Research status and trends of pharmaceutical care in hospitals from an international perspective (1990–2024): A bibliometric analysis

Abstract

Background:

Pharmaceutical care is a key component of clinical pharmacy practice and plays a vital role in improving medication safety, therapeutic effectiveness, and patient outcomes. Although research in this field has grown rapidly since the 1990s, a comprehensive global analysis of its research landscape, collaboration patterns, and emerging trends remains lacking.

Methods:

A bibliometric analysis was conducted using publications retrieved from the Web of Science Core Collection. English-language articles and reviews published between 1990 and 2024 were identified using title-based search strategies. CiteSpace (version 6.3R2) and a bibliometric online analysis platform were applied to evaluate publication trends, influential authors and institutions, international collaboration networks, keyword co-occurrence, burst detection, clustering patterns, and co-cited references.

Results:

A total of 3905 publications were included. The annual number of publications showed a sustained upward trend, with rapid growth after 2005 and a peak in 2023. Research in this field involved 689 authors from 717 institutions across 87 countries or regions, reflecting broad international participation. The United States ranked first in publication output and collaboration influence, while China ranked second in output but showed relatively limited centrality in international collaboration networks. High-frequency keywords indicated that research mainly focused on medication management, clinical pharmacist interventions, medication adherence, pharmaceutical services, and patient safety. Burst and clustering analyses further revealed a shift toward pharmaceutical care for special populations, chronic disease management, and medication safety, particularly involving children and older adults.

Conclusion:

Pharmaceutical care research has evolved from an emerging concept to a mature and rapidly expanding field, with increasing emphasis on patient-centered and safety-oriented practice. Despite substantial growth, challenges remain in international collaboration and the translation of research into high-impact clinical practice. Future studies should strengthen global cooperation, focus on real-world clinical applications, and pay greater attention to chronic disease management, special populations, and the long-term effects of medication use.

1. Introduction

Pharmaceutical care is a professional pharmacy service provided by pharmacists in healthcare institutions to promote the safe, effective, and rational use of medications.^[1,2] As a central component of clinical pharmacy practice, pharmaceutical care represents an advanced stage in the development of hospital pharmacy services. Its major functions include identifying, resolving, and preventing actual or potential drug-related problems, thereby optimizing therapeutic outcomes, improving patient safety, and enhancing quality of life. The clinical application of pharmaceutical care began relatively early in some countries. For example, practice standards related to pharmaceutical care for clinical pharmacists were introduced in the United States as early as 1993.^[3] Since then, the positive effects of pharmaceutical care in medication optimization and disease management have been widely recognized.^[4,5] Marín-Gorricho et al,^[6] for instance, reported that pharmaceutical care interventions reduced potentially inappropriate prescribing and drug-related problems among polymedicated older inpatients.

In recent years, with the continuous development of hospital pharmaceutical services worldwide, research on disease-specific medication management, key drug monitoring, and pharmaceutical care for special populations has expanded considerably. At the same time, advances in biomedical research have further highlighted the value of individualized, evidence-based, and safety-oriented pharmaceutical care in modern medicine.^[7,8] Emerging biomedical approaches have promoted a deeper understanding of disease mechanisms, therapeutic targets, and patient heterogeneity, thereby creating stronger demands for precise medication management and multidisciplinary pharmaceutical support. In hospital settings, pharmaceutical care has therefore become increasingly important for optimizing treatment regimens, reducing medication-related risks, and improving clinical outcomes.

In China, guidelines and standards for pharmaceutical services and pharmaceutical care in medical institutions have been successively issued,^[9–11] providing important policy and institutional support for the implementation of pharmaceutical care. However, despite the rapid growth of related publications, most existing studies have focused on specific diseases, intervention outcomes, or local practice models. In addition, although several bibliometric studies have been reported in related healthcare fields, a comprehensive global evaluation of publication trends, collaboration patterns, knowledge structure, and emerging hotspots in hospital pharmaceutical care remains limited. Therefore, a systematic bibliometric investigation is needed to clarify the current research landscape, identify major contributors and research frontiers, and provide references for future development in this field.

