Pharmacy Practice is a full-text peer-reviewed journal with a scope on pharmacy practice. Pharmacy Practice is published quarterly.
The burden cost of adverse drug reaction related to admission at Chaophrayayommarat hospital
Background: Adverse Drug Reaction-related Hospital Admissions (ADRA) represent a significant impact on clinical problem and healthcare expenditure. This study aimed to determine the clinical manifestations, prevalence and cost burden from ADRA in the context of Chaophrayayommarat hospital, regional hospital level, Thailand. Methods: An observational study of adult patients who unplanned hospital admissions to Chaophrayayommarat hospital caused by adverse drug reactions (ADRs) during May 2024 – March 2025. The prevalence of ADRs, their economic burden from the hospital perspective, severity, and preventability were assessed using standard criteria. Results: Out of 23,247 hospital admissions, 217 ADRA have been identified. The incidence of ADRA was 0.93% (95% CI 0.81-1.06). Antimicrobial agents related ADRs, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Anti-diabetic were the commonest ADRs seen accounting for 27.18, 13.36, and 14.28 events respectively out of the 217 events. Out of 217 events, 143 (65.89%) were identified as the potential preventability of ADRA. The total cost for 217 patients with ADRA admitted to Chaophrayayommarat hospitals was estimated at 1,555,206 Bath. The mean total cost per patient with ADRA was estimated at 7,167 ± 4193 Bath. Conclusion: In addition to the increase in the number of expensive drugs, the ageing population and polypharmacy, the economic impact of ADRA weighs on healthcare spending. It should be emphasized that in most ADRA, medications were contributory reason of hospital admissions and that benefits and risks have to be carefully balanced.
Copyright (c) 2026 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/
How social media influencers shape medical and health product purchases: A Cross-sectional analysis
Background: Social media influencers significantly influence health-related consumer behavior in Saudi Arabia, driving engagement with wellness products while raising concerns about misinformation and safety. Identifying the factors that motivate such purchases is crucial for guiding policy and public awareness. Objectives: This study aimed to assess the prevalence, determinants, and perceived risks of purchasing health-related products promoted by social media influencers among adults in Saudi Arabia, and to identify the main predictors influencing buying behavior. Methods: A cross-sectional online survey was conducted between January and April 2025 among Saudi adults aged ≥ 18 years using convenience and snowball sampling via WhatsApp. Data were analyzed with IBM SPSS v28. Descriptive statistics summarized participant data, while Chi-square and logistic regression analyses identified significant associations and predictors of purchasing behavior (p ≤ 0.05). Results: The sample (n = 244) consisted predominantly of young adults aged 18–35 years (n = 179; 73.4%) and females (n = 173; 70.9%). Instagram (n = 84, 34.6%) and TikTok (n = 79, 32.5%) were the most frequently used purchasing platforms. The most influential factors were lower cost and discounts (n = 173; 71%; p = 0.006), convenience over pharmacies (n = 146; 60%; p = 0.002), and greater product variety (n = 152; 62%; p = 0.011). Logistic regression showed that participants motivated by affordability were 2.8 times more likely to purchase via social media (OR = 2.80; 95% CI: 1.24–6.33; p = 0.013), and those valuing variety were 2.5 times more likely (OR = 2.55; 95% CI: 1.03–6.29; p = 0.042). Although 63 (26%) expressed concern about unsafe products, 109 (45%) about limited information, and 110 (45%) about unverified sources, these factors did not significantly reduce purchasing intent. Conclusions: Health product purchasing via social media in Saudi Arabia is widespread and primarily driven by affordability, convenience, and variety, rather than demographics or perceived risk. Despite moderate safety concerns, consumers remain highly engaged. Enhanced regulatory oversight, transparent influencer marketing, and targeted digital health literacy initiatives are essential to ensure safer, evidence-based online health consumption.
Pharmacist-Integrated Early Screening for Postoperative Complications in Pediatric Cardiac Surgery: Evidence Synthesis and Derivation of the Pediatric Early Complication Score
Background: Early postoperative complications remain a major determinant of morbidity and mortality in pediatric cardiac surgery despite improved survival. Conventional risk systems such as RACHS and RASCH focus on procedural complexity and mortality rather than real-time complication prediction Objectives: This systematic review and meta-analysis aimed to quantify the pooled incidence and predictors of early postoperative complications and to derive a concise, evidence-based Pediatric Early Complication Score (PECS) to support early screening and pharmacist-integrated care. Methods: Eligible studies enrolled patients <18 years undergoing congenital heart surgery and reported extractable complication incidences or predictor-adjusted effects. Data were pooled using random-effects meta-analysis with prespecified thresholds (e.g., cardiopulmonary bypass [CPB] ≥120 minutes, C-reactive protein [CRP] >118 mg/L). Internal validity was reinforced by preregistration, standardized definitions, duplicate assessment, adjusted-effect preference, and ROBINS-I/RoB2 risk-of-bias tools. Results: Across 13 observational studies (n≈25,000) and two randomized trials, higher operative complexity (RACHS 3–6 or RASCH-2 ≥4), prolonged CPB exposure, neonatal age (≤60 days), and elevated CRP/D-dimer were consistently associated with approximately threefold higher early-complication risk (pooled adjusted effect ≈2.8, 95% CI 2.03–3.88, I²≈23%). These reproducible predictors were transformed into integer points (4, 2, 2, 2, 1 respectively) to form the PECS, which stratifies patients into low (0–3), moderate (4–6), and high (≥7) risk tiers via a logistic probability link. Conclusions: The PECS offers a transparent, internally valid, and clinically tractable bedside tool integrating surgical complexity, CPB duration, age, and inflammatory response to predict early postoperative complications. Its pragmatic design supports pharmacist-led, prevention-focused care and warrants multicenter calibration and external validation.
