Effectiveness and safety of pharmacist prescribing: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not pooled; individual study significance reported narratively

• Effect Size: No pooled effect size calculable (narrative synthesis). Of 153 outcomes: 74 (48%) showed no significant difference; 46 (30%) significantly favoured pharmacist prescribing; 4 (3%) favoured non-pharmacist prescribing; 29 (19%) had no inferential statistics reported

• Primary Outcome: Effectiveness and safety of pharmacist prescribing compared with non-pharmacist prescribing across 15 health conditions and 153 outcomes

• Nnt Or Sensitivity: Not calculable from available data; GRADE certainty rated low or very low for all outcomes, indicating high uncertainty around any effect estimate

• Confidence Interval: Not applicable — no meta-analysis conducted; individual study confidence intervals not pooled

Clinical Application

Pharmacist prescribing is already operational in several jurisdictions (USA, Canada, UK, Australia, Singapore). Implementation feasibility depends on jurisdiction-specific regulatory frameworks, collaborative practice agreements, and workforce capacity. The evidence suggests pharmacist prescribing is at minimum non-inferior to physician prescribing for most outcomes, supporting cautious expansion where regulatory frameworks permit. Cost-effectiveness data are absent, which is a critical gap for health system planning. Australia has a limited but evolving pharmacist prescribing framework. The Pharmacy Board of Australia and the Therapeutic Goods Administration (TGA) regulate pharmacist scope of practice. As of 2024, collaborative prescribing arrangements exist in some jurisdictions (notably Queensland's pharmacist prescribing pilot and the broader scope of practice reforms recommended by the Scope of Practice Review). Only two Australian studies were included in this review, reflecting the nascent state of Australian pharmacist prescribing research. The RACGP has expressed concerns about fragmentation of care with expanded pharmacist prescribing, and this review does not resolve those concerns given the low certainty of evidence. PBS implications of pharmacist prescribing authority (e.g., authority prescriptions, streamlined authorities) are not addressed. The findings are directionally supportive of policy expansion but insufficient to override existing RACGP and Australian Medical Association positions without higher-certainty evidence. Adults receiving pharmacist prescribing services across outpatient, primary care, community pharmacy, inpatient, emergency department, and long-term care settings for a range of chronic and acute conditions including but not limited to hypertension, diabetes, dyslipidaemia, anticoagulation, and infectious diseases

Abstract

OBJECTIVE: To examine the effectiveness and safety of pharmacist prescribing across multiple healthcare settings. DESIGN: A systematic review of quantitative studies. ELIGIBILITY CRITERIA FOR THE SELECTION OF STUDIES: Quantitative studies assessing the effectiveness and safety of pharmacist prescribing compared with non-pharmacist prescribing in any healthcare setting and for any healthcare population. A clear statement of pharmacists' prescriptive authority was required for inclusion in this systematic review. DATA SOURCES: A systematic search was conducted using six electronic databases: Embase (Ovid), MEDLINE (EBSCO), SCiELO, Dimensions AI, Cochrane Library and Epistemonikos. Database searches were conducted from database inception to 29 January 2025. Additional grey literature searches were conducted using Google and DuckDuckGo. Both backward and forward citation chasing were conducted for all included studies. DATA EXTRACTION AND SYNTHESIS: Data were extracted using standardised bespoke data extraction forms. The revised Cochrane Risk of Bias 2 tool for randomised controlled trials and the Risk of Bias in Non-Randomised Studies of Interventions tool were used to assess risk of bias. A narrative synthesis approach was applied following the Synthesis Without Meta-analysis guideline. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the level of certainty of the evidence. RESULTS: Of the 39 included studies, 32 studies reported on effectiveness and 20 studies reported on safety across 15 health conditions. Healthcare settings included outpatient (n=14), primary care (n=10), community pharmacy (n=6), inpatient (n=5), emergency department (n=1) and long-term care (n=3). These studies were based in the USA (n=26), Canada (n=5), the UK (n=4), Australia (n=2) and Singapore (n=2). In total, there were 153 outcomes related to safety and effectiveness. For 74 outcomes, no significant difference was reported between pharmacist prescribing and non-pharmacist prescribing, while 46 outcomes were significantly improved with pharmacist prescribing. Four outcomes reported in favour of non-pharmacist prescribing. Inferential statistics were not reported for 29 outcomes, meaning we cannot comment on their statistical significance. The certainty of evidence was low or very low for all outcomes. CONCLUSIONS: The consistency of effectiveness and safety findings across studies, showing either no significant difference (indicating equivalence of care and outcomes) or significant improvement in pharmacist prescribing groups, suggests it is a potential policy option. Future research on implementation, public and patient preferences and cost-effectiveness would provide valuable insights into the potential benefits of pharmacist prescribing at a health system level.

References

1. 1.Teahan, Á., Sharp, M., Farragher, A., Strawbridge, J., & Long, J. (2026). Effectiveness and safety of pharmacist prescribing: a systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2025-112886