Yen-Ming Huang

Context: Doping and inadvertent exposure to prohibited substances are major concerns in sport because of their implications for athlete health, medication safety, and fair competition. The growing use of prescription medications, over-the-counter products, and dietary supplements has complicated anti-doping practice, particularly among athletes who manage their own medications or rely on nonprofessional sources of information. Pharmacists are well positioned to support athletes through medication counseling, supplement evaluation, and anti-doping education; however, their role in anti-doping systems remains incompletely understood. Objective: To explore the evolving role of pharmacists in anti-doping practice by reviewing pharmacist-led interventions related to athlete medication management and identifying barriers to their implementation and utilization. Data Sources: PubMed, Scopus, and Web of Science were searched for studies published from January 2016 onward. Study Selection: Studies describing pharmacist-led anti-doping interventions, services, or programs related to medication or supplement use among athletes were included. Study Design: Scoping review. Level of Evidence: Level 4. Data Extraction: Data on intervention type, service delivery, implementation barriers, and reported outcomes were extracted and synthesized descriptively. Results: A total of 16 studies were included. Pharmacist-led anti-doping interventions were categorized into 3 areas: (1) anti-doping education, (2) individualized medication and supplement review, and (3) drug information and policy support within sports medicine settings. Pharmacists contributed to identifying prohibited substances, evaluating supplement contamination risks, supporting Therapeutic Use Exemption applications, and counseling athletes. Educational interventions improved athlete knowledge and reduced favorable attitudes toward doping. However, implementation in routine practice remained inconsistent. Doping-related consultations in community pharmacies were infrequent, and simulated-patient studies demonstrated variability in counseling quality. Common barriers included insufficient anti-doping education, lack of confidence, limited access to reliable resources, inadequate multidisciplinary integration, and absence of remuneration for time-intensive consultations. Athletes frequently relied on coaches, peers, or online sources rather than pharmacists for anti-doping information. Conclusion: Pharmacists represent an underutilized resource within anti-doping systems. Expanding pharmacist involvement through structured education, reliable resources, and stronger integration into multidisciplinary sports medicine teams may improve medication safety, reduce the risk of inadvertent doping, and strengthen athlete support. Future implementation-focused research is needed to evaluate sustainable models of sports pharmacy practice across elite and community settings.

Purpose of Review: Consistent medication adherence is fundamental for achieving favorable health outcomes in diabetes care; however, attaining optimal adherence remains a challenge. This review summarized recent evidence on digital behavioral interventions designed to improve medication adherence in type 2 diabetes (T2D) and identified key components commonly incorporated in these interventions. Recent Findings: Thirty-two studies evaluating digital strategies to support medication adherence were identified. Interventions were delivered through a range of digital platforms, including mobile apps, short message service messaging, telemedicine systems, conversational artificial intelligence, and remote monitoring technologies. Medication adherence was assessed using a variety of measures, including self-reported adherence questionnaires, medication-taking records, and refill-based measures. Most studies reported improvements in medication adherence, and several also observed improvements in glycemic outcomes, most commonly A1C. Effective interventions frequently combined reminders, educational content, self-monitoring tools, and patient-provider communication. Summary: Digital behavioral interventions represent increasingly utilized strategies to promote medication adherence among individuals with T2D. Multifaceted digital approaches that integrate behavioral support, monitoring, and communication may enhance long-term diabetes self-management and treatment engagement. Recent advances have focused on improving personalization, integration across digital platforms, and interactive patient support rather than introducing entirely new digital modalities.

