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The 2021-22 Professional Affairs Committee was charged to (1) Develop a resource guide for member institutions and faculty regarding payment for the practice-related activities of pharmacy faculty; (2) Nominate at least one person for an elected AACP or Council Office; and (3) Consider ways that AACP can improve its financial health. This report describes the methodology and content utilized for the development of an online resource guide for member institutions, faculty, and practice sites regarding the integration of clinical faculties’ patient care services into patient care settings, including models for payment and value-based payment structures that can be utilized to support the practice-related activities of faculty. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Objectives A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center’s EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor of pharmacist workload and to assess its potential as an additional dimension to traditional workload measures. Materials and methods Data were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and 2 traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged. This was a single-center study of an EHR-integrated MRC-ICU tool. The primary outcome was the association of MRC-ICU with institutional metrics of pharmacist workload. Associations were assessed using the initial 24-h maximum MRC-ICU score’s Pearson’s correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling. Results A total of 1205 patients over 5083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman’s rho 0.41, P < .001) and cumulative interventions placed (Spearman’s rho 0.27, P < .001). A 1-point increase in maximum daily MRC-ICU was associated with a 31% increase in order volume (95% CI, 24%-38%) and 4% increase in interventions (95% CI, 2%-5%). Discussion and conclusion The MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with 2 traditional objective measures of pharmacist workload, including orders verified and interventions placed, which is an important step for its use as a tool for resource utilization needs. Lay Summary Measuring critical care clinical pharmacist workload is challenging because currently available metrics, including the number of medication orders verified or medication interventions logged, do not capture the full breadth of work critical care pharmacists do. The medication regimen complexity-intensive care unit (MRC-ICU) score is a tool designed to quantify the complexity of an ICU patient’s medication regimen and may serve as an alternative measure of the overall critical care pharmacist workload. In this study, we assessed whether MRC-ICU scores from 1205 ICU patients admitted to a single academic medical center were correlated with traditional metrics used to assess pharmacist workload, including medication orders and documented interventions. MRC-ICU was correlated with both workflow measures and traditional measures of patient acuity and also was predictive of the next day’s workload, suggesting MRC-ICU could be explored as an additional tool to optimize critical care pharmacist resource utilization. Further studies should assess how MRC-ICU can be utilized to optimize critical care pharmacist workload.

In Australia, around 3.6 million people suffer from hearing loss, more than 1.3 million with preventable hearing conditions. Ear diseases are prevalent in Indigenous populations, particularly children and are associated with poor educational outcomes and subsequent high rates of unemployment and incarceration. In Australia, rural and remote communities have rates of middle ear perforations five times the rate that the World Health Organisation regards to be a significant public health problem.Barriers to accessing ear health services have been identified including gaps in testing during the 'early years' and difficulty in accessing these services. Reducing the risk of hearing loss through improved ear health care can directly impact the ability to learn and develop. Collaboration between community, health providers and government is crucial to ensure necessary support for change. An opportunity presents for rural community pharmacists, who are both qualified and accessible to provide an ear health programme and thus improve health outcomes for both Indigenous and non-Indigenous Australians in their communities. The aim of this study was to identify published evidence of pharmacists' involvement in ear health care interventions to inform the development of ear health services able to be delivered in rural community pharmacy in Australia. The search strategy was applied to the following electronic databases: MEDLINE, Scopus, CINAHL, Emcare, Cochrane, Google Scholar and Google.Study selection articles were included if they described an ear health intervention in a community pharmacy setting. The interventions reported in the articles were evaluated for their inclusion of effectiveness, whether the service was sustainable, and the inclusion of enablers and barriers to the provision of ear care. The articles were also thematically analysed using the Deadly Ears Deadly Kids Deadly Communities Framework. A total 8427 articles were identified and evaluated against inclusion and exclusion criteria, with eleven eligible articles suitable for inclusion in the review. The articles included were conducted in Australia (n = 4), England (n = 4), United States of America (n = 2) and Brazil (n = 1). The ear health interventions identified included hearing screening (n = 3), otoscopy pilot studies (n = 2), audiometry services (n = 1), specific education for undergraduate pharmacy students (n = 2) and a pharmacy-based clinic (n = 3). Effectiveness and sustainability were not formally reported in any of the included articles. Positive outcomes, funding availability, consumer access to community pharmacy, cost savings for consumers and improved connection to health providers were identified as enablers. Difficulty in attracting funding was the most commonly reported barrier. Improving ear health of both Indigenous and non-Indigenous peoples through services provided in community pharmacy presents as an important opportunity for rural pharmacists. Pharmacists are accessible and thus well placed to improve ear healthcare and resultant quality of life for these vulnerable populations. This review has identified factors required to effectively develop ear health models of care in community pharmacy including a pharmacist training program, continuous funding to ensure sustainability and support from pharmacy stakeholders and the community.

