A cross-sectional, descriptive study was conducted between January and April 2026 to evaluate the availability and utilization of professional pharmacy services in community pharmacy settings within Saudi Arabia. The study also aimed to identify the demographic, professional, and operational factors, as well as the perceived barriers, associated with service provision.

The target population comprised licensed pharmacists actively working in community pharmacy settings in Saudi Arabia. Participants were recruited through a non-probability, convenience sampling approach via professional networks, pharmacy associations, and online distribution channels. Inclusion criteria required that respondents be currently employed in a community pharmacy at the time of data collection. Participation was voluntary, and no incentive was offered. A total of 188 respondents completed the questionnaire and were included in the final analysis.

Data were collected using a structured, self-administered online questionnaire developed specifically for this study through a review of the relevant literature on community pharmacy practice and pharmacy workforce studies [13, 26–29]. It was administered in English only and therefore did not require translation. Prior to data collection, it was pilot-tested with 10 community pharmacists to assess clarity, comprehensibility, and feasibility. Minor amendments were made based on their feedback, and these pharmacists were not included in the final study sample.

The instrument comprised four sections: (1) demographic and workplace characteristics, including age, gender, years of experience, highest qualification, workplace setting, region, number of pharmacists per shift, opening hours per day, and average number of prescriptions dispensed per day; (2) availability and utilization of 26 professional pharmacy services, grouped into three domains: core pharmacy services, clinical and public health services, and advanced and access services; (3) eleven perceived barriers to service provision, rated on a five-point Likert scale (Strongly Disagree to Strongly Agree); and (4) overall satisfaction with the current scope of pharmacy services, rated from Very dissatisfied to Very satisfied. The complete questionnaire, including the exact wording of the 26 service items, is provided in Supplementary Material 1.

Participants were recruited through a non-probability, convenience sampling approach via professional networks, pharmacy associations, and online distribution channels. The questionnaire was distributed electronically via Microsoft Forms over a period of 4 months. The survey link was shared through direct messaging and community pharmacy professional groups. Participants were provided with a brief introduction describing the study aims and were required to provide informed consent electronically before accessing the questionnaire.

Service provision was operationalized using two complementary summary measures: service availability and overall service utilization. All respondents were asked about the same 26 professional pharmacy services. For each service, respondents selected one of five response categories: Not available, Rarely (1–3 times/month), Sometimes (1–3 times/week), Often (≥4 times/week), or Always (daily). These categories were coded from 0 to 4, respectively. All respondents completed all 26 service items; therefore, there were no missing data for these items.

Service availability was calculated by recoding each service as 0 (Not available) or 1 (available at any frequency, from Rarely to Always) and summing across the 26 services, resulting in a score ranging from 0 to 26. This measure represents the breadth of professional pharmacy services reported as available by each respondent. Overall service utilization was calculated as the mean frequency score across the 26 services, resulting in a score ranging from 0 to 4. Given the heterogeneity of the services assessed, this measure was not intended to represent a single underlying latent construct but rather a pragmatic summary index of the overall frequency of service provision across the predefined set of services. It complements the availability score by capturing frequency of provision in addition to service breadth. Individual service frequencies were also reported separately to preserve differences across service types.

All statistical analyses were performed using R (version 4.4.1; R Core Team, Vienna, Austria). The individual pharmacist was treated as the unit of analysis, with each respondent considered an independent observation. Categorical variables were summarized as frequencies and percentages; continuous variables were summarized as means and standard deviations (SD). Internal consistency of the survey domains was assessed using Cronbach’s alpha. Spearman rank-order correlation coefficients (r∼s∼) were used to assess associations between ordinal predictor variables and the two service provision outcomes: service availability score (number of services offered at any frequency, range 0–26) and service utilization score (mean frequency across all 26 services, range 0–4).

Seven candidate predictors were included in the multivariable logistic regression model based on their potential relevance to service utilization: prescription volume per day, years of experience, highest qualification, workplace setting, opening hours per day, number of pharmacists per shift, and age. All seven predictors were entered simultaneously irrespective of their bivariate statistical significance. Gender and region were excluded because of limited variability and sparse subgroup representation. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). For multivariable analysis, the utilization score was dichotomized at the sample median (1.27), with scores above the median classified as higher utilization and scores at or below the median as lower utilization. The cut-off was data-driven rather than prespecified and was used to obtain approximately balanced groups for binary logistic regression. Model performance was assessed using the likelihood-ratio test, Nagelkerke R², and area under the receiver operating characteristic curve (AUC). Multicollinearity was assessed using variance inflation factors (VIFs). As a sensitivity analysis, multiple linear regression was additionally performed using the continuous utilization score as the outcome and the same seven primary predictors, to assess the robustness of findings independent of the median-based dichotomization. All statistical tests were two-tailed and a p-value of <0.05 was considered statistically significant.

Ethical approval for this study was obtained from the Institutional Review Board of Taif University (IRB No. 47-109; approved on 11 December 2025). The study was conducted in accordance with the principles of the Declaration of Helsinki. Participation was voluntary, and electronic informed consent was obtained before participants commenced the questionnaire. No personally identifiable information was collected, and the anonymity of responses was maintained throughout data collection, analysis, and reporting.

