Implications Derived from Global Experiences of Barriers to Integrating Community Pharmacists into Primary Healthcare: A Scoping Review

Abstract

Introduction/objectives:

Primary healthcare (PHC) is a comprehensive and efficient system that promotes people’s health by providing a range of services in easily accessible locations. Integrating pharmacists into PHC has emerged as a promising approach to enhance healthcare delivery. This study aimed to explore the barriers to integrating community pharmacists into the various components of PHC.

Methods:

A scoping review was conducted in 2024 reviewing the evidence published between 2000 and 2024. For such purpose, multiple databases were searched including PubMed, Scopus, ProQuest, Web of Science, and the Google Scholar.

Results:

A total of 90 studies were found to be eligible for inclusion. The study identified key challenges to pharmacists’ integration in PHC across 6 areas: governance issues such as lack of trust and regulatory barriers; financial constraints and payment problems; workforce shortages and inadequate training; infrastructure and technology limitations; restricted access to health information; and service delivery problems including poor collaboration and fragmented care.

Conclusions:

The study provided several barriers to pharmacists integration in PHC. In such context, the study proposed policymakers to fund sustainably, strengthen infrastructure, enact supportive policies, and promote collaboration, coordination, and expanded pharmacist roles.

Keywords

primary healthcare pharmacist community pharmacies pharmaceutical services pharmacy practice

Introduction

Primary healthcare (PHC) refers to fundamental health services that are universally accessible to individuals and families within a community. These services employ scientifically validated and socially acceptable methods and technologies, and are delivered at a cost that is affordable for both the community and the nation.^1,2 According to the World Health Organization’s (WHO), PHC consists of 3 key components, including (1) empowered people and community, (2) multisectoral policy and action, and (3) integrated health services with an emphasis on primary care and essential public health functions.³

In modern healthcare service delivery systems, no single profession (e.g., physicians, nurses, or pharmacists) is assigned a predominant role, and none can operate in isolation. In this context, pharmacists are multifaceted healthcare professionals serving as caregivers, communicators (with patients), decision-makers, educators, lifelong learners, leaders, and managers.⁴ In this regard, pharmacists constitute a critical component of PHC by enhancing medication management, supporting the management of chronic diseases, and delivering patient education. Their expertise facilitates the optimization of therapeutic regimens and alleviates the workload of physicians, thereby improving access to care.^5
-7

There are multiple studies within the context investigating the barriers of integrating pharmacists in PHC. In this regard, 1 study explored barriers to integrating pharmacists into 23 primary care teams in urban and rural Saskatchewan. Through interviews with healthcare providers and thematic analysis, 7 key themes were identified, including role definition, relationships, support, and resources.⁸ Another study examined factors influencing the integration of non-dispensing pharmacists (NDPs) into Aboriginal community-controlled health services in Australia. Through qualitative evaluation of 104 participants, it identified key barriers including limited system support, logistical issues, weak community connections, and resource constraints.⁹ Another study surveyed 119 pharmacists in primary care with integrated behavioral health to assess their roles and challenges. Key barriers included financial constraints, unclear roles, underutilization, and limited workspace.¹⁰

While several studies have explored the barriers to pharmacists’ integration in PHC, there is a lack of comprehensive review articles that consolidate the existing evidence into a single synthesis. In this regard, 1 protocol for scoping review aimed to propose a methodology to map barriers to implementing pharmacist services in primary care clinics by analyzing studies from 8 databases and gray literature up to August 2021.¹¹ This underscores the need for updated reviews to address this gap in the literature.

Reviewing the barriers to integrating pharmacists into PHC offers valuable insights for various stakeholders. Healthcare policymakers and administrators can utilize the findings from such studies to inform their planning and strategic efforts to enhance pharmacist integration within their respective organizations. Additionally, future researchers can leverage this consolidated data to validate frameworks and checklists relevant to the context.

Methods

This scoping review was conducted in 2024 in accordance with the Joanna Briggs Institute framework and adhered to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for review studies.^12,13

Identification of the Research Question

The research question was formulated as follows: “What are the barriers to the integration of community pharmacists into PHC globally?”

