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24 August 2025

Clinical Role of Pharmacists in the Care of Incarcerated People at Correctional Facilities: A Scoping Review

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1
Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
2
Department of Pharmacy and Pharmaceutical Administration, Faculty of Pharmacy, Federal Fluminense University, Niterói 24241-000, RJ, Brazil
3
Department of Pharmacy, Federal University of Paraná, Curitiba 80210-170, PR, Brazil
*
Author to whom correspondence should be addressed.
Pharmacy2025, 13(5), 113;https://doi.org/10.3390/pharmacy13050113
This article belongs to the Section Pharmacy Practice and Practice-Based Research
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Abstract

This study aimed to map the literature on the clinical role of pharmacists in the care of incarcerated people at correctional facilities and to identify gaps in this field. A scoping review was conducted on 30 July 2024, using the PubMed, Scopus, and LILACS databases. Gray literature was searched via Google Scholar, and references of included studies were manually reviewed. Primary studies of any design reporting pharmacists’ clinical services and/or activities for incarcerated individuals were eligible. Study selection and data extraction were performed independently by two reviewers, with a third resolving disagreements. The search yielded 894 records, from which 27 studies were included. Most studies were conducted in the United States (n = 16; 59%) and France (n = 7; 26%). Eleven (41%) focused exclusively on male populations, and one (4%) on female inmates. Most studies addressed pharmacists’ clinical roles in mental health conditions and substance use disorders (n = 9; 33%), infectious diseases (n = 5; 19%), and diabetes (n = 4; 15%). Clinical services and/or activities related to direct patient care were the most frequently reported (n = 18; 67%). Process measures were reported in 18 studies (67%), and clinical outcomes were the most common type of outcome (n = 13; 48%). This review highlights the pharmacist’s clinical role in treating mental health conditions and substance abuse, infectious diseases, and diabetes in incarcerated care. It underscores the need for further research in low- and middle-income countries, on women’s health, and on other prevalent conditions.

1. Introduction

Globally, around 11 million people are incarcerated, with the largest populations found in the United States (1,808,100), China (1,690,000), and Brazil (850,377) [1]. The incarcerated population has significantly increased across almost every continent in the last twenty years [1]. This population is socially vulnerable, as many prisoners face inadequate living conditions in facilities with structural problems, overcrowding, low-quality or insufficient food, and limited access to healthcare [2,3]. These factors increase their susceptibility to developing diseases or exacerbating pre-existing conditions [3]. The right to health must be guaranteed to this population, regardless of the crimes committed, as it is fundamentally a human rights issue [3].
Compared to the general population, the incarcerated population in correctional facilities is more vulnerable to various infectious and communicable diseases, including tuberculosis, viral hepatitis, syphilis, and HIV/AIDS [4,5]. Additionally, many individuals are diagnosed with chronic conditions such as hypertension, diabetes, and mental health conditions [4]. Substance use disorders and withdrawal also frequently affect prisoners [4,5]. In light of this, the American Society of Health-System Pharmacists (ASHP) recommends that correctional facilities provide at least a basic, humane, and adequate level of healthcare services, accessible to inmate-patients 24 h a day [6].
Despite policy efforts, correctional facilities often have underdiagnosed patients, leading to untreated and uncontrolled health conditions [7]. Adding to these challenges, limited access to appropriate treatments is also a reality. Studies reveal an underuse of medications in this population, ranging from 1.9 to 5.5 times less, depending on the condition, compared to the general population [8,9]. Due to this scarcity, some patients tend to seek alternative ways to obtain medications, such as relying on family members, which can potentially lead to a lack of knowledge among the healthcare team regarding their treatments. There are still patients who are unable to access medications through alternative ways, resulting in going without medication, adversely affecting their health outcomes [10].
Pharmacists, as integral members of the healthcare team, can provide pharmacist services in various settings, particularly for vulnerable populations, including those incarcerated. It is recommended that all correctional facilities secure the services of a pharmacist [6]. However, the presence of pharmacists in correctional facilities remains limited in some settings, particularly in underfunded correctional facilities or in low- and middle-income countries [11]. When pharmacists are present, they encounter numerous challenges. Pharmacists often have limited contact with incarcerated individuals and must work in pharmacy facilities with poor infrastructure and scarce resources, including insufficient access to necessary medications. These limitations further complicate their ability to perform daily duties effectively [11].
Thus, pharmacists are frequently restricted to technical and logistical responsibilities [12]. Despite these limitations, pharmacists remain essential contributors to the patient-centered care of the incarcerated population. Correctional pharmacists could be dedicated to helping inmate-patients achieve optimal health outcomes while minimizing the risk of harm [6]. To the best of our knowledge, only one narrative literature review has explored the roles of pharmacists in correctional facilities. This review indicated that pharmacists acting as primary care providers in this setting may engage in activities such as direct patient care, participation in healthcare clinics, and medication management, based on data published up to 2017 [12]. Since then, a substantial body of literature has emerged, and it is important to map these new findings to assess whether the clinical role of pharmacists in this context has evolved. In addition, this scoping review aims to identify, where available, outcomes that demonstrate the potential benefits of integrating pharmacists into healthcare teams caring for incarcerated populations, as well as best practices that could be replicated to optimize their clinical contributions. The chosen study design supports not only the synthesis of existing evidence but also the identification of knowledge gaps that may guide future research.

