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Background

Poor adherence is a well-known problem for statins, key medicines for reducing cardiovascular morbidity and mortality. Community pharmacy services have been identified as a way to increase adherence. We assessed the effect of motivating counseling in Swedish community pharmacies on treatment persistence in patients starting statin therapy.

Methods

In this cohort study, one-year persistence was evaluated in patients who initiated statin therapy (ATC C10AA) between October 2022 and June 2023 following pharmacy-based counseling, and compared with five age- and sex-matched controls per patient from pharmacies not providing the service. Data were collected from Swedish national health registers on dispensed medications, diagnoses and socioeconomic characteristics of patients. Odds ratios for being persistent with 95 % confidence intervals were calculated using a logistic regression model adjusted for socioeconomics, cardiovascular comorbidity and pharmacy size.

Results

A total of 902 patients who had data available in the Swedish national registers received the intervention. They had a higher education and income, mostly Swedish born and they had less history of cardiovascular disease, compared to the 4510 age- and sex-matched controls. The one-year persistence was significantly higher among those who received the service compared to controls (80.2 % compared to 73.6 %). Adjusted odds ratios for being persistent after the intervention was 1.43 (95 % CI 1.19-1.71).

Conclusion

Patients who receive a motivating counseling service in community pharmacies have a higher persistence to statin treatment, one year after initiation, after adjustment for differences in patient characteristics.

The pharmacy systems have undergone fundamental changes in some Nordic and Baltic countries: Iceland, Norway, Sweden and Estonia. The political declared aims of the reforms have included increasing competition and/or effectiveness of the pharmacy market and the availability of medicines or pharmacies. The aim of this commentary is to describe the policy measures taken in these countries changing community pharmacy ownership, the arguments and rationales behind, and the evidence of the intended and unintended outcomes. Furthermore, we discuss the lessons learned for social pharmacy researchers. The aim of increasing the availability of pharmacies has been achieved, if interpreted as more pharmacies. However, the number of pharmacies has increased, mainly in urban areas, with a need to assure the availability of pharmacies in rural areas with regulations and/or subsidies in some countries. There were also unintended consequences. The aim to increase competition and diversity failed, as big domestic and foreign pharmacy chains conquered most of the pharmacy market. Learning for researchers in social pharmacy when studying pharmacy system changes includes considering the social, economic, and political reality in which the sector exists. The intended and unintended consequences of changes need a multi-method approach, often mixing quantitative (epidemiology and economics) and qualitative social science methods. Lastly, if we want evidence-based policymaking, we as researchers need to do better in communicating our research evidence to politicians and to the public.

  Aim

To explore the challenges and risks associated with the manipulation of solid oral dosage forms in paediatric healthcare. To compile recommendations to support the safety, efficacy and patient outcomes in paediatric patients.

Methods

A narrative review was conducted based on literature searches in PubMed, Scopus and Web of Science (2000–2024), including regulatory guidelines and clinical case reports. Selection focused on studies involving oral drug manipulation in children, particularly dose extraction, dispersing tablets, and administration via enteral tubes.

Results

Between 15%–37% of paediatric oral drug administrations require manipulation due to lack of age-appropriate formulations. Common manipulations include tablet splitting, crushing or dispersing, often resulting in dose inaccuracies, variable solubility and inconsistent pharmacokinetics. Risks are elevated in children using enteral feeding tubes or when manipulating poorly soluble drugs. Studies show manipulation can lead to dosing errors with potential harm.

Conclusion

Oral drug manipulation in paediatrics is widespread but often unsupported by evidence. Safer practices require improved access to licensed formulations, better training and clinical support tools. Pharmacy compounding, personalised manufacturing and technologies like 3D printing may reduce risks. Regulatory alignment and interdisciplinary collaboration are critical to improving drug safety and outcomes for paediatric patients.

Introduction Care transitions, particularly hospital discharge, present significant risks to patient safety. Deficient medication-related discharge communication is a major contributor, posing substantial risk of harm to older patients. This protocol outlines the Improved Medication communication and Patient involvement At Care Transitions (IMPACT-care) intervention study, designed to evaluate the effects of a multifaceted intervention for older hospitalised patients on medication-related discharge communication compared with usual hospital care.

