Pharmacist-Led Prescribing in Austria: A Mixed-Methods Study on Clinical Readiness and Legal Frameworks

In Austria, pharmacists’ clinical responsibilities are shaped by two legal frameworks: one allows community pharmacists to dispense prescription-only medications in exceptional emergency cases without a physician’s prescription; the other permits hospital pharma-cists to adapt or discontinue therapy with prior physician approval. This mixed-methods study explores how Austrian pharmacists interpret and apply these frameworks, their readiness for expanded roles, and the systemic conditions required to support broader clinical engagement. A cross-sectional design was used with two online surveys targeting community and hospital pharmacists. Additionally, 15 semi-structured interviews were conducted (ten community, five hospital pharmacists). Quantitative data were analyzed descriptively; qualitative data were examined using Mayring’s content analysis. Data in-tegration followed a triangulation design via mixed-methods matrices. A total of 238 community and 53 hospital pharmacists responded. Findings show that community pharmacists frequently apply clinical judgment in urgent situations and navigate regula-tory grey zones. Over 88% support expanded roles, particularly in continuing contracep-tives, managing chronic diseases, and treating infections using point-of-care testing. Hos-pital pharmacists report limited implementation of their framework, hindered by institu-tional inertia, staffing shortages, and poor access to patient data. Confidence in clinical pharmacotherapy decisions was limited. Targeted training and policy support are essen-tial.