Pharmacist independent prescribing in Middle Eastern countries: Insights from a systematic review of awareness, readiness, and barriers to implementation

Background: Independent Prescribing Practice (IPP) by pharmacists has been internationally recognized as an effective strategy to improve healthcare access, optimize medication use, and reduce physician workload. This review aimed to examine pharmacists' awareness, readiness, attitudes systematically, and perceived barriers and facilitators toward implementing IPP in selected Middle Eastern countries. Methods: A systematic review followed the PRISMA 2020 guidelines for conducting and reporting systematic reviews and the Cochrane Handbook guidelines. PubMed, Web of Science, regional journals, and the grey literature published between 2015 and 2025 was systematically searched using predefined keywords related to pharmacist prescribing. Eligible studies were quantitative, peer-reviewed (qualitative studies were excluded), and focused on pharmacists' readiness or perceptions of IPP in the Middle East. Data on study characteristics, awareness, readiness, barriers, and facilitators were extracted and synthesized descriptively. Results: Nine cross-sectional studies from Saudi Arabia, Jordan, and the United Arab Emirates (UAE), involving pharmacists, were included in this analysis. Pharmacists demonstrated high readiness and positive attitudes toward IPP, acknowledging its potential to enhance patient access and improve healthcare efficiency. However, implementation remains limited by the absence of legal frameworks, insufficient diagnostic training, and weak interprofessional collaboration. Identified facilitators included national health reforms, professional development initiatives, and institutional support for expanding clinical roles. Conclusion: Pharmacists in Saudi Arabia, Jordan, and the UAE demonstrate readiness to adopt independent prescribing; however, evidence is limited to these countries and cannot be generalized to the wider Middle East. Structural, regulatory, and educational barriers persist, highlighting the need for context-specific policy and training frameworks.