{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:02:24Z","timestamp":1780635744098,"version":"3.54.1"},"reference-count":57,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Patients with ileostomy face unique pharmacotherapeutic challenges, including altered drug absorption, yet structured pharmaceutical care for this population is rarely integrated into routine clinical practice. This retrospective monocentric cohort study evaluated the reach, effectiveness, adoption, implementation, and maintenance of a structured ileostomy-specific clinical pharmacy service using the implementation science-based RE-AIM framework at a 1245-bed teaching hospital in Vienna, Austria. Sixty-two patients (54.8% male; median age of 65.5 years) were included, receiving a median of 11 medications. A total of 324 drug-related problems (DRPs) were identified, of which 202 (62.3%) were classified as stoma-specific drug-related problems (SDRPs), representing a predefined subgroup of DRPs associated with ileostomy-related pharmacotherapy challenges. This distinction enabled separate evaluation of the clinical relevance of stoma-specific pharmaceutical interventions. The implementation rate was significantly higher for SDRP-related interventions than for general DRP recommendations (92.0% vs. 63.9%; p &lt; 0.001), with no significant interdepartmental differences observed in either DRPs (p = 0.137) or SDRPs (p = 0.071). Patients with high-output stoma (HOS) had significantly more SDRPs than those without (p &lt; 0.001), while no differences were observed in general DRPs. The service demonstrated wide adoption, high interprofessional acceptance, full protocol fidelity, and continuous implementation over 30 months. The findings provide implementation evidence that may support healthcare decision-makers, hospital administrators, and policy stakeholders in establishing and sustaining structured clinical pharmacy services for ileostomy patients in Austria and similar healthcare settings.<\/jats:p>","DOI":"10.3390\/pharmacy14030078","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:36:56Z","timestamp":1779892616000},"page":"78","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation and Clinical Impact of a Structured Clinical Pharmacy Service for Hospitalized Ileostomy Patients: A Retrospective Observational Study Using the RE-AIM Framework"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6464-9746","authenticated-orcid":false,"given":"Stefanie","family":"Hehenberger","sequence":"first","affiliation":[{"name":"Hospital Pharmacy, Klinik Ottakring, Montleartstra\u00dfe 37, 1160 Vienna, Austria"},{"name":"Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lagoja","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, Klinik Ottakring, Montleartstra\u00dfe 37, 1160 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Der Ileostomapatient Und Seine Arzneimitteltherapie. Arzneimittelresorptionsprobleme Bei Ileostomapatienten","volume":"36","author":"Hasait","year":"2015","journal-title":"Was Tun. Krankenhauspharmazie"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"951","DOI":"10.2165\/00003088-200443140-00001","article-title":"Enteral Drug Absorption in Patients with Short Small Bowel","volume":"43","author":"Severijnen","year":"2004","journal-title":"Clin. Pharmacokinet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.4140\/TCP.n.2006.262","article-title":"Ostomy Care and the Consultant Pharmacist","volume":"21","author":"Zanni","year":"2006","journal-title":"Consult Pharm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1007\/s00228-018-2539-9","article-title":"Systematic Review of Drug Bioavailability Following Gastrointestinal Surgery","volume":"74","author":"Villafranca","year":"2018","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"136","DOI":"10.18773\/austprescr.2013.048","article-title":"Prescribing for a Patient with Reduced Intestinal Length","volume":"36","author":"Sood","year":"2013","journal-title":"Aust. Prescr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s00053-024-00844-3","article-title":"Metabolische Komplikationen Bei Ileostoma","volume":"47","author":"Hehenberger","year":"2025","journal-title":"Coloproctology"},{"key":"ref_7","first-page":"121","article-title":"Arzneistoffresorption Bei Stomapatienten","volume":"41","year":"2020","journal-title":"Krankenhauspharmazie"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Berger, V., Reeh, M., Scherer, M., H\u00e4rterich, S., M\u00f6ller, S., Wansing, E.