Mapping the international research on pharmacists' prescribing to initiate medications: a scoping review

Pharmacists globally are increasingly involved in patient-centered care, including prescribing to initiate medication. This review aims to explore the extent and nature of research on pharmacists' prescribing to initiate medication, by country, research focus, study design, and key findings.

Scoping review according to the Arksey and O'Malley framework. Ovid MEDLINE, Ovid Embase, and CINAHL were searched from 2000 to 2024. Eligible studies were empirical research on pharmacists who initiated medication in any setting. Data were analyzed using descriptive statistics and content analysis.

A total of 188 studies were included, originating from the USA (49%), the UK (25%), Canada (21%), and other countries (5%). US studies were primarily conducted in community pharmacies and specialty clinics, focusing on reproductive health and infectious diseases. They used quantitative observational designs and reported improved clinical outcomes. UK studies, primarily in community settings integrated with general practice, focused on policy, often using qualitative and mixed-methods to document safe prescribing processes. Mostly conducted in community pharmacies, Canadian research employed quantitative designs, including randomized trials in cardiovascular disease, and reported economic benefit and improved surrogate clinical outcomes. Studies from other regions primarily reported early-stage feasibility research.

Researchers have been responsive to exploring pharmacist prescribing in the context of their respective health systems' needs. While research objectives and practice settings for examining pharmacist prescribing were similar, countries differed in diseases studied, study designs, and outcome measures. Future research is needed to explore pharmacists' clinical reasoning in medication initiation.