Searching and Retrieving Relevant Studies

A search was conducted across 5 major international online databases: PubMed, Scopus, ProQuest, Web of Science, and Google Scholar. The search encompassed English-language publications dated from January 1, 2000, to December 1, 2024. The detailed search strategy, as presented in Table 1, utilized Medical Subject Headings (MeSH) terms organized into 2 categories. Within each category, synonymous keywords were combined using the Boolean operator “OR,” and the resulting sets from both categories were then intersected using the “AND” operator. Duplicate records were removed. Additionally, the reference lists of all included articles were reviewed to identify any potentially relevant studies not captured in the initial database search. To ensure that no relevant manuscripts pertaining to the research question were overlooked, the search strategy was deliberately designed to be as comprehensive as possible, notwithstanding the increased time required for screening the references.

Table 1.

Research Strategy in Databases.

Search strategy	#1 AND #2
#1	#1 Primary Health Care OR PHC OR primary healthcare OR primary care
#2	#2 Pharmacy OR Pharmacies OR community pharmacy OR Community Pharmacy Services OR Pharmaceutical Services OR pharmacist services
Databases	PubMed, Scopus, ProQuest, Web of Science
Limits	Language: English; Time frame: 2000-2024

Inclusion/Exclusion Criteria

The inclusion criteria encompassed studies that were written in the English language, addressed the research question, and were published after the year 2000. The exclusion criteria comprised conference proceedings and letters to the editor, as these were deemed less precise and valid compared to other types of manuscripts. Moreover, those studies corresponding to the clinical pharmacists or hospital pharmacists were excluded during the screening process due to their irrelevancy to the research question.

Study Selection

All titles and abstracts were independently screened and selected by 2 authors. Full-text articles were subsequently obtained and reviewed to assess their eligibility based on the predefined criteria. In cases where full texts were not accessible through the databases, corresponding authors were contacted via email or professional social media platforms (e.g., ResearchGate). Any disagreements arising during the selection process were resolved through discussion among all of the authors.

Data Extraction

Following a thorough review of the full texts of the final selected studies, data relevant to the research question were extracted. A standardized data extraction form was employed to facilitate systematic data charting. This form was developed through consultation among the authors and included fields such as the study title, year of publication, author(s), country, study design, and data pertinent to the research question. The determination of which data is relevant to the research question was made based on each individual author’s interpretation. Data extraction was conducted independently by the authors using a formatted spreadsheet in Microsoft Excel. Any discrepancies were resolved through discussion among all authors.

Data Analysis

In this step, using the Best Fit Framework approach, the authors in cooperation with each other identified different models and theories to categorize the experiences presented in the studies and selected the WHO’s Six Building Blocks to categorize the research data (the barriers of pharmacists integration in PHC).¹⁴ The Health System Building Blocks Framework was presented in 2007 to provide a structured approach for strengthening health systems globally. This framework delineates 6 fundamental components essential for effective health system performance: service delivery, health workforce, health information systems, access to essential medicines and technologies, financing, and leadership/governance.¹⁵

The data analysis was conducted using the deductive qualitative analysis approach. Deductive thematic analysis is a qualitative method where researchers apply pre-established themes (WHO’s six building blocks in this study), based on existing theory or literature, to code the data. Unlike inductive analysis, which derives themes directly from the data, this approach is guided by prior knowledge and research objectives. It enables systematic categorization while allowing for the identification of new sub-themes, thereby enhancing the rigor and transparency of the analysis.^16,17 During the analysis, 2 authors collaboratively developed sub-themes by thoroughly reviewing the data extracted from the included studies, assigning each sub-theme a contextually appropriate label. To ensure the validity of the analysis and minimize potential bias, the remaining authors independently reviewed and approved the analytical process.

Results

Search Results

The electronic search found 21 567 potentially relevant studies. 7809 of the studies were found to be duplicates. Finally, 90 studies met the inclusion criteria and were included for review. A flow chart of the literature review is presented in Figure 1.

Figure 1.

PRISMA flow diagram.

Data Analysis

As presented in Table 2, the thematic analysis identified a total of 19 themes and 74 sub-themes across 6 key building blocks corresponding to the challenges of pharmacists’ integration into the PHC. Governance and Leadership comprised 2 themes with 20 sub-themes, highlighting issues such as lack of trust, support, inclusion, and systemic regulatory obstacles. Financing included 3 themes and 11 sub-themes, focusing on financial and legal resource shortages, payment problems, and an excessive focus on product supply. Human Resources presented 3 themes with 8 sub-themes, emphasizing workload, distribution inequalities, and insufficient training. Medical Products and Technology contained 2 themes and 6 sub-themes, addressing infrastructure deficits and technological limitations. Health Information Systems had 2 themes and 6 sub-themes related to restricted access to patient information and decision support tools. Service Delivery was the most complex, with 7 themes and 23 sub-themes, covering user dissatisfaction, lack of trust, poor awareness, limited cooperation, pharmacists’ low independence and confidence, time inefficiencies, and discontinuity of care (Figure 2).