Background: Medication adherence is a key determinant of treatment effectiveness, yet few brief, freely available, and culturally appropriate adherence assessment tools are available in Traditional Chinese for use in routine community pharmacy practice. The 15-item Screening Tool for AdheRence to medicineS (15-STARS) is a pharmacy-based questionnaire designed to identify medication non-adherence and its underlying barriers. Objective: To translate, culturally adapt, and validate the 15-STARS in Traditional Chinese and evaluate its utility for screening medication non-adherence and identifying barriers to adherence among patients with type 2 diabetes (T2D) in Taiwanese community pharmacies. Methods: This cross-sectional study comprised two sequential phases: translation and cross-cultural adaptation, followed by field testing. Translation involved forward-backward translation and cognitive debriefing with pharmacists and patients. The Traditional Chinese 15-STARS was administered to adults with T2D recruited from six community pharmacies in Taiwan. Psychometric evaluation included content validity, item-level criterion validity against the Traditional Chinese Adherence to Refills and Medications Scale (ChARMS-T), and internal consistency assessed using McDonald’s omega (ω). Associations among adherence, medication-related factors, and glycemic control were examined. Results: Ten pharmacists and ten patients participated in cognitive debriefing, and 215 patients completed field testing. Content validity was excellent, with item-level and scale-level content validity indices of 1.00 after revision. Items 6– 9 demonstrated good internal consistency (ω = 0.831), and selected 15-STARS items were significantly correlated with corresponding ChARMS-T measures. Among the participants, 53.0% of participants reported no missed medication doses during the previous two weeks, whereas 47.0% reported missing at least one dose. The most common reasons for non-adherence were forgetfulness (33.0%), concerns about taking too many medications (18.6%), and concerns about side effects (15.3%). Greater regimen complexity and higher dosing frequency were associated with lower adherence and poorer glycemic control. Conclusion: The Traditional Chinese 15-STARS demonstrated satisfactory content validity, evidence of criterion validity for selected items, and internal consistency among conceptually related belief-based items in Taiwanese community pharmacies. The instrument may serve as a practical screening tool for identifying patients at risk of non-adherence and exploring adherence-related barriers, thereby supporting targeted pharmacist-led interventions.

Sustainable financing of community pharmacy services requires reimbursement models that accurately reflect resource use. However, empirical cost data for dispensing services remain limited in many health systems, including Taiwan's single-payer National Health Insurance (NHI) program. This study estimated the cost of dispensing services in community pharmacies and assessed the extent to which current reimbursement reflects underlying resource utilization. A cost analysis was conducted from the healthcare provider perspective using a time-driven activity-based costing approach. Eight community pharmacies in Taiwan were included. Dispensing workflows were systematically mapped into six sequential steps, and time-and-motion data were collected across six simulated standardized dispensing scenarios designed to capture variation in medication number and type. Resource use included direct, indirect, and personnel-related cost components. Indirect costs were allocated using both space-based and revenue-based approaches. Personnel costs were calculated using capacity cost rates based on pharmacist salaries and practical working capacity. All costs were expressed in New Taiwan Dollars (NT$), and sensitivity analyses assessed robustness under alternative allocation assumptions. Mean dispensing time ranged from 195 to 303 s per prescription and increased with prescription complexity. Total dispensing costs ranged from NT$30.82 to NT$61.21 per prescription. Each additional medication increased costs by NT$13-17, while controlled substances added NT$18-23 due to additional regulatory procedures. Personnel-related costs were the primary cost driver, and cognitive verification activities accounted for the largest share of workload. Compared with current NHI dispensing reimbursement of approximately NT$49-68 per prescription, reimbursement may inadequately reflect the resources required for more complex prescriptions. Cost patterns were consistent across allocation methods. Dispensing services are resource-intensive and vary with prescription complexity, yet current flat-fee reimbursement under Taiwan's NHI does not adequately reflect this variation. Complexity-adjusted reimbursement mechanisms, such as per-medication or controlled-substance modifiers, may better align payment with actual resource utilization and support sustainable community pharmacy services.

