Identifying outcomes for evaluating the impact of pharmacist prescribing: A rapid overview of reviews

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Identifying outcomes for evaluating the impact of pharmacist prescribing: A rapid overview of reviews Ahmed Hassan Ali , Anais Essilini , Aaron Daunt , Michelle Flood , Caroline McCarthy , Judith Strawbridge , Barbara Clyne , Frank Moriarty doi: https://doi.org/10.1101/2025.09.04.25334869 Ahmed Hassan Ali a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Anais Essilini a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Aaron Daunt a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Michelle Flood a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences b RCSI PPI Ignite Network, Office of Research and Innovation, RCSI University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Caroline McCarthy c Department of General Practice, RCSI University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Judith Strawbridge a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Barbara Clyne d Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site Frank Moriarty a School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: frankmoriarty{at}rcsi.ie Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Objectives Given the expansion of pharmacist prescribing, this study aims to identify and categorise outcomes reported in research evaluating impacts of pharmacist prescribing specifically for minor ailments (or common conditions) and in other broader contexts. Methods A rapid overview of reviews was conducted, searching PubMed, Embase, Cochrane Database of Systematic Reviews, and Epistemonikos using keywords relating to pharmacy/pharmacists, prescribing or minor ailments schemes, and evidence syntheses. Reviews evaluating the impact of any aspect of pharmacist prescribing were included if they reported ≥1 outcome assessing the impact of pharmacist prescribing. Data extraction focused on the clinical settings, disease areas/conditions, prescribing models and reported outcomes. Results Of 43 reviews included, 14 reported on outcomes of pharmacist prescribing in minor ailments, and 35 reviews in broader contexts (some reporting both). Outcomes were categorised as clinical, drug-related/prescribing, patient-reported/experience, and economic/other outcomes. For minor ailments, 14 outcomes were identified, most frequently clinical cure or symptom resolution, and cost of service delivery (both reported in n=8 reviews). In other prescribing contexts, 12 outcomes were reported, with general satisfaction being the most common (n=18), followed by clinical effectiveness and healthcare resource use (both n=15). Conclusions Capturing impact of pharmacist prescribing requires assessment of outcomes across multiple dimensions. Background Global healthcare systems are experiencing a shortage of skilled health care professionals, which is burdening primary care services, causing delays in access and increasing pressure on emergency departments and secondary care. 1 , 2 , 3 Therefore various countries, including the United Kingdom (UK), Canada, the United States of America (USA), Australia, New Zealand, and France, have implemented strategies to expand the roles of healthcare professionals through task-shifting approaches. 1 , 2 These measures include granting prescribing authority to additional healthcare professionals, such as pharmacists to improve patient care outcomes without compromising safety, improve patient access to treatment, and make better use of existing clinical expertise. 3 , 4 Pharmacist prescribing varies significantly between and even within countries, particularly with respect to terminology and the extent of prescriptive authority. 5 , 6 In the UK, independent pharmacist prescribers are legally authorised to assess patients, make clinical decisions, and prescribe autonomously within their clinical competence without direct supervision. 7 In Canada and the USA, prescribing authority differs by province and state, ranging from no prescribing rights to initiating prescriptions for specific indications and independent authority. 5 , 6 In other countries like Brazil and New Zealand, dependent or collaborative models apply following a prior medical diagnosis and collaborative agreements with medical prescribers. 6 , 8 In Ireland, a phased implementation of pharmacist prescribing is proposed, starting with common conditions in community pharmacy and progressing to full prescribing authority across primary and secondary care, in line with pharmacists’ scope of practice and competence. 9 Expanding pharmacists’ roles through prescriptive authority is intended to alleviate the burden on overextended healthcare systems and enhance access to care. 1 , 2 It has also been linked with a range of positive clinical impacts, such as better glycaemic and hypertension management, improved quality of life for patients with chronic conditions, and enhanced prescribing practices (e.g. medicines optimisation/deprescribing). 2 , 10 , 11 , 12 However, evaluation of such role expansion to assess the effects (both intended and unintended) is important to assess whether changes are beneficial. Understanding the outcomes that have been used to evaluate the impact of pharmacist prescribing in a structured way can add coherence to the literature to-date and support alignment of future research on this topic. Therefore, this review aims to identify and categorise the outcomes synthesised in the literature on evaluation of the impact of pharmacist prescribing, guiding the identification of core outcomes and providing a foundation for more robust service evaluation. Methods This was a rapid overview of reviews, for which a protocol was registered on Open Science Framework at the stage of title/abstract screening, 13 and reported in line with the preferred reporting items for overviews of reviews (PRIOR) statement. 