2. Materials and Methods

2.1. Study Design

A scoping review was carried out following the recommendations of the Joanna Briggs Institute (JBI) Reviewer’s Manual [13] and reported according to the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement for Scoping Reviews (PRISMA-ScR) [14]. The protocol for this review is available upon request from the corresponding author.

2.2. Review Question

The following research question was formulated to guide this scoping review: What research has been published on the clinical services and/or activities performed by pharmacists in correctional facilities, and what are the main outcomes and process measures reported among incarcerated individuals?

2.3. Search Strategies

A comprehensive literature search was conducted in the PubMed, Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS) databases for studies published from the inception of the database until 30 July 2024. Additionally, the gray literature was explored through Google Scholar (limited to 100 entries, excluding patents and citations). The complete search strategies for all databases are detailed in Appendix A. Furthermore, references from all included articles were reviewed to identify any studies that may have been missed.

2.4. Eligibility Criteria

Eligibility criteria were established based on the Population, Concept, and Context framework: (a) Population: incarcerated people; (b) Concept: clinical services and/or activities provided by pharmacists; (c) Context: correctional facilities.
Articles were included if they addressed clinical services and/or activities provided by pharmacists to incarcerated individuals in any type of custodial correctional facility, regardless of whether they reported process measures or outcomes data. Survey studies, books/book chapters, dissertations and theses, editorials, conference proceedings or abstracts, the literature reviews, and guidelines were excluded. Articles unavailable or published in non-Roman characters were also excluded.

2.5. Study Selection

The manuscripts retrieved from the databases were allocated to the Rayyan QCRI web program [15] to exclude duplicate files, analyze the titles and abstracts of the articles, and analyze complete articles whose abstracts were previously selected. The initial screening of titles and abstracts was independently conducted by two authors (C.E.C.S. and M.B.), followed by a full-text reading of studies that met the inclusion criteria. Disagreements were resolved by the third reviewer (M.B.V.). When full-text access was unavailable, the corresponding authors were contacted via email or through the Researchgate platform—www.researchgate.net (accessed on 15 September 2024).