A total of 188 community pharmacy practitioners completed the survey (Table 1). The majority were male (n = 170, 90.4%), with a mean age of 31.3 years (SD 7.4; range 23–58). Most respondents held a PharmD degree (n = 118, 62.8%), followed by BPharm (n = 62, 33.0%). Years of experience were distributed across all categories: 40 respondents (21.3%) had less than 1 year of experience, 52 (27.7%) had 1–3 years, 37 (19.7%) had 4–6 years, 17 (9.0%) had 7–10 years, and 42 (22.3%) had more than 10 years. The majority of respondents worked in urban settings (n = 146, 77.7%), and most were based in Makkah region (n = 141, 75.0%). Regarding workplace characteristics, 90 respondents (47.9%) reported working with one pharmacist per shift and 85 (45.2%) with two pharmacists per shift, while 104 (55.3%) reported pharmacy operating hours of 17–23 h per day. Most respondents reported dispensing fewer than 50 prescriptions per day (n = 113, 60.1%), whereas 75 (39.9%) reported dispensing 50 or more prescriptions daily.

Spearman correlation analysis identified several factors significantly associated with both the availability and utilization of pharmacy services (Table 2). Prescription volume per day demonstrated the strongest positive correlation with service provision outcomes, showing moderate positive associations with both service availability (rs = 0.378, p < 0.001) and service utilization (rs = 0.430, p < 0.001). Similarly, years of professional experience were positively correlated with service availability (rs = 0.255, p < 0.001) and utilization (rs = 0.356, p < 0.001). Highest qualification was negatively correlated with both service availability (rs = −0.150, p = 0.040) and utilization (rs = −0.198, p = 0.006). In contrast, opening hours per day, workplace setting, and the number of pharmacists per shift were not significantly associated with either service availability or utilization (all p > 0.05).

The overall utilization score ranged from 0 to 4, with a median of 1.27. Using the median-based classification, 91 respondents (48.4%) were classified as having higher utilization and 97 (51.6%) as having lower utilization. In the fully adjusted multivariable model (Table 3), higher prescription volume was significantly associated with higher service utilization, with each category increase associated with 3.52-fold higher odds of higher utilization (aOR = 3.52, 95% CI: 2.15–5.75, p < 0.001). Years of experience was also positively associated with utilization (aOR = 1.56 per category increase, 95% CI: 1.04–2.34, p = 0.034). Compared with BPharm respondents, PharmD respondents had lower odds of higher utilization (aOR = 0.29, 95% CI: 0.11–0.79, p = 0.016), while postgraduate qualification was not significantly associated with utilization. Increasing age was also associated with lower odds of higher utilization (aOR = 0.91 per year, 95% CI: 0.83–0.99, p = 0.021). Opening hours, workplace setting, and number of pharmacists per shift were not significantly associated with utilization. The overall model was statistically significant (LR χ² [8] = 56.20, p < 0.001), with a Nagelkerke R² of 0.345 and an AUC of 0.807. No concerning multicollinearity was identified (maximum VIF = 3.48).

As a sensitivity analysis, multiple linear regression using the continuous utilization score and the same seven predictors produced findings consistent with the primary analysis (R² = 0.260; adjusted R² = 0.227). Prescription volume (β = 0.347, p < 0.001) and years of experience (β = 0.211, p = 0.002) remained significant positive predictors, while age was inversely associated with utilization (β = −0.029, p = 0.039). The postgraduate group was also positively associated with utilization (β = 0.667, p = 0.023), although this estimate should be interpreted cautiously because of the small subgroup size (n = 8). Other predictors were not significant.

Internal consistency was acceptable to high across the survey domains, with Cronbach’s alpha values of 0.796 for core dispensing and traditional services, 0.895 for clinical and advanced patient care services, 0.843 for infrastructure and professional collaboration, and 0.839 for barriers to pharmacy service provision.

Core dispensing and traditional services were strongly positively correlated with clinical and advanced patient care services (rs = 0.836, p < 0.001) and moderately positively correlated with infrastructure and professional collaboration (rs = 0.670, p < 0.001). Barriers were not significantly correlated with core dispensing and traditional services (rs = 0.105, p = 0.151) or clinical and advanced patient care services (rs = 0.064, p = 0.381). A weak positive correlation was observed between barriers and infrastructure and professional collaboration (rs = 0.155, p = 0.034.

Respondents identified several barriers that may hinder the provision and utilization of pharmacy services (Figure 4). The most frequently reported barriers were lack of clear regulations (55%), high workload and time constraints (53%), and Wasfaty-related administrative burden (51%). More than one-third of respondents also agreed that limited training or continuing professional development (39%), technical or software issues (36%), and lack of financial incentives (36%) negatively affected service provision. In contrast, medication stock shortages (28%), high competition between pharmacies (26%), and insurance restrictions (24%) were less commonly perceived as barriers, with a greater proportion of respondents disagreeing than agreeing with these statements.

Overall satisfaction with the current scope of pharmacy services was rated on a five-point scale. As shown in Figure 5, most respondents reported neutral satisfaction (n = 80, 42.6%), followed by satisfied (n = 63, 33.5%), dissatisfied (n = 17, 9.0%), very satisfied (n = 16, 8.5%), and very dissatisfied (n = 12, 6.4%). Taken together, only 42.0% of respondents expressed positive satisfaction (satisfied or very satisfied), while 15.4% expressed dissatisfaction.