**3. Extended pharmacy services**

It is noted that there is a wide range of extended pharmacy services available in many countries throughout the world as illustrated in **Table 2** [9–37]. In the absence of Pakistan's scenario [38], other such extended services divulge the true color of CPs' knowledge and skills in an authentic practice. For example, it is noted that CPs in Australia are operating supreme services such as anticoagulant and drug-level monitoring, ostomy counseling, chemotherapy, parenteral, and nutrition preparation. In Canada, it is noted that CPs are executing the roles to advocate their customers for alcohol consumption, smoking cessation, physical activities, and immunization. Interestingly, CPs in the developing country like Sudan are making available services such as emergency oral contraception counseling, hyperlipidemia monitoring, and hypertension care. However, the prominence extended service notified in the table is the provision of pharmaceutical care (PC) in community pharmacy settings as noted in Japan, Hong Kong, China, and the United Arab Emirates. Such extended service is also notified in other countries like Peru [39] and Estonia [40]. It divulges PC as a paramount importance to be performed in the healthcare system side-by-side with other extended services.

**Extended services: Country published [Article #]**

Advising on healthy diets: Canada [17]

Offering a body piercing service: Aust [13] Chemotherapy preparation: Aust [13]

Community clinic service: Aust [13], Mal [36, 37]

Geriatric care service: Aust [13], Japan [26, 28] Harm reduction methadone service: Aust [13]

Drug misuse counseling: Mal [30]

Referring patients to GPs: Mal [32]

[23], UAE [19, 22], Mal [30, 31, 32, 34]

Naturopathy counseling: Aust [13]

Ostomy counseling: Aust [13]

Pediatric pharmacy service: Aust [13]

Osteoporosis care service: Aust [13], Japan [26]

Counseling on physical activities: Canada [17], Mal [30, 35]

Drug-level monitoring or kinetic dosing service: Aust [13]

Diabetes care service: Aust [13], Canada [17], UAE [19, 22], Mal [30]

Emergency oral contraception counseling: Canada [17], Sudan [23]

Service for patients discharged from hospital settings: Aust [13], Netherlands [12]

Herbal and nutritional supplement counseling: Aust [13], UAE [19], Mal [30, 35]

Minor ailment or self-care consultation: Sin [9], HK [29], China [15], UAE [19], Mal [32]

Nutritional support including parenteral and enteral nutrition service: Aust [13]

Hyperlipidaemia monitoring service: Aust [13], Canada [17], Sudan [23] Hypertension care service: Aust [13], Canada [17], Sudan [23], Mal [30, 35]

Immunization program service: Canada [17], UAE [22], Mal [30]

Lifestyle modification counseling: HK [27], Canada [17], UAE [19]

Organizing aboriginal health services: Aust [13] Counseling on alcohol consumption: Canada [17] Running an anticoagulation monitoring: Aust [13] Deliver an asthma care: Aust [13], UAE [22], Mal [30]

Determine DRP: Jordan [14], Netherlands [12], China [15], Sudan [23], UAE [22], Mal [32] Legal right to prescribe selected medications: United Kingdom [11], Aust [16], South Africa [18]

Proffer the pharmaceutical care concept: Japan [28], HK [29], China [15], UAE [20, 22]

Managing a SC program: Japan [28], Aust [13], Canada [17], Sudan [23], UAE [19], Mal [30, 32, 35]

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Community health education: Aust [13], Sin [9], HK [27], China [15], Sudan [23], UAE [22], Mal [30, 32]

Medication counseling or review: Nepal [25], Netherlands [12], Sin [9], HK [27, 29], China [15], Russia [10], Sudan

There are a lot of earlier studies which disclose such extended service has accomplished positive end results via an authentic practice. For example, it is noted that CPs in Spain are having the quality necessary to exalt medication adherence among the hypertensive patients [41]. In Australia, CPs have executed the role to ameliorate the clinical and humanistic net results among patients who possess type 2 diabetes [42]. Another pharmaceutical care study in Malaysia discloses the potential of CPs to diagnose a wide range of potential undesirable drug-related problems among their customers [43]. It is also notified that there is a review article which divulges the positive impact of smoking cessation program performed by CPs [44]. Consequently, these significant positive impacts are putting on a screen for the consumers and other healthcare practitioners to acknowledge the roles of CPs in community pharmacy settings. Additionally, it might inspire other CPs to persuade the exact service for the benefits of their customers.