2.6. Data Extraction and Analysis

For each included article, the following information was extracted: author, year of publication, country, article type, study design, setting (prison or jail), population (number of inmates, age, gender, and clinical condition or treatment prescribed), clinical services and/or activities provided by pharmacists, processes measures and/or outcomes analyzed, and main results of the studies.
The identified clinical services and/or activities provided by pharmacists were categorized into three main categories [16,17]: ‘Direct patient care’; ‘Medication order review and reconciliation’; and ‘Medication counseling, education, and training’. ‘Direct patient care’ includes serving as a resource on the optimal use of medication in symptom management, optimizing medication regimens, and improving adherence to medication regimens. ‘Medication order review and reconciliation’ involves managing and improving the medication-use process in patient care settings, optimizing medication regimens, and increasing patient safety and pharmacoeconomy. ‘Medication counseling, education, and training’ encompasses providing medication counseling and training to educate staff, patients, caregivers, and families.
Donabedian’s framework for the process dimension was used, which refers to the core activities within healthcare, including diagnosis, treatment, rehabilitation, prevention, and patient education, generally performed by specialized professionals [18]. The outcomes were evaluated considering the Economic, Clinical, Humanistic Outcomes (ECHO) Model [19], which categorizes outcomes into three domains: clinical (e.g., improved disease or symptom control), humanistic (e.g., patient satisfaction and quality of life), and economic (e.g., reduction in healthcare costs) [20].
Two reviewers (C.E.C.S. and B.B.S.) performed the data extraction and analysis using a preformatted spreadsheet in Microsoft Excel, with disagreements resolved by the third reviewer (M.B.V.).
Following the PRISMA-ScR guidelines [14], no methodological quality (risk of bias) assessment was performed as scoping reviews aim to identify all the available evidence and highlight its main characteristics, regardless of the quality of such evidence. The results of this scoping review are presented as a narrative and tabular synthesis.

3. Results

3.1. Search Results

The electronic search found 894 potentially relevant studies. After removing duplicates and reviewing the titles and abstracts, 58 articles were selected for full-text reading. After careful full-text screening, 27 articles [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47] met the inclusion criteria and were included in the review. Additionally, no relevant studies were identified from searching the reference lists of the included studies or other literature reviews related to the theme. A flowchart of the literature search is shown in Figure 1.
Figure 1. Study selection flowchart through literature search.

3.2. Characteristics of the Articles

Table 1 summarizes the main characteristics of the included studies. All the included articles were published between 1982 and 2023. Most of the articles in this review originated from the United States (n = 16; 59%) [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36], followed by France (n = 7; 26%) [37,38,39,40,41,42,43], Canada (n = 3; 11%) [44,45,46], and Ireland (n = 1; 4%) [47]. Most of the studies were research/original articles (n = 18; 67%) [22,24,26,28,29,30,31,32,33,34,35,37,39,41,42,43,45,46], followed by reports (n = 7; 26%) [21,23,25,27,38,44,47] and short/brief reports (n = 2; 7%) [36,40]. The authors described the study designs in different ways, but most were descriptive or analytical observational studies; there were no randomized controlled trials. Regarding the settings, 15 studies (55%) addressing prisons (state or federal; long-term duration; for convicted individuals) [21,22,23,24,25,26,27,28,29,30,35,36,41,46,47] and 13 studies (48%) focusing on jails (local—city or county; short-term duration; pre-trial detainees; short sentences) [31,32,33,34,37,38,39,40,41,42,43,44,45]. Among the studies that reported the mean age of patients, the average ranged from 33 to 53 years. Eleven (41%) articles reported exclusively male populations [23,30,32,36,37,38,39,40,42,44,46], while only one (4%) focused on a female-only population [27]. Mixed-gender populations were mentioned in five (19%) articles [31,34,35,41,43], but the proportion of females was low. Furthermore, the most prevalent health issues among the studied populations were mental health conditions and substance use disorders, which were the focus of nine articles (33%) [31,33,36,37,39,42,43,44,47], followed by infectious diseases such as HIV/AIDS and Hepatitis B (HBV) and C (HCV), addressed in five studies (19%) [25,26,29,30,35]. Regarding chronic diseases—excluding mental health conditions—diabetes mellitus was the main focus in four articles (15%) [27,28,32,40], thromboembolism in two (7%) [24,34], arterial hypertension in one (4%) [22], chronic noncancer pain in one (4%) [46], and seizures in one (4%) [23]. Other studies did not report the health conditions of incarcerated individuals or included people with various conditions without focusing on any specific one.
Table 1. Characteristics of the included articles in this scoping review (n = 27).