Background Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions’ mechanisms of action and are more likely to result in effective and sustained interventions. Aim To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research. Method PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed. Results Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework). Conclusion This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Background: To promote model-informed precision dosing (MIPD) for vancomycin (VCM), we developed statements for therapeutic drug monitoring (TDM). Methods: Ten clinical questions were selected. The committee conducted a systematic review and meta-analysis as well as clinical studies to establish recommendations for area under the concentration-time curve (AUC)-guided dosing. Results: AUC-guided dosing tended to more strongly decrease the risk of acute kidney injury (AKI) than trough-guided dosing, and a lower risk of treatment failure was demonstrated for higher AUC/minimum inhibitory concentration (MIC) ratios (cut-off of 400). Higher AUCs (cut-off of 600 μg·h/mL) significantly increased the risk of AKI. Although Bayesian estimation with two-point measurement was recommended, the trough concentration alone may be used in patients with mild infections in whom VCM was administered with q12h. To increase the concentration on days 1–2, the routine use of a loading dose is required. TDM on day 2 before steady state is reached should be considered to optimize the dose in patients with serious infections and a high risk of AKI. Conclusions: These VCM TDM guidelines provide recommendations based on MIPD to increase treatment response while preventing adverse effects.

Background The development of clinical pharmacy in China has been relatively slow, and standardized, effective training for clinical pharmacists remains a major challenge. At present, traditional teaching methods are not conducive to cultivating clinical practice abilities or critical thinking, leading to a lack of enthusiasm among students. To address this issue, a hybrid teaching model combining an AI-assisted multi-advisor system with the BOPPPS (bridge, objective, pre-assessment, participatory learning, post-assessment, summary) teaching method was applied in clinical pharmacy education. Methods In this study, a teaching model was developed that consists of five components: advisor system, teaching strategy, teaching method, teaching mode, and assessment methods. The model was implemented in the Pharmacy Department of Xiangya Hospital at Central South University in Changsha, China, from spring 2023 to spring 2024. After the spring 2024 training session, anonymous questionnaires were completed by students. The effects of the teaching reform were evaluated. The questionnaire focused on clinical practice effectiveness, course design rationality, improvement in professional ability, interest in learning, and perceptions of ChatGPT as a teaching tool. Results A total of 81 students participated in the study, with 69 completing the questionnaire survey (response rate: 85.2%, n  = 69). Overall, students gave positive comments regarding the instructional improvements. A higher proportion of interns and advanced students considered the courses difficult (32.4%, n  = 12 and 31.6%, n  = 6, respectively). Identified shortcomings include the frequent periodic assessments and increased pressure. Regarding the use of ChatGPT, 49 students (71.0%, n  = 49) commented that it played a multidimensional role in teaching. The most valued asset was its ability to provide massive data information (43.5%, n  = 30), while the lack of interactivity was a prominent issue (56.5%, n  = 39). Conclusion This innovative teaching model integrating an AI-assisted BOPPPS framework with a supervised ChatGPT implementation may facilitate the comprehensive self-evaluation of abilities. This research offers a replicable model for AI-driven educational transformation in clinical pharmacy training.