Even though there are some CPs who might operate their extended services without demanding dollars as a price from their customers for a service rendered, it is essential to reimburse CPs for their knowledge and skills. For example, an earlier review article has pointed out 60 reimbursement programs for CPs in the United States, Canada, Europe, Australia, and New Zealand [45]. Such reimbursement comprises of payment as such for emergency contraception counseling, advice on minor ailments, comprehensive medication management, medication review, follow-up visit, and time-dependent fee. It is noted that there are variable charges in different countries for the similar extended services. It discloses that the charges must take into account of knowledge, skills, and time exercised by CPs to perform the extended services [46]. Consequently, CPs are given the image as a professional healthcare practitioner like GPs rather than as an entrepreneur.

Nevertheless, it is crucial to perform a systematic inquiry to notify the facts of barriers and perception among the consumers and other healthcare providers so as to establish the truth of these extended services. Such inquiry might intensify the truth operation of these extended services in an authentic practice. Over and above that, the facts and figures which put into picture might have potential to manoeuvre CPs to instigate a strategy formula to get rid of them.


**3. Extended pharmacy services**

132 Marketing

rather than as an entrepreneur.

It is noted that there is a wide range of extended pharmacy services available in many countries throughout the world as illustrated in **Table 2** [9–37]. In the absence of Pakistan's scenario [38], other such extended services divulge the true color of CPs' knowledge and skills in an authentic practice. For example, it is noted that CPs in Australia are operating supreme services such as anticoagulant and drug-level monitoring, ostomy counseling, chemotherapy, parenteral, and nutrition preparation. In Canada, it is noted that CPs are executing the roles to advocate their customers for alcohol consumption, smoking cessation, physical activities, and immunization. Interestingly, CPs in the developing country like Sudan are making available services such as emergency oral contraception counseling, hyperlipidemia monitoring, and hypertension care. However, the prominence extended service notified in the table is the provision of pharmaceutical care (PC) in community pharmacy settings as noted in Japan, Hong Kong, China, and the United Arab Emirates. Such extended service is also notified in other countries like Peru [39] and Estonia [40]. It divulges PC as a paramount importance to

be performed in the healthcare system side-by-side with other extended services.

There are a lot of earlier studies which disclose such extended service has accomplished positive end results via an authentic practice. For example, it is noted that CPs in Spain are having the quality necessary to exalt medication adherence among the hypertensive patients [41]. In Australia, CPs have executed the role to ameliorate the clinical and humanistic net results among patients who possess type 2 diabetes [42]. Another pharmaceutical care study in Malaysia discloses the potential of CPs to diagnose a wide range of potential undesirable drug-related problems among their customers [43]. It is also notified that there is a review article which divulges the positive impact of smoking cessation program performed by CPs [44]. Consequently, these significant positive impacts are putting on a screen for the consumers and other healthcare practitioners to acknowledge the roles of CPs in community pharmacy settings. Additionally, it might inspire other CPs to persuade the exact service for the benefits of their customers.

Even though there are some CPs who might operate their extended services without demanding dollars as a price from their customers for a service rendered, it is essential to reimburse CPs for their knowledge and skills. For example, an earlier review article has pointed out 60 reimbursement programs for CPs in the United States, Canada, Europe, Australia, and New Zealand [45]. Such reimbursement comprises of payment as such for emergency contraception counseling, advice on minor ailments, comprehensive medication management, medication review, follow-up visit, and time-dependent fee. It is noted that there are variable charges in different countries for the similar extended services. It discloses that the charges must take into account of knowledge, skills, and time exercised by CPs to perform the extended services [46]. Consequently, CPs are given the image as a professional healthcare practitioner like GPs

Nevertheless, it is crucial to perform a systematic inquiry to notify the facts of barriers and perception among the consumers and other healthcare providers so as to establish the truth of these extended services. Such inquiry might intensify the truth operation of these extended services in an authentic practice. Over and above that, the facts and figures which put into picture might

have potential to manoeuvre CPs to instigate a strategy formula to get rid of them.

