ObjectiveTo compare clinical outcomes, quality of life (QoL), medication behaviors, and readmission risk between older adults with multimorbidity receiving integrated Internet-based pharmaceutical care and those receiving conventional pharmaceutical care.MethodsThis prospective observational study enrolled 196 older adults with multimorbidity who received either conventional or integrated Internet-based pharmaceutical care according to the service model in routine practice. After 6 months, BG and BP control rates, hospitalization rates, and patient satisfaction were compared. Frailty, health-related quality of life, medication self-management, and adherence were assessed using the FRAIL scale, EQ-5D/EQ-VAS, SEAMS, and ARMS-12, respectively. Logistic regression was used to examine the association between care model and 12-month readmission.ResultsAt the 6-month follow-up, the integrated Internet-based pharmaceutical care group had significantly higher BG and BP control rates and patient satisfaction than the conventional care group (P < 0.05). The integrated Internet-based care group also had lower FRAIL scores and higher EQ-5D and EQ-VAS scores. SEAMS scores were significantly higher, and ARMS scores were significantly lower in the Internet-based care group (P < 0.001). The integrated Internet-based pharmaceutical care model was significantly associated with a lower risk of 12-month readmission (OR = 0.424, 95% CI: 0.203–0.884, P = 0.022).ConclusionIntegrated Internet-based pharmaceutical care was associated with favorable medication-related and clinical outcomes in older adults with multimorbidity. Further studies are needed to confirm these findings and clarify their generalizability.

BackgroundMany patients, especially those with chronic conditions (eg, hypertension, cardiovascular disease), struggle to adhere to long-term medication regimens, leading to serious complications and reduced quality of life.MethodsA cross-sectional study at Thumbay University Hospital was conducted among hypertensive patients (≥18 years, ≥6 months on antihypertensive therapy) to assess medication adherence and its association with health-related quality of life (HRQoL). Data were collected using a structured questionnaire; adherence and HRQoL were measured by the Hill-Bone and WHOQOL-BREF instruments; data were analyzed with descriptive statistics, chi-square tests, binary logistic regression, and Spearman correlations.ResultsAmong 377 patients medication adherence was predominantly high in 55.7% of patients, medium in 40.6%, and low in 3.7%; 76.9% reported high HRQoL, with the highest domain score in Environment (81.25%) and lowest in Physical health (67.86%) (differences were significant). Spearman correlations showed small but significant associations between adherence and Physical (ρ = −0.10, p = 0.05) and Environment (ρ = 0.12, p = 0.02); other domains were non-significant. Longer hypertension duration increased adherence (AOR 6.98 for 10–<15 years, p < 0.001; 8.81 for ≥15 years, p = 0.01), whereas non-Muslim religion (AOR 0.49, p = 0.03) and no family history (AOR 0.57, p = 0.04) predicted lower adherence. In multivariate HRQoL analysis, age ≥60, home ownership, comorbidity, and ≥3 antihypertensives had AORs of 0.40, 0.34, 0.22, and 0.10 (p = 0.03, 0.01, 0.03, 0.00) for lower HRQoL; regular income and no alternative medicine had AORs of 2.67 and 2.60 (p = 0.03, 0.01) for higher HRQoL.ConclusionAdherent in this UAE study was high (55.7%), and HRQoL was generally favorable; HRQoL was higher with regular income, home ownership, and no alternative medicine, but lower with comorbidities, age ≥60, and ≥3 antihypertensives. Adherence improved with longer disease duration and was influenced by religion and family history, highlighting the need for targeted interventions to improve adherence and HRQoL.

