Introduction: Post-stroke medication adherence can be assessed using dispensing data; however, variations in methods hinder reliable comparisons across regions.

Aims: We aimed to develop and pilot test the implementation of standardised methods to compare post-stroke adherence to direct oral anticoagulants (DOACs) between countries.

Methods: An observational study was conducted across two countries participating in the International Network for Standardised Population Insights and Real-world Evidence for STROKE (INSPIRE-STROKE). Australia and Canada, with population-based data and universal healthcare systems, provided the case example. Metadata structures were shared to harmonize variables and response options. Patients admitted with incident ischaemic stroke and atrial fibrillation (Victoria, Australia [July 2014-June 2017]; Ontario, Canada; [July 2014–March 2022]), aged 66-105 years, who survived ≥90 days post-discharge were included. The proportion of days covered (PDC) of DOACs was measured from initiation to 1-year post-discharge. Adherence was measured using standardised code from the TEN-SPIDERS pharmacoepidemiology framework. Seven simulations were undertaken adjusting for different PDC measurement parameters (e.g., in-hospital stays, pre-supply, survival, early refills and switching). Aggregated outputs were compared between countries.

Results: Among 2471 Australians (50% female; 36% aged 85+ years) and 16622 Canadians (51% female; 34% aged 85+ years), 50% and 65% were dispensed a DOAC within 90 days post-stroke, respectively. Among initiators, median 1-year DOAC PDC was 86.8% (interquartile range [IQR]: 75.9%–92.6%) in Australia vs 96.2% (IQR: 89.6%–98.6%) in Canada. Simulations adjusting for pre-supply, early refills, and switching increased median PDC by +10.3% in Australia and +3.5% in Canada. Further adjustment for in-hospital stays had negligible impacts on PDC.

Conclusions: Implementation of standardised methods across two countries revealed high levels of adherence to DOACs in patients with ischaemic stroke and atrial fibrillation. Scale-up of these methods to other countries and medications is warranted to reliably measure and compare trends in post-stroke medication adherence.

Keywords: Stroke; Medication Adherence; Standardisation

Introduction: Cardiovascular disease remains the leading cause of mortality worldwide, with dyslipidemia representing a major modifiable risk factor. While pharmacist-led interventions have demonstrated clinical benefit in high-income countries, evidence from low- and middle-income settings remains limited.

Aim: To assess the impact of a structured pharmacist-led intervention on clinical and humanistic outcomes.

Methods: Following ethical approval and trial registration (CTRI/2020/12/030065), a three-phase study was conducted at a tertiary care teaching hospital. Phase I involved cross-sectional surveys to identify barriers to optimal dyslipidemia management. Phase II comprised development, validation, and user-testing of multilingual (English, Kannada, Marathi) patient information leaflets. Phase III was an 18-month randomized controlled trial enrolling 378 patients with dyslipidemia. Participants were randomized to either a pharmacist intervention group (n=186), receiving clinical review based on NCEP ATP III guidelines, individualized counseling, and culturally adapted educational materials, or a usual care group (n=192). Monthly telephonic follow-ups and in-person assessments at 3, 6, and 12 months were conducted. The primary outcome was mean change in LDL-C. Secondary outcomes included medication adherence and HRQoL.

Results: Major barriers identified were patient forgetfulness, low educational level, and the asymptomatic nature of dyslipidemia. Repeated measures two-way ANOVA showed a significant main effect of time on LDL-C reduction (F(2.75,1033.88)=329.80, p<0.001, partial η²=0.467) and a significant time × treatment interaction (F(2.75,1033.88)=22.85, p<0.001, partial η²=0.057), indicating greater LDL-C reduction in the intervention group. Medication adherence significantly improved in the intervention group at 6 months (mean difference=1.01, p=0.006) and 12 months (mean difference=1.35, p<0.001). HRQoL increased by 19.44% (10.10-point improvement) in the intervention group compared with 10.21% in usual care.

