Abstract
BACKGROUND: Pharmacists are well positioned to contribute to the expansion of vaccination program outreach, owing to their high accessibility, pharmacotherapy knowledge, and patient-centered services. Over the past decade, the scope of pharmacy practice has progressively evolved, shifting from a product-oriented role toward more direct involvement in public health initiatives, including immunization. Despite this advancement, the full potential of pharmacists as immunization providers remains underutilized due to several barriers. OBJECTIVE: This systematic review aims to synthesize evidence on the barriers and facilitators of pharmacist-led vaccination services using the Consolidated Framework for Implementation Research (CFIR). METHOD: A comprehensive literature search was conducted across multiple databases (Ovid/Medline, EMBASE, ISI Web of Science, ProQuest Dissertations, PROSPERO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elsevier Science Direct, Health Management Information Consortium (HMIC), and Google Scholar. Studies were included if they focused on pharmacist-initiated vaccinations and reported relevant barriers or facilitators. The findings were mapped to CFIR. RESULTS: A total of 33 studies were included. Barriers to pharmacist-led vaccination services were reported in 32 studies. The main barriers in the Outer Domain were mainly fear of conflicting roles with physicians and public attitudes, lack of physician support, patient unwillingness to receive vaccinations in community settings, liability and regulation related issues, and reimbursement for pharmacist vaccination services. In the Inner Domain, lack of pharmacist training and lack of adequate facilities for delivering community pharmacy vaccination services were the main barriers. Facilitators in the Outer Domain were professional recognition, cooperation between pharmacists and healthcare centers, and financial remuneration. In the Inner Domain, immunization training was frequently considered as a crucial element. Under the Individual Characteristics Domain, opportunities to strengthen the pharmacist-patient relationship, pharmacist interest, patient trust, and patient demand were considered as key facilitators. CONCLUSION: This study identified the main barriers and facilitators to pharmacist-led vaccination services using the CFIR framework, primarily within the Outer and Inner Setting domains. Findings highlight the need for targeted training, regulatory support, and reorganized reimbursement. Future research should explore context-specific interventions and evaluate training effectiveness to advance pharmacist-led immunization.