Structural barriers and implementation opportunities for clinical pharmaceutical care in panamanian community pharmacies

Abstract

This study aimed to analyze structural barriers and implementation opportunities for clinical pharmaceutical care in Panamanian community pharmacies by integrating scientific evidence and the national regulatory framework. A scoping review of academic literature (PubMed/PMC, BMC, Scielo and selected regional grey literature) and a documentary analysis of Panama’s regulatory instruments were conducted. Findings were grouped into five domains: (1) regulation and governance, (2) service organization and business model, (3) financing and remuneration, (4) workforce capacity and infrastructure (including digital interoperability), and (5) health culture and  interprofessional  collaboration. Recurring barriers included  lack of financial incentives for clinical services, heterogeneous applied clinical training, limited physical space/privacy/time, low integration with primary care, and governance still oriented to medicines as products rather than longitudinal pharmacotherapy follow-up. Opportunities were also identified: recent regulatory reforms in medicines; regional positioning of pharmacies as accessible primary care entry points; and international policy statements recommending full integration of pharmacists within health systems. Panama shows partial enabling conditions but requires a phased implementation agenda including service-based payment models, minimum standards for infrastructure and documentation, certifiable training pathways, and interoperability with the broader health system.