Integration of community pharmacy in primary health care
Awareness, perceptions, and concerns of community pharmacists regarding online pharmacies: A Cross-sectional survey
Background: The numerous benefits offered by online pharmacies have led to their spread in many countries. These pharmacies provide consumers with a source for purchasing drugs and services online and delivering them to their homes. Objective: To explore the concerns, awareness, and perceptions of community pharmacists regarding online pharmacies. Method: This was a web-based survey conducted from November 2022 to October 2023 through the distribution of a self-administered questionnaire. The pharmacists were approached at their locations and asked to fill out the questionnaire. Results: A total of 478 pharmacists agreed to participate in this study, with a response rate of 88.5% (478/540). The mean awareness score for all participants was 11.94 ±3.72 out of 25 (median: 12, IQR: 6). And the perception score was 17.07 ±5.42 out of 30 (median: 17, IQR: 6). Around three-quarters (73.01%) of the participants are willing to offer online services, but most of them are concerned about the safe delivery of medications (63.18%). Conclusion: In conclusion, the study underscores the need for targeted interventions to enhance community pharmacists' awareness of online pharmacies, particularly in Amman. Factors such as recent graduation, social media activity, and frequent internet use play crucial roles. These findings address critical gaps in understanding Jordanian pharmacists' concerns, perceptions, and awareness regarding online pharmacy services.
Improving medication safety in home enteral nutrition: Uncovering drug-related problems in patients using telepharmacy
Background: The complexity of drug administration via tube feeding makes home enteral nutrition (HEN) difficult. Telepharmacy was established to provide continuous pharmacological care to assure safety and efficacy of the patients at home care. Objective: To examine drug-related problems (DRPs) in patients receiving HEN, and a pharmacy-led intervention on optimizing medication administration via feeding tubes at home care settings. Methods: This cohort study was conducted between April 2021 and January 2024 involving adult patients on tube feeding who received pharmaceutical care via telepharmacy. Medication review, pharmaceutical consultation, documentation and follow-up planning were performed by pharmacists. During remote consultations, DRPs were identified, and recommendations were made based on current clinical guidelines and evidence-based resources. Results: A total of 90 patients were included, with a mean age of 81.5±14.5 years (63% females). During 153 telepharmacy sessions, pharmacists identified 189 DRPs in 85 patients (94.44%), involving 207 medications. The common drug categories involved in DRPs included gastrointestinal drugs (26.09%), cardiovascular drugs (9.18%), and micronutrients (7.25%). The most frequent DRPs were “failure to receive drugs” (38.10%), improper drug selection (14.28%), untreated indications (8.47%), and drug interactions (8.47%). Telepharmacy-based pharmaceutical counseling and management successfully resolved 134 from 189 DRPs (70.89%). Most issues were addressed through caregiver medication counseling, clarification of drug administration techniques, correction of inappropriate dosage forms, and adjustment of drug regimens in collaboration with physicians. Some problems remained unresolved due to factors beyond immediate pharmacist management, such as unavailable of appropriate dosage forms, or limited authority to modify therapy. Conclusion: These findings highlight the importance of telepharmacy services in optimizing pharmacotherapy and ensuring medication safety among patients receiving HEN.
Impact of Clinical Pharmacists in Medication Management within the Diabetic Foot Multidisciplinary Team
Background: Diabetic foot complications account for about 20% of diabetes-related hospital admissions worldwide and are a leading cause of non- traumatic lower limb amputations. In Saudi Arabia, approximately 3,970 diabetes-related amputations occur each year. Clinical pharmacists can enhance medication management and patient education for those with diabetic foot disease, although evidence of their impact is limited. The purpose of this study is to assess the effectiveness and role of a Clinical Pharmacist within a Multidisciplinary Diabetic Foot Team. Method: This retrospective, single- institution study involved two patient groups: those who visited the clinical pharmacist DM-Foot clinic (Group P1) and those who did not (Group P0). Primary outcomes included a composite measure of HbA1c, LDL reduction, no re-infection, and patient adherence. Secondary outcomes comprised LDL and HbA1c differences, re-infection, major/minor amputations, 30-day readmission rates, and mortality. Results: A total of 200 patients participated, with 100 in each group. The composite outcome was achieved by 100% of patients in Group P1 compared to 87% in Group P0 (P <0.001). Group P1 exhibited significant improvements in re-infection rates (34% vs 77%, p < 0.001), HbA1c reduction (75% vs 43%, p < 0.001), LDL reduction (78% vs 14%, p < 0.001), and medication adherence (93% vs 38%, p < 0.001). No significant differences were noted in mortality, readmission rates, or amputation rates between the groups. Conclusion: Clinical pharmacists significantly contribute to the diabetic foot multidisciplinary team, improving infection prevention and medication adherence.
The Impact of Using E-Portfolios for Pharmacy Students in Advanced Pharmacotherapy: Complicated Comorbidity Cases Compared to Traditional Assessment Methods in the AI Era
Objective: To evaluate the effectiveness of electronic portfolios (e-portfolios) as an assessment method for fifth-year pharmacy students in advanced pharmacotherapy courses focusing on complex comorbidity cases compared to traditional assessment methods, and to analyze their impact on Objective Structured Clinical Examination (OSCE) performance in the artificial intelligence era. Methods: A quasi-experimental study was conducted with 32 fifth- year pharmacy students at Fatima College of Health Sciences. Students were randomly assigned to either an e-portfolio assessment group (n=16) or a traditional assessment group (n=16). The e-portfolio group documented complex comorbidity cases with reflective components, while the control group completed traditional assessments. Both groups participated in identical OSCEs. Data were analyzed using independent samples t-tests, Mann- Whitney U tests, and thematic analysis. Results: The e-portfolio group demonstrated significantly higher scores in clinical reasoning assessment (mean 83.5±4.2 vs 76.3±5.1, p=0.008) and OSCE stations involving complex cases (mean 86.8±5.3 vs 79.2±6.1, p=0.001). Qualitative analysis revealed enhanced metacognitive awareness and therapeutic decision-making in the e-portfolio group. Cohen’s d effect sizes ranged from 0.76 to 1.33, indicating medium to large effects. Conclusion: E-portfolios focusing on complex comorbidity cases provide significant advantages over traditional assessment methods in advanced pharmacotherapy courses, particularly for developing integrated clinical reasoning skills necessary for managing patients with multiple disease states. Implementation of e-portfolios may better prepare students for the complexities of modern pharmacy practice in the AI era.
