{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T06:59:14Z","timestamp":1770101954648,"version":"3.49.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to identify the pharmacists\u2019 perspectives on the barriers and facilitators to implementing pharmacist-managed anticoagulation clinics (PMACs) in Ministry of Health (MOH) hospitals in the Makkah Region, Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study employed a qualitative, cross-sectional design. An interview guide was developed after a review of the literature and the adaptation of the Consolidated Framework for Implementation Research tool. Semi-structured interviews were conducted with licensed regular pharmacists, clinical pharmacists, and pharmaceutical care leaders who were working or had worked in MOH hospitals in the Makkah Region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 11 participants were interviewed. The barriers to implementing PMACs predominantly related to professional and interprofessional barriers (e.g., lack of leader support and staff expertise, physician resistance), organizational and operational barriers (e.g., lack of resources), and patient-related barriers (e.g., poor commitment to follow-up). The main facilitators to implementing PMAC services were associated with improving workforce capacity and training, leadership and interprofessional support, organizational and patient support mechanisms, and infrastructure and digital resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The factors identified in this study can be used to develop potential strategic plans to improve existing PMAC services and extend their implementation across the country. Future research should aim to quantify the effectiveness of PMAC services on patients\u2019 clinical\/non-clinical outcomes. Positive findings could provide further evidence of the value of PMAC services, speed up their expansion, and ensure their sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0342079","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:29:11Z","timestamp":1770056951000},"page":"e0342079","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacists\u2019 perspectives on implementing pharmacist-managed anticoagulant clinics in Makkah Region Ministry of Health Hospitals: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"given":"Wassan L.","family":"Zarei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0316-1825","authenticated-orcid":true,"given":"Sarah M.","family":"Khayyat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"pone.0342079.ref001","doi-asserted-by":"crossref","first-page":"743","DOI":"10.2147\/JMDH.S359558","article-title":"Challenges of anticoagulation management service and need of establishing pharmacist-led anticoagulation clinic in tertiary care teaching hospital, Ethiopia: a qualitative study","volume":"15","author":"TA Tadesse","year":"2022","journal-title":"J Multidiscip Healthc"},{"issue":"6","key":"pone.0342079.ref002","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1177\/10600280211045075","article-title":"A qualitative systematic review of facilitators of and barriers to community pharmacists-led anticoagulation management service","volume":"56","author":"O Egunsola","year":"2022","journal-title":"Ann Pharmacother"},{"issue":"4","key":"pone.0342079.ref003","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.18549\/PharmPract.2018.04.1214","article-title":"Improving warfarin therapy through implementation of a hospital-based pharmacist managed clinic in Jamaica","volume":"16","author":"J-A Mckenzie","year":"2018","journal-title":"Pharm Pract (Granada)"},{"issue":"12","key":"pone.0342079.ref004","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1177\/1060028017721241","article-title":"Quality of Pharmacist-Managed Anticoagulation Therapy in Long-Term Ambulatory Settings: A Systematic Review","volume":"51","author":"BS Manzoor","year":"2017","journal-title":"Ann Pharmacother"},{"issue":"8","key":"pone.0342079.ref005","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1080\/00325481.2021.1949212","article-title":"Effects of a pharmacist-managed anticoagulation outpatient clinic in Taiwan: evaluation of patient knowledge, satisfaction, and clinical outcomes","volume":"133","author":"S-Y Lin","year":"2021","journal-title":"Postgrad Med"},{"issue":"3","key":"pone.0342079.ref006","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1310\/hpj4903-260","article-title":"Implementation of pharmacist-managed anticoagulation clinic in a saudi arabian health center","volume":"49","author":"JG Dib","year":"2014","journal-title":"Hosp Pharm"},{"key":"pone.0342079.ref007","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.2147\/RMHP.S248222","article-title":"Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study","volume":"13","author":"S Alghadeeer","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"issue":"12","key":"pone.0342079.ref008","doi-asserted-by":"crossref","first-page":"3887","DOI":"10.3390\/jcm12123887","article-title":"Impact of Clinical Pharmacist Running Anticoagulation Clinic in Saudi Arabia","volume":"12","author":"A Alshaiban","year":"2023","journal-title":"J Clin Med"},{"key":"pone.0342079.ref009","unstructured":"The Ministry of Health. Clinical Practical Guidance for Warfarin Monitoring for Adult [Internet]. 