3.3. Synthesis of Clinical Services and/or Activities Provided by Pharmacists

The pharmacists carried out several clinical services and/or activities, as detailed in Table 2 and Appendix B. Most articles cited clinical services and/or activities related to ‘Direct patient care’ (n = 18; 67%) [21,22,23,24,25,26,28,29,32,33,34,35,36,38,44,45,46,47], involving direct patient contact and active participation in patient-centered care, with a focus on improving outcomes through the optimization of medication regimens. Most of these studies were conducted in the United States and Canada [21,22,23,24,25,26,28,29,32,33,34,35,36,44,45,46]. This was followed by ‘Medication counseling, education, and training’ (n = 14; 52%) [22,23,24,25,27,28,30,31,32,34,35,36,40,46], which encompassed patient counseling and education on diseases, treatment regimens, appropriate medication use and adherence, dietary guidance, and the importance of communication with healthcare professionals. Most of these studies were conducted in the United States [22,23,24,25,27,28,30,31,32,34,35,36]. ‘Medication order review and reconciliation’ was cited less frequently (n = 9; 33%) [21,22,30,37,38,39,41,42,43]; this involves more indirect patient contact, typically through chart and medical records reviews, order assessment, or healthcare team discussions and meetings, providing technical and clinical support for the team, with a focus on process optimization and medication safety. Most of these studies were conducted in France [37,38,39,41,42,43].
Table 2. Clinical services and/or activities provided by pharmacists in the articles included in this scoping review (n = 27).

3.4. Synthesis of Process Measures and Outcome

The process measures and outcomes identified in the studies are detailed in Table 3. Three articles did not report any outcomes or process measures [21,38,44]. Among the 27 studies, process measures were reported in 18 (67%) [22,23,25,26,29,30,32,33,35,36,37,39,41,42,43,45,46,47], such as pharmacist interventions [26,29,33,35,37,41,45,46], improvements in medication/treatment adherence [23,25,32,36], reductions in the average time physicians spent per patient [22], increases in statin prescriptions [32], reductions in mean daily dose of benzodiazepines [37,39,42], and decreases in the prescription of antibiotics [30] and in the use of nonsteroidal anti-inflammatory drugs [46]. Thirteen studies (48%) included clinical outcomes [22,24,26,27,28,29,32,33,34,35,36,40,47], highlighting the pharmacist’s role in improving health outcomes and treatment effectiveness. Reported clinical outcomes include reductions in HbA1c levels [27,28,32,40], effective control of the International Normalized Ratio (INR) [24,34], reductions in blood pressure and improved hypertension management [22], increased rates of undetectable HIV viral load or favorable viral load response [26,29], high sustained virologic response rate in HCV treatment [35], improvement in mental health symptoms [36], and reach of fully detoxification from methadone [47]. Additionally, five studies (19%) reported humanistic outcomes [22,27,31,40,46], including patient satisfaction [40,46], improved knowledge about medications [31,40], patient empowerment and confidence [27,31], and acceptance of the pharmacist’s services [22]. Ultimately, three studies (11%) reported economic outcomes related to pharmacists’ interventions [22,35,36], particularly physician salary savings [22,36], reduction in medication acquisition costs [22], and lower cost to cure [35].
Table 3. Process and/or outcome measures and main findings on the impact of pharmacists integrated within interdisciplinary teams in correctional facilities (n = 24).