Accordingly, this study conducted a bibliometric analysis of international research on pharmaceutical care published between 1990 and 2024. By examining publication outputs, influential countries, institutions, and authors, as well as keyword networks, co-cited references, and emerging themes, this study aimed to reveal the research status, collaboration characteristics, and developmental trends of pharmaceutical care from an international perspective. The findings may provide useful evidence for future research planning, optimization of pharmaceutical care practice, and the further development of pharmaceutical care in China.

2. Data and methods

2.1. Literature search and inclusion/exclusion criteria

The Web of Science Core Collection (WOSCC) was selected as the data source because of its wide coverage and high recognition in bibliometric studies.^[12] To improve retrieval precision and ensure close relevance to the research topic, a title-based search strategy was adopted.^[13] The search formula was as follows: (((((((TI=(“pharmaceutical care”)) OR TI=(“pharmacy care”)) OR TI=(“medication monitoring”)) OR TI=(“pharmacy monitoring”)) OR TI=(“medication care”)) OR TI=(“pharmaceutical monitoring”)) OR TI=(“drug monitoring”)) OR TI=(“drug care”). The literature search was performed on October 20, 2024. Because the concept of pharmaceutical care was formally proposed in 1990,^[14] the time span of the search was set from 1990 to 2024.

Only English-language articles and reviews were included. Publications unrelated to the topic, non-English records, and records lacking essential bibliographic information, such as author names or keywords, were excluded.

2.2. Literature download and data standardization

All eligible records were downloaded from WOSCC in plain text format with the option “Full Record and Cited References” selected. To improve the accuracy of keyword-based analyses, synonymous and near-synonymous terms were standardized in CiteSpace 6.3R2 using the alias function. For example, “pharmacy care,” “medication monitoring,” “drug care,” “medication care,” and “drug monitoring” were merged into “pharmaceutical care,” while variant expressions such as “high blood-pressure” and “high bloodpressure” were unified as “hypertension.”

2.3. Data analysis and visualization

After duplicate removal in CiteSpace 6.3R2, Microsoft Excel 2017 was used to generate the annual publication trend chart. Vosviewer 1.6.20 was used to calculate publication output by country/region and to visualize international collaboration networks. CiteSpace 6.3R2 was further used to analyze institutions, keywords, burst terms, and co-cited references, thereby identifying the research landscape, knowledge structure, and emerging trends in pharmaceutical care.

In CiteSpace, the time slicing was set from 1990 to 2024, with 1 year per slice. The thresholds were set at Top N = 25 and Top N% = 100. For keyword analysis, the link strength was set to pointwise mutual information and the link scope to Across Slices.^[15] The minimum spanning tree algorithm was used to simplify the keyword co-occurrence network.^[16] Keyword clustering was performed based on the co-occurrence network, and the reliability of clustering was evaluated using modularity (Q) and silhouette (S). In general, Q > 0.3 and S > 0.7 indicate that the clustering results are acceptable and reliable.^[17]

2.4. Ethics statement

This study was based exclusively on publicly available literature and did not involve human participants, patient data, or animal experiments. Therefore, ethical approval and informed consent were not required.

3. Results

3.1. Inclusion of literature

A total of 7190 records were initially retrieved from the WOSCC. After screening according to the inclusion and exclusion criteria, 3905 publications were finally included in the bibliometric analysis. The literature screening process is presented in Figure 1.

Figure 1.

Research process.

3.2. Analysis of the number of publications

The annual number of publications in pharmaceutical care showed an overall upward trend from 1990 to 2024 (Fig. 2). Research output remained relatively stable during 1990 to 2004, suggesting a formative stage of development. Since 2005, the number of publications has increased continuously, indicating a period of rapid expansion. The highest annual output was recorded in 2023, with 333 publications.

Figure 2.

Scatter plot of publishing trend.

3.3. Cooperation among authors and institutions

A total of 689 authors and 717 institutions contributed to research on pharmaceutical care. Among them, 10 authors published at least 10 papers, and 172 institutions produced at least 10 publications (Tables 1 and 2). The institutional collaboration network is shown in Figure 3. Productive institutions were mainly universities, including Queen’s University Belfast, State University System of Florida, Swansea University, and the University of Antwerp. Overall, these findings indicate that academic institutions play a leading role in this field. However, the collaboration network among authors and institutions appeared relatively dispersed.