Conclusion: Structured pharmacist-led interventions significantly improve lipid parameters, adherence, and HRQoL among patients with dyslipidemia in a resource-limited setting supporting the integration of clinical pharmacy services into routine cardiovascular care.

Keywords:
LDL-C; Medication adherence; Quality of life

Introduction: Digital transformation in healthcare requires pharmacists to have digital health competencies; however, evidence on their competency levels and determinants in Indonesia remains limited.

Aims: To assess digital health competency among pharmacists and identify determinants of lower competency levels.

Methods: This cross-sectional national survey of pharmacists was conducted across all Indonesian provinces during November 2025–April 2026 using proportional quota sampling based on provincial distribution of registered pharmacists, distributed through the Indonesian Pharmacists Association central board. Digital health competency was assessed using the Competencies for Primary Health Care questionnaire and classified by total scores as literacy (>25–33), fluency (>33–42), or mastery (>42). Literature-based covariates, including gender, age, practice location, facility type, region, years of practice, frequency of digital health training, and education, were screened by bivariate analysis; those with p-value < 0.25 were included in ordinal logistic regression and reported as ORs with 95% CIs.


Results: A total of 802 pharmacists participated, predominantly female (77.43%), aged <30 years (48.63%), urban-based (66.33%), and holding a professional pharmacist degree (84.91%). Most had 1–5 years of experience (37.91%), practiced in community pharmacies (41.40%), attended digital health training 2–4 times (38.90%), and demonstrated fluency-level competency (44.89%). In multivariate analysis, pharmacists aged >40 years had lower competency than those aged <30 years (OR = 1.50; 95% CI: 1.02–2.22; p-value = 0.042). Professional-degree pharmacists had lower competency than postgraduate graduates (OR = 1.50; 95% CI: 1.01–2.23; p-value = 0.044). Community pharmacy practice was associated with lower competency than practice in more than one facility (OR = 1.47; 95% CI: 1.02–2.13; p-value = 0.040).

Conclusion: Indonesian pharmacists demonstrated fluency-level digital health competency. Lower competency was associated with older age, lower education, and community pharmacy practice, indicating the need for targeted training and curriculum improvement; future research should evaluate interventions for lower-competency groups.


Keywords: digital health competency, pharmacists, Indonesia

Background: Australia’s National Medicines Policy recognises that the collection, analysis and reporting of population level medicines use data is required to improve the quality of medicines use. A range of policies, systems and capability exists across the health system to conduct and respond to such monitoring; however, significant gaps remain.

Objective: To describe the current scope, processes and policies for monitoring the quality of medicines use at population level, and identify opportunities for developing more comprehensive and integrated systems and policies.

Methods: An initial eight semi-structured qualitative interviews have been conducted with purposively recruited expert stakeholders across Australia, including researchers, policymakers and lead practitioners working in quality use of medicines; population health; primary, hospital and aged care; and digital health.
Data were analysed using a thematic analysis approach. A preliminary coding framework was developed a priori and additional codes were generated from interview data.

Results: Preliminary findings show that even in the context of a National Medicines Policy, national leadership is needed for determining and implementing priorities for monitoring medicines use. Despite available and sophisticated administrative drug utilisation data and innovations in linkage methods, ongoing assessment of quality use of medicines is not coordinated other than for subsidised medicine use. Interviewees highlighted the opportunity to broaden the focus of real-world evidence generation, as pharmacoepidemiologists tend to focus on benefits and harms of individual medicines or drug classes, with disjointed determination of priorities. Interviewees proposed significant potential in applying artificial intelligence to electronic record systems. Current policy focus on value in health care and prevention of medication misadventure are drivers for improving monitoring capability.

Conclusion: To build on current monitoring capability, Australia needs coordinated leadership and effort. The significant and evolving maturity of digital health infrastructure and escalating sophistication in the use of real-world evidence offers opportunities to consolidate monitoring capability.