14 A rapid overview of reviews was selected because of the need to identify outcomes within a constrained time period within a broader research project, and because synthesised evidence on evaluations of pharmacist prescribing was appropriate for identifying outcomes used. 15 Eligibility criteria and search strategy Table 1 outlines the full eligibility criteria. A search string was developed reflecting the eligibility criteria, combining keywords and subject headings relating to the concepts of pharmacy or pharmacists, prescribing or minor ailments schemes, and systematic or other reviews. The search was conducted from database inception to 29 th November 2024 in the following databases: PubMed, Embase, Cochrane Database of Systematic Reviews, and Epistemonikos. Full search strategies are included in Appendix 1. View this table: View inline View popup Table 1. Inclusion and exclusion criteria Screening and full-text review Records from searches were uploaded to Covidence (Veritas Health Innovation, Melbourne, Australia), where duplicate records were removed. Screening was then conducted to exclude records clearly not meeting eligibility criteria based on title and abstract. Remaining records progressed to full-text review, where they were assessed against the eligibility criteria. For both stages, each record was reviewed independently by two reviewers (of AE, AD, AHA, or FM), with disagreements resolved by consensus. Data extraction and synthesis For included reviews, data extraction focused on the review characteristics e.g. study details, type of pharmacist role examined (for common condition/minor ailments and other pharmacist prescribing), any restriction in setting, specific patient population(s), or other aspects, extracting details of the outcomes used to assess effect/impact. A narrative synthesis was conducted, mapping outcomes to the taxonomy developed by Dodd et al . 16 For the purpose of the current review, which aimed to explore and describe the body of evidence concerning the relevant outcomes of pharmacist prescribing, results of all included reviews were considered regardless of any overlap, and no quality appraisal was conducted to enable rapid identification of outcomes used. 17 , 18 , 19 Results Of 1,727 articles initially retrieved, 1,152 articles underwent title/abstract screening where, 1,056 were excluded for not meeting the inclusion criteria. Ninety-six full texts were reviewed and 43 reviews fulfilled the eligibility criteria (see Figure 1 ). Download figure Open in new tab Figure 1. Flow chart of process of including eligible reviews within the overview of reviews Characteristics of the studies The included reviews, published between 2008 and 2024, primarily consisted of systematic (n=30) and scoping reviews (n=10), with 3 overviews of reviews. The reviews included studies conducted across various healthcare settings, including community pharmacies, primary and secondary care, emergency departments, outpatient clinics, and nursing homes (Appendix 2). The types of prescribing examined across the included reviews encompassed varying levels of pharmacist authority in medication management. These included dependent, collaborative, supplementary, and independent prescribing and non-medical switching. The included studies covered diverse disease areas such as cardiovascular disease, diabetes, mental health, chronic kidney disease, oncology, perioperative care, and self-limiting and minor ailments. Overall, 14 out of 43 reviews reported outcomes assessing the impact of pharmacist prescribing for minor ailments. Thirty-five reviews examined the impact of pharmacist prescribing for management of acute and chronic diseases beyond minor ailments (six covered prescribing in both minor ailments and other prescribing contexts). Outcomes for prescribing for minor ailments and other contexts Tables 2 and 3 summarise the outcomes that were identified as assessing the impact of pharmacist prescribing for management of minor ailments and other pharmacist prescribing (with review-level results in Appendices 3-6). Outcomes were grouped into four categories: clinical; drug-related and prescribing; patient reported and experience; and economic and other related outcomes. View this table: View inline View popup Table 2. Outcomes reported for evaluating pharmacist prescribing for minor ailments (n=14 reviews) View this table: View inline View popup Table 3. Outcomes for evaluating Other Pharmacist Prescribing (n=35 reviews) For minor ailments, 14 outcomes were identified. The outcomes evaluated in the most reviews were “Clinical cure or symptom resolution/improvement” and “Cost of service delivery”, both reported in 8 of 14 reviews. For other pharmacist prescribing, 12 outcomes were identified, with “General satisfaction” reported in the most reviews (n=18), followed by “Clinical Effectiveness” and “Resource use due to healthcare utilisation” (both n=15). Discussion Summary of main findings This rapid overview synthesised evidence from 43 reviews (systematic, scoping and overviews of reviews) to identify outcomes used to evaluate pharmacist prescribing for minor ailments and other broader clinical contexts from international settings. Across the 14 reviews covering pharmacist prescribing for minor ailments, 14 outcomes were reported, while from 35 reviews in other pharmacist prescribing contexts, 12 outcomes were reported. These identified outcomes broadly encompass clinical, drug-related and prescribing, patient-reported experiences, and economic dimensions, reflecting a comprehensive framework for assessing pharmacist prescribing services. 