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March 14, 2026

Extended Pharmacy Services in Pakistani Community Pharmacies: A Cross-Sectional Assessment of Implementation Status, Barriers, andPractitioner Perspectives

AKAisha KamalUniversity of Karachi IMIftikhar MuhammadHoward University CWCalvin R. WeiHuafan University

Key Points

Evaluate the implementation status of extended pharmacy services in Pakistani community pharmacies and identify barriers and practitioner perspectives.
Conducted a cross-sectional mixed-methods survey in Karachi, Pakistan.
Utilized online and in-person questionnaires with 220 community pharmacy professionals.
Assessed EPS knowledge, perceptions, and demographic characteristics.
Validated the questionnaire’s reliability using Cronbach's alpha coefficient.
Medication Therapy Management was the most commonly offered service at 45.5%.
Primary barriers included workload and time constraints (56.4%), insufficient staffing (44.1%), and medication shortages (47.3%).
43.6% of respondents were familiar with EPS, but nearly half (49.5%) had no specialized training.
65.5% of respondents viewed EPS as valuable to healthcare, and 58% anticipated future expansion.

Abstract

Introduction: Extended pharmacy services (EPS) encompass comprehensive healthcare interventions beyond traditional medication dispensing, representing a paradigmatic shift toward patient-centered pharmaceutical care. While well-established internationally, EPS implementation remains limited in Pakistan due to regulatory gaps and insufficient public awareness. This study evaluated current EPS provision in Pakistani community pharmacies and identified key implementation barriers. Method: A cross-sectional mixed-methods survey was conducted between July toOctober 2024 in Karachi, Pakistan. Data collection utilized online and in-person questionnaires comprising 12 structured items addressing EPS knowledge, perceptions, and demographic characteristics among 220 community pharmacy professionals. The Questionnaire's reliability was validated using Cronbach's alpha coefficient (α = 0.705). Results: Among 220 respondents (127 pharmacists, 93 pharmacy technicians), Medication Therapy Management emerged as the most frequently offered extended service (45.5%). Primary implementation barriers included workload and time constraints (56.4%), insufficient staffing (44.1%), and medication shortages (47.3%). While 43.6% demonstrated EPS familiarity, 49.5% reported no specialized training. Most respondents perceived EPS as valuable healthcare additions (65.5%) and anticipated significant future expansion (58%). Discussion: Study findings reveal Pakistan's community pharmacy practice remains predominantly dispensing-focused despite growing recognition of expanded pharmacist roles nationwide. Barriers reflect significant systemic challenges requiring coordinated multisectoral interventions across regulatory, educational, and infrastructure domains to enable sustainable EPS implementation. Conclusion: Extended pharmacy services present significant opportunities for Pakistani healthcare advancement but require comprehensive paradigmatic shifts through legal frameworks, enhanced professional training, and increased stakeholder awareness to successfully transform community pharmacists into fully recognized clinical healthcare providers nationwide.

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