Emerging trends: the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economics

ABSTRACT

Introduction

The aim of this study was to analyze existing research on the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economic strategies.

Methods

The researcher searched five scholarly databases: Medline, BioMed Central (BMC), Excerpta Medica Database (EMBASE), ProQuest, and PubMed for the reviewed articles. The search and selection of the articles involved searching each of the databases using specific keywords and a combination of them to form phrases and the Boolean search string. The researcher adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in developing this study.

Results

From the original search, a total of 537 articles emerged from which 17 articles remained upon screening. Findings show that the community pharmacy role has expanded over the past years to enable pharmacists serve diverse roles, but there is a high lack of involvement of these stakeholders in the planning and execution of policies. The pharmaceutical and health-care sectors operate in a way that does not recognize nor engage community pharmacists sufficiently in the policy planning and execution.

Conclusions

Relevant stakeholders need to create an enabling and supportive environment for utilizing the abilities, knowledge, and skills of community pharmacists in policy planning and execution.

KEYWORDS:

• Community pharmacists
• economic policies in pharmacy
• execution of pharmaceutical policies
• pharmaceutical policies
• planning in pharmacy

1. Introduction

Pharmaceutical policies and economics play a pivotal role in shaping the healthcare landscape, influencing access to medications, healthcare expenditure, and patient outcomes. Within this dynamic framework, community pharmacists can assume a significant responsibility in the planning and execution of pharmaceutical policies and economic strategies. This mandate is notably important considering the expanding role of community pharmacists over time to allow them to serve as more than the traditional drug dispensing agents [1]. Community pharmacists are increasingly recognized for their expertise in medication management and their potential to positively influence health-care outcomes. As accessible health-care professionals, they have a unique opportunity to interact directly with patients, provide medication counseling, conduct medication therapy management, and address medication-related issues. Moreover, community pharmacists possess a thorough understanding of the healthcare system, including drug regulations, reimbursement mechanisms, and cost considerations, which positions them as valuable stakeholders in policy development and implementation. Such knowledge can be of major positive impact in the planning and execution of various policies and strategies for efficient economic operation of the pharmaceutical and the wider health-care sector [2].

In the context of this paper and as used within the medical world, a community pharmacist is a health-care professional who works in community pharmacies, drug stores, or retail settings with the primary mandate of ensuring safety for patients in accessing and using over-the-counter drugs. Goode et al. note that in executing their role within the health-care sector, community pharmacists are highly trained and licensed to oversee the prescriptions of drugs, as well as engage in activities that promote patient wellness at the pharmacy level [3]. Serving in these roles, community pharmacists play a crucial role in the healthcare system, particularly helping bridge the gap between patients and physicians by providing accessible and expert pharmaceutical care.

The landscape of pharmaceutical policies and economics is multifaceted, encompassing various aspects such as drug pricing, formulary management, medication adherence, pharmacovigilance, and the integration of innovative health-care technologies. Each of these areas represents a crucial intersection between patient care, economic considerations, and public health objectives [4,5]. Recognizing the potential impact of community pharmacists on these dimensions, policymakers and health-care professionals should increasingly seek their input into decision-making processes.

Previous research has explored different aspects of community pharmacists’ involvement in pharmaceutical policies and economics. Some studies have examined their role in promoting cost-effective prescribing patterns [6], ensuring medication safety [7,8], and improving medication adherence [9]. In other cases, researchers have investigated the implementation of pharmacist-led interventions to optimize drug utilization and minimize unnecessary health-care costs, and research has also highlighted the involvement of community pharmacists to contribute to the evaluation and selection of therapeutic alternatives, as well as their role in reducing medication-related adverse events and hospital readmissions.

While individual studies have shed light on the impact of community pharmacists’ engagement in policy and economic initiatives [10,11], a comprehensive review of the existing literature is needed to provide a holistic perspective. By systematically examining and synthesizing a broad range of research, this study aims to identify common themes, gaps in knowledge, and potential areas for improvement. Additionally, it seeks to provide policymakers, health-care professionals, and researchers with evidence-based insights into the contributions community pharmacists can make toward the planning and execution of pharmaceutical policies and economic strategies for effectiveness in pharmaceutical health-care services delivery. This review will provide a comprehensive analysis of existing research studies that investigate the trends and perspectives on the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economic strategies. The findings of this systematic literature review will be of particular interest to policymakers seeking to enhance the effectiveness and efficiency of health-care systems, health-care professionals aiming to optimize patient care, and researchers interested in advancing knowledge in the field.

