Although the conventional definition of a pharmacist is likely to be similar around the world, professional requirements and the pharmacist’s practice skills diverge widely across countries [
12]. While in some countries, such as Australia and India, pharmacists’ training and title (Bachelor in Pharmacy) match those requirements in Israel (or require an additional examination following graduation, as required in Canada), other countries have different training requirements and recognize pharmacists only after they acquire what Israel considers advanced degrees (Pharm.D. in the United States [US], or Master of Pharmacy [M.Pharm] in the United Kingdom [UK]). Moreover, health systems display vast differences across the world. Such variation further influences pharmacists’ training needs, skill sets, and service roles.
Perruadin et al. performed a systematic review to synthesize cost-effectiveness analyses on professional pharmacy services performed in Europe [
14]. Twenty-one studies were included, conducted in the UK (
n = 13), the Netherlands (
n = 3), Spain (
n = 2), Belgium (
n = 1), France (
n = 1) and Denmark (
n = 1). The authors reported that professional services to enhance medicine safety (interprofessional meetings to reduce errors,
n = 2) and access to medicines (minor ailment scheme,
n = 1) were in favor of their cost-effectiveness in the UK context, but the evidence was not sufficient. Eleven studies assessed professional services to improve treatment outcomes of individual patients-such as pharmaceutical care services, medication review, educational and coaching program, disease support service, medicines management and telephone-based advisory for improving adherence. Findings were contradictory and did not lead to strong conclusion. Screening programs for different diseases showed robust positive results (
n = 2) as well as smoking cessation services (
n = 5) and should be considered to be more widely available in accordance with national context. The authors concluded that their review provides arguments for the implementation services aimed at improving public health through screening programs and smoking cessation service; but full economic evaluations are needed to support or refute the added value of other services.
Specific non-dispensing/unconventional activities performed by pharmacists in the community setting around the world have been implemented, assessed, and described in the literature. Within the UK there have been several programs [
15] aimed at extending the role of the community pharmacist to include provision of services at time of changes in drug therapy, such as the “Help for HARRY discharge referral service”, where a referral is made to the patient’s chosen community pharmacy for advanced services (Medicines Use Review [MUR] or New Medicine Service [NMS]). A similar program (“Reablement Service”) has been offered on the Isle of Wight [
16]. Patients identified as being at a higher risk of readmission are assessed by a hospital pharmacist prior to discharge and a referral to a community pharmacist is made and a home visit arranged. During such visits a full medication review is carried out by the pharmacist. Twigg et al. reported on another service offered in some community pharmacies in England [
17]. This service, offered to patients over the age of 65 on 4 or more medications, involves pharmacist’s evaluation of the medications’ appropriateness, and discussions and consultations with the patients. Twigg et al. [
18], describe a multidisciplinary team led by a community pharmacist providing MTM (comprehensive medication review and self-management education) to geriatric patients (65+), high-risk, diabetic Medicare beneficiaries in the US. In another study [
19] conducted at an independent community pharmacy in the Midwest US, patients whose proportion of days covered (PDC; a measure of the percent of time that patients have their medication on hand, available for use) for their oral anti-diabetic medications was less than 80% were counseled by phone by a pharmacist. Abughosh et al. [
20] described a program involving a brief pharmacist telephone intervention to identify adherence barriers and improve adherence to certain medication classes in non-adherent patients with comorbid hypertension (HTN) and diabetes mellitus (DM) who were enrolled in a Medicare Advantage plan in Texas. Kovačević et al. described a study [
21] involving Serbian community pharmacies, in which pharmacists delivered a 30-min counseling session on asthma. Other single-intervention studies among asthmatics have been conducted in several countries (Schulz et al. in Germany [
22], García-Cárdenas et al. in Spain [
23], and Wong et al. in Malaysia [
24]). In a study by Närhi et al. [
25], 31 patients suffering from unstable asthma consulted with physicians, nurses, and at least once every 3 months with their community-pharmacists over the period of 1 year. A study by Stuurman-Bieze et al. [
26] included 1002 patients initiating lipid lowering therapy at 9 Dutch community pharmacies. The investigators utilized and assessed the effectiveness of a proactive pharmaceutical care intervention (Medication Monitoring and Optimization; MeMO) plan, that continued for a year, on the discontinuation rate and patient adherence as compared to a historical control group. In a study by Holdford and Inocencio [
27], conducted in rural Midwestern US, the investigators examined the appointment-based medication synchronization (ABMS) method on medication adherence and persistence with chronic medications. In the UK, pharmacists at 192 community pharmacies were trained to provide a first line, urgent care service for minor ailments under a campaign called “The Pharmacy First” [
28]. Immunization by pharmacists has also gained in popularity around the world. According to a 2016 report by the International Pharmaceutical Federation [
29], as of 2016, 13 countries authorized pharmacists to administer vaccines. Disease screening programs are available in community pharmacies in several countries. In 2012–2013 a pilot program in the UK offered a screening service in community pharmacies for early detection of COPD [
30]. Likewise, in many European countries, community pharmacists screen for high blood pressure, BMI and blood glucose and cholesterol levels [
31]. Also according to the report, bowel cancer screening programs are provided through pharmacies in Italy, Spain, and Switzerland. Examples of other chronic disease management programs and educational programs conducted in some European community pharmacies include diabetes management, asthma management, hypertension management, and smoking cessation. A more detailed description of all of the aforementioned activities is available in the Additional file
1.