Literature Collection

BACKGROUND: Community pharmacists' practice has shifted from product-oriented to patient-oriented in recent decades with the goal of achieving the optimal use of medications while enhancing the patient's quality of life. The impact of pharmaceutical care services provided by community pharmacists is yet to be determined. OBJECTIVE: This study aimed to summarize the findings from secondary literature on pharmacist-led pharmaceutical care interventions and their impact on clinical, economic, humanistic, and behavioral outcomes of patients attending community pharmacies. METHODS: An overview of systematic reviews, with or without meta-analysis, was conducted using PubMed, Embase, and Cochrane library databases. Articles published up until October 2023 were identified. The following data were extracted: eligible study details, the country in which the study was conducted, year, population, interventions, and resulting outcomes. RESULTS: Out of 310 publications, 90 full-text articles were evaluated for eligibility, and 29 studies that evaluated the impact of pharmacy services provided within the community pharmacies were selected. The articles covered patients with or without health conditions. Interventions were diverse, focusing on a patient-centered approach, varying between collaborating with other healthcare professionals to achieve desired health outcomes or collaborating with patients through education and counseling and promoting healthier lifestyles. Improving patients' medication adherence and understanding of their conditions resulted in better clinical and behavioral outcomes. While evidence on economic and humanistic outcomes is less conclusive, some studies suggest that these services can lead to cost savings, improved quality of life, and patient satisfaction. CONCLUSION: Pharmacy services provided by community pharmacists can lead to an improvement in clinical and behavioral outcomes. While there is some evidence indicating benefits in economic and humanistic outcomes, this evidence is less consistent and should be interpreted cautiously. This umbrella review highlights the importance of further research to strengthen the evidence base and guide the integration of pharmacy services into healthcare systems worldwide, supporting the shift to a patient-centered approach.

BACKGROUND: Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to determine the frequency of subjective sleep disturbance in a sample of patients receiving medication treatment and to examine clinical factors related to sleep disturbance. METHODS: Participants were 328 persons receiving buprenorphine at 3 primary care sites. Sleep difficulty was assessed 2 questions adapted from the Patient Health Questionnaire-9 (PHQ-9) item assessing sleep. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. Demographics, buprenorphine treatment history, and depressive symptoms were compared for those with and without self-reported sleep difficulty. Logistic regression was used to estimate the adjusted association of sleep disturbance with these correlates. RESULTS: Seventy-one percent of persons receiving medication treatment with buprenorphine in the present study reported sleep difficulty. Persons reporting sleep disturbance reported shorter time in buprenorphine treatment and more depressed mood compared with those without sleep difficulty (p < .01). Men were significantly less likely to report disturbed sleep than women (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.33, 0.98). Sleep disturbance was not associated significantly with age, ethnicity, educational attainment, or buprenorphine dose. CONCLUSIONS: Sleep disturbance is common in patients receiving medication treatment with buprenorphine and is associated with more depressive symptoms as well as a shorter duration of medication treatment. Future research, using subjective and objective sleep measures, is warranted to understand whether sleep disturbance is mitigated by longer buprenorphine treatment and whether difficulty sleeping predicts buprenorphine discontinuation among patients seeking treatment for opioid dependence.

BACKGROUND: The rapid advancement of Large Language Models has sparked heated debate over whether Generative Artificial Intelligence (AI) chatbots can serve as “digital therapists” capable of providing therapeutic support. While much of this discussion focuses on AI’s lack of agency, understood as the absence of mental states, consciousness, autonomy, and intentionality, empirical research on users’ real-world experiences remains limited. OBJECTIVE: This study explores how individuals with mental distress experience support from both generative AI chatbots and human psychotherapy in natural and unguided contexts, with a focus on how perceptions of agency shape therapeutic experiences. By drawing on participants’ dual exposure, the study seeks to contribute to the ongoing debate about “AI therapists” by clarifying the role of agency in therapeutic change. METHODS: Sixteen adults who had sought mental health support from both human therapists and ChatGPT participated in semi-structured interviews, during which they shared and compared their experiences with each type of interaction. Transcripts were analyzed using reflexive thematic analysis. RESULTS: Three themes captured participants’ perceptions of ChatGPT relative to human therapists: (1) encouraging open and authentic self-disclosure but limiting deep exploration; (2) the myth of relationship: caring, acceptance, and understanding; (3) fostering therapeutic change: the promise and pitfalls of data-driven solutions. We propose a conceptual model that illustrates how differences in agency status between AI chatbots and human therapists shape the distinct ways they support individuals with mental distress, with agency functioning as both a strength and a limitation for therapeutic engagement. CONCLUSION: Given that agency functions as a double-edged sword in therapeutic interactions, future mental health services should consider integrated care models that combine the non-agential advantages of AI chatbots with the agentic qualities of human therapists. Rather than anthropomorphizing AI chatbots, their non-agential features—such as responsiveness, absence of intentions, objectivity, and disembodiment—should be strategically leveraged to complement specific functions in human-delivered psychotherapy. At the same time, practitioners should maximize the benefits of their agentic qualities while remaining cautious of the risks. The findings should be interpreted with caution as the sample consisted mainly of young, well-educated Chinese participants from a collectivist cultural context, which may limit transferability to other populations, particularly those from individualistic cultures with different mental health literacy levels, stigma patterns, and therapeutic norms. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-025-07671-w.

BACKGROUND: As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). METHODS: Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. RESULTS: Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. CONCLUSIONS: We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.