Systematic Review:The opportunities and challenges for digital health in pharmacy practice
Background: Digital health technologies, including tele pharmacy, artificial intelligence (AI), mHealth, and electronic health records (EHRs), have all started to alter pharmacy practice by improving medication safety, adherence, workflow, and patient care. However, the unique impacts and challenges of these technologies in pharmacy practice necessitate more exploration. Objectives: The current systematic review explores the effectiveness of digital health interventions in pharmacy practice using evidence from recent studies. Method: A systematic review was performed on 50 studies published from 2019 to 2024, each assessing different digital health tools in pharmacy. Studies sourced from databases such as CINAHL, Cochrane Library, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science. Primary outcomes included medication safety improvements, better clinical decision making, and operational factors like workflow efficiency and patient engagement. Results: Overall, the interventions yielded significant improvements in pharmacy practice activities among the surveyed 50 studies. Tele pharmacy service and AI - based decision support tools advanced medication, patient safety and care services over older technologies. On the contrary, key challenges identified included: issues of data privacy, regulations and standards, required infrastructure and IT support systems for tele pharmacy and AI - based technology systems, within underserved locations or lower - resourced pharmacy settings. Conclusion: The current systematic review concluded that while digital health technologies improve accessibility and medication management, addressing issues like regulatory limits and data security is critical for realizing their full potential. While digital health has shown promise, there is still a need for more research to demonstrate its effectiveness in pharmacy practice, especially regarding long-term patient outcomes.
Assessing knowledge of village health volunteers on pharmaceutical consumer protection and unsafe health products in Thailand
Background: Village health volunteers (VHVs) are pivotal to Thailand’s primary care and increasingly engage in pharmaceutical consumer protection; however, evidence linking their knowledge to role perception and personal factors is limited. Objective: To measure VHVs’ knowledge of health consumer protection, examine associations with personal and role-related factors, and inform targeted training and policy. Methods: Cross-sectional census of active VHVs in Ko Chan District, Chonburi (n=270). A validated questionnaire captured demographics, role perception, and a 10-item knowledge test (0–10; also categorized). Descriptive statistics, group comparisons, Pearson/Spearman correlations, and multivariable logistic regression (outcome: high knowledge ≥80%) were applied (α=0.05). Results: Mean knowledge was 6.71±0.92 (median 7, IQR 6–7); mean role perception was 37.13±4.92 (median 36, IQR 34–41). Correlations between role perception and knowledge were non-significant (Pearson r=0.027, p=0.664; Spearman ρ=0.073, p=0.232). Logistic regression identified no independent predictors of high knowledge: role perception AOR 0.956 (95% CI 0.873–1.047; p=0.337); prior training AOR 0.691 (0.271–1.758; p=0.437); years of service and other demographics also non-significant, with some subgroup estimates imprecise due to sparsity. Conclusions: VHVs demonstrated moderate knowledge with limited variability and no detectable effects of role perception, training, or service duration. Findings support universal, competency-based refresher training and structured CPD aligned with pharmacy-practice priorities (e.g., recognition/reporting of substandard/falsified products) to strengthen community-level pharmaceutical safety.
Clinical Outcomes Determinants Among Community-Acquired Pneumonia (CAP) Paediatric Patients Admitted to Tertiary Hospital UAE
Background: Community-Acquired Pneumonia (CAP) represents one of the most important causes of paediatric admissions and deaths globally, with an exceptionally high impact, particularly on children under the age of five years of age. Objective: The purpose of this study was to describe the clinical manifestations, severity scores and outcomes of paediatric patients with CAP and evaluate the usability of the PIRO score as an indicator of outcomes. Methods: This observational retrospective cohort study involved 177 confirmed paediatric CAP patients admitted from 1/1/2021 to 31/12/2023. Data on sociodemographic status and clinical characteristics were obtained, and results were stratified according to the inclusion and exclusion criteria. Results: Among the clinical outcomes, 53 children (72%) and 35 infants (21.3%) were discharged with no complications, while 51 children (49.5%), 18 infants (31.7%) and 2 neonates (9.7%), were discharged with antibiotics. The clinical outcome data in relation to the PIRO score shows a significant association between illness severity and patient outcomes (p < 0.001). Among patients with a low PIRO score (n=175), 40.5% (71 patients) were discharged with antibiotics, 50.8% (89 patients) were discharged with no complications, and 6.2% (11 patients) were discharged with minor complications. Only 2.5% (4 patients) with low PIRO scores required transfer to the NICU/ICU, and there were no deaths reported in this group. Conclusion: The PIRO score was found to have internal construct validity in predicting illness severity and clinical outcomes. Patients with significant PIRO scores had significantly longer hospital durations, more frequent ICU transfers and more complications.
Comparative studies on characterization and effectiveness of various alginate-based raft-forming antacid products
Background: Gastroesophageal reflux disease develops from exposure of the esophagus to acidic refluxate from the stomach and duodenal bile. While a floating raft, in which calcium carbonate was the main antacid ingredient, is formed on top of the stomach fluid to provide a physical barrier against acid gastroesophageal reflux after ingesting alginate-based antacid products. Objective: This work aimed to test in vitro effectiveness of five alginate suspensions commercially available in the Thai market to understand their characteristics and behaviors in gastric conditions mimicking the human stomach. Methods: Five commercial alginate suspensions were tested under simulated gastric conditions (0.1 N HCl, 37 °C). Raft formation was assessed by recording onset time, volume, mass, and buoyancy. Raft strength was quantified using a texture analyzer with a penetration probe, while porosity was examined visually. Acid neutralization capacity (ANC) was measured by titration against 0.1 N HCl to pH 3.0, and neutralization duration was monitored over time. Correlations between raft characteristics and ANC were analyzed. Results: Rafts of products formed voluminously (64.9-83.8 mL, 39.8-46.4 g), porous and floating rafts within 0.4-6.3 min. Raft strength and neutralization duration was in the range of 13.3-29.9 g and 24-46 min, respectively. Marked differences were not evident in the acid neutralization capacity (ANC) values of the products (8.8-9.9 mEq). No correlation was observed between ANC and raft-forming capacity or duration of neutralization though raft structures could affect their neutralization profiles. Conclusion: The results demonstrated that formulation design and raw material sourcing could vary product performance. While the obtained values of in vitro effectiveness could be applied to set the specifications and characterization methods for developing new raft-forming formulations and products. Importantly, understanding raft characteristics could empower pharmacists to make informed recommendations, providing patients with improved symptom relief and management.