BackgroundTopical corticosteroid (TCS) phobia is increasingly recognized as a barrier to treatment adherence in dermatology. However, evidence from community-based primary care settings in urban China remains limited. Understanding patient perceptions in these settings is essential for improving adherence and promoting shared decision-making.PurposeTo investigate the prevalence of TCS phobia among urban primary care patients in Shenzhen, identify associated factors, and evaluate its influence on treatment preferences and adherence behaviors.Patients and MethodsA cross-sectional survey was conducted among community residents attending urban primary care clinics using an anonymous electronic questionnaire. Of the 300 eligible patients approached, 199 provided valid responses, yielding a response rate of 66.3%. An anonymous electronic questionnaire captured demographic data, TCS knowledge, attitudes, information sources, and treatment behaviors. Associations with TCS phobia were assessed using Chi-square tests.ResultsTCS phobia was reported by 26.1% of participants. Higher educational attainment was significantly associated with greater phobia (P = 0.021), demonstrating an “education paradox.” Misconceptions related to systemic adverse effects—especially weight gain (P < 0.001) and organ damage (P = 0.009)—were the strongest contributors to phobia. Concerns about local side effects did not differ significantly between groups. TCS phobia was strongly associated with refusal of prescribed therapy and preference for “natural” products (both P < 0.001). Knowledge of appropriate TCS use and information sources (physicians or media) did not significantly influence phobia levels.ConclusionTCS phobia is common among educated urban primary care patients and is driven primarily by incorrect beliefs about systemic toxicity. These fears have direct, negative consequences on treatment adherence. Current communication strategies appear insufficient. Patient-centered counseling that directly addresses misconceptions and emphasizes the distinction between topical and systemic corticosteroids is urgently needed in primary care practice.

BackgroundMedication non-adherence remains a common challenge among kidney transplantation recipients and is associated with graft dysfunction and loss. Although numerous interventions have been proposed, medication-taking is increasingly recognized as a dynamic process shaped by patients’ daily experiences and changing perceptions after transplantation. This study explored how kidney transplant recipients experience and manage immunosuppressive medication adherence over time and identified factors that influence adherence behaviors during recovery.MethodsThis qualitative study used a phenomenology-informed thematic analysis to explore kidney transplant recipients’ lived experiences of immunosuppressive medication adherence. Semi-structured face-to-face interviews were conducted with kidney transplant recipients at a medical center in Taiwan between March and July 2022. A dual-sampling strategy recruited participants in the early post-transplant period and recipients more than one-year post-transplant who had experienced adherence challenges. Participants were followed longitudinally beginning shortly after hospital discharge. Contextual information from a mobile communication application used for clinical follow-up was incorporated to support interpretation of adherence-related experiences. Interviews were audio-recorded, transcribed verbatim, and analyzed using data-driven thematic analysis with NVivo software. Reflexive and collaborative coding processes were applied to enhance analytical rigor.ResultsTwelve kidney transplant recipients participated in the study. Six themes described the evolving nature of medication adherence. Improved well-being after transplantation reinforced motivation to adhere, as recipients linked medication-taking with maintaining restored health and independence. However, persistent but mild side effects sometimes created uncertainty about treatment. Over time, vigilance toward medication-taking declined as perceived risk of graft rejection decreased. Daily routines and personal beliefs about medications also shaped adherence behaviors. Mobile-based consultation with healthcare professionals provided timely guidance and reassurance.ConclusionMedication adherence after kidney transplantation is dynamic and influenced by perceptions of health improvement, treatment burden, and evolving beliefs about medication necessity. Phase-specific and patient-centered strategies, including tailored education and accessible consultation support, may help sustain long-term adherence and optimize graft outcomes.