Background: Online health information seeking (OHIS) has become a central component of chronic disease management within an increasingly interactive, algorithm-mediated digital ecosystem. For individuals with diabetes, ongoing self-management demands create sustained needs for accessible, actionable health information. Although prior reviews have described general information-seeking behaviors, few have integrated technological evolution, multilevel determinants, and equity considerations specific to diabetes. Objective: This scoping review maps patterns of OHIS among individuals with diabetes, identifies the types of information sought, synthesizes the multilevel determinants of OHIS, and explores temporal shifts across major phases of digital health development. Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension (PRISMA-S) reporting guidelines and was guided by the Sample, Phenomenon of Interest, Design, Evaluation, Research type framework. Five electronic databases (PubMed, Scopus, Web of Science, CINAHL, and Embase) were systematically searched for English-language empirical studies from inception to May 4, 2026. Eligible studies included empirical research investigating OHIS behaviors among individuals with type 1 diabetes, type 2 diabetes, or gestational diabetes. Data were extracted using a standardized charting form and synthesized descriptively. Determinants were organized according to the Social Ecological Model, and qualitative findings were analyzed using content analysis. Studies were stratified into 3 periods reflecting shifts in digital infrastructure: early web environments (2002-2010), expansion of social media and mobile technologies (2011-2018), and integrated digital and artificial intelligence (AI)–enabled ecosystems (2019-2025). Results: Eighty-one studies from 32 countries met the inclusion criteria. The use of digital sources diversified over time. Early studies emphasized search engines and institutional websites, whereas later studies increasingly reported engagement with social media platforms and online communities. Mobile health apps and generative AI chatbots appeared in recent publications, although evidence on AI use remained limited. The most frequently sought content included self-management and lifestyle guidance, general diabetes knowledge, and treatment-related information. Determinants of OHIS operated across multiple levels. At the individual level, younger age, greater educational attainment, higher income, and better eHealth literacy were associated with increased engagement, while psychological factors such as perceived knowledge gaps and a desire for autonomy motivated searching. Interpersonal influences included peer support and clinician communication. Organizational and environmental factors encompassed health care access, digital infrastructure, information quality, and platform characteristics. Persistent disparities were observed among older adults and socioeconomically disadvantaged groups. Conclusions: This review synthesizes OHIS among individuals with diabetes through the lenses of technological evolution, multilevel determinants, and digital health equity. Unlike previous reviews that focused on specific platforms or general information-seeking behaviors, it maps the transition from web-based resources to social media and emerging AI-enabled ecosystems. This temporally informed synthesis advances understanding of digital engagement in diabetes self-management, identifies key evidence gaps, and informs clinical, organizational, and policy strategies to promote equitable access to trustworthy online health information.

Background: Tigecycline-associated hypofibrinogenemia has been increasingly reported, but its clinical significance and predictors of bleeding remain unclear. We assessed incidence, predictors, and bleeding outcomes in routine care. Methods: We conducted a retrospective cohort study of adults receiving tigecycline at a tertiary medical center in 2022. Hypofibrinogenemia was defined as fibrinogen less than 200 mg/dL during treatment. Major bleeding was defined using International Society on Thrombosis and Haemostasis criteria. Patients were followed from treatment initiation until 7 days after discontinuation. Multivariable logistic regression identified independent predictors of hypofibrinogenemia and major bleeding. Receiver operating characteristic analyses determined optimal cut-offs using the Youden index. Results: Among 231 included patients, 98 (42.4%) developed hypofibrinogenemia. Major bleeding occurred in 52 (22.5%) patients and was more frequent in patients with hypofibrinogenemia (30.6% vs 16.5%, p = 0.01). Independent predictors of hypofibrinogenemia included baseline fibrinogen less than 350 mg/dL (aOR: 3.27, 95% CI: 1.73– 6.19), hemodialysis (aOR: 2.34, 95% CI: 1.02– 5.38), peptic ulcer disease (aOR: 7.10, 95% CI: 1.38– 38.53), and cumulative tigecycline dose greater than 1125 mg (aOR: 2.60, 95% CI: 1.40– 4.84). Hypofibrinogenemia was the only independent predictor of major bleeding (aOR: 2.25, 95% CI: 1.14– 4.44). Conclusion: Hypofibrinogenemia was common during tigecycline therapy and independently associated with major bleeding. Baseline fibrinogen and cumulative exposure may help identify high-risk patients. Routine fibrinogen monitoring should be considered during tigecycline treatment. Plain Language Summary: Tigecycline is often used when infections are difficult to treat, especially when bacteria are resistant to many standard antibiotics. However, this drug can sometimes lower fibrinogen, a clotting protein that helps prevent bleeding. This change may not be noticed right away, but it can become clinically important during treatment. We studied hospitalized adults who received tigecycline at a tertiary medical center. Our goal was to find out how often low fibrinogen developed, which patients were at higher risk, and whether this complication was associated with bleeding. We found that hypofibrinogenemia was common and was linked to major bleeding. Higher-risk groups included people with lower fibrinogen levels before treatment, those undergoing hemodialysis, those with peptic ulcer disease, and those who received a greater total amount of tigecycline. Our results support the use of fibrinogen monitoring before and during tigecycline treatment. This may be particularly helpful when longer treatment courses are expected or when patients already have factors that increase bleeding risk.