Table 1.

Author’s publication information.

Authors (year)	Publications	Authors (year)	Publications
De baetselier, Elyne (2021)	39	Hepler, CD (1990)	19
Van rompaey, Bart (2021)	32	Hughes, CM (1998)	19
Morillo-Verdugo, Ramon (2021)	26	Dilles, Tinne (2021)	15
Mcelnay, JC (1998)	22	Hughes, Carmel M (2007)	10
Lillo-crespo, Manuel (2021)	20	Azhar, Saira (2015)	10

Table 2.

Number of publications and centrality of institutions.

Institutions	Publications	Centrality	Institutions	Publications	Centrality
Queens University Belfast	35	0.25	China Pharmaceutical University	23	0
State University System of Florida	30	0.01	University System of Ohio	23	0.11
Swansea University	28	0.13	University of Florida	22	0
University of Antwerp	25	0.01	Qatar University	22	0
Charles University Prague	25	0.14	University of British Columbia	22	0.11

Figure 3.

Co-occurrence network of institutional.

3.4. Analysis of cooperation among countries/regions

A total of 87 countries or regions participated in pharmaceutical care research. The United States ranked first in publication output (797, 20.41%), followed by China (434, 11.11%), Brazil (324, 8.30%), the United Kingdom (248, 6.35%), and Spain (238, 6.09%). As shown in Figure 4 and Table 3, the United States, Spain, the Netherlands, and Germany occupied central positions in the international collaboration network. Although China ranked second in publication output, its centrality was relatively low, indicating limited influence in international collaboration. The annual publication volume of countries/regions is presented in Figure 5.

Figure 4.

Visualization of country/region cooperation.

Table 3.

Number of publications and centrality of countries.

Countries	Publications	Centrality
USA	797	0.28
China	434	0.04
Brazil	324	0.11
UK	248	0.09
Spain	238	0.15
Netherlands	230	0.15
Germany	185	0.17
Canada	145	0.01
Malaysia	101	0.08
Poland	97	0.08

Figure 5.

Annual publication volume of countries/regions.

3.5. Keyword co-occurrence analysis

After synonym merging, 652 keywords were identified in this field. The keyword co-occurrence network is shown in Figure 6. Excluding the search term “pharmaceutical care,” the most frequent and central keywords included “medication management,” “clinical pharmacist,” “medication adherence,” “pharmaceutical services,” “quality of life,” and “pharmacist interventions” (Table 4). These results suggest that the main research themes in this field focus on medication management, pharmacist-led interventions, patient adherence, quality of life, and medication safety.

Figure 6.

Visualization of keyword co-occurrence.

Table 4.

Frequency and centrality of keywords.

Keywords	Frequency	Centrality	Keywords	Frequency	Centrality
Pharmaceutical care	1810	0.40	Program	247	0.06
Medication management	570	0.16	Pharmacy	233	0.08
Clinical pharmacist	545	0.13	Outcome	141	0.08
Medication adherence	532	0.16	Clinical pharmacy	128	0.08
Pharmaceutical services	447	0.15	Drug related problems	117	0.09
Impact	381	0.12	Education	104	0.04
Community pharmacy	375	0.15	Adverse drug events	91	0.06
Quality of life	352	0.13	Risk	89	0.02
Pharmacist interventions	275	0.14	Patient safety	80	0.06

3.6. Keyword burst analysis

Keyword burst analysis was used to identify topics that attracted increased attention over specific periods (Fig. 7). Keywords with relatively strong bursts included “implementation” (2020–2024, strength = 5.50), “adverse drug events” (2011–2014, 3.87), “children” (2018–2024, 3.51), “medication adherence” (2017–2019, 3.49), and “patient safety” (2020–2024, 3.23). Among these, “children,” “implementation,” and “patient safety” remained active in recent years, suggesting that pharmaceutical care for special populations and medication safety are current research frontiers.

Figure 7.

Keyword emergence result.

