Barriers and facilitators to implementing pharmacist-led services in community and primary care settings: A CFIR-Informed qualitative study

Abstract

Aim/Background: The expansion of pharmacists’ roles in community and primary healthcare settings is supported by national policies. However, implementation in Indonesia remains inconsistent due to persistent structural and contextual barriers. This study aims to examine barriers and facilitators influencing the implementation of pharmaceutical care services provided by pharmacists in community pharmacies and primary healthcare centers in Indonesia, guided by the Consolidated Framework for Implementation Research (CFIR). Materials and Methods: A qualitative study was conducted using semistructured in-depth interviews with pharmacists practicing in community pharmacies and primary healthcare facilities. The interview guide was informed by CFIR domains and constructs. Interviews were audio recorded, transcribed verbatim, and independently coded by two researchers. A thematic analysis was performed using a hybrid deductive-inductive approach, with identified themes mapped to CFIR domains. Data collection continued until thematic saturation was achieved. Ethical approval was obtained prior to study commencement. Results: Data saturation was achieved after 30 interviews. Barriers and facilitators were identified across all CFIR domains. Key facilitators included pharmacists’ professional motivation, the perceived value of pharmacist-led services, and management and governmental support for maintaining service quality. Major barriers were primarily related to the outer and inner factors, including limited public understanding of pharmacists’ roles, patient-related challenges, restricted access to external training, inadequate workforce capacity, suboptimal interprofessional collaboration, and infrastructure constraints. Conclusion: Implementation of pharmacist-led services in the Indonesian community and primary care settings is shaped by interactions among multilevel determinants across CFIR domains, highlighting the need for strengthened management and governmental support to address constraints within the outer and inner settings.