A Systematic Review of Community Pharmacy-Led Depression Services: Service Components, Outcomes, and Implementation Barriers and Facilitators

Clinical Snapshot

Key Findings

• P Value: Not applicable — narrative synthesis only

• Effect Size: No pooled effect size calculated; individual study results varied. Services included depression advice/education (n=15), screening (n=12), medication adherence (n=4), medication review (n=1), and disease therapy management (n=1).

• Primary Outcome: Narrative synthesis of service components, clinical/humanistic/economic/service outcomes, and implementation barriers and facilitators across 50 included studies. Clinical outcomes were the most commonly reported but showed varied results across studies.

• Nnt Or Sensitivity: Not reported; screening services used validated tools (e.g., PHQ-9) in some studies but sensitivity/specificity data were not pooled. No NNT calculable from available data.

• Confidence Interval: Not applicable — no meta-analysis performed

Clinical Application

Feasibility is supported by the accessibility of community pharmacies and generally positive staff and public attitudes identified in the review. However, implementation is constrained by funding limitations, absence of private consultation infrastructure in many pharmacies, variable pharmacist training in mental health, and limited integration with primary care and mental health teams. Standardised service models and validated referral pathways are not yet established. In Australia, community pharmacies are highly accessible, with over 5,600 pharmacies nationally and no appointment required for consultation. The Pharmacy Guild of Australia and the Pharmaceutical Society of Australia have advocated for expanded pharmacist scope of practice in mental health. The 7th Community Pharmacy Agreement (7CPA) and its successor funding frameworks provide a potential vehicle for formalising depression-related pharmacy services. The PBS funds antidepressants including SSRIs and SNRIs, making medication adherence support a natural pharmacy role. However, MBS-funded mental health services (e.g., Better Access initiative, Mental Health Treatment Plans under GP item 2715) are GP-led, and formal integration of pharmacist-led depression services into these pathways is not yet established. RACGP guidelines emphasise collaborative care for depression, which aligns with the review's finding that inter-professional collaboration is a key facilitator. TGA scheduling of antidepressants as Schedule 4 (prescription-only) means pharmacists cannot initiate pharmacotherapy but can play important roles in screening, adherence, and referral. State-based pharmacist prescribing pilots may eventually expand this role. Adults with depression or at risk of depression who access community pharmacy services; particularly relevant for populations with limited access to primary care mental health services, those on antidepressant therapy requiring adherence support, and individuals who may present to pharmacy before engaging with formal mental health services

Abstract

BACKGROUND: Depression is the most common mental ill health condition, and its prevalence is increasing. Despite this, its treatment is variable often due to a lack of capacity within healthcare systems to support this vulnerable population. Community pharmacy staff could offer additional support. This systematic review identifies depression services led by community pharmacy staff, their service components, outcomes, and barriers/facilitators to their implementation. METHODS: Four bibliographic databases were searched (Medline, EMBASE, PsycINFO, and CINAHL) from 2000 onwards. Title/abstract and full-text screening was conducted. Data on the service components were mapped to the Template for Intervention Description and Replication (TIDieR). Clinical, humanistic, economic, and service outcomes were charted. Barriers and facilitators were mapped to the Consolidated Framework for Implementation Research (CFIR). Quality assessment was performed using the Quality Assessment with Diverse Studies (QuADS) tool. RESULTS: Fifty studies were included. Seventeen studies identified general attitudes regarding community pharmacy services for depression, which were generally supportive. The majority (n = 33) explored an implemented depression service focusing on depression advice/education (n = 15), screening (n = 12), medication adherence (n = 4), medication review (n = 1), and disease therapy management (DTM) (n = 1). Clinical outcomes were the most commonly reported types of outcomes, with varied results. Key facilitators were linked to the pharmacy 'inner setting', including accessibility of community pharmacies, the use of private consultation rooms, and skills/training of staff. Barriers to service delivery related often to the external 'outer setting', especially societal stigma, low public awareness of pharmacy roles, funding constraints, and limited collaboration with other healthcare professionals. CONCLUSION: This international review identified a range of different services that community pharmacy staff can deliver to support people with depression, ranging from supporting diagnosis, health literacy, and management plans. The accessibility of community pharmacies for depression service delivery warrants further investigation. However, limited empirical evidence of clinical and economic outcomes and reported implementation barriers may complicate broader implementation.

References

1. 1.Kernaghan, D., Alshammari, H., Akram, G., Pratt, J., Maxwell, M., Watson, M. C., & Weir, N. (2026). A systematic review of community pharmacy-led depression services: Service components, outcomes, and implementation barriers and facilitators. Depression and Anxiety. https://doi.org/10.1186/s43058-023-00409-3