Pharmacist-Led Prescribing in Austria: A Mixed-Methods Study on Clinical Readiness and Legal Frameworks

In Austria, community pharmacists may dispense prescription-only drugs in exceptional emergency cases. Hospital pharmacists are permitted to adapt or discontinue therapy with prior physician approval. This mixed-methods study explores how Austrian pharmacists interpret and apply these frameworks, their readiness for expanded roles, and the systemic conditions required to support broader clinical engagement. A cross-sectional design was used with two online surveys targeting community and hospital pharmacists. Additionally, 15 semi-structured interviews were conducted (ten community, five hospital pharmacists). Quantitative data were analyzed descriptively; qualitative data were examined using Mayring's content analysis. Data integration followed a triangulation design via mixed-methods matrices. A total of 238 community and 53 hospital pharmacists responded. Findings show that community pharmacists frequently apply clinical judgment in urgent situations and navigate regulatory grey zones. Over 88% support expanded roles, particularly in continuing contraceptives, managing chronic diseases, and treating infections using point-of-care testing. Hospital pharmacists report limited implementation of their framework, hindered by institutional inertia, staffing shortages, and poor access to patient data. Confidence in clinical pharmacotherapy decisions was limited. Targeted training and policy support are essential.