More than Words: The Interplay between Forms of Communication and Emotional Intelligence in Pharmaceutical Care
Background: This study investigates the impact of emotional intelligence on communication in the pharmacist-patient relationship, where effective communication is crucial to treatment outcomes and the overall therapeutic process.Objective: The research aimed to examine how empathy, emotional self-regulation, and social skills influence verbal, non-verbal, and paraverbal communication in community pharmacy.Methodology: A quantitative descriptive-correlational cross-sectional design was employed for this study. Specifically, an online questionnaire consisting of 25 items was distributed to a sample of 246 community pharmacists. Jamovi-type analyses were conducted, which included descriptive statistics, Spearman correlations, multiple linear regression, independent t-tests, and ANOVA.Results: The results indicated significant correlations among several variables. There was a positive correlation between empathy and the use of non-verbal communication (ρ = 0.187; p = 0.003), between emotional self-regulation and paraverbal modulation (adjustments in voice tone; ρ = 0.245; p < 0.001), and between social skills and the clarity of verbal communication (ρ = 0.224; p < 0.001). Conclusion: Multiple regression analyses showed that empathy and social skills predicted the clarity of verbal explanations, self-regulation predicted the use of nonverbal language, while both self-regulation and empathy predicted the adaptation of voice tone. The results emphasize the vital importance of emotional skills, particularly empathy and self-regulation, improving communication between pharmacists and patients. This analysis could be further developed and integrated into pharmacist education and ongoing professional development.
Practical Guidance on the Use of Heat Therapy for Musculoskeletal Pain in Pharmacy Practice
Objective: Musculoskeletal pain (MSKP) is a leading cause of disability worldwide and a frequent concern for community pharmacy consultations. While superficial heat therapy (HT) is commonly recommended in clinical guidelines, practical pharmacy-specific guidance remains limited. This paper provides condition-specific recommendations and practical decision-making algorithms for the use of HT in MSKP within pharmacy practice. Methods: Recommendations were developed through two international multidisciplinary meetings that synthesized published evidence and real-world clinical experience. A structured consensus approach was used to identify patient profiles, red-flag indicators for referral, and appropriate use of HT as monotherapy or in combination with pharmacological and non-pharmacological interventions. Results: Practical algorithms tailored to pharmacy settings are presented for common MSKP scenarios including neck pain, low back pain, knee pain, and osteoarthritis. Guidance emphasizes a symptom-driven model, outlining when HT is appropriate, when combination strategies are needed, and when referral is required. Conclusions: This paper provides pharmacists with actionable, evidence-informed tools to support safe, patient-centered care in MSKP. While further research is warranted to validate these recommendations in prospective studies, these algorithms address an urgent need for practical pharmacy-based guidance in non-pharmacological pain management.
Pharmacoeconomic evaluation of Ofatumumab in the management of relapsing-remitting multiple sclerosis patients: Narrative review
Ofatumumab offers new hope as the first medication of its kind for treating relapsing–remitting multiple sclerosis (RRMS); however, questions remain about its long-term effectiveness and affordability. This narrative review aims to provide concise and precise updates on the cost-effectiveness of ofatumumab in the management of RRMS. A literature search was conducted between 2020 and 2025 in English-language databases via the following keywords: RRMS, disease-modifying therapies (DMTs), ofatumumab, economic evaluation, cost-effectiveness, cost-utility, and cost consequences. The overall findings varied significantly by country, reflecting differences in methodological approaches, time horizons, analytical perspectives, and discount rates. The increase in quality-adjusted life years (QALYs) associated with the use of ofatumumab ranged from 0.17 (vs. ocrelizumab) to 1.26 (vs. BSC). The incremental cost- effectiveness ratio (ICER) ranged from $24,189 per QALY (vs. glatiramer acetate) to $28,014 per QALY (vs. BSC) in Canada. In the United Arab Emirates (UAE), ICERs ranged from Arab Emirates Dirham (AED) 108,221 ($29,463.64) per QALY (vs. interferon beta 1-alpha) to AED 256,238 ($69,761.92) per QALY (vs. BSC). However, the ICERs were higher than the WTP threshold compared to those of cladribine: AED was 713,068 ($194,135.90) per QALY in the UAE and $50,969 per QALY in Canada. Collective evidence from available studies indicates that ofatumumab is a cost-effective option compared with a range of DMTs, including ocrelizumab, dimethyl fumarate, fingolimod, intravenous natalizumab, teriflunomide, generic fingolimod, glatiramer acetate, interferon therapies, and BSC. To support informed decision-making further, future research should aim to generate robust data on the costs and health-related quality-of-life outcomes associated with ofatumumab and other DMTs.
Disease-modifying therapies relapsing-remitting multiple sclerosis
Pharmacist-led evaluation of a novel nail-cutting innovation versus conventional trimming in hemiplegic patients: A Randomized controlled trial
Background: Hemiplegic patients often have trouble maintaining nail hygiene due to unilateral hand dysfunction, increasing the risk of perionychial injury, infection, and reduced quality of life. Assistive devices enabling safe, independent nail trimming may address these challenges while supporting preventive health strategies. Objective: To evaluate the efficacy and safety of a novel one-handed, electrically powered nail-cutting device compared with conventional manual clippers in hemiplegic patients. Methods: A randomized controlled trial was conducted at Naresuan University Hospital in two phases: preliminary testing in healthy volunteers (n=10) and clinical evaluation in hemiplegic patients (n=20). Participants were randomized to use either the novel device or conventional clippers. Primary outcomes were trimming quality (shape uniformity, smoothness of edges) and safety (incidence of perionychial injury, pain scores). Secondary outcomes included user satisfaction and completion time. Randomization, independent allocation, standardized training, and blinded outcome assessment were employed to enhance internal validity. Results: In hemiplegic patients, the novel device achieved smoother nail edges, preserved nail integrity, and significantly reduced pain compared with conventional clippers (mean difference in pain score: –0.68; 95% CI: –1.28 to –0.08). No perionychial injuries occurred in the intervention group. Satisfaction scores were consistently high, with participants reporting enhanced self-esteem and perceived safety. Similar performance and safety were observed in healthy volunteers. Conclusion: The novel one-handed electric nailcutting device demonstrated superior efficacy, safety, and user satisfaction compared with conventional clippers in hemiplegic patients. While findings are promising, larger multi-center trials with longer follow-up are warranted to confirm these results and assess cost-effectiveness and long-term adherence.