Table 2.

Thematic Analysis of Findings.

Building block	Theme	Sub-theme	Citation
Governance and leadership	Lack of trust, support and inclusion	Limited support from policymakers	^18 -22
		Exclusion of pharmacists from governance and decision-making structures	^23 -27
		Pharmacist not recognized as the PHC team	^24,28 -31
		Lack of social, professional and organizational integration	^30,32 -34
		Lengthy and gradual process of integration	^35,36
		Disconnection between pharmacists and policy makers on the future direction of pharmacy	³⁷
		Suboptimal benefits and support from the current systems for pharmacists	^38 -40
		Lack of trust in the healthcare professionals or healthcare system	^41,42
	Systemic and Regulatory Obstacles	Weak regulatory systems	^34 -36
		Rapidly changing and conflicting guidelines	^32,38
		Lack of related policy document	^43 -45
		Low transparency in the legal framework	^41,43,46 -48
		Absence of an official and national association of pharmacists	^49,50
		Lack of accreditation system	^22,28
		Increasing need for frequent and long-term monitoring of conditions	^41,51,52
		Need for practical outpatient stewardship programs	⁴⁵
		Insufficient guidelines and protocols for certain services	^43,53,54
		Absence of a defined communication process between pharmacists and physicians	^26,55
		Consideration of private pharmacies as only a retail medication supply business or shopkeepers	^{25,26,30,56 -58}
		Lack of sustainability of the healthcare system	⁴⁵
		Risk of adaption by pharmacists to the evolving market	³⁵
Financing	Lack of financial and legal resources	Lack of financial and legal resources for pharmacists’ new services	^{8,18,20,22,29,44,48,59 -62}
		Rising clinic costs due to pharmacist integration	^42,63,64
		Financial constraints pressure for community pharmacists	^43,65
		No funding for pharmacists integrated into other primary care settings	⁵¹
		Lack of financial capacity to hire and retain skilled personnel	^43,66
	Payment issues	Out-of-pocket payment for pharmacist services	^{28,49,50,62,67}
		Inadequate remuneration	^40,65,68 -72
		Poor payment system	^22,43
		Unwillingness to pay pharmacist services	^51,63,73
	Excessive focus on product supply	Focus on product supply rather than service provision	^{29,44,48,59,74 -76}
	Excessive focus on product supply	Incentivization of pharmacists to prioritize and maximize their supply function rather than the provision of advanced services	^35,51
Human resources	High workload and distribution issues	Unequal pharmacist distribution in urban and rural areas	^21,48
		Lack of pharmacists in deprived areas	^56,77
		High workload in pharmacies	^18,78 -80
	Lack of human resources and time	Lack of human resources	^{38,43,45,77,80,81}
		Inflexible working hours	⁷⁸
		Pharmacy’s dispensing busy nature and time insufficiency	^{44,47,65,70,82}
		Absence of pharmacists in some PHC centers	^{56,76,77,83,84}
	Insufficient training	Lack of training programs for pharmacy staff	^{18,21,27,44,45,78,85 -87}
Medical products and technology	Infrastructure, space and drug stock issues	Inadequate pharmacy infrastructure	^{18,19,26,32,44,47,69,73,81,88 -93}
		Lack of patient waiting space in pharmacies	^69,91
		Drug shortage	^22,74,78,81
	Technological issues	Insufficient technology	^{18,20,43,93,94}
		No internet access	^38,92,94
		Challenge of adaptation of different systems and ensuring data privacy	³⁵
Health information system	Lack of health information technology	Low access to patient records	^{18,28,50,81,95,96}
	Lack of health information technology	Lack of decision support systems	⁴³
	Lack of access to information and public resources	Restricted information access	⁷⁹
	Lack of access to information and public resources	Lack of availability and exchange of information	^25,83,97
Service delivery	User dissatisfaction and unwillingness	Dissatisfaction among users with pharmaceutical services	^26,39
		Unwillingness to receive the expanded pharmacists’ services	^27,39,81
		Unwillingness and inability of patients with lower social education to utilize mobile phone services	^26,55,97
	Lack of user trust	Lack of trust in pharmacists among patients	^{42,67,90,27,39,81}
	Lack of user trust	Uncertainty among other healthcare professionals regarding pharmacists’ skills	^53,56
	Literacy, awareness, and perception issue	Poor societal perception of the pharmacists as a PHC services providers	³⁵
		Low level of health literacy among patients	^53,98
		Lack of awareness among other health professionals about the pharmacist’s role	^{19,20,35,43,58,61,67,69,99}
		Misinformation about treatments among service users	³²
	Lack of cooperation and participation	Lack of cooperation and participation of physicians and nurses in referring patients to pharmacists	^35,79,83,86
		General physicians’ reluctance due to potential encroachment on their roles and income	^51,83,100
		Hesitation of general practitioners due to increased clinic costs	^41,82
		Tensions and inconsistencies created among members of the healthcare team	^{35,39,58,77,86,101}
		Failure to integrate pharmacist services with other healthcare services effectively	^{26,35,39,52,55,102}
		Reluctance of pharmacists to work in PHC clinics	³⁷
		Reluctance of pharmacists to work in community pharmacies	^35,37
		Reluctance of pharmacists to provide expanded services	^25,39
		Low participation of pharmacies in the universal health coverage plans	³⁹
	Pharmacists’ independence and self-confidence	Limited clinical independence for pharmacists	^33,67
	Pharmacists’ independence and self-confidence	Low self-confidence of pharmacists	^56,81,98,103
	Time inefficiency and lack of transparency	Dissatisfaction from the lengthy wait times at pharmacies	¹⁰⁴
	Time inefficiency and lack of transparency	Lack of transparency in defining roles in times of intersectoral collaboration	^25,43
	Discontinuity of services and lack of reconciliation	Discontinuity of care and the lack of medication reconciliation	^51,79,81,105