Introduction: Potentially inappropriate medications (PIMs) are medicines where risks may outweigh benefits in older adults. PIMs are associated with increased risk of falls, fractures, and hospitalisations. There is limited national level real-world data outlining prevalence and costs of PIM use in Australia. This is the first national Australian study to identify prevalence and costs of PIMs in older Australians.

Aims: To examine national trends in prevalence and costs of PIMs among older Australians from 2014 to 2024. Sub-analysis included breakdown by sex, age, states and payer type.

Methods: A population-based retrospective study was conducted using dispensing claims from a nationally representative 10% sample of Pharmaceutical Benefits Scheme (PBS) data from 2014 to 2024. PIMs were defined using the 2023 American Geriatrics Society Beers and STOPP version 3 criteria. PIM costs were derived from publicly available PBS data. Annual prevalence and medication costs were stratified by sex, age, state and payer category.

Results: In older adults, PIM prevalence decreased from 59% in 2014 to 52% in 2024. PIM use remained consistently higher among females and was most prevalent in adults aged 85–99 years. The most prevalent PIM classes were proton pump inhibitors (25%), opioids (13%), benzodiazepines (10%), non-selective-oral-NSAIDs (10%) and gabapentinoids (7%). In 2024, national expenditure decreased from approximately AUD 600 million in 2014 to AUD 510 million in 2024. The breakdown by payer type comprised approximately AUD 360 million in government expenditure, AUD 90 million from concession patients and AUD 60 million from general patients.

Conclusions: Although PIM prevalence and costs declined over the past decade, one in two older Australians still received a PIM in 2024. With more than half a billion dollars spent annually on PIMs, targeted deprescribing initiatives are important in improving patient outcomes and reducing healthcare expenditure.

Keywords: potentially inappropriate medications; older adults; deprescribing

Introduction
Prior research has shown that one in two Australians initiating SGLT2 inhibitors (SGLT2i) or GLP-1 receptor agonists (GLP-1 RA) are adherent during the first 12 months. Contemporary adherence patterns since updated 2020 T2D guidelines, which recommend earlier use of these agents remain unknown.
Aims
To characterise adherence patterns to SGLT2i and GLP-1 RA during the first 12 months in adults living with T2D in 2020.
Methods
Using a 10% sample of the Pharmaceutical Benefits Scheme (PBS), we identified adults (18–99 years) who initiated SGLT2i or GLP-1 RA following metformin in 2020. Adherence was quantified using the proportion of days covered (PDC), and longitudinal adherence trajectories were examined using group-based trajectory modelling (GBTM). Models with 2–6 trajectory groups were evaluated, with the optimal model selected. Sensitivity analyses were conducted to account for death and therapy switching.
Results
Among 26,475 SGLT2i initiators, 60% were 40-69 years and 30% were women. Among 7,303 GLP-1 RA initiators, 60% were 40-69 years and half were women. In both groups, adherence of prior diabetes medications were 20% adherent for sulfonylureas and DPP 4 inhibitors, 30% for SGLT2i, but low adherence (<2%) for GLP-1 RA, insulin and thiazolidinedione. Five adherence trajectories were identified for SGLT2: early discontinuation (7.0%; PDC=0.21), late discontinuation (5.8%; PDC=0.51), intermediate adherence (11.2%; PDC=0.5), good adherence (26.5%; PDC=0.81) and very good adherence (48.6%; PDC=0.96). Five trajectories were also observed for GLP-1 RA: early discontinuation (8.2%; PDC=0.19), late discontinuation (7.6%; PDC=0.49), low adherence (9.0%; PDC=0.38), intermediate adherence (25.7%; PDC=0.76) and good adherence (49.5%; PDC=0.95).
Conclusion
Adherence to SGLT2i and GLP-1 RA varied widely, including early or gradual discontinuation pathways. Despite this, high proportion of people with good adherence is encouraging, and suggests that updated guidelines may have contributed to sustained use.
Keywords
Type 2 diabetes; SGLT2i; GLP-1 RA; adherence; GBTM