Prescribing patterns of fall-risk-increasing and hypotension-inducing drugs in older emergency department patients: ACross-sectional study
Objectives: Older adults are frequently exposed to fall-risk-increasing drugs (FRIDs) and orthostatic hypotension-inducing drugs (OHDs), which significantly elevate the risk of adverse outcomes. However, evidence on prescribing patterns of these medications in emergency department (ED) settings, especially in the Middle East, remains limited. This study aimed to investigate the prescribing patterns of FRIDs and OHDs among older ED patients and to identify factors assocaited with thier prescription in ED setting. Methods: This cross-sectional study analyzed retrospecctivly the electronic health records of patients aged ≥ 65 years who visited the ED of a tertiary hospital in Saudi Arabia between January 2020 and December 2021. FRIDs and OHDs were identified using established classification criteria. To estimate one year mortality risk, the Charlson Comorbity Index (CCI) was calculated and documented. Logistic regression models were used to assess associations between patient characteristics and FRIDs/OHDs prescription and result were presented as adjusted odds ratio (OR) and corresponding 95% confidence interval (95%CI). Results: Among 5441 patients, 22% of patients were prescribed OHDs and 15% received FRIDs. Opioids were the most common FRIDs; calcium channel blockers and beta-blockers were the most frequent OHDs. FRID prescribing was significantly higher among females and was associated with a higher ACB score (OR = 1.9; 95%CI 1.8:2.1). OHD prescribing was associated with higher CCI scores (OR = 1.47; 95%CI 1.41:1.54). Conclusion: The high prevalence of FRID and OHD prescribing highlights the need for pharmacist-led medication reviews and incorporation of validated risk assessment tools into ED workflows to reduce fall risk in older adults.
Healthcare Providers’ Perceptions of Patients’ Prescription Medication Sharing Practices
Background: Prescription medications are essential for managing health conditions. However, when these medications are shared between individuals without medical supervision—a practice referred to as prescription medication sharing—it may lead to harmful outcomes such as incorrect dosing, drug interactions, and treatment delays. While medication sharing is widely reported internationally, limited research explores the perspectives of healthcare providers on this issue within specific cultural contexts, particularly in Saudi Arabia. This study aims to understand the views of healthcare providers on the reasons for and consequences of prescription medication sharing among Saudi Arabian adults. Methods: Forty-two healthcare professionals, including physicians, pharmacists, and nurses licensed to practice in Saudi Arabia, participated in semi-structured, in-person qualitative interviews conducted in the Eastern Province. Recruitment followed a snowball sampling technique. Interviews continued until thematic saturation was achieved. All sessions were audio-recorded, transcribed verbatim, and subjected to thematic analysis using NVivo 12 software. The analysis employed a hybrid approach, incorporating both inductive and deductive coding strategies. Results: Providers confirmed that medication sharing is a common practice involving a range of drugs, including analgesics, antibiotics, antidiabetics, and antihypertensives. Frequently cited drivers included convenience (74%), cost-saving due to financial hardship (40%), leftover medications (45%), limited access to medicines and healthcare services (60%), social influence (50%), and the need for emergency use or to maintain continuity of care (67%)—factors consistent with global literature. However, unique local factors also emerged, such as embarrassment related to gender norms (38%), mistrust of the healthcare system (33%), preference for specific brands (26%), and a low perceived value of free public medications (45%). Providers expressed concerns about the health and public safety risks of sharing, including adverse drug reactions, incorrect dosing, treatment failure, and antimicrobial resistance. Conclusion: Prescription medication sharing is prevalent in Saudi Arabia. While many motivations are globally recognized, others reflect sociocultural norms and healthcare system challenges unique to the Saudi context. Healthcare providers emphasized the need for public education, improved healthcare access, and culturally tailored strategies, such as campaigns to address stigma and national programs for safe disposal of unused medications. Interventions guided by frameworks like the Behavior Change Wheel may support safer practices and reduce harm.
Assessment of community pharmacists’ knowledge, attitudes,and beliefs toward drug misuse and abuse in Jordan: A Cross-sectional study
Background: Community pharmacists are often the first point of contact for patients seeking medications, positioning them as key stakeholders in addressing drug abuse and misuse. However, limited data exist on their readiness and perspectives in this area, particularly in Jordan.Aims: This study aimed to assess the knowledge, attitudes, and beliefs of community pharmacists regarding drug abuse, to identify potential pharmacy-based initiatives to address the issue, to examine the barriers they encounter, and to highlight opportunities for enhancing pharmacist-led interventions in controlling medication misuse. Method: A reliability-validated online survey was created and sent out through social media to the community pharmacists to fill out and gain the knowledge and practice about drug abuse and misuse. Results: Most pharmacists (90.7%) reported encountering cases of drug misuse in their workplace, with over half (51.9%) facing ten or more incidents. While some claimed to know the difference between “misuse” and “abuse,” only a certain percentage had received formal training on the topic. Despite ethical concerns, 30.6% admitting to treat suspected abusers differently, most pharmacists (92.9%) recognized their preventive role and expressed high willingness (93.8%) to receive future training. Knowledge levels were generally moderate, but practical preparedness and confidence in regulatory frameworks varied. Conclusion: In conclusion, the research highlights the need to monitor prescription and distribution processes properly; Jordanian community pharmacists demonstrate a moderate awareness of drug abuse issues and a clear willingness to engage in prevention. However, gaps in training and inconsistent attitudes highlight the need for enhanced education.
A Pharmacy practice perspective on the performance of a non-pharmacological device for wound protection in contaminatedwater exposure
Background: Wound exposure to water significantly increases the risk of infection and delayed healing, particularly in seawater immersion wounds (SWIs) where microbial contamination exceeds 100 million organisms per liter. NU_Woundguard, a medical-grade silicone protective device, was designed to maintain a watertight seal over standard dressings and reduce contamination risk. Objective: To rigorously evaluate the efficacy and safety of NU_ Woundguard in preventing water ingress under control, reproducible laboratory conditions simulating freshwater and seawater immersion. Methods: A controlled laboratory experiment was conducted using anatomically accurate, 3D-printed foot models with clinically validated normal and SWI wound simulations. Models were randomly assigned to Control (standard dressing only) or Intervention (standard dressing plus NU_Woundguard) groups. Both groups underwent standardized immersion at 10, 30, and 60 minutes in freshwater and seawater (n = 5 per condition). The primary efficacy outcome was water penetration, quantified by analytical weighing of absorbent detection sheets pre- and post-immersion. Safety outcomes included structural integrity, tensile strength retention, and dressing compatibility following 10 immersion cycles and 30 mechanical stress cycles. All measurements were performed in duplicate by blinded assessors using calibrated instruments. Results: NU_Woundguard achieved zero leakage across all conditions (0/30 samples; 0.00 ± 0.00 g), while controls exhibited 100% leakage. At 60 minutes, mean penetration in controls was 1.85 ± 0.42 g (freshwater) and 2.14 ± 0.39 g (seawater). Tensile strength retention was 94.6% ± 2.1%, with no structural defects observed. Conclusion: Under validated, standardized conditions, NU_Woundguard demonstrated complete prevention of water penetration and maintained mechanical durability, supporting its clinical potential as a non-pharmacological wound protection strategy.