3.7. Keyword cluster analysis

Keyword clustering analysis generated 10 clusters (#0–#9) (Fig. 8). The clustering quality was acceptable, with Q = 0.6542 and S = 0.8748, indicating good reliability of the results. As shown in Table 5, the identified clusters could be broadly grouped into 3 major categories: pharmaceutical care services and their functions, pharmaceutical care for special populations and specific diseases, and medication safety-related topics such as adverse drug reactions and medication errors. These findings indicate that the field has gradually expanded from general pharmaceutical service models to more targeted, patient-centered, and safety-oriented research topics.

Figure 8.

Visualization of keyword clustering.

Table 5.

Keyword clustering results and label words.

ID NO.	Nodes	Keyword clusterings	Label words
#0	361	Clinical pharmacy	Diabetes mellitus; time in the therapeutic range; pharmaceutical care service; therapeutic range
#1	252	Medication adherence	Kidney transplantation; secondary prevention; prescriptions; patient-reported outcome; opioid overdose; patient compliance
#2	190	Formal consensus	Community pharmacists; key performance indicators
#3	143	Pharmaceutical care	Individualized pharmaceutical care;health care; pharmaceutical services; pharmacy-institutional-hospital
#4	97	Adverse drug reactions	Adverse drug; patient safety; older-people; medicines management; medical education; medication monitoring
#5	89	Randomized controlled trial	Clinical trial; osteoporosis; bisphosphonates; management program; inhalation therapy; drug utilization
#6	67	Medication errors	Adverse drug events; case report; dosing error; drugs/prescription errors; medication appropriateness index; critical care
#7	44	Cost savings	Pharmacist interventions; psychoactive medication; health care disparities; antibiotic prophylaxis
#8	31	Pharmaceutical care process	Full process; indicators; qualitative research; patient medication records; drug-related problems
#9	31	Children	Adolescents; sulfasalazine; safety; dosing regimen adjustments; child health; accuracy

3.8. Co-cited reference analysis

Co-cited reference analysis was conducted to identify the knowledge base of pharmaceutical care research. The co-citation network consisted of 1158 nodes and 2522 links, with a density of 0.0038 (Fig. 9). The most influential co-cited references are listed in Table 6. These core references mainly addressed the definition of pharmaceutical care, drug-related problems, health outcomes, and the implementation of pharmaceutical care in different practice settings, collectively forming the conceptual and practical foundation of this field.

Figure 9.

Visualization of co-citation of articles.

Table 6.

The important node articles.

Title	First author	DOI
Opportunities and responsibilities in pharmaceutical care	C. D. Hepler	10.1093/ajhp/47.3.533
Pharmaceutical Care: the PCNE definition 2013	Samuel S. Allemann	10.1007/s11096-014-9933-x
Drug-related problems: their structure and function	L. M. Strand	10.1177/106002809002401114
Drug-related morbidity and mortality. A cost of illness model	J. A. Johnson	10.1001/archinte.155.18.1949
Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care: a multicentre study in 7 European countries	C. Bernsten	10.2165/00002512-200118010-00005
Qatar pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care	Maguy Saffouh, El Hajj	10.1007/s11096-016-0246-0
Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus	Nadia Rashid, Al Mazroui	10.1111/j.1365-2125.2009.03391.x
The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program	C. W. Cranor	10.1331/108658003321480713
Critical analysis of the pharmaceutical care research literature	N. R. Kennie	10.1177/106002809803200101
Fighting against COVID-19: innovative strategies for clinical pharmacists	Li Huibo	10.1016/j.sapharm.2020.04.003

4. Discussion

This bibliometric study provides a comprehensive overview of the global research landscape of pharmaceutical care from 1990 to 2024. The findings show that research output in this field has increased steadily over the past 3 decades, particularly after 2005, and reached its highest annual level in 2023. This trend indicates that pharmaceutical care has evolved from an exploratory concept into an increasingly mature and practice-oriented field of clinical pharmacy. The sustained growth in publication volume may be closely related to the expansion of clinical pharmacy services, increasing concerns about medication safety, the growing burden of chronic diseases, and the rising demand for individualized pharmacotherapy. In hospital settings, pharmaceutical care has become an important strategy for identifying, resolving, and preventing drug-related problems, improving medication adherence, and optimizing therapeutic outcomes. Previous studies have also shown that pharmaceutical care interventions can reduce potentially inappropriate prescribing, improve disease management, and enhance the health status of hospitalized patients, particularly among vulnerable populations such as older adults.^[18,19]