Methods and analysis A pre–post intervention study will be conducted in two surgical and one geriatric ward of a university hospital in Sweden. The study will begin with a control period delivering usual care, followed by a training period and then an intervention period. The intervention comprises four components performed by clinical pharmacists: (1) information package provided to patients and/or informal caregivers, (2) preparation of medication-related discharge documentation, (3) facilitation of discharge communication and (4) follow-up call to patients or their informal caregiver. Eligible participants are aged ≥65 years, manage their own medications independently or with informal caregiver support, and are admitted to the study wards. Each study period (control and intervention) will last until 115 patients have been included. The primary outcome is the quality of medication-related discharge documentation, assessed using the Complete Medication Documentation at Discharge Measure (CMDD-M). Secondary outcomes include patients’ perceptions of knowledge and involvement in discharge medication communication, and their sense of security in managing medication post-discharge; adherence to medication changes from hospitalisation that persist after discharge; and unplanned healthcare visits following discharge. A process evaluation is planned to explore how the intervention was implemented. Patient inclusion began in September 2024.

Ethics and dissemination The study protocol has been approved by the Swedish Ethical Review Authority (registration no.: 2023-03518-01 and 2024-04079-02). Results will be published in open-access international peer-reviewed journals, and presented at national and international conferences.

Trial registration number NCT06610214.

Background

Pharmacist prescribing legislation aims to enhance healthcare quality and accessibility. However, in many countries, like the Netherlands, it has not yet been legally established.

Aim

To investigate pharmacists’ perspectives on potential pharmacist prescribing in the Netherlands.

Method

An online survey using a questionnaire that was distributed via e-mail and electronic newsletters to most practicing pharmacists in the Netherlands during October and November 2023. The questionnaire was based on previous literature, further developed during an international conference with pharmacists and piloted with Dutch pharmacists. Agreement with statements about potential prescribing models, settings, preconditions, and perceived benefits and risks was measured using a 4-point Likert scale. Data were analysed descriptively.

Results

In total, 625 participants from community pharmacy (n = 432; 69.1%), hospital pharmacy (n = 149; 23.8%), or other/combined settings (n = 44; 7.0%) completed the questionnaire. Most pharmacists (somewhat) agreed with the introduction of an independent prescribing model with limitations (n = 538; 86.1%) or a model dependent on collaborative agreements with physicians (n = 471; 75.4%). A minority (n = 245; 39.2%) supported independent prescribing with diagnostic authority. The precondition that participants most frequently (somewhat) agreed with was access to health records (n = 607; 97.1%). The most (somewhat) agreed-upon benefits were enhanced professional position of pharmacists (n = 574; 91.8%) and reduced workload for other prescribers (n = 573; 91.7%). Increased workload for pharmacists (n = 495; 79.2%) was the most (somewhat) agreed-upon identified risk.

Conclusion

Pharmacists in the Netherlands are generally supportive of an independent but limited or collaborative pharmacist prescribing model. These findings support further investigations into the potential introduction of pharmacist prescribing legislation.

Aims: Prescribing pharmaceuticals is essential to improve health, but it also has substantial environmental impact. This study investigated the extent to which Swedish general practitioners (GPs) are willing to integrate environmental aspects into treatment decisions and their opinions on policies to reduce pharmaceutical pollution.

Methods: A questionnaire assessing environmental considerations in prescribing was developed and distributed to 1233 Swedish GPs and physicians in training (response rate: 22%) between September 2023 and June 2024. It included 3 patient cases to assess trade-offs between therapeutic effect and environmental impact of pharmaceuticals used for pain management, blood pressure reduction, and contraception. Questions about attitudes to policies to reduce the environmental impact of pharmaceuticals were also included. Data were analysed using descriptive and inferential statistics.

Results: Most respondents were willing to prescribe a less effective pharmaceutical if it was environmentally preferable, 77% for pain management and blood pressure reduction, and 50% for contraception. Environmental impact was ranked as the least important factor in prescribing decisions when compared to cost, regional treatment guidelines, dosage intervals, and user-friendliness. A total of 68% of respondents agreed that physicians should consider environmental aspects when prescribing, however only a few often searched for environmental information when prescribing. Policies directed towards other stakeholders, such as authorities and the pharmaceutical industry, received substantial support.

Conclusion: Swedish GPs are willing to consider environmental factors when prescribing. However, other factors are more often considered and GPs attribute higher responsibility to other actors. Improving access to environmental information about pharmaceuticals could support greener prescribing.