Figure 2.

Thematic analysis of findings.

Governance and Leadership

Pharmacists experienced a significant lack of trust, support, and inclusion within governance and leadership structures. There was limited support from policymakers, and pharmacists were frequently excluded from governance and decision-making bodies. They were not recognized as members of the PHC team, which led to poor social, professional, and organizational integration. The integration process was described as lengthy and gradual, with a notable disconnection between pharmacists and policymakers regarding the future direction of pharmacy. The existing systems provided suboptimal benefits and support, compounded by a general lack of trust in healthcare professionals and the healthcare system.^18
-42

Under systemic and regulatory challenges, weak regulatory systems were evident. These included rapidly changing and conflicting guidelines, absence of related policy documents, low transparency in the legal framework, and the lack of an official national pharmacists’ association and accreditation system. There was also an absence of defined communication processes between pharmacists and physicians. Private pharmacies were often viewed merely as retail medication suppliers or shopkeepers, which limited their clinical role. The sustainability of the healthcare system was questioned, and pharmacists faced the risk of adapting primarily to evolving market demands rather than clinical needs.^{22,25,26,28,30,32,34
-36,38,41,43,53
-58}

Financing

Financial challenges were prominent, with a lack of financial and legal resources to support pharmacists’ new services. Integration led to rising clinic costs, and community pharmacists faced financial constraints. There was no funding allocated for pharmacists integrated into other primary care settings, and limited financial capacity existed to hire and retain skilled personnel.^{8,18,20,22,29,42-44,48,51,59
-66} Payment issues included out-of-pocket payments for pharmacist services, inadequate remuneration, poor payment systems, and unwillingness among patients to pay for pharmacist services.^{22,28,40,43,49
-51,62,63,65,67
-73} Additionally, there was an excessive focus on product supply rather than service provision, which incentivized pharmacists to prioritize dispensing over advanced clinical services.^{29,35,44,48,51,59,74
-76}

Human Resources

Human resource challenges included high workload and uneven distribution of pharmacists, with shortages particularly in rural and deprived areas.^{18,21,48,56,77
-80} Pharmacists faced inflexible working hours and time constraints due to the busy dispensing nature of pharmacies. Some PHC centers lacked pharmacists altogether.^{38,42
-45,47, 56,65,70,76
-78,80
-84} There was also insufficient training available for pharmacy staff to support expanded roles.^{18,21,27,44,45,78,85
-87}

Medical Products and Technology

Pharmacists confronted issues related to infrastructure, space, and drug stock. Pharmacy infrastructure was inadequate, with insufficient patient waiting space and frequent drug shortages.^{18,19,22,26,32,44,47,69,73,74,78,81,88
-93} Technological challenges included insufficient technology availability, lack of internet access, and difficulties adapting to different systems while ensuring data privacy.^{18,20,35,38,43,92
-94}