PurposeTo compare the outcomes of routine versus intensive adverse drug reaction (ADR) monitoring programs among adult in-patients initially treated with phenytoin, and to identify risk factors associated with severe cutaneous adverse reactions (SCARs).Patients and MethodsThis retrospective cohort study recruited phenytoin-naïve patients treated at a general hospital in Northern Thailand. Potentially eligible admissions were identified through the electronic medical record by extracting all medication orders for phenytoin during October 2018 to May 2021. Patients were consecutively enrolled and divided into routine adverse drug reaction monitoring (n = 500, rADRM) and intensive adverse drug reaction monitoring (n = 500, iADRM) allocated based on ward-based monitoring models. All participants received standard counseling regarding phenytoin dosing and administration. The rADRM group underwent ADR monitoring during routine follow-up visits, while the iADRM group received additional individualized instruction on ADR recognition and access to a direct pharmacist contact for reporting suspected ADRs. Multivariable logistic regression was performed to identify independent risk factors for SCARs.ResultsPatients in the intensive adverse drug reaction monitoring group had a significantly higher detection rate of phenytoin-induced ADRs compared with those in the routine adverse drug reaction monitoring group (OR 2.301, 95% CI 1.091:4.853, p = 0.029), as well as a greater patient-initiated reporting (OR 4.527, 95% CI 2.274:9.010, p < 0.001). Type B ADRs occurred in 3.6% of patients, with the iADRM group documenting more SCARs (36.84% vs. 5.88%, p = 0.044). Discontinuation of phenytoin and prolonged hospitalization were observed in both groups (42.1 vs. 52.9%, p = 0.045). Multivariable logistic regression identified iADRM (OR 13.304, 95% CI 1.183–149.581, p = 0.036), comorbidities (OR 12.935, 95%Cl 1.514:110.48, p =0.019), omeprazole use (OR 57.112, 95%Cl 9.569:340.875, p <0.001), and increased age (OR 0.940, 95%Cl 0.893:0.989, p =0.023) as significant risk factors associated with SCARs.ConclusionIntensive ADR monitoring facilitates earlier detection and reporting of phenytoin-associated ADRs including SCARs. Comorbidities, concomitant omeprazole use, and older age were associated with SCARs. Intensive monitoring programs may enhance patient engagement and improve medication safety by enabling timely recognition and management of adverse reactions.

BackgroundEthical and professional pharmacy practice is fundamental to supporting patient safety and trust. Despite advances in Good Pharmacy Practice (GPP), evidence from developing systems indicates gaps in ethical performance. This study aimed to assess the ethical dimensions of community pharmacists’ practice in Jordan from the public’s perspective, focusing on counseling quality, privacy, autonomy, and fairness.MethodsA cross-sectional survey was conducted among 710 community pharmacy clients across Jordan using a validated questionnaire measured five ethical domains and an attitude scale. Composite scores for patient satisfaction, ethical conduct, and pharmacist attitude were calculated. Descriptive statistics and logistic regression were used to identify demographic predictors.ResultsParticipants were predominantly female (57.9%) and from central Jordan (69.6%). Mean domain scores were: history-taking (51.3 ± 34.3), counseling (60.3 ± 29.6), privacy (67.8 ± 26.1), autonomy (60.2 ± 36.6), and justice (86.5 ± 24.0). Counseling was strongest for medication use and timing but weakest for safety aspects—adverse effects (41.4%), storage (40.1%), and drug interactions (31.7%). Justice and professionalism received the highest perception scores, while privacy and autonomy received moderate ratings. Gender (female) and south region predicted higher satisfaction and ethical perception (p < 0.05).ConclusionCommunity pharmacists in Jordan were perceived as demonstrating strong fairness and professionalism, but gaps remain in safety-oriented counseling and privacy assurance. These findings highlight areas where communication practices, privacy infrastructure, and ethics-oriented training may warrant further attention. Strengthening these areas could contribute to supporting patient trust and the ethical quality of community pharmacy services.