4. Discussion

This scoping review identified a growing number of articles addressing the clinical role of pharmacists in the care of incarcerated individuals in correctional facilities, which exceeded our initial expectations. However, all included studies originated from high-income countries. This may be attributed to persistent challenges in low- and middle-income countries regarding the provision of pharmaceutical care in correctional facilities. These challenges include structural weaknesses such as the absence of pharmacies, non-compliance with legal requirements related to the availability of qualified professionals with technical expertise in medication dispensing, and inadequate adherence to quality and safety standards. Furthermore, there is often a lack of clear guidelines for medication use and storage, as well as ambiguity concerning the health-related responsibilities of governmental authorities [11,48]. In contrast, high-income countries tend to have more robust correctional facilities infrastructures, enabling pharmacists to provide not only logistical support but also clinical services.
Most studies either do not report gender-specific data, focus exclusively on male individuals, or include a disproportionately low number of women. Notably, only one study focused exclusively on incarcerated women, and it addressed health education for diabetes [27]. However, this is not a topic specific to women’s health, although women with diabetes are at higher risk of cardiovascular complications than men with the same condition [49]. This highlights the need for further research on the pharmacist’s clinical role in women’s health, menstrual dignity, menopause, pregnancy, and the management of newborn care in correctional facilities. Other issues that could also be explored in studies involving incarcerated women include the management of substance abuse and sexually transmitted infections. Although the prevalence of drug abuse is higher among women than men, treatment options for female inmates remain more limited [50]. Moreover, incarcerated women are five times more likely to be HIV-positive compared to women in the general population [51].
Most of the studies were conducted in prisons rather than jails. This is expected, mainly because people stay much longer in prisons, which requires continuous monitoring and management of chronic health conditions. In prisons, due to the extended length of stay, pharmacist services can develop more structured programs to monitor and optimize medication use, improve adherence, prevent adverse events, and even provide health education. In jails, higher turnover rates and shorter lengths of stay limit opportunities to provide chronic disease care [32]. However, contrary to this expectation, the study by Lin et al. [32] demonstrated that improvements in glycemic control achieved through pharmacist intervention in a jail setting were comparable to, or even better than, those observed in prison settings. Additionally, within these facilities, pharmacists can play a targeted role in monitoring medications with a narrow therapeutic index [34] and in managing withdrawal associated with substance use disorders [31,33,44].
The clinical role of pharmacists in serving the incarcerated population primarily involves clinical services and/or activities related to direct patient care, especially in the United States and Canada. This aligns with the recommendations of the ASHP, which advocates for pharmacists in correctional facilities to take an active role within the healthcare team responsible for incarcerated individuals, delivering direct patient care aimed at improving health outcomes—particularly within the framework of collaborative practice agreements [6,12]. Another service frequently highlighted in the studies was related to patient counseling and education, further reinforcing the pharmacist’s close involvement in the care of incarcerated patients. This is also emphasized by the ASHP, which recommends that pharmacists provide appropriate counseling to incarcerated patients through the availability of educational materials, direct counseling, or small group meetings, using language adapted to their context, since inmates often have low health literacy [6]. Despite this, one study included in this review, conducted in France in 2010, reported persistent challenges in implementing patient education within the correctional facility, primarily due to limited resources and security-related constraints [38]. This may also explain why the French studies focused more on medication order review.
Despite the promising findings regarding the role of pharmacists in mental healthcare within correctional facilities, more detailed data are needed to better evaluate clinical outcomes and the cost-effectiveness of pharmacists’ interventions in this area, as well as to support the expansion of training opportunities and professional involvement [52,53]. Mental health conditions are risk factors for substance use disorders and the relationship is bidirectional [54]. Given that pharmacists play a crucial role in supporting individuals through substance withdrawal, their work represents a significant contribution to the process of social reintegration [33].