Background: Pharmaceutical pollution is an increasing environmental concern. As key actors in the healthcare chain, community pharmacies play an important role in managing pharmaceuticals from an environmental perspective. Although environmental initiatives exist at the corporate level in Sweden, it remains unclear how well these are known to, or implemented by, pharmacy staff. Objectives: To explore how community pharmacy staff in Sweden perceive their role in reducing pharmaceutical pollution, and identify the opportunities and challenges they face in promoting environmentally friendly use of pharmaceuticals. Methods: Focus group discussions and individual semi-structured interviews were conducted with pharmacy staff in Sweden between May 2024 and February 2025. All focus group discussions and interviews were audio recorded, transcribed, and analysed using inductive qualitative content analysis. Results: Four focus group discussions and five individual interviews were conducted. The analysis resulted in three main categories. First, while there was an awareness of environmental issues, participants expressed a lack of concrete guidance and requested more information, such as lists of environmentally harmful pharmaceuticals. Second, pharmaceutical waste, originating both from households and pharmacies, was highlighted as a major concern. Third, there appeared to be a sense of limited agency and a wish for support from, for example, regulatory authorities to address pharmaceutical pollution. Conclusion: Swedish pharmacy staff view themselves as potential contributors to reducing pharmaceutical pollution, but struggle to identify concrete actions. They are concerned about pharmaceutical waste and responsibility is often shifted to other stakeholders.

This chapter focuses on research ethics, an area where norms and values are universally accepted. These norms and values are expressed in codes of ethics, that is, a set of principles and guidelines regarding ethics. Drug utilization research is a type of health-related research, and ethics is essential to consider. Central ethical aspects are to protect the rights, welfare, and anonymity of research subjects and to ensure the scientific quality of the ongoing research. The key aim of research ethics reviews committee approvals is to safeguard the rights, safety, and well-being of the research participants. One essential ethical focus when conducting research is to protect research participants against harm and to ensure that any participation in research is voluntary and based on informed consent. Policymaking in both developed and developing countries plays a role in making high-information content available for public health purposes while ensuring the protection of privacy.

Background: Patient involvement in medical-decision making is linked to improved patient outcomes and increased patient satisfaction.

Objectives: The aim was to explore how hospitalised older patients are and wish to be involved in medication decisions affecting their medication therapy after hospital discharge.

Methods: Naturalistic observations of consultations between healthcare professionals and hospitalised older patients who were about to be discharged were performed at in total three medical wards at two hospitals in Sweden. Subsequent semi-structured interviews with the patients were conducted within one week after discharge. The data were thematically analysed, guided by systematic text condensation.

Results: Twenty patients were included (mean age: 81 (SD 8) years, 45 % female). Three themes were identified: 1) Predetermined authoritarian structures; describes that neither patients nor healthcare professionals expected patients to be involved in medication decisions. The medication decisions were frequently already taken by the healthcare professionals prior to the consultations, 2) Difficulties in finding the right time and setting; displays inhibitory factors in patient involvement in medication decisions when the consultations occur in hospital, and 3) Communication focusing on benefits over side-effects; demonstrates that newly prescribed medications were rarely accompanied with information about side-effects. Patients felt they lacked sufficient knowledge to take informed decisions about medications.

Conclusions: There are structures limiting involvement of older patients in medication decisions prior to hospital discharge. A change in approach to consultations from both the patients and healthcare professionals is needed to provide patients with the knowledge they feel is needed to be sufficiently involved.

Data sharing is key for artificial intelligence and for future healthcare systems, but the perspectives of patients are seldom included in the larger debates of how, when, and what data to share. This chapter provides an overview of research on patient perspectives on data sharing and associated aspects, including patients’ motivations, concerns, and views on privacy and conditions for sharing. Moreover, these perspectives are put into the evolving context of informed consent and today’s European context of the General Data Protection Regulation (GDPR) and Data Governance Act (DGA). Overall, there seems to be a discrepancy between the patients’ perspective on data sharing and the reality in which their data are to be shared. The current patient views are researched within relatively ‘local’ contexts, where the patient would consent to collecting data for primary use and on patients’ preferences regarding consent and what they see as barriers and motivators for data sharing. However, the reality of data use is moving towards re-use of data for secondary purposes and a context of more altruistic consent such as the DGA. Questions remain regarding how patients perceive sharing and the role of their data in the larger governance of data; seemingly, patient views are lost in the wider debate of innovation and jurisdictional competitiveness. Ensuring that patients’ voices are heard is essential for public acceptance of data sharing, and thus for inclusiveness and equity of results and innovations originating from patients’ shared data.