · 2026 · DOI

• Notably, almost two-thirds of the participants affirmed that Italian pharmacy degrees were insufficient to meet the requirements for practising as a pharmacist in GB.

  Challenges and opportunities of Italian-qualified pharmacists relocated to work in Great Britain: A cross-sectional survey · 2024 · DOI

• Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC) pharmacies that provide them.

  Long-Term Care Pharmacy Market Shares and Differences in Skilled Nursing Facilities Served · 2023 · DOI

• The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region.

  Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours · 2021 · DOI

Most-cited papers in Pharmaceutical Practices and Patient Outcomes

• Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults · Archives of Internal Medicine · 2003 · 1,806 citations
• Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States · JAMA · 2002 · 1,431 citations
• American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults · Journal of the American Geriatrics Society · 2023 · 1,275 citations
• Pharmacist Participation on Physician Rounds and Adverse Drug Events in the Intensive Care Unit · JAMA · 1999 · 1,165 citations
• Health Outcomes Associated with Polypharmacy in Community‐Dwelling Older Adults: A Systematic Review · Journal of the American Geriatrics Society · 2014 · 586 citations
• Hospital-Based Medication Reconciliation Practices · Archives of Internal Medicine · 2012 · 423 citations
• Causes of Medication Administration Errors in Hospitals: a Systematic Review of Quantitative and Qualitative Evidence · Drug Safety · 2013 · 372 citations
• The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes · International Journal of Geriatric Psychiatry · 2006 · 290 citations
• Physician Communication When Prescribing New Medications · Archives of Internal Medicine · 2006 · 281 citations
• Effect of a Collaborative Approach on the Quality of Prescribing for Geriatric Inpatients: A Randomized, Controlled Trial · Journal of the American Geriatrics Society · 2007 · 240 citations

Most recent work

• Factors associated with potentially inappropriate medication use, medication underuse and overuse in older adults in the German National Cohort · Journal of Internal Medicine · 2026
• Assessment of the knowledge, attitudes, and practices (KAP) of Saudi citizens toward expired medications · Critical Public Health · 2026
• Optimization of Pharmacist Medication Management and Mortality in the Intensive Care Unit · medRxiv · 2026
• IMPACT OF A NEW CLINICAL PHARMACY CONSULTATION SYSTEM: A RETROSPECTIVE STUDY AT A TRAINING AND RESEARCH HOSPITAL IN TÜRKİYE · Ankara Universitesi Eczacilik Fakultesi Dergisi · 2026
• Medication process-related burden among informal caregivers of people with dementia: a nationwide cross-sectional survey in Germany · BMC Health Services Research · 2026
• 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 · International Journal of Drug Delivery Technology · 2026
• AN ANALYTICAL CROSS-SECTIONAL OBSERVATIONAL STUDY ON DRUG UTILISATION AND EVALUATION OF NARROW THERAPEUTIC INDEX DRUGS IN A TERTIARY CARE HOSPITAL · Zenodo (CERN European Organization for Nuclear Research) · 2026
• Challenges in understanding dosing instructions among polypharmacy patients with chronic illnesses in Iraq · GSC Biological and Pharmaceutical Sciences · 2026
• A comparative evaluation of two clinical decision support systems for safer prescribing in older adults: an exploratory single-patient case study · Frontiers in Pharmacology · 2026
• Defining Optimal Pharmacist-to-Patient Ratios for Comprehensive Direct Patient Care in Pediatric Settings: A Nationwide Survey in Canada · Canadian Journal of Hospital Pharmacy · 2026

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