1 , 2 Several outcomes were frequently cited for evaluating pharmacist prescribing, regardless of the prescribing or clinical context. These include outcomes relevant to clinical improvement, patient experience, cost of care, access to care and guidelines’ concordance/appropriateness of medications. However, some outcomes, such as mortality, prescribing patterns, resource use and GP workload, were context-dependent and more frequently reported in specific clinical or prescribing settings. Symptom improvement or clinical cure was the most frequently reported clinical outcome of pharmacist prescribing for minor ailments. Similarly, clinical effectiveness and improvements in chronic disease (e.g. blood pressure and glycaemic control, attainment of therapeutic goals) were among the most frequently reported clinical outcomes in evaluating pharmacist prescribing for other broader clinical contexts (e.g. cardiovascular disease, diabetes, mental health). Notably, mortality was cited in identified reviews as an outcome for evaluating the impact of pharmacist prescribing in contexts beyond minor ailments, underscoring the potential for pharmacist prescribing to impact complex, multifactorial and clinically significant endpoints. Adherence to guidelines and appropriateness of medication were commonly synthesised outcomes in reviews evaluating pharmacist prescribing in minor ailments and other contexts. A key finding in identified reviews evaluating prescribing in the broader context beyond minor ailments was the inclusion of detailed prescribing patterns, which encompassed prescribing rates and medication changes/discontinuations. Evidence suggested that pharmacist prescribing was associated with increased initiation of evidence-based therapies in eligible patients (e.g. antihypertensives, statins, aspirin, contraceptives), more frequent dose changes, and improved deprescribing practices. 5 , 30 In mental health, pharmacist prescribing improved prescribing patterns, most commonly reducing the dosage and absolute number of psychotropic drugs. 38 This emphasises pharmacists’ role in optimising pharmacotherapy, potentially reducing medication-related harms. Patient-reported outcomes such as patient experience and satisfaction and access to the care were frequently reported across reviews evaluating the impact of pharmacist prescribing in minor ailments and other contexts across primary and secondary care settings. These outcomes were extensively explored, addressing various aspects, including access to medicines, quality and comprehensiveness of the service, professional relationship, interpersonal communication, continuity and coordination, trust in healthcare providers, patient-reported impacts of care and patient–knowledge and adherence to prescribed medicines. 26 , 52 , 58 The ease of accessing a pharmacist, avoiding delays associated with physician appointments, and the convenience of receiving care when medical clinics were unavailable or when patients lacked a regular physician were among the common reasons for choosing a pharmacist prescriber for management of minor ailments and other conditions. 5 This underscores the potential impact of adopting pharmacist prescribing, not only on patient outcomes but also on more efficient use of healthcare resources. Implications and future directions The identification and synthesis of outcomes across multiple domains demonstrate the variety of potential impacts of pharmacist prescribing, and the findings could support consistent evaluation for pharmacist prescribing. Future studies evaluating pharmacist prescribing, or reviews of such studies, should consider aligning their outcome measurement and synthesis with this structure. However, further work to refine definitions and outcome measures to capture these outcomes would be beneficial. The identified outcomes could inform core outcome set development, and have already been used within a Delphi study to identify critical outcomes for pharmacist prescribing in Ireland. Strengths and limitations The use of an overview of reviews is appropriate to summarise the extent of previous synthesised evidence on a topic, and given the availability of more than 40 systematically conducted reviews which included studies evaluating the effect of pharmacist prescribing. Although it employed many features of a standard overview of reviews, including structured searches of multiple databases and screening and full-text review by two independent reviewers, data extraction was conducted by one reviewer and critical appraisal of included reviews was not conducted (as this was less relevant given the focus of the research question). In addition, by focusing on systematic and scoping reviews, we were unable to include primary studies published since reviews were conducted which may have added further outcomes. However, any outcomes that were not identified in the high number of reviews included would be unlikely to be critically important. Additionally, primary study overlap across the reviews was not quantified. While critical appraisal and overlap identification are important for ensuring reliable conclusions, their omission aligns with circumstances where rapid review methods are tailored to the timeframe and available resources, particularly when conducted for policymakers. 18 Similar to other reviews, we were unable to clearly define the model of prescribing in some reviews concerning minor ailments, as many included reviews frequently included such conditions but did not clearly delineate the role or scope of independent pharmacist prescribers. 2 Conclusions This rapid overview identified the most frequently synthesised outcome domains for evaluating pharmacist prescribing in minor ailments and other contexts. The identified outcomes encompass clinical, drug-related and prescribing, patient-reported experiences, and economic and other related dimensions. The significance of specific outcomes within these domains are contextually dependent and reflect the acuity of minor ailments versus the chronicity and complexity of managing other conditions. Future research should incorporate core outcome sets to prioritise and standardise outcome measures and definitions, and to enable more robust and setting-specific conclusions on the significant outcomes that appropriately capture the value of pharmacist prescribing across diverse healthcare landscapes. Data Availability All data produced in the present study are available upon reasonable request to the authors Footnotes Declaration of interests No interests to declare References 1. ↵ Mesbahi Z , Piquer-Martinez C , Benrimoj SI , Martinez-Martinez F , Amador-Fernandez N , Zarzuelo MJ , Dineen-Griffin S , Garcia-Cardenas V. Pharmacists as independent prescribers in community pharmacy: A scoping review . 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