The review demonstrated that pharmacists have a positive impact on clinical outcomes related to HIV and HCV. UNAIDS report highlights that 4.2% of the global incarcerated population is HIV-positive, 15.4% are infected with HCV, and 4.8% with chronic HBV. The incarcerated population has a 7.2 times higher risk of living with HIV than the general population, primarily due to interruptions in treatment during admission, transfer, or release [51], as well as exposure to risk factors like injectable drug use with reused syringes or unprotected sexual activity [50,55].
According to the International Diabetes Federation, in 2021, there were 537 million adults (20–79 years old) living with diabetes worldwide, with projections that this number will rise to 783 million by 2045. In the USA alone, the prevalence of diabetes mellitus in the general adult population was estimated to increase from 9.8% to 12.4% between 1988 and 1994 and 2011–2012, respectively [56]. Rolling et al. found that individuals involved in the criminal justice system were 15% (p = 0.015) more likely to receive a diabetes mellitus diagnosis compared to those not involved in the system, with income and level of education being risk factors for both populations [57].
A person with uncontrolled diabetes mellitus is subject to many complications, such as ketoacidosis, retinopathy, neuropathy, nephropathy, and macrovascular complications [58]. Thus, the findings of this review highlight the impact pharmacists have on inmate-patients with diabetes, helping them achieve better disease control, such as lowering HbA1c levels closer to the target for good glycemic control (guidelines recommend a HbA1c < 7.0%) [59,60]. In the four studies included in this review that reported diabetes outcomes, the range of average reduction in HbA1c was from 0.6 to 2.3% points [27,28,32,40]. An average of reduction close or inside this range was found in some literature analyzing pharmacist-led collaborative care of patients with type 2 diabetes in non-correctional settings (literature reduction values of 1.5% [61], and 0.46% [62]).
This scoping review conducted a broad mapping of the services and clinical activities that pharmacists may provide in correctional facilities. As shown in systematic reviews evaluating the economic impact of pharmacist services, particularly in the management of chronic conditions, the inclusion of additional clinical activities within the pharmacist’s role has been associated with cost-beneficial and cost-effective outcomes [63,64]. Based on the findings and topics previously discussed, this review may serve as a foundation for the development of projects and programs aiming to expand the role of pharmacists in such environments. Their involvement contributes not only to improved clinical outcomes for incarcerated individuals but also to economic benefits, such as physician salary savings [22,36], which align with institutional management priorities. Integrating pharmacists may enhance resource efficiency by allowing higher-cost staff to focus on patients with more complex clinical needs [22,23]. In addition, pharmacists also play a key role in providing disease-related education, even in contexts where access to medications is limited [8,9], and in supporting understaffed healthcare teams to offer better health opportunities to this neglected population [65,66].
Although this scoping review presents valuable insights, it is limited by inconsistent methodological approaches and variable presentation formats, as well as the accessibility of results across the included articles. Since scoping reviews do not require a quality assessment of the included studies, this review encompasses broad practices that, while varying in methodological rigor, help illustrate the diverse and multifaceted roles of pharmacists in correctional facilities. For instance, some articles were included despite not reporting any outcomes or process measures [21,38,44]. Other examples can be found in studies that report outcome data but lack essential information necessary for comprehensive analysis. These gaps range from fundamental elements, such as population characteristics, detailed intervention descriptions, and limited process measure and outcome assessment, to more advanced aspects, including the use of rigorous study designs such as randomized clinical trials.
To the best of our knowledge, this is the first scoping review to identify studies reporting on the role of pharmacists and the clinical services and/or activities they provide in correctional facilities. The use of three databases, the inclusion of gray literature, manual searching, and the absence of language restrictions reflect the robustness of the comprehensive search strategy. However, this review has limitations. Twelve potentially eligible studies were excluded due to the inability to retrieve the full texts, despite multiple attempts and strategies to obtain them. Moreover, most of the studies analyzed come from high-income countries, which may limit the applicability of the findings to low- and middle-income contexts.