2. Methods

2.1. Study design

This study took the SPIDER design. I sought to explore the emerging trends in the perspectives of community pharmacists (S) regarding their involvement in the planning and execution of pharmaceutical policies and economics (P) through a systematic review of literature (I), evaluating current research and publications (E). The systematic review of literature was carried out on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

2.2. Search strategy

The researcher carried out a comprehensive research on five databases including Medline, BMC Medicine, EMBASE, ProQuest, and PubMed. The key words used to search for articles in these databases included community pharmacists, pharmaceutical policies, planning in pharmacy, execution of pharmaceutical policies, economic policies in pharmacy, and a combination of these keywords to form short phrases that helped in further identification of relevant studies for inclusion in this review. The Boolean search strategy was adopted with the main search string being planning and execution OR community pharmacists OR pharmaceutical economics. The search was limited to articles published in English between the years 2010 to early 2023. The researcher also conducted additional research on Google Scholar to identify any relevant articles for inclusion in this study, but the emerging articles in this search only supported the background of the study and were not directly included in the systematic review. The researcher adopted the double screening method and utilized the help of two assistant researchers to screen the articles. The two assistants independently assessed the titles, abstracts, and contents of the search results based on the inclusion and exclusion criteria, each assistant making a decision on whether the article should be included or excluded based on their evaluation and perusal of the contents of the article. If both reviewers agree that an article should be included, it was selected for the next stage of the review until a final decision was made to include it in the study. Important to note, in cases where the assistants did not agree on the inclusion or exclusion of an article, it proceeded to the next stage of review, as well as involved the researcher in considering whether the article should or should not be included in the study. The researcher read the selected full-text articles in English from the assistants and made the final selection for the included articles.

2.3. Study selection and inclusion criteria

The process of identifying and selecting the studies for review in this research is captured in Figure 1. In the selection phase, the researcher selected articles on the basis of the inclusion and exclusion criteria. The included studies were those that the authors explored topics on planning and execution of pharmaceutical policies and economic strategies. Another inclusion criterion was that all articles included in the review were full articles, all others with only abstracts available being excluded. On language, all included studies were those in English language. The researcher was indifferent to include studies based on qualitative, quantitative, and mixed methods research.

Figure 1. Flow chart of the study selection procedure.

2.4. Data extraction and synthesis

The researcher, with the help of two research assistants, used a standardized form to extract data from the selected studies. As shown in Table 1, the extracted data included the author(s) and publication details, study design, sample size, and key findings.

Table 1. Summary of the results.