Pain management service: Aust [13] Pharmacist-led patient self-management of chronic disease: HK [27, 29] Psychiatric pharmacy service: Aust [13], Belgium [24] Sexual health counseling: Canada [17] Skin-care management service: Aust [13] Specialized compounding service: Aust [13], UAE [22] Weight management counseling: Aust [13], Canada [17], UAE [19], Mal [30] Wound care service: Aust [13], UAE [19] Monitoring medication outcome: Mal [32] Providing medication information to GPs: Mal [32] Oral health counseling: Mal [30] Special population counseling: Mal [30] Breast cancer counseling: Mal [33]

**Barriers**: **Country published (Article #)**

Not regular customers: Canada [17]

Customers do not like to be condemned for their lifestyles: Canada [17]

Lack of clinical components in pharmacy education: Russia [10], Sudan [23]

CPs are not always available at pharmacies: Canada [17]

Lack of interrelationship among the CPs: Sin [9]

Shortage of supporting staffs: UAE [19], Mal [33]

CPs have been overworking: Canada [17]

Lack of managing support: UK [11], Mal [30]

Lack of continuing support: UK [11]

On-going searching for a location to perform: UK [11]

Competition with colleagues for a location to perform: UK [11]

Customers reject to reimburse for such extended service: Aust [13]

Lack of clinical supporting tools: Canada [17], South Africa [18]

Language barrier: Mal [34]

Lack of financial support: UK [11], Canada [17], Mal [33, 36, 37]

Low perception of self-competence: UK [11], South Africa [18]

Customers are in rush and do not have much time to interact with pharmacists: Canada [17]

Absence of legal regulation to conserve customer medication documentation: Jordan [14]

Customers do not have an idea about benefit of such extended services: Canada [17]

Shortage of pharmacists: Aust [13], Pakistan [38], Canada [17], China [15], Mal [34]

Lack of self-confidence to execute such services: UK [11], Aust [13], South Africa [18]

Pharmacy program in university is basically product-oriented rather than patient-oriented: China [15]

Owner does not have the interest to provide such extended services: Canada [17], Russia [10], Mal [30]

Lack of working relationship with other HPs: UK [11], Aust [13], Belgium [24], Sin [9], HK [27], Canada [17]

Such extended services are not composed of a conservative pharmacy profession: Aust [13], China [15]

Lack of confidence or trust among customers: UK [11], Belgium [24], Nepal [25], HK [29], UAE [20, 22]

Lack of reimbursement scheme: UK [11], Aust [13], Belgium [24], Sin [9], UAE [19], Canada [17], China [15], Mal [30]

Lack of recognition as a supreme healthcare practitioner: Pakistan [38], Sin [9], HK [27, 29], Sudan [23], UAE [21, 22]

Customers are not ready to undergo a chance in the conservative practice: Canada [17]

Having existence of many technical burdens to be sorted out: UK [11], Canada [17]

[17]

Lack of on-going interaction between CPs and customer: Jordan [14], Japan [28], Pakistan [38], HK [27, 29], Canada

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CPs put more effort into product-oriented service: Jordan [14], Japan [28], Sin [9], HK [27], Russia [10], UAE [19, 20]

Lack of time to counsel: UK [11], Aust [13], Belgium [24], Nepal [25], Netherlands [12], Sin [9], Canada [17], UAE [19]

GPs, general practitioners; UAE, United Arab Emirates; HK, Hong Kong; Mal, Malaysia; Aust, Australia; Sin, Singapore; DRP, drug-related problem; SC, smoking cessation; #, number.

**Table 2.** Details of countries which indicate extended pharmacy services.
