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Rapid realist review of the role of community pharmacy in the public health response to COVID-19

Maidment, Ian; Young, Emma; MacPhee, Maura; Booth, Andrew; Zaman, Hadar; Breen, Juanita; Hilton, Andrea; Kelly, Tony; Wong, Geoff


Ian Maidment

Emma Young

Maura MacPhee

Andrew Booth

Hadar Zaman

Juanita Breen

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Dr Andrea Hilton
Reader and Programme director, Non-Medical Prescribing

Tony Kelly

Geoff Wong


Introduction Community pharmacists and their teams have remained accessible to the public providing essential services despite immense pressures during the COVID-19 pandemic. They have successfully expanded the influenza vaccination programme and are now supporting the delivery of the COVID-19 vaccination roll-out. Aim This rapid realist review aims to understand how community pharmacy can most effectively deliver essential and advanced services, with a focus on vaccination, during the pandemic and in the future. Method An embryonic programme theory was generated using four diverse and complementary documents along with the expertise of the project team. Academic databases, preprint services and grey literature were searched and screened for documents meeting our inclusion criteria. The data were extracted from 103 documents to develop and refine a programme theory using a realist logic of analysis. Our analysis generated 13 context-mechanism-outcome configurations explaining when, why and how community pharmacy can support public health vaccination campaigns, maintain essential services during pandemics and capitalise on opportunities for expanded, sustainable public health service roles. The views of stakeholders including pharmacy users, pharmacists, pharmacy teams and other healthcare professionals were sought throughout to refine the 13 explanatory configurations. Results The 13 context-mechanism-outcome configurations are organised according to decision makers, community pharmacy teams and community pharmacy users as key actors. Review findings include: supporting a clear role for community pharmacies in public health; clarifying pharmacists' legal and professional liabilities; involving pharmacy teams in service specification design; providing suitable guidance, adequate compensation and resources; and leveraging accessible, convenient locations of community pharmacy. Discussion Community pharmacy has been able to offer key services during the pandemic. Decision makers must endorse, articulate and support a clear public health role for community pharmacy. We provide key recommendations for decision makers to optimise such a role during these unprecedented times and in the future.


Maidment, I., Young, E., MacPhee, M., Booth, A., Zaman, H., Breen, J., …Wong, G. (2021). Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ open, 11(6), Article e050043.

Journal Article Type Review
Acceptance Date Apr 29, 2021
Online Publication Date Jun 16, 2021
Publication Date 2021-06
Deposit Date Apr 13, 2022
Publicly Available Date Apr 13, 2022
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 11
Issue 6
Article Number e050043
Keywords General Medicine
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Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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