Author(s)	Country	Area of focus in Pharmaceutical Management Strategies	Number of participants	Study Type	Key Findings
Mahmoud et al. (2014)	Saudi Arabia	Pharmacovigilance	104 community pharmacists	Quantitative survey	Many community pharmacists do not understand the process for reporting on adverse drug reactions, an important activity related to the pharmacovigilance pharmaceutical management strategy.
Valinciute-Jankauskiene and Kubiliene (2021)	Lithuania	Pharmacovigilance	12 interviews with general practitioner community pharmacists	Qualitative	There are a variety of barriers that hinder effective pharmacovigilance involvement among community pharmacists, including lack of information and education, heavy workload, complicated ADR reporting procedure, limitations of the e-health system, organizational culture, and lack of trust in authority.
Hussain (2021)	Pakistan	Pharmacovigilance	11 interviews with community pharmacists	A qualitative case study	Community pharmacists serve the crucial role of being sources of information for effective pharmacovigilance.
Kallio et al. (2020)	Finland	Risk management	56 online surveys with community pharmacists	Quantitative survey	Pharmacists rarely use the wide range of risk management tools that they have at their disposal for supporting risk management pharmaceutical strategies.
Kallio et al. (2021)	Finland	Risk management	574 pharmacists	National online cross-sectional survey	Pharmacists have good knowledge in risk management strategies such as confirming patient medication doses and in the identification of drug-drug interactions, but lack sufficient competency in practices related to ADR such as serotonergic load and anticholinergic load. They also have a variety of tools for assessing risks associated aspects in pharmacy, but indicate a need for receiving further training on methods used in ADR reporting procedure.
Duarte et al. (2016)	Portugal	Risk management	271 pharmacies and 10 community pharmacists	A cross-sectional survey and a Focus Group study.	About 50% of community pharmacists in the study area rate themselves as having poor knowledge in risk management strategies in pharmacy.
Hagar et al. (2020)	United Arab Emirates	Risk management	322 pharmacists	A cross-sectional study	Community pharmacists manifested positive attitudes toward the identification of risks within the pharmacy industry.
Abubakar et al. (2022)	Saudi Arabia	Quality assurance	130 community pharmacists	A cross-sectional study	Most pharmacists have positive knowledge in relation to quality assurance, and they show willingness toward supporting pharmaceutical management strategies in place for better service delivery.
Ting et al. (2017)	Malaysia	Regulatory compliance	Community pharmacists and General Practitioners in Sarawak state Pharmaceutical Enforcement Division (PED).	Observation study	Community pharmacists have a good level of compliance with set laws on pharmacy related practices, the observed compliance rate in this study being 53% between 2012 and 2014.
Jeyamani et al. (2018)	India	Regulatory compliance	95 community pharmacists	A cross sectional survey	Most of community pharmacists lack in-depth knowledge on current regulatory laws around pharmaceutical practices, and this could hinder their participation toward supporting initiatives around regulatory compliance.
Duban et al. (2017)	Slovakia	Regulatory compliance	181 community pharmacists and 347 general practitioners		Community pharmacists are open to support regulatory compliance practices within their organizations, but lack of good knowledge on all areas relevant to this field prevents them from fully engaging in roles that support regulatory compliance.
Rajiah et al. (2021)	India	Quality assurance	19 studies	Systematic review	One of the common practices through which community pharmacists support quality assurance is through interaction with patients.
Winslade & Tamblyn (2017)	Canada	Quality assurance and risk management	1742 pharmacies	Population based cohort study	Management of pharmacies play a vital role in helping pharmacists gain knowledge required of them to support quality assurance and minimize risk incidences within the pharmacy field, particularly risks related to non-adherent drug dispensing.
Parekh et al. (2023).	U.K	Risk management	Data from 165,244 patient cases	Quantitative	Community pharmacists practices for contributing toward risk management strategies include referring patients to prescribers for review.
Goode et al. (2019)	U.S	Research and development	-	Review	Community pharmacists support development in healthcare delivery as they are involved in leading and advancing team-based patient care services in communities to improve the quality of care.
Moussa et al. (2021)	Australia	Research and development	Six community pharmacists serving as change implementation facilitators	Observational study	Community pharmacists are an important agent in supporting research and development in pharmacy by serving as change facilitators and also identifying barriers that hinder change implementation.
Kho et al. (2017)	Malaysia	Quality assurance	20 pharmacists	Qualitative study with semi-structured interviews	In their efforts to support quality assurance, community pharmacists face different challenges including market competition, customers knowledge and expectations, legal issues, and macroeconomic impacts.
Abdulsalim et al. (2023)	Saudi Arabia	Pharmacovigilance	209 community pharmacists	A quantitative cross-sectional study	Community pharmacists have good knowledge on pharmacovigilance, and they also have positive attitude toward reporting ADRs
Jawad (2016)	Pakistan	Quality assurance and regulatory compliance	1003 drug stores	Observational study	Many of the drug stores, which in a way include the practices of community pharmacists toward compliance and quality assurance, are non-regulatory compliant.
Aziz et al. (2022)	Egypt	Pharmacovigilance	37 pharmacists	A quantitative cross-sectional study	Pharmacists have a positive attitude toward supporting pharmacovigilance initiatives, but organizations need to support them by creating enabling environment.
Latif et al. (2021)	U.K	Quality assurance	333 community pharmacists	Qualitative case study with focus groups	Community pharmacists gain useful knowledge toward supporting quality assurance from effective collaboration between higher education institutions and local community pharmaceutical committees.

3. Results

3.1. Study characteristics

The initial search identified 537 articles. After screening and applying inclusion/exclusion criteria, 17 studies were included in the review. The included studies explored different topics around emerging trends and perspectives in relation to the involvement of community pharmacists in the planning and execution of pharmaceutical policies and economic strategies. Four of the studies (23.53%) were quantitative, six (35.29%) were qualitative design studies, five (29.41%) were reviews of literature, one (5.88%) was a case study, and another one (5.88%) was a mixed methods design study. All studies were published between 2012 and 2022. The findings of the review of these studies are captured in Table 1.

4. Discussion

4.1. Benefits of community pharmacists in pharmaceutical policy planning and execution

Community pharmacists continue to serve an important role in the health-care sector, and over time their involvement has been transitioning beyond the classical medication dispensing agents [1,12,13]. According to El Bizri, community pharmacists offer substantial benefits that could be leveraged within the health-care sector to enhance success in planning and execution of pharmaceutical and economic policies [14]. They are on a daily interaction with the community and routinely experience the challenges that affect members of the community from a healthcare perspective. As frontline health-care professionals, community pharmacists possess valuable insights into patients’ medication needs, preferences, and challenges [15]. As pharmaceutical policies have to focus on creating an environment where members of the community can access pharmaceutical services in the most safe and efficient way, the input of community pharmacist could be vital in ensuring that such policies are fully informed of the issues and concerns of the members of the public and seek to address them when implemented [10]. Through a dedicated effort to involve community pharmacists in policy planning, policymakers can gain a deeper understanding of the real-world impact of policies and make informed decisions that align with patient-centered care. Ultimately, this involvement can lead to more patient-friendly policies that promote medication adherence, reduce medication errors, and enhance overall patient satisfaction with health-care services.

