Health equity in pharmacy services: A scoping review

Pharmacy services are well positioned to address health inequities by reducing barriers to care for underserved populations. Previous reviews have examined the role and attitudes of pharmacists towards health equity and equity-oriented initiatives among specific populations, without examining how equity is considered in service design.

To examine how health equity is considered in the design of pharmacy services and the reported effects of these equity-oriented services.

Two independent reviewers searched PubMed, Embase, PsycINFO, CINAHL, SCOPUS, and grey literature. Primary studies published in English, involving pharmacy personnel delivering services explicitly addressing health equity were included. PROGRESS-PLUS defined equity domains and the Socioecological Model classified services' level of influence. Outcomes were categorized using the Economic, Clinical, and Humanistic Outcomes model.

Sixty-eight studies were included from 1879 records, predominantly from high-income countries (97%). Socioeconomic status (56%), race/ethnicity/culture/language (54%) and place of residence (50%) were the most common equity domains studied. Most interventions were implemented at individual (81%) or institutional (82%) levels. Expanding service reach and access was the most common approach to addressing health inequities (66%). Few studies (4%) used equity frameworks in design and evaluation. Clinical outcomes were the most frequently evaluated (53%), with the majority reporting favorable effects.

Existing evidence reports impact of equity-oriented pharmacy services on a variety of clinical, humanistic, economic and process evaluation outcomes for underserved populations. Evidence from low- and middle-income settings is needed. Future research should explore the impact of social capital on outcomes and employ equity frameworks in service design and evaluation to strengthen comparability and transferability of evidence.