-M.A., Van Der Linde, A., and Langebrake, C. (2024). Enhancing Drug Therapy in Ostomy Patients: Best Practice Recommendations for Medication Management. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0305047"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s11096-012-9724-1","article-title":"A Retrospective Analysis of Drug-Related Problems Documented in a National Database","volume":"35","author":"Westerlund","year":"2013","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_10","unstructured":"(2026, April 02). PCNE Association PCNE Classification for Drug-Related Problems V9.1. Available online: https:\/\/pcne.org\/wp-content\/uploads\/2026\/01\/PCNE_classification_V9-1-en-2026.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Urba\u0144czyk, K., Guntschnig, S., Antoniadis, V., Falamic, S., Kovacevic, T., Kurczewska-Michalak, M., Miljkovi\u0107, B., Olearova, A., Sviestina, I., and Szucs, A. (2023). Recommendations for Wider Adoption of Clinical Pharmacy in Central and Eastern Europe in Order to Optimise Pharmacotherapy and Improve Patient Outcomes. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1244151"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11096-021-01321-3","article-title":"On behalf of ESCP Education Committee A Cross-Sectional Survey to Map Clinical Pharmacy Education and Practice in Europe","volume":"44","author":"Moura","year":"2022","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1007\/s11096-020-01066-5","article-title":"Self-Reported Clinical Pharmacy Service Provision in Austria: An Analysis of Both the Community and Hospital Pharmacy Sector\u2014A National Study","volume":"42","author":"Deibl","year":"2020","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s11096-022-01422-7","article-title":"The European Society of Clinical Pharmacy European Society of Clinical Pharmacy Definition of the Term Clinical Pharmacy and Its Relationship to Pharmaceutical Care: A Position Paper","volume":"44","author":"Dreischulte","year":"2022","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"518","DOI":"10.5414\/CP203264","article-title":"Development of Clinical Pharmacy Services in Australia, Austria, Belgium, Bosnia-Herzegovina, Canada, Germany, Japan, Kosovo, Switzerland, the Netherlands, Thailand, USA and Correlation with Educational Standards, Level of Research, and Implemen","volume":"56","author":"Rose","year":"2018","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e70104","DOI":"10.1111\/jep.70104","article-title":"A Qualitative Study to Explore Global Trends in Clinical Pharmacy Practice","volume":"31","author":"Steurbaut","year":"2025","journal-title":"Eval. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1136\/ejhpharm-2019-001973","article-title":"Clinical Pharmacy Services in Germany: A National Survey","volume":"28","author":"Schulz","year":"2021","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the Public Health Impact of Health Promotion Interventions: The RE-AIM Framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e1143","DOI":"10.1161\/CIR.0000000000001231","article-title":"Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association","volume":"149","author":"Breathett","year":"2024","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Harden, S.M., Smith, M.L., Ory, M.G., Smith-Ray, R.L., Estabrooks, P.A., and Glasgow, R.E. (2018). RE-AIM in Clinical, Community, and Corporate Settings: Perspectives, Strategies, and Recommendations to Enhance Public Health Impact. Front. Public Health, 6.","DOI":"10.3389\/fpubh.2018.00071"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.2146\/ajhp070366","article-title":"Intervention Design, Implementation, and Evaluation","volume":"65","author":"Planas","year":"2008","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kwan, B.M., McGinnes, H.L., Ory, M.G., Estabrooks, P.A., Waxmonsky, J.A., and Glasgow, R.E. (2019). RE-AIM in the Real World: Use of the RE-AIM Framework for Program Planning and Evaluation in Clinical and Community Settings. Front. Public Health, 7.","DOI":"10.3389\/fpubh.2019.00345"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.sapharm.2019.11.002","article-title":"Community Pharmacist-Led Medication Review Procedures across Europe: Characterization, Implementation