Expanding the role of community pharmacists: policymaking in the absence of policy-relevant evidence?

Background and objectives: Policies to expand the traditional role of community pharmacists have been implemented or at least considered in a number of countries, as advocated by academics, professional organizations, and governments. Such reforms come on the heel of pressing system-wide challenges. At a time of growing interest in evidence-based policymaking, what is the policy-relevant evidence base in support of this new expanded role for community pharmacists?

Methods: An umbrella review was conducted to identify published systematic reviews of evidence on the effectiveness of community pharmacist interventions. Findings of the identified reviews were documented according to Pharmaceutical Care and Total Pharmacy Care models, and evaluated on the basis of internal and external validity. The internal validity of identified reviews was evaluated in terms of the comparability of populations, interventions, and outcomes. External validity was based on the reproducibility and generalizability of review findings.

Results: Thirty-three systematic reviews published since 2000 evaluated the evidentiary support for the expanded role of community pharmacists, which focuses on two primary objectives: (1) to encourage the effective, safe and appropriate use of medicines and (2) to promote the prevention and management of chronic diseases. The results of most systematic reviews were mixed, with unclear policy relevance. Important methodological drawbacks were found in terms of study identification and selection, and comparability of interventions and outcomes. In addition, the external validity of the findings was inconclusive on the basis of reproducibility and generalizability.

Conclusions: There is inconclusive evidence in support of expanding the role of community pharmacists. This raises an important question: should the pharmacy profession only undertake tasks for which there is strong policy relevance with evidence of economic and public health benefits? In spite of this tension between the necessity to formulate new policies during a period of economic constraints and the level of corresponding evidence, several countries have begun entertaining policies to equip community pharmacists with patient-centered responsibilities. As implementing such expanded roles requires significant changes in the wider health care system, further research is needed to evaluate country-level policy developments.