Another important finding of this study is the broad international participation in pharmaceutical care research. A total of 689 authors from 717 institutions across 87 countries or regions contributed to this field, suggesting that pharmaceutical care has attracted wide academic and clinical interest worldwide. However, the collaboration network among authors and institutions remained relatively dispersed, indicating that stable, large-scale, and highly integrated research teams have not yet been fully established. High-output institutions were mainly universities, suggesting that academic institutions remain a major driving force in the development of pharmaceutical care research. At the same time, this pattern may also imply that theoretical and descriptive research is more active than real-world, multicenter clinical implementation research in some areas. From the perspective of international collaboration, the United States, Spain, the Netherlands, and Germany occupied central positions in the cooperation network, indicating their important roles in shaping the global knowledge structure of pharmaceutical care. Although China ranked second in publication output, its relatively low centrality suggests that its international collaborative influence remains limited. This finding implies that future development in China should focus not only on increasing publication quantity, but also on strengthening cross-national collaboration, interdisciplinary cooperation, and participation in high-impact international research networks.

The keyword co-occurrence, burst, and clustering analyses further revealed the knowledge structure and thematic evolution of pharmaceutical care research. High-frequency keywords such as “medication management,” “clinical pharmacist,” “medication adherence,” “pharmaceutical services,” “quality of life,” and “patient safety” indicate that the field has gradually shifted from general pharmaceutical service concepts to patient-centered, outcome-oriented, and safety-focused practice. This change reflects the transformation of hospital pharmacy from a traditional dispensing-centered model to a clinical service model that emphasizes direct participation in patient care. In this context, pharmaceutical care is not only a technical activity related to medication monitoring, but also a comprehensive practice model integrating risk assessment, medication optimization, patient education, adherence support, and multidisciplinary collaboration.^[20–23] Therefore, the expansion of pharmaceutical care research also reflects the broader evolution of modern hospital pharmacy toward evidence-based and patient-centered clinical services.

The clustering results suggest that current research in pharmaceutical care can be broadly grouped into 3 major domains: pharmaceutical care services and their functions, pharmaceutical care for special populations and specific diseases, and medication safety-related issues such as adverse drug reactions and medication errors. These domains are highly relevant to current clinical needs. First, pharmaceutical care services and their functions remain the conceptual and practical core of the field, including individualized care, pharmacist intervention, treatment monitoring, and process management. Second, special populations such as older adults, children, pregnant or lactating women, and patients with hepatic or renal dysfunction have become increasingly important targets of pharmaceutical care because of their higher vulnerability to inappropriate prescribing, adverse drug reactions, and treatment failure.^[24] Third, adverse drug events, medication errors, and other safety-related topics have emerged as major focal points, highlighting that medication safety continues to be one of the most important goals of pharmaceutical care practice. Taken together, these results indicate that the field is moving beyond general service descriptions toward more targeted, clinically meaningful, and problem-oriented research.

The burst analysis further supports this trend. Early burst terms such as “quality assurance,” “quality of life,” and “medication use” suggest that the initial stage of pharmaceutical care research was mainly concerned with demonstrating the practical value and service effect of pharmaceutical care. In contrast, more recent burst terms such as “implementation,” “children,” and “patient safety” suggest that the field has entered a more advanced stage characterized by implementation in real clinical settings, care for special populations, and risk prevention. This transition is important because it shows that pharmaceutical care research is increasingly focusing on how to integrate pharmacist expertise into routine clinical pathways and how to generate measurable clinical benefits. In particular, the growing attention to pediatric and geriatric pharmaceutical care is clinically meaningful, as these populations often require individualized dosing, close monitoring, and more comprehensive medication management because of developmental, physiological, or pathological differences.^[25–27]

In addition, the recent emphasis on adverse drug events, medication errors, glycemic control, diabetes mellitus, asthma, and other disease- or safety-related keywords indicates that pharmaceutical care research is becoming more closely aligned with chronic disease management and long-term pharmacotherapy. This trend is also consistent with Reviewer concerns regarding the need to consider the effects of chronic medication use on biochemical and physiological responses. In routine clinical practice, long-term medication use may lead to changes in organ function, metabolic indicators, treatment tolerance, adverse reactions, and drug–drug interactions, particularly in patients with multiple comorbidities or polypharmacy. These issues further increase the need for pharmacist-led monitoring, medication review, and individualized pharmaceutical care. Therefore, future pharmaceutical care research should not only assess service models and intervention effectiveness, but also pay greater attention to the dynamic biological and physiological consequences of chronic medication exposure, especially in high-risk and special populations.^[28–30] Such a direction may help bridge pharmaceutical care research with broader developments in precision medicine, translational therapeutics, and patient safety research.