Modern characteristics of specialists of pharmacy based on the results of sociological research
Introduction:In the context of growing economic uncertainty and regulatory challenges in Kazakhstan, the sustainability and development of pharmacy practice require informed strategic management decisions. Personnel with pharmaceutical education, directly involved in operational processes, represent a valuable source of data for assessing organisational efficiency, financial resilience, and adaptation capacity in the current market.Objectives:This study aimed to characterise pharmaceutical workers and the internal structure, as well as the economic stability, of pharmacies in Kazakhstan based on employee perspectives. It also examined workforce motivation, strategic trends, logistics, and client base analytics in the context of sectoral transformation.Methods and materials: A cross-sectional survey was conducted among 200 pharmacy professionals across Kazakhstan, all holding a pharmaceutical education. The survey instrument consisted of five thematic blocks: (1) influence of external and internal factors; (2) use of human resources; (3) financial sustainability; (4) development trends and strategic initiatives; and (5) client base analysis.Results: Most organisations provide for personnel training (91%) and use predominantly material forms of motivation (58.1%). At the same time, the share of those who confirmed the presence of strategic planning in case of external instability was 61.6%. More than a third of respondents are unaware of financial strategies and capital structure, indicating a low level of personnel involvement in management processes. The analysis also revealed the need to develop management competencies, especially in the field of “soft” skills and strategic thinking, which emphasizes the need to revise pharmaceutical education programs.Conclusion: The study revealed significant variation in the strategic and financial management practices of pharmacies in Kazakhstan. While some companies exhibit adaptive capacity and invest in human capital, others face constraints due to regulatory and structural gaps. The findings underscore the importance of enhancing financial strategies, employee involvement, and internal communication to ensure resilience and long-term competitiveness in the pharmaceutical sector.
ChatGPT performance on pharmacology examination andboard review questions: Implications for medical education andknowledge assessment
Objectives: This study aimed to evaluate ChatGPT’s performance on pharmacology exam questions by assessing its accuracy in basic and clinical pharmacology, reasoning processes, and response consistency over time. Methods: A dataset of 583 multiple-choice questions from the Pharmacology Examination and Board Review (13th edition) was used. ChatGPT’s responses were evaluated for logical justification, use of internal question stem information, and integration of external knowledge. Statistical analyses, including chi-square and McNemar tests, assessed associations and changes in response accuracy over a four-week interval. Results: ChatGPT achieved 76.2% accuracy (444/583 questions), demonstrating logical reasoning in 97% of responses. Internal information was used in 99.7% of cases, while external information was incorporated in 98% of correct and 93.5% of incorrect responses (p = 0.008). Information errors were the most common reason for incorrect answers. A statistically significant improvement in accuracy upon re-evaluation (χ² = 37.3, p < 0.0001) was observed, suggesting potential temporal variation in performance. Conclusion: ChatGPT meets or exceeds typical passing standards in many educational settings, with evidence of improved response accuracy over time. These findings highlight its capabilities in processing pharmacological content, with potential implications for future research into AI-assisted educational tools.
Reducing outpatient drug-related problems through pharmacist led interventions: A multi-center interventional study in provincial hospitals in Vietnam
Background: Drug-related problems (DRPs) significantly affect patient safety, clinical outcomes, and healthcare efficiency. Pharmacist-led interventions have demonstrated potential in improving prescribing practices, yet limited data exist on their effectiveness in outpatient settings in Vietnam. This study evaluated the impact of structured pharmacist interventions on reducing DRPs in outpatient prescriptions at multiple healthcare facilities in a province in Vietnam. Methods: A pre-post interventional study was conducted at three hospitals in a province in Vietnam. Pharmacists systematically reviewed outpatient prescriptions identified DRPs using version v9.1 of the Pharmaceutical Care Network Europe (PCNE) classification and selected criteria from Vietnam’s Ministry of Health classification, and provided structured interventions, including quarterly seminars, hospital DRP bulletins, and personalized physician-specific DRP information sheets. Multivariate logistic regression assessed factors associated with DRP. Results: In total, 4,070 prescriptions preintervention and 4,051 prescriptions post-intervention were analyzed. Pharmacist-led interventions significantly reduced the proportion of prescriptions with at least one DRP from 21.7% (pre-intervention) to 9.1% (post-intervention; p<0.001). Significant reductions were observed across multiple DRP categories, including inappropriate drug indications, contraindicated medications, unnecessary drug prescriptions, incorrect dosing, improper timing of administration, and clinically significant drug-drug interactions (p<0.001). Factors independently associated with higher DRP risk included patient age ≥60 years (OR=1.554; p<0.001) and prescriptions containing five or more medications (OR=2.435; p<0.001). Proton pump inhibitors, gastrointestinal motility regulators, and non-steroidal anti-inflammatory drugs (NSAIDs) were most frequently implicated in DRPs. Conclusions: Pharmacist-led interventions effectively reduced DRPs in outpatient prescriptions at provincial hospitals in Vietnam. Older patients and those receiving polypharmacy were at higher risk, highlighting the need for targeted pharmaceutical care. This intervention model is practical, scalable, and well-suited for integration into electronic prescribing systems, significantly enhancing medication safety and prescribing quality.