2020 [cited 2025 Jan 23]. Available from: https:\/\/www.moh.gov.sa\/Ministry\/MediaCenter\/Publications\/Documents\/Protocol-017.pdf"},{"issue":"6","key":"pone.0342079.ref010","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0342079.ref011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"LJ Damschroder","year":"2022","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0342079.ref012","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1002\/chp.47","article-title":"Lost in knowledge translation: time for a map?","volume":"26","author":"ID Graham","year":"2006","journal-title":"Journal of Continuing Education in the Health Professions"},{"issue":"3","key":"pone.0342079.ref013","first-page":"83","article-title":"An analysis of the Saudi health-care system\u2019s readiness to change in the context of the Saudi National Health-care Plan in Vision 2030","volume":"12","author":"MF Alharbi","year":"2018","journal-title":"Int J Health Sci (Qassim)"},{"key":"pone.0342079.ref014","unstructured":"Tenny S, Brannan JM, Brannan GD. Qualitative Study. StatPearls Publishing \u2013 National Library of Medicine [Internet]. 2022 [cited 2025 Jan 23]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470395\/#:~:text=Qualitative%20research%20gathers%20participants\u2019%20experiences,how%20many%20or%20how%20much"},{"key":"pone.0342079.ref015","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"LJ Damschroder","year":"2009","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0342079.ref016","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/rth2.12157","article-title":"Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixed-methods study","volume":"3","author":"GD Barnes","year":"2018","journal-title":"Res Pract Thromb Haemost"},{"issue":"4","key":"pone.0342079.ref017","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"B Saunders","year":"2018","journal-title":"Qual Quant"},{"key":"pone.0342079.ref018","first-page":"133","article-title":"Deductive and inductive approaches to qualitative data analysis.","volume-title":"Analyzing and interpreting qualitative data: After the interview","author":"AJ Bingham","year":"2022"},{"issue":"2","key":"pone.0342079.ref019","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/EFI-2004-22201","article-title":"Strategies for ensuring trustworthiness in qualitative research projects","volume":"22","author":"AK Shenton","year":"2004","journal-title":"EFI"},{"key":"pone.0342079.ref020","first-page":"1189","article-title":"Enhancing the quality and credibility of qualitative analysis","volume":"34","author":"MQ Patton","year":"1999","journal-title":"Health Serv Res"},{"key":"pone.0342079.ref021","volume-title":"Naturalistic Inquiry","author":"YS Lincoln","year":"1985","edition":"1"},{"key":"pone.0342079.ref022","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"S Michie","year":"2011","journal-title":"Implement Sci"},{"issue":"3","key":"pone.0342079.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0283836","article-title":"Qualitative investigation of barriers to providing an electronic hospital to community pharmacy referral service for discharged patients","volume":"18","author":"SM Khayyat","year":"2023","journal-title":"PLoS One"},{"issue":"6","key":"pone.0342079.ref024","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/ijpp.12097","article-title":"A 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Arabia: a cross-sectional study","volume":"11","author":"SM Khayyat","year":"2024","journal-title":"J Patient Exp"},{"key":"pone.0342079.ref031","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2147\/AMEP.S503289","article-title":"Healthcare Undergraduates\u2019 Attitudes and Readiness Toward Interprofessional Education at a Saudi University","volume":"16","author":"M Aladwani","year":"2025","journal-title":"Adv Med Educ Pract"},{"issue":"1","key":"pone.0342079.ref032","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s40545-021-00377-w","article-title":"How confident are pharmacists in providing pharmaceutical care on anticoagulants? 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