Abstract / Summary
Pharmaceutical indication and pharmacist prescribing have become strategies for expanding the capacity of primary care, particularly in the management of minor symptoms and low-complexity clinical conditions. This narrative review, guided by the SANRA domains, integrated scientific, regulatory, and institutional evidence identified through PubMed/MEDLINE, ScienceDirect, and Google Scholar, supplemented by grey literature from regulatory bodies, health services, and professional organizations, to comparatively characterize regulatory and practice models described across jurisdictions. Four main configurations were identified: pharmaceutical indication, protocol-based models, collaborative prescribing, and independent prescribing, with heterogeneous implementation internationally. Available evidence reports favorable outcomes in some services, including improved accessibility, high user satisfaction, and a potential shift in consultations from other healthcare settings to community pharmacy; however, heterogeneity in study designs, settings, and outcome measures, together with the predominance of observational and implementation studies, limits the certainty of these findings. Rather than demonstrating the superiority of a particular level of professional autonomy, the literature consistently shows that structured models incorporate clinical protocols, eligibility criteria, red-flag assessment, safety-netting, referral, and documentation. Effective implementation also requires consideration of professional training, care integration, documentation systems, and sustainable funding mechanisms. In Latin America and Costa Rica, the literature documents frequent pharmaceutical consultation and indication practices, although with variable levels of formalization and standardization.