The risks and benefits associated with the self-selection of pharmacy medicines (PMEDs): A rapid systematic review
Background: Pharmacies in the UK are increasingly implementing a self-selection model for Pharmacy medicines (PMEDs) in physical pharmacies and allowing their purchase from online pharmacies. This model potentially weakens the additional level of protection recommended by the Medicines and Healthcare products Regulatory Agency (MHRA) by removing the opportunity for intervention, possibly risking patient harm. Objective: To assess the risks and benefits associated with a PMEDs self-selection model in pharmacy settings. Methods: A systematic search was conducted across three databases (PubMed/Medline, Embase, and Cochrane Library) from 01/10/2024 to 22/10/2024. The search terms comprised Medical Subject Headings (MeSH) terms and free text with wildcard truncations. Only studies published from 01/2014 – 10/2024 and published in English were eligible for inclusion. Studies identified were exported to Excel, where duplicates were removed. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of all included studies. Results: A total of 54 studies of the 104 initially screened were included in the review. The country most frequently reported on was Australia (9/54; 16%), alongside multi-location/global studies (9/54; 16%). The majority (29/54; 54%) of studies focussed on the views and experiences of pharmacy professionals or students, and approximately half (26/54; 48%) focussed on patient views, experiences, or behaviours. The benefits identified from the included literature were relatively consistent, focussing on access to care, reducing pressure on health systems, and improved patient autonomy. However, the list of risks identified was heterogenous, covering a range of themes, including, adverse effects of medication, inappropriate use of medication, and reduced intervention opportunities, and self-diagnoses delaying required care. The risks associated with medication self-selection were more frequently discussed when compared with benefits. Conclusions: Although this review identified risks and benefits associated with medication self-selection more broadly, none of the included publications solely discussed PMEDs. More research is needed to fully understand the risks and benefits of the self-selection model for this classification of medicines.
Willingness to pay for extended community pharmacy services among general public in the United Arab Emirates
The study examined individuals’ willingness to pay for extended community pharmacy services (ECPS) in the United Arab Emirates (UAE). Data was collected from all seven emirates in the UAE through an online descriptive cross-sectional survey which was conducted in March and May 2021. A stratified random sample of 406 respondents participated, 71.43% were females and 28.57% males from different socioeconomic backgrounds. While SPSS was used to analyze respondents’ feedback, descriptive statistics were utilized to examine the sample’s sociodemographic features, views and readiness to pay for services. Using regression analysis, the researcher determined the link between consumers’ sociodemographic attributes and their perceptions of pharmacies and pharmacists and their willingness to pay for extended community services. The findings show that individuals purchase prescription drugs (68.97%), while others buy pharmaceutical products (59.36%) and non-prescription medications (54.43%). Proximity to pharmacies (82.51%) is the main factor influencing people’s choices. Most individuals in the UAE are confident that pharmacists have sufficient knowledge of medications and are concerned about public well-being (55.17%). Willingness to pay extended community services depends on pharmacists’ professionalism and honesty (77.83%), expertise on medication and illnesses (79.06%), and communication skills (57.39%).
Comparative Evaluation of Large Language Models in Assessing Off-label Drug Use and Generating Patient Consent Forms: A Cross-sectional Study.
Background: Off-label drug use (OLDU) involves the prescription of medications beyond their approved indications, populations, or dosages, and is a common practice in areas such as pediatrics, geriatrics, psychiatry, and oncology. Ethical OLDU necessitates sound clinical justification and transparent, patient-centered consent. With the rise of large language models (LLMs) in healthcare, their utility in supporting OLDU through evidence synthesis and consent documentation remains underexplored. Methods: A cross-sectional study was conducted evaluating the performance of two LLMs, ChatGPT-4.0 and DeepSeek-V3, across seven OLDU scenarios encompassing vulnerable populations and emerging indications. Each LLM was prompted to assess OLDU using the BRAvO decision-making framework based on the PrOACT-URL structure and to generate corresponding patient consent forms. Fifteen standardized prompts were used, and responses were evaluated using rubric-based scoring systems for clinical reasoning (maximum score = 27) and consent form quality (maximum score = 33 when reproductive concern was applicable and 30 for others). Results: Both LLMs provided structured and complete responses across all scenarios. ChatGPT demonstrated superior readability, empathetic tone, and patient-focused consent forms, consistently scoring in the excellent range. DeepSeek provided higher clinical detail and included extensive guideline references, with strong medico-legal structuring in its documentation. Scenario-specific variations were noted in how each LLM addressed uncertainties, risk mitigation, and reproductive considerations. Overall, both models scored within the excellent range for OLDU assessment and consent generation. Conclusion: LLMs such as ChatGPT and DeepSeek can effectively support OLDU decision-making and informed consent processes. Their integration into clinical workflows offers promise, though expert oversight remains essential to ensure accuracy, ethical compliance, and patient-centered care.
Evaluating community pharmacists’ dispensing and counseling practices of semaglutide for weight loss in the United Arab Emirates: A simulated patient study
Background: The rising global prevalence of obesity has led to increased demand for medications such as Semaglutide (Ozempic®), which is approved for the treatment of type 2 diabetes. However, its off-label use for weight loss has raised international concerns regarding misuse, patient safety, and pharmacist accountability. Objectives: This study aimed to assess whether community pharmacists in the UAE dispense Ozempic® without a valid prescription and to evaluate the quality and comprehensiveness of pharmacists’ screening and counseling regarding Ozempic®. Methods: A cross-sectional study was conducted using the simulated patient (SP) methodology. A trained SP visited 153 randomly selected community pharmacies across Dubai and the Northern Emirates and requested Ozempic® without a prescription for weight loss. Data was collected using a structured checklist covering prescription requirements, screening practices, and counseling quality. Results: Of the 153 pharmacies visited, only a minority (26.8%) requested a prescription for Ozempic® before dispensing the medication. Chain pharmacies (35.4%) and female pharmacists (38.6%) were significantly more likely to request a prescription (p = 0.011 and p = 0.004). Additionally, when comparing the total percentage of pharmacists willing to dispense the medication without a prescription to a hypothetical benchmark of 50%, the difference was statistically significant (p<0.001). Screening practices were minimal, with only 3–30% of pharmacists inquiring about basic patient information. Counselling quality was generally low, with 27% of visits receiving no counselling. Male pharmacists had significantly higher counselling scores than female pharmacists (p = 0.024). Time spent in the pharmacy was significantly correlated with better counselling (p < 0.001). In 20.3% of visits, alternatives, such as Tirzepatide or herbal weight loss products, were suggested. Conclusion: The study revealed significant gaps in prescription compliance and patient counseling among UAE community pharmacists when dispensing Ozempic®. These findings reflect broader global concerns about off-label medication use and the critical role of pharmacists in ensuring safe access to high-demand therapies.