Community pharmacists also have skills around medication management and the drug market, both of which are vital aspects that can contribute toward successful planning and execution of pharmaceutical policies inclined on achieving efficient operations for pharmacies while upholding the safety of health-care services they deliver to patients. Given the pivotal role that they play in detecting and resolving medication-related issues, their involvement in policy planning and execution has the potential to lead to the implementation of standardized medication safety procedures, promoting rational drug use, and reducing adverse drug events [16]. Further, these are professionals with comprehensive understanding of the medication market, drug pricing, and formulary management [11]. Consequently, through engaging them with their involvement and inclusion in pharmaceutical policy discussions, policymakers can present valuable knowledge around cost-saving measures without compromising patient care quality.

4.2. Emerging trends

In line with the above benefits and the findings of this study, emerging trends indicate that the expanded role of the community pharmacists needs to be appreciated at the health-care stakeholder levels, but the current literature shows that such appreciation and recognition are lacking, making it difficult for community pharmacists to receive the support they need to fully transition into wider roles than the traditional drug dispensing agents [17]. Community pharmacists and members of the public alike recognize the need for an enabling environment where community pharmacists can involve and be more impactful in shaping the pharmaceutical and health-care field through influencing policy planning and execution [18–20]. Nevertheless, such an environment is lacking due to a variety of barriers and challenges [21,22], from too authoritative health-care stakeholders to pharmaceutical management that does not appreciate the need for engaging community pharmacists in policy planning and executions [23–25].

Community pharmacists lack an in-depth understanding of the issues that can affect the efficiency of pharmaceutical operations for better economic performance [26]. Such challenge arises in part due to less involvement in the planning and execution of policies around economic strategies in the pharmaceutical field as well as shortcomings in the curriculum design for pharmacy students where important issues to help them acquire vital knowledge for understanding necessary concepts for better economic policies and strategies are not accorded the necessary attention [2]. In most of the current literature, there is a high-level lack of involvement of community pharmacists in matters related to economic strategies and planning in the pharmaceutical area [14]. There is hardly available literature on the involvement of community pharmacists in economic strategic planning both at the pharmacy and health-care sectors, a situation that warrants deeper investigation into the issue to understand the reasons why these important players in the health sector are not recognized and have their input integrated in the planning and execution of general policies as well as those focused on economic strategies in the health-care sector [27–29].

5. Conclusion

The community pharmacy role has expanded over the recent past years to enable pharmacists to serve diverse roles, but there is still a lack of involvement of these important stakeholders in the planning and execution of policies that shape service delivery and economics in the pharmaceutical industry. Very little involvement of community pharmacists is notable in the current literature on the policy planning and execution, and in the perspective of economic strategic planning community pharmacists are hardly involved. Consequently, it is vital that stakeholders in the pharmaceutical field and the wider health-care sector take note of the positive impact that community pharmacists can have in enhancing the quality of health-care services if fully involved in the planning and execution of different policies that shape the operations of the pharmaceutical and health-care sectors. A more proactive approach is inevitable and urgently needed from all core stakeholders to push for the involvement of community pharmacists in the planning and execution of policies, both at the general strategic planning and the planning of economic approaches for better efficiency in service delivery.

5.1. Limitations and directions for future research

A major limitation of the current systematic review is that it was based on studies published in the English-language. Other studies in different languages than English could contain information that could present different findings and perspectives on the study topic. Consequently, future research could focus on reviewing studies not done in the English language on the topic to evaluate whether the findings of the current study are supported outside the English language research publications. The study was also limited to studies published between 2012 and 2022, and future research could explore studies before 2012 to investigate whether there are different views on the topic of study. Noting that the current study assumed global equality in the role of community pharmacists within the health-care sector, future research could also focus on including elements of whether there are variations in how community pharmacists contribute into the health-care sector and ultimately whether presence of such differences affects their influence and involvement in the planning and execution of pharmaceutical policies and economics.

Article highlights

• Community pharmacists play a vital and expanded role in ensuring patient safety of care.

• The role has continuously expanded from the traditional limited space of drug dispensers to include other aspects like overseeing adherence to medical-related regulations within the pharmaceutical sector.

• Community pharmacists have good knowledge of community needs from a healthcare perspective as well as knowledge of medication management and the drug market. This knowledge can be vital if leveraged to guide the planning and execution of pharmaceutical policies.

• Despite these benefits, there is a high lack of involvement of these important stakeholders in the planning and execution of policies that shape service delivery and economics in the pharmaceutical industry.

• This lack of inclusivity for community pharmacists creates a challenge for them not to be up to date with issues that can affect the efficiency of pharmaceutical operations for better economic performance.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The researcher would like to acknowledge Dr Ahmed Fatehalrahman and Dr Saad Alqahtani, who helped in the screening of the research articles, for their inclusion in this study.

Additional information

Funding

This manuscript was funded by the Deanship of Scientific Research, Taif University.