ObjectiveThis study aimed to evaluate treatment preferences for anticancer drugs among patients with non–small cell lung cancer (NSCLC), in order to provide evidence not only for clinical prescribing decisions but also for broader applications such as health insurance reimbursement and policy-making.MethodsA Best–Worst Scaling object‐case (BWS‐1) questionnaire was administered to NSCLC patients. Thirteen choice sets, each containing four attributes, were generated using Balanced Incomplete Block Design. Respondents were asked to identify the most and least important attribute within each set. The attributes include overall survival (OS), disease control rate, progression-free survival (PFS), dyspnea, pain, objective response, hemoptysis, fever, nausea and vomiting, monthly out-of-pocket expenditure, cough, mode of administration, fatigue. Relative attribute importance and preference heterogeneity were estimated using counting analysis and a conditional logit model (CLM).ResultsA total of 102 NSCLC patients were enrolled. High concordance was observed between counting analysis and conditional logit results. In the CLM, OS (β=3.537, P<0.01), disease control rate (β=2.025, P<0.01), and PFS (β=1.574, P<0.01) showed the strongest positive preferences. Fatigue (β=–1.158, P<0.01) and mode of administration (β=–0.600, P<0.01) were associated with lower relative importance. Cough showed a negative coefficient but was not statistically significant (β=–0.185, P=0.11).ConclusionThis study is the first to explore the NSCLC patient medication preference using a BWS-1. The findings suggest OS, disease control rate, and PFS are prioritized by patients when choosing treatment regimens.

ObjectiveThis study investigated situational factors associated with dietary behavior in stroke patients during rehabilitation using the Capability, Opportunity, Motivation - Behavior (COM-B) model, which explains behavior via three components: capability, opportunity, and motivation.MethodsThis study employed a qualitative and descriptive design. Using purposive sampling, 17 stroke patients during rehabilitation were recruited from a tertiary hospital in Jiangsu Province, China, between July and September 2024. Semi-structured interviews were conducted, and data were analyzed using directed content analysis.ResultsThe following themes and (sub)themes were identified. Capability: (1) a lack of knowledge relating to dietary management; (2) difficulty managing negative emotions; (3) reduced self-regulatory ability; (4) distress caused by symptoms of functional impairment. Opportunity: (1) support from the physical environment; (2) using and adjusting assistive feeding devices; (3) influence of the social environment; (4) accessibility and quality of external help services. Motivation: (1) clarification of eating intentions; (2) lack of focus during eating; (3) differences in food assessment.ConclusionThe situational factors associated with dietary behavior in stroke patients during rehabilitation are influenced by a complex interplay of factors within the personal, social, and environmental domains. The application of the COM-B model in this research is a significant contribution. It not only helps to clearly categorize and understand the various situational factors but also provides a structured framework for developing targeted interventions. Interventions that promote healthy dietary behaviors for stroke patients during rehabilitation should incorporate strategies to enhance capability, optimize opportunity, and strengthen motivation.

To investigate the effects of positional nursing combined with positive suggestions on anxiety, procedural outcomes, and patient comfort in patients undergoing painless gastroscopy. This retrospective cohort study enrolled 153 patients undergoing sedated gastroscopy between March 2024 and August 2025. Patients were assigned to the conventional nursing group (n=73, March-October 2024) or the comprehensive nursing group (n=80, November 2024-August 2025). The comprehensive group received individualized positioning optimization and standardized positive psychological suggestions. Primary outcomes included State-Trait Anxiety Inventory-State subscale (STAI-S), examination success rate, examination duration, and General Comfort Questionnaire (GCQ). Secondary outcomes included hemodynamic stability, adverse events, recovery time, and patient satisfaction. Baseline characteristics were comparable between groups. The comprehensive nursing group demonstrated significantly lower STAI-S scores (43.23±7.68 vs 48.67±8.45, P <0.001) and shorter examination duration (6.54±1.62 min vs 7.23±1.87 min, P =0.016). GCQ scores were significantly higher in the comprehensive group (P <0.001). The comprehensive group maintained better intra-procedural hemodynamic stability with lower heart rates (P =0.002), higher oxygen saturation (P <0.001), and higher blood pressure levels (systolic BP: P =0.020; diastolic BP: P =0.008). Comprehensive group had lower overall adverse event incidence, shorter recovery time and higher modified Patient Satisfaction Questionnaire scores (modified PSQ-18) (all P <0.05). Positional nursing combined with positive suggestion may help reduce pre-procedural anxiety, improve hemodynamic stability, decrease adverse events, and enhance patient comfort and satisfaction in painless gastroscopy. This non-pharmacological intervention shows promise for integration into routine endoscopy nursing protocols.