and Remuneration","volume":"16","author":"Soares","year":"2020","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hehenberger, S., Bielitz-Holzer, S., Virgolini, A., and Lagoja, I. (2026). Optimising Drug Therapy and Patient Safety in Patients with Ileostomy: Development and Evaluation of a Structured Medication Analysis Approach. Eur. J. Hosp. Pharm., Epub ahead of print.","DOI":"10.1136\/ejhpharm-2025-004821"},{"key":"ref_25","first-page":"1","article-title":"Das High-Output-Syndrom","volume":"45","author":"Hehenberger","year":"2024","journal-title":"Krankenhauspharmazie"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gamston, C.E., Westrick, S.C., Zmajevac, M., Qian, J., Peden, G., Hagan, D., and Lloyd, K.B. (2025). The Use of RE-AIM to Evaluate a Pharmacist-Led Transitions of Care Service for Multivisit Patients at a Regional Hospital. Pharmacy, 13.","DOI":"10.3390\/pharmacy13040099"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/cc2857","article-title":"Statistics Review 10: Further Nonparametric Methods","volume":"8","author":"Bewick","year":"2004","journal-title":"Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4097\/kjae.2016.69.1.8","article-title":"Nonparametric Statistical Tests for the Continuous Data: The Basic Concept and the Practical Use","volume":"69","author":"Nahm","year":"2016","journal-title":"Korean J. Anesthesiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4103\/2229-3485.76288","article-title":"Quality Assurance: Importance of Systems and Standard Operating Procedures","volume":"2","author":"Manghani","year":"2011","journal-title":"Perspect. Clin. Res."},{"key":"ref_30","unstructured":"(2026, May 18). European Directorate for the Quality of Medicines Guidelines on Medication Review. Available online: https:\/\/sfus.rs\/wp-content\/uploads\/2024\/12\/EDQM_MR-guidelines-on-medication-review.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1002\/phar.1459","article-title":"Clinical Pharmacy Should Adopt a Consistent Process of Direct Patient Care","volume":"34","author":"Harris","year":"2014","journal-title":"Pharmacotherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.sapharm.2017.05.021","article-title":"Dissemination and Implementation Sciences in Pharmacy: A Call to Action for Professional Organizations","volume":"13","author":"Seaton","year":"2017","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1002\/jac5.1673","article-title":"Research and Scholarly Methods: Implementation Science Studies","volume":"5","author":"Kuo","year":"2022","journal-title":"J. Am. Coll. Clin. Pharm."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00384-025-04907-9","article-title":"Drug Dissolution Problems in Ostomy Patients: A Chart Review and Patient Interview Analysis","volume":"40","author":"Remane","year":"2025","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1111\/codi.12252","article-title":"The \u2018Not so Short-bowel Syndrome\u2019: Potential Health Problems in Patients with an Ileostomy","volume":"15","author":"Ng","year":"2013","journal-title":"Colorectal Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11096-020-00970-0","article-title":"Physicians\u2019 Acceptance of Pharmacists\u2019 Interventions in Daily Hospital Practice","volume":"42","author":"Zaal","year":"2020","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1136\/ejhpharm-2012-000131","article-title":"Comprehensive Evaluation of Clinical Pharmacists\u2019 Interventions in a Large Austrian Tertiary Care Hospital","volume":"19","author":"Stemer","year":"2012","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Durand, A., Gillibert, A., Membre, S., Mondet, L., Lenglet, A., and Mary, A. (2022). Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.811289"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/bcp.14987","article-title":"Factors Affecting Physician Implementation of Hospital Pharmacists\u2019 Medication Appropriateness Recommendations in Older Adults","volume":"88","author":"Dalton","year":"2022","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11096-022-01526-0","article-title":"Using National Data to Describe Characteristics and Determine Acceptance Factors of Pharmacists\u2019 Interventions: A Six-Year Longitudinal Study","volume":"45","author":"Bouzeid","year":"2023","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lombardi, N., Wei, L., Ghaleb, M., Pasut, E., Leschiutta, S., Rossi, P., and