Development of a framework for pharmacist recommended medicines

Abstract

Improving access to medicines is widely recognised as a key factor for better patient outcomes, particularly within primary care settings where timely treatment is essential¹. The criteria used to determine which medicines are appropriate for pharmacist recommendation remain inconsistent and highly variable across jurisdictions. The aim was to design and validate a structured, evidence based framework which may be used to identify medicines that may be appropriately classified as pharmacist recommended medicines (PRMs). A focus group discussion was conducted with eight healthcare professionals, comprising two regulatory pharmacists, two community pharmacists, two hospital pharmacists, and two general practitioners. This multidisciplinary group defined the framework’s sections and domains, assigned relative weightings according to perceived impact on patient health, and developed the scoring equation used for PRM categorisation. Domain-specific options were identified through a targeted review of literature. Inclusion criteria for the literature included studies published in English, free full access, published between 2016-2026 and peer reviewed. Another focus group composed of three subject-matter experts for each section of the framework was convened to determine the scores for each option. The resulting framework underwent face and content validation by five community pharmacists to ensure clarity, relevance, and practical applicability. The final framework consisted of 34 domains distributed across four sections: (A) Patient Safety, (B) Access to Medicines, (C) Overall Cost to Patients and the Healthcare System, and (D) Overall Risk. Consensus was reached for 77 of the 122 scoring options, with most disagreements arising in Section A, where participants were unable to agree on 18 of the 38 options. For options without consensus, mean scores were applied to ensure balanced representation of all expert opinions. Each section was weighted according to its relative importance, and the weighted section scores were aggregated to generate an overall score. This score was then normalised against the score of a “ideal medicine.” The ideal medicine was defined as a medicine which provides the maximum benefit, i.e. obtains maximum scores in section A (+300), section B (+100) and section C (+200), and has no threats with a zero score in section D (0). Based on the final value, each medicine was classified into one of three categories: 1) May be considered as PRM (67%-100%), 2) May be considered as PRM with guidelines (34%-66%), 3) Shall only be recommended by physicians (0%-33%). This study provides a validated, structured framework to categorise pharmacist recommended medicines, integrating expert consensus, weighted scoring, and practical evaluation. Its application may support more consistent decision making, enhances access to medicines, reduce the burden on general practitioners and the healthcare system, and strengthen the pharmacist’s role in improving patient outcomes within primary care.