From a practical perspective, the findings of this study suggest that the future development of pharmaceutical care should emphasize several priorities. First, international and interdisciplinary collaboration should be strengthened in order to improve research quality and promote the translation of findings into clinical practice. Second, more attention should be paid to high-impact application scenarios, including chronic disease management, pediatric and geriatric care, polypharmacy, and prevention of adverse drug events. Third, pharmaceutical care research should move beyond descriptive bibliometric patterns and further develop toward implementation research, outcome evaluation, and real-world evidence generation. Fourth, in countries where pharmaceutical care is developing rapidly, such as China, stronger efforts are needed to improve international visibility, standardize service models, and integrate pharmaceutical care more deeply into routine hospital practice. These efforts may contribute to improving medication safety, treatment effectiveness, and the overall quality of healthcare delivery.

This study has some limitations. First, only the WOSCC was used as the data source, which may have excluded relevant studies indexed in other databases. Second, a title-based search strategy was adopted to improve retrieval precision, but some relevant publications may have been missed if the selected terms did not appear in the title. Third, bibliometric analysis mainly reflects publication patterns and knowledge structures and cannot directly evaluate the actual quality or clinical effectiveness of pharmaceutical care interventions. Despite these limitations, this study provides a systematic and long-term overview of the development of pharmaceutical care research and offers useful references for future academic research, clinical practice, and policy development.

Overall, the present study demonstrates that pharmaceutical care has become an increasingly important and rapidly developing field with broad international participation and expanding clinical relevance. Recent research hotspots indicate a clear move toward patient-centered care, medication safety, special populations, and chronic disease management. However, challenges remain in terms of international collaboration, implementation depth, and translation into high-impact clinical practice. Addressing these challenges and strengthening future-oriented, clinically meaningful research may help further advance the development of pharmaceutical care worldwide.

5. Conclusion

This bibliometric study provides a comprehensive overview of the global research status and development trends of pharmaceutical care from 1990 to 2024. The findings indicate that pharmaceutical care has evolved from an emerging concept into a mature and rapidly expanding field, with increasing emphasis on patient-centered services, medication safety, and clinical application. Current research hotspots focus on medication management, pharmacist-led interventions, and pharmaceutical care for special populations, particularly children and older adults, reflecting the growing demand for individualized and safety-oriented healthcare.

Despite the substantial growth in publication output, several challenges remain. International collaboration is still uneven, with some countries, such as China, demonstrating high productivity but relatively limited influence in global research networks. In addition, much of the existing literature remains descriptive or exploratory, and there is a need for more high-quality, multicenter, and practice-oriented studies to evaluate the real-world effectiveness of pharmaceutical care.

Future research should focus on strengthening international and interdisciplinary collaboration, promoting the integration of pharmaceutical care into routine clinical practice, and enhancing its role in chronic disease management and long-term pharmacotherapy. Greater attention should also be paid to high-risk and special populations, medication safety, and the biological and physiological impacts of long-term medication use. Furthermore, the development of standardized pharmaceutical care models and the generation of real-world evidence may help improve clinical outcomes and support healthcare decision-making.

In conclusion, pharmaceutical care is an increasingly important component of modern healthcare systems. Addressing current challenges and advancing clinically meaningful, evidence-based research will be essential for the continued development and global impact of pharmaceutical care.

Author contributions

Data curation: Shujuan Zhang.

Formal analysis: Shujuan Zhang.

Writing – original draft: Chunxing Wu, Lan Liang, Junhu Yan.

Writing – review & editing: Chunxing Wu, Lan Liang, Junhu Yan.