Health Information System

There was a notable lack of health information technology, which limited pharmacists’ access to patient records and decision support systems.^{18,28,43,49,81,95,96} Restricted information access and poor availability and exchange of information contributed to misinformation among service users and hindered pharmacists’ ability to provide effective care.^{25,32,79,82,97}

Service Delivery

At the service delivery level, user dissatisfaction and unwillingness to engage with expanded pharmacist services were evident. Patients showed dissatisfaction with pharmaceutical services and reluctance to use mobile phone services, especially among those with lower social education.^{26,27,39,54,81,97} There was a lack of trust in pharmacists among patients and uncertainty among other healthcare professionals regarding pharmacists’ skills.^{27,39,42,53,56,67,81,90} Poor societal perception of pharmacists as PHC providers, low health literacy among patients, and lack of awareness among other health professionals about pharmacists’ roles further complicated service delivery.^{19,20,35,43, 58,61,67,69,98,99}

Cooperation and participation from physicians and nurses were limited. General practitioners showed reluctance to refer patients to pharmacists due to concerns over role encroachment, increased clinic costs, and professional tensions. Pharmacists themselves demonstrated reluctance to work in PHC clinics or community pharmacies and to provide expanded services. Participation of pharmacies in universal health coverage plans was low.^{25,26,35,37,39,41,51,52,55,58,77,79,82,83,84,100
-102}

Pharmacists faced limited clinical independence and low self-confidence, alongside time inefficiency, lengthy wait times, and lack of transparency in role definitions. These factors contributed to discontinuity of care and lack of medication reconciliation, resulting in fragmented clinical pharmaceutical services.^{25,43,51,79,81,104,105}

Discussion

The findings revealed several significant barriers within the WHO building blocks framework. In this regard, the thematic analysis indicated that the service delivery building block encompassed the most extensive range of themes and subthemes pertaining to barriers identified in the included studies. Following this, the governance and leadership building block demonstrated the second-largest number of subthemes. These findings highlight the critical importance of both building blocks in effectively addressing and mitigating the encountered barriers. In this section of the study, the findings are discussed and analyzed in relation to existing literature from other contexts.

It is highlighted that pharmacists in the UK, despite being the third most abundant healthcare professionals after physicians and nurses, are not effectively utilizing their skills and abilities.¹⁰² The support and commitment of policymakers and health managers is one of the most important facilitators for its realization.^23,59,66,106 Moreover, in Canada, decentralization has been used in decision-making as one of the facilitators of the governance process.⁹⁵ Besides these cases, defining the processes and providing executive guidelines for the developed services of pharmacists will reduce confusion within the PHC teams.^{50,53,54,60,107}

Although transparency in guidelines is a major global challenge for integrating community pharmacists into PHC as presented by the study findings, some regions have seen improvements through effective implementation.^41,43,46
-48 For example, the Lebanese Order of Pharmacists (OPL) has developed Good Pharmacy Practice (GPP) guidelines to enhance community pharmacist services. However, adherence to these standards remains low across regions, with ongoing initiatives aimed at raising awareness and strengthening guideline adoption within Lebanon’s evolving healthcare system despite existing constraints.¹⁰⁸ In another instance, the Australian government has implemented initiatives including Primary Health Networks (PHNs) and the 7th Community Pharmacy Agreement (7CPA) to expand pharmacists’ clinical roles and remuneration, foster multidisciplinary collaboration, and establish community pharmacies as integral health hubs in primary care.²³

It is presented that the remuneration of community pharmacy is tied to the supply of a product rather than providing health services⁵⁹; this poses a significant challenge as it fails to adequately account for the financial value of expanding pharmacist services. Numerous studies have pointed out the need for a more robust financial framework that recognizes the expertise and complexity of pharmaceutical services and establishes sustainable funding sources involving government entities, insurers, and public support.^{8,18,20,21,29,59,60
-62,71} Such a framework would not only benefit patients, the government, and other healthcare professionals but also enable the expansion of pharmacists’ activities.⁷⁵ Moreover, it would enhance pharmacists’ motivation to deliver extended services.⁴⁴

It is presented that inadequate physical infrastructure is a major challenge for integration of pharmacists in PHC. This encompassed limitations in terms of space, facilities, patient privacy, the ability to conduct clinical examinations, and the availability of waiting areas.⁴⁷ Additionally, several other studies have corroborated these findings, underscoring the significance of addressing this factor.^{18,19,44,47,69,73,88
-93}