Optimizing Vancomycin dosing in a sample of critically ill patients comparing current practices to individualized dose regimen: A Randomized study
Background: In 2020, a revised consensus guideline of therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections was published, and reviewed by many regulatory authorities Stated that, in patients with suspected or definitive serious MRSA infections, an individualized dose targeting area under the curve over 24 hour (AUC24) to minimum inhibitory concentration (MIC) ratio of 400 to 600 mcg*hr/mL should be advocated to achieve clinical efficacy and improving patient safety, while many hospitals in Iraq utilize fixed manufacturer-recommended dose for vancomycin in patients with normal renal function which is 30 mg/kg/d given as two or four divided daily doses. Objective: Comparing vancomycin AUC24/MIC ratio of patients receiving conventional vancomycin doses to patients receiving individualized doses calculated by pharmacokinetic dosing methods. Methods: A prospective randomized study conducted in the Intensive Care Units (ICU) of two tertiary centers at Baghdad Medical Complex (Baghdad Teaching Hospital and Ghazi Al-Hariri Hospital for Surgical Specialties), Patients were assigned alternately, 30 patients who met inclusion criteria were assigned to the conventional group (group 1), receiving the conventional dose of 1 g of vancomycin every 12 hours or any other dose prescribed by ICU physicians, representing the current practice; and 30 patients were assigned to the interventional group (group 2), where vancomycin dose was calculated by pharmacokinetic dosing method. Results: The target AUC24/MIC Ratio of 400 – 600 mcg*hr/mL was achieved in 6 (20%) patients of group 1, and 16 (53.33%) patients of group 2, which was statistically significant with P-value 0.000. Conclusions: Individualized vancomycin dosing improved achievement of the therapeutic AUC24/MIC target versus conventional dosing (53.3% vs 20.0%) but was associated with increased nephrotoxicity.
Artificial Intelligence-Enabled Competency Assessment in Jordanian Pharmacy Programs: A Vision for the Future
Background: The evolution of pharmacy education to competency-based education (CBE) demands novel assessment tools that are objective, prompt and scalable. Artificial Intelligence (AI) is considered a disruptive power in medical education worldwide, but its penetration in Jordanian pharmacy education is unassessed. Objective: To model the integration and impact of AI-enhanced competency assessment instruments in the education of pharmacy at a university and its college. Methods: Mixed-methods design was utilized. A virtual cohort of 200 students was used to simulate AI-proctored examinations at the Faculty of Pharmacy, Mutah University. Simulation results consisted of diagnostic accuracy, feedback quality, faculty burden, and student/faculty impressions. From the hypothetical focus group simulations, qualitative data was synthesized. Results: Simulated AI evaluations were more accurate than traditional evaluations diagnostically above threshold levels at 94% versus 76%, respectively, as well as provided immediate feedback and resulted in a 70% reduction in faculty time for grading. Students expressed relatively high levels of satisfaction with AI feedback clarity (4.6/5) and fairness (4.7/5). Faculty reported increased congruence with curriculum objectives and augmentation of personalized teaching. Conclusion: AI-based assessment systems had potential to enhance competency tracking, support high-quality feedback and be time efficient within Jordanian pharmacy education. A staged approach to real-world implementation is advised, along with training of stakeholders and regulatory support.
Implementing Green Pharmacy in the UAE: Knowledge,Perceptions, and Practice Gaps – A Cross-Sectional Analysis
Background: Medical waste is considered one of the most hazardous types of waste. Improper disposal of medical waste, whether by medical institutions or households, can lead to serious environmental pollution, such as soil and groundwater contamination, harm to aquatic wildlife, and the spread of infections. The purpose of this study was to investigate the behavior of the public and pharmacists toward expired or unused medicines and their knowledge of green pharmacy. Furthermore, the study aimed to explore the benefits, concerns, and barriers to adopting green pharmacy practices in the UAE to help preserve the environment and public health. Materials and Methods: A cross-sectional prospective study was conducted. Data was collected using two instruments: a questionnaire survey distributed to two populations—the public and pharmacists. Data analysis was performed using IBM SPSS Statistics version 29. Results: The questionnaire was completed by 344 members of the public and 57 pharmacists. Among the public, 79.7% reported disposing of expired medicines by throwing them in the trash. Notably, 23,788 expired medicines were collected, the majority of which were tablets and capsules. Responses regarding knowledge of green pharmacy and related attitudes were as follows (pharmacists vs. public): Unaware of green pharmacy: 40.4% vs. 52.5%, Recycling is a main issue: 75% vs. 79.7%, Support green pharmacy initiatives: 56.9% vs. 62.7%, Believe green pharmacy can be implemented in the UAE: 23.5% vs. 96.6%. These differences between pharmacists and the public were statistically significant (p < 0.05). Conclusion: Implementing green pharmacy practices in the UAE is a vital component of medical waste management, aimed at reducing the release of hazardous chemicals into the environment and safeguarding public health.
Prescribing pattern, appropriateness, and factors influencing medication use in heart failure patients with reduced ejection fraction at a private tertiary hospital in Malaysia
Background: Heart Failure with Reduced Ejection Fraction (HFrEF) is a prevalent and serious medical condition worldwide. It affects millions of people and contributes significantly to morbidity and mortality. Inappropriate use of the medications may lead to adverse health outcomes and treatment failure. Objectives: This study aimed to assess prescribing patterns, the prevalence of potentially inappropriate medications (PIMs), the proportion of patients receiving the target guideline-directed medical therapy (GDMT) dose, and factors associated with suboptimal dosing in patients with HFrEF at a private tertiary care hospital in Malaysia. Methodology: This retrospective observational study involved 118 Malaysian adult patients with HFrEF who attended at least two outpatient cardiology appointments at the study hospital. The study reviewed prescriptions to identify drug prescribing patterns, GDMT use, target dose attainment, and prescribing of PIM. Results: The cohort was primarily comprised of Chinese individuals (84.80%) and males (78.80%), with a mean age of 58.7 years. The majority of patients (51.70%) received a combination of three GDMT drugs. Only 23.70% of patients were prescribed all four GDMT drugs, with 82.14% of these patients achieving at least one drug at the target dose. The prescribing rates of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors were 98.31%, 72.97%, 48.31%, and 78.81%, respectively. The attainment of target doses was low, with only 11.21% reaching the target for RAAS inhibitors, 2.32% for beta-blockers, and 1.89% for MRAs. The study indicated no significant association between target dose attainment and clinical factors, except for betablockers in atrial fibrillation and SGLT-2 inhibitors in diabetes mellitus. Additionally, 4.24% of patients were prescribed PIM. Conclusion: Both adequate prescribing rates and target dose attainment of GDMT remain challenging in clinical practice, underscoring the need for strategies to improve adherence and enhance patient outcomes.