Troncon, M.G. (2018). Evaluation of the Implementation of a Clinical Pharmacy Service on an Acute Internal Medicine Ward in Italy. BMC Health Serv. Res., 18.","DOI":"10.1186\/s12913-018-2988-y"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s00053-019-00396-x","article-title":"High-output-Stoma: Definition, Pr\u00e4vention und Therapie","volume":"41","author":"Jehle","year":"2019","journal-title":"Coloproctology"},{"key":"ref_43","first-page":"20","article-title":"High Output Ileostomies: The Stakes Are Higher than the Output","volume":"XLIII","author":"Bridges","year":"2019","journal-title":"Pract. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1007\/s10151-023-02830-1","article-title":"Clinical Management of High-Output Stoma: A Systematic Literature Review and Meta-Analysis","volume":"27","author":"Lederhuber","year":"2023","journal-title":"Tech Coloproctol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"6732","DOI":"10.3748\/wjg.v28.i47.6732","article-title":"Obstructive and Secretory Complications of Diverting Ileostomy","volume":"28","author":"Tsujinaka","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_46","first-page":"32","article-title":"The Clinician\u2019s Toolkit for the Adult Short Bowel Patient Part I: Nutrition and Hydration Therapy","volume":"46","author":"Parrish","year":"2022","journal-title":"Pract. Gastroenterol."},{"key":"ref_47","first-page":"7","article-title":"Mistakes in Short Bowel and How to Avoid Them","volume":"18","author":"Oke","year":"2019","journal-title":"UEG Educ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1016\/j.clnu.2023.07.019","article-title":"ESPEN Guideline on Chronic Intestinal Failure in Adults\u2014Update 2023","volume":"42","author":"Pironi","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1136\/flgastro-2018-101108","article-title":"How to Manage a High-Output Stoma","volume":"13","author":"Nightingale","year":"2022","journal-title":"Frontline Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1017\/S0007114520003360","article-title":"Restricted v. Unrestricted Oral Intake in High Output End-Jejunostomy Patients Referred to Reconstructive Surgery","volume":"125","author":"Sobocki","year":"2021","journal-title":"Br. J. Nutr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1080\/08998280.2020.1712926","article-title":"Ileostomy Diarrhea: Pathophysiology and Management","volume":"33","author":"Rowe","year":"2020","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Iesalnieks, I. (2020). Stomakomplikationen. Chirurgie des Intestinalen Stomas, Springer Berlin Heidelberg.","DOI":"10.1007\/978-3-662-59123-9"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1136\/flgastro-2013-100375","article-title":"A Practical Approach to the Management of High-Output Stoma","volume":"5","author":"Mountford","year":"2014","journal-title":"Frontline Gastroenterol."},{"key":"ref_54","unstructured":"(2026, April 02). Registered Nurses\u2019 Association of Ontario Supporting Adults Who Anticipate or Live with an Ostomy, 2nd ed. Available online: https:\/\/rnao.ca\/bpg\/guidelines\/ostomy."},{"key":"ref_55","first-page":"S12","article-title":"Medication Absorption for Patients with an Ileostomy","volume":"24","author":"Moore","year":"2015","journal-title":"Br. J. Nurs."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1080\/17425255.2023.2256216","article-title":"Drug Absorption from Oral Formulations in Patients with Short Bowel Syndrome: A Comprehensive Update of the Literature","volume":"19","author":"Azuz","year":"2023","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s11096-023-01631-8","article-title":"Pharmaceutical Care Network Europe Definition of Quality Indicators for Pharmaceutical Care: A Systematic Literature Review and International Consensus Development","volume":"46","author":"Fujita","year":"2024","journal-title":"Int. J. Clin. Pharm."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/3\/78\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:26:34Z","timestamp":1780633594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/3\/78"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":57,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["pharmacy14030078"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14030078","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}