Over time, community pharmacists have tended to work in isolation from other healthcare professionals with only minimal contact on routine matters.¹⁰⁹ Nonetheless, evidence has demonstrated that the participation and collaboration of physicians are essential for the effective integration of such services.⁸³ This collaboration not only reduces the workload of general physicians, nurses, and other health providers, but also increases the physicians’ time to focus on patients with more complex problems.^{53,82,90,107,110}

The challenges encountered between physicians and pharmacists can be attributed to conflicting interests arising from the overlap of their clinical roles and authorities.^{19,20,60,62,67,90} Addressing this issue necessitates the formulation of regulatory frameworks that delineate the boundaries of each profession’s jurisdiction, thereby facilitating the seamless integration of pharmacists within PHC settings. Furthermore, the integration of electronic health records can foster transparency in professional relationships by enabling the identification of financial interactions among various service providers and facilitating the enforcement of clinical guidelines.¹¹¹

Establishing clinical independence for pharmacists requires legal changes in countries. Among the good examples in this field are the countries of the United States, Canada, England, and New Zealand, where an agreement on the provision of clinical services between a physician and a pharmacist specifies the limits of the pharmacist’s authority to prescribe the necessary tests, drugs, and other services.^50,96 This presents major obstacles for integration of pharmacists in PHCs.

Various countries have adopted different strategies to integrate pharmacists into PHC. Some have focused on expanding the role of pharmacists within pharmacies and supporting their transition^{21,23,49,59,61,71,73}; while others have sought to extend community pharmacists’ role beyond the walls of the pharmacy and establish collaboration with PHC clinics.^42,63,67,76 The rationale behind these approaches varies. For instance, in the United States, there is recognition that redefining the pharmacy profession can help protect against threats from online pharmacies such as Amazon.⁵⁰ Additionally, pharmacies are easily accessible to people, making them potential centers for delivering healthcare services and improving access to care.⁹⁰ The literature indicates that patients are more likely to seek care from primary care pharmacists than from primary care physicians.¹¹² Furthermore, the presence of various healthcare professionals, including pharmacists, in a shared space can enhance collaboration and knowledge exchange among the PHC team.⁸³ However, both of these integration programs face similar challenges and facilitators. Overall, there is a consensus that the future of community pharmacies and pharmacists lies in providing professional clinical services alongside drug distribution.^113
-115

Limitations and Implications

There is a limitation associated with this study. First, the research only included studies that were in English language and were published until 2024, which may have missed some data within the context. On the other hand, the study had a significant strength to address. In this regard, the search strategy was utilized as broad as possible to gather as much as data possible regarding the topic.

The study had several implications to address for the beneficiaries within the context such as healthcare policy makers and administers in the PHC. In this regard, healthcare policymakers and PHC providers should create sustainable funding models that value pharmacists’ clinical services, improve infrastructure, and foster strong policy support. Promoting collaboration between pharmacists and physicians through clear regulations and legal reforms is essential to resolve role conflicts and grant clinical independence. Integrating electronic health records can enhance transparency and care coordination. Furthermore, strategies should be tailored to local contexts, leveraging community pharmacies’ accessibility to expand pharmacists’ roles beyond medication supply.

Conclusions

The study presented multiple themes and sub-themes across 6 key building blocks reflecting the challenges of pharmacists’ integration into PHC. The thematic analysis showed that service delivery building block had the most barriers, followed by governance and leadership. This highlights the importance of these 2 blocks in addressing challenges. Overall, the study proposed that policymakers ensure sustainable funding, improve infrastructure, and enact policies recognizing pharmacists’ clinical roles. It advocated clear regulations to foster collaboration and independence, integration of electronic health records for better coordination, and locally tailored strategies to broaden pharmacists’ scope beyond medication supply.

Footnotes

ORCID iDs

Fatemeh Homayounifar

Mohsen Khosravi

Ghazal Davar

Manica Negahdaripour

Hassan Joulaei

Ethical Considerations

Not applicable.

Consent for Participate

Not applicable.

Consent for Publication

Not applicable.

Author Contributions

F.H. theorized and led the conduction of the study, and performed data collection and analysis. H.J. contributed to study design, data collection, and analysis. F.H and G.D. contributed to screening the articles and drafting the manuscript. H.J. and M.N. supervised the project and provided consultation throughout the preparation of the manuscript. M.K revised the final version of the manuscript.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Research Council of Shiraz University of Medical Sciences (Grant No. IR.SUMS.REC.1401.376).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data of the research is available through making contact with the corresponding author.

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