Medication management is among the most complex tasks faced by dependent older adults and requires substantial physical and cognitive effort from their family caregivers. Although prior research has described the roles of primary caregivers (PCGs) and secondary caregivers (SCGs) in caring for older adults, limited attention has been paid to how these caregivers collaborate in daily caregiving activities. This study aimed to explore PCGs' experiences of collaborating with SCGs in managing medications for older adults and to understand the contextual factors that shape this collaboration. Using a qualitative descriptive design, this study analyzed 28 semi-structured interview transcripts from PCGs. A combination of deductive and inductive content analysis was used to identify medication management activities performed by PCGs and SCGs, as well as the factors shaping their collaboration. The findings were then integrated to categorize and characterize distinct collaboration styles for medication management. Primary caregivers were predominantly adult children or children-in-law, who reported collaborating with SCGs including family members, paid home care aides, or both. Primary caregivers primarily handled medication management activities requiring higher cognitive effort, whereas SCGs often assisted with activities requiring greater physical effort and co-presence with care recipients. Two main categories emerged as shaping collaboration in medication management: (1) conferring decision-making authority and (2) positioning the SCG as an active or passive supporter. Contextual factors influencing collaboration were largely caregiver-related and included kinship ties between PCGs and SCGs, caregivers' knowledge of the care recipient's medications, geographic proximity to the care recipient, marital status, and employment status. Four distinct styles of collaboration between PCGs and SCGs were identified and categorized as Partnering, Operating, Bench-Playing, and Intervening. This study provides valuable insights into how multiple family caregivers collaborate to manage medications for older adults, highlighting differences in task responsibility allocation and degrees of collaboration. Future research should systematically investigate the social and demographic factors shaping these collaborative strategies to inform the development of tailored interventions that better support caregivers.

Background: Medication 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. Methods: This 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. Results: Twelve 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. Conclusion: Medication 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.

Despite the broad coverage offered by Taiwan’s National Health Insurance system, attention-deficit/hyperactivity disorder (ADHD) care continues to face a critical “leaky pipeline” problem. There is a clear gap between diagnostic prevalence and long-term treatment retention. This perspective article applies the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework to synthesize evidence on the multidimensional factors that contribute to medication non-adherence among Taiwanese children and adolescents. The barriers are grouped into five domains. These domains include medication-related issues such as dosing complexity, child-level developmental challenges related to growing autonomy, family dynamics that reveal a distinctive “socioeconomic status paradox”, stigma within school environments, and vulnerabilities at the healthcare system level. Together, these factors demonstrate that existing hospital-centered care models alone may not sufficient to support sustained treatment engagement. To address this gap, we propose a pharmacist-driven precision approach to improving adherence in ADHD. This approach redefines the pharmacist’s role and emphasizes proactive involvement in ADHD management rather than passive medication dispensing. The proposed approach includes regimen optimization, digital tools that support adolescent self-management, and shared decision-making strategies that respond to family-specific concerns. Because community pharmacists are highly accessible, they can serve as continuity anchors across care settings and developmental stages and help strengthen treatment persistence and therapeutic outcomes.