Purposes We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality. Methods Thirty-eight internal medicine wards in Italy participated in the Re gistro Po literapie SI MI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders. Results The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p  < 0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01–1.08; p  = 0.02), comorbidities (OR 1.18; 95% CI 1.12–1.24; p  < 0.0001), and AEs (OR 6.80; 95% CI 3.58–12.9; p  < 0.0001) were significantly associated with in-hospital mortality. Conclusions Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk.

Pharmacogenomics (PGx) offers a powerful strategy to improve medication safety and efficacy, yet its integration into community pharmacy practice remains limited. While an “attitude-knowledge gap” is known to exist globally, limited national data exist concerning PGx readiness among community pharmacists in Jordan. This study aimed to (i) quantify Clinical Pharmacogenetics Implementation Consortium (CPIC)-aligned PGx knowledge and characterize attitudes; (ii) assess implementation readiness across organizational, leadership, and structural dimensions; (iii) map perceived barriers; and (iv) identify independent predictors of knowledge, attitudes, and readiness. A national, cross-sectional survey was conducted using a proportionate stratified random sampling method. A content-validated and reliability-tested electronic questionnaire was distributed to community pharmacists across Jordan’s three administrative regions. The instrument assessed demographics, CPIC-aligned knowledge, attitudes and perceived barriers on five-point Likert scales, and theory-informed implementation readiness. Data were analyzed using descriptive statistics, bivariate tests, and multiple linear regression. A total of 347 community pharmacists completed the survey. A vast majority (83.0%) reported no prior formal PGx training. Knowledge of practical PGx was low, with a mean score of 5.54 ± 2.12 out of 10. Attitudes were neutral (mean = 3.49 ± 0.26), while perceived barriers were rated as significant (mean severity = 3.45 ± 0.30), with privacy concerns being the highest-rated challenge (mean = 3.65 ± 0.78). Total implementation readiness was moderate (mean = 3.34 ± 0.25), with organizational readiness (mean = 3.39) rated higher than structural readiness (mean = 3.21) or leadership support (mean = 3.27). Bivariate analyses revealed few significant associations, and crucially, multiple linear regression models showed that no demographic or practice characteristics within the variables tested were significant independent predictors of knowledge or readiness. Jordanian community pharmacists demonstrated a significant gap between their positive attitudes towards PGx and the practical knowledge and systemic support required for clinical implementation. The findings revealed that the identified deficits in knowledge and readiness were widespread across all surveyed subgroups, not concentrated in specific demographic or professional subgroups. Translating the existing positive sentiment into routine clinical practice urgently requires a nationwide, standardized educational strategy coupled with the development of systemic enablers, including reimbursement pathways, integrated clinical workflows, and explicit leadership support.

This commentary narrates on the building of an effective and innovative medicines optimisation model. It discusses the essential features, emphasizes the need, and considers the strong health and pharmacy system as a prerequisite before such a model could be built. The paper argues that it is important to strengthen the health system before the elements of pharmaceutical care and medicine optimisation can take shape. It discusses the discourse and interplay between medicine use and medicine access research. The other important elements to include are the “selection of medicines by health technology assessment”, “economic evaluation of pharmacy services”, “pharmacists’ remuneration by the government”, “Health system strengthening status”, “quality use of generic medicines programmes”, “rationale prescribing”, “access to medicines and medicines pricing”, “medicines advertising” and the “state of pharmacy practice and the development of the pharmacist’s role”. A set of different high-, middle- and low-income countries are used to provide examples of the status of the health system and the subsequent development of pharmacy practice and medicines optimisation. The countries include the UK, Australia, New Zealand, Pakistan, Türkiye, Malaysia, India, and Pakistan.

This article represents the first in a series of tutorials on model evaluation in nonlinear mixed effect models (NLMEMs), from the International Society of Pharmacometrics (ISoP) Model Evaluation Group. Numerous tools are available for evaluation of NLMEM, with a particular emphasis on visual assessment. This first basic tutorial focuses on presenting graphical evaluation tools of NLMEM for continuous data. It illustrates graphs for correct or misspecified models, discusses their pros and cons, and recalls the definition of metrics used.