Abstract
Increasing healthcare demands and physician shortages have prompted many countries to expand clinical responsibilities of pharmacists. Although Canada, the UK, and the US have implemented pharmacist prescribing, other nations lag behind. This review compares international roles, identifies inferred competencies, and explores implications for role expansion. A systematic search of MEDLINE, CINAHL, and the Cochrane Library was conducted using the PICO framework; studies were appraised with Critical Appraisal Skills Programme (CASP) checklists, and interrater reliability assessed via Cohen's Kappa. Data from 23 studies were thematically synthesized following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four themes emerged: (1) expanding clinical and public health roles and pharmacists' self-perceived readiness; (2) regulatory frameworks defining legal authority, qualifications, and temporary pandemic exemptions; (3) inferred competencies, including micro-skills (patient assessment, guideline application) and macro-capabilities (clinical judgment, accountability, reflective practice); and (4) contextual barriers such as training gaps, limited funding, unclear legal provisions, and workflow challenges. Implementation implications were synthesized and included training, funding, acceptance, and integration. Evidence indicates pharmacist prescribing is safe and patient-centered when supported by regulation, structured training, and systemic integration. Insights from established models can guide incremental implementation, optimizing medication management, enhancing healthcare access, and promoting equitable care.