5. Conclusions

This scoping review identified a substantial number of studies highlighting the pharmacist’s clinical role in the care of incarcerated people, particularly in direct patient care and patient education. Mental health and substance abuse, infectious diseases, and diabetes were the most conditions addressed. Moreover, process measures and clinical outcomes were frequently reported. The results of our study highlight the scarcity of research conducted in low- and middle-income countries, particularly studies focused on women’s health—including prenatal and postpartum care—as well as other prevalent conditions in incarcerated populations, such as tuberculosis and syphilis. These represent critical gaps that should be addressed in future research. Targeted studies in low- and middle-income countries are recommended to better understand the barriers and opportunities related to the integration of pharmacists into local correctional health systems. Additionally, research focused on incarcerated women and other relevant health conditions is essential to further demonstrate the role and potential impact of pharmacists in these specific contexts.

Author Contributions

Conceptualization, M.B.V. and C.E.C.S.; methodology, M.B.V., T.d.M.L. and I.R.; investigation, C.E.C.S., M.B. and B.B.S.; data curation, M.B.V. and C.E.C.S.; writing—original draft preparation, C.E.C.S., B.B.S. and M.B.V.; writing—review and editing, S.J.M., P.M.A., T.d.M.L. and I.R.; visualization, C.E.C.S. and M.B.V.; supervision, M.B.V.; project administration, M.B.V. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Acknowledgments

We would like to thank the University of São Paulo (USP). ChatGPT-4o mini was employed for specific adjustments in English language and to enhance the clarity of sentences.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ADUAlcohol Detox Unit
AIDS
ASHP		Acquired Immune Deficiency Syndrome
American Society of Health-System Pharmacists
BZDBenzodiazepines
CHSCermak Health Services of Cook County
HBVHepatitis B Virus
HbA1cGlycated hemoglobin
HCVHepatitis C Virus
HIVHuman Immunodeficiency Virus
HMG-CoAhydroxymethylglutaryl-coenzyme A
INRInternational Normalized Ratio
JBI
LILACS		Joanna Briggs Institute
Latin American and Caribbean Health Sciences Literature
MMTMethadone Maintenance Therapy
NSAIDsNonsteroidal Anti-inflammatory Drugs
PRISMA-ScR Systematic reviews and Meta-Analyses statement for Scoping Reviews
SSDSelf-directed Detoxification
USAUnited States of America

Appendix A

Electronic Bibliographic DatabasesSearch Strategy
Pubmed#1 “Prisoners”[Mesh] OR Prisoner* OR “Imprisoned Individual*” OR Inmate* OR “Incarcerated Individual*” OR Hostage* OR “Detained Person*” OR “Incarcerated population*” OR “Imprisoned population*” OR Convict OR “Incarcerated Offender*” OR “Prisons”[Mesh] OR Prison* OR Penitentiar* OR “Correctional facilit*” OR “Correctional institution*” OR Jail* OR “Correctional setting*” OR “Correctional site*” OR “Correctional institution*” OR “Correctional center*” OR “Detention center*” OR Jailhouse* OR “Correctional complex*” OR “Incarceration facility*” OR “Penal institution*” OR Lockup*
#2 “Pharmacists”[Mesh] OR Pharmacist* OR “Clinical Pharmacist*” OR “Community Pharmacist*” OR “Hospital Pharmacist*” OR “Pharmacies”[Mesh] OR Pharmacy OR Pharmacies OR “Community Pharmacy” OR “Community Pharmacies” OR “Pharmacy Distribution*” OR “Pharmacy Service, Hospital”[Mesh] OR “Hospital Pharmacy Service*” OR “Hospital Pharmaceutical Service*” OR “Clinical Pharmacy Service*” OR “Community Pharmacy Services”[Mesh] OR “Community Pharmacy Service*” OR “Community Pharmaceutic Service*” OR “Community Pharmaceutical Service*” OR “Pharmaceutical Services”[Mesh] OR “Pharmaceutic Service*” OR “Pharmaceutical Service*” OR “Pharmacy Service*” OR “Pharmaceutical Care” OR Telepharmacy OR “Telepharmacy Service*” OR “Remote pharmacy” OR “Remote dispensing” OR “Virtual pharmacy” OR “Digital pharmacy” OR “Online pharmacy” OR E-pharmacy OR Telepharmaceutic* OR “Medication Therapy Management”[Mesh] OR “Medication Therapy Management” OR “Drug Therapy Management” OR “Comprehensive Medication Management” OR “Medication Management” OR “Medicines Management” OR “Pharmacotherapeutic follow-up” OR “Medicines Optimisation” OR “Medication Review”[Mesh] OR “Medication Review*” OR “Drug Dispensing” OR “Drug Monitoring”[Mesh] OR “Drug Monitoring” OR “Therapeutic Drug Monitoring” OR “Medication Reconciliation”[Mesh] OR “Medication Reconciliation*” OR “Drug Information Services”[Mesh] OR “Drug Information Service*” OR “Drug Storage”[Mesh] OR “Drug Storage*” OR “Drug Supply” OR “Drug Supplies”
#1 AND #2
LILACSMH:Prisoners OR Prisoner* OR “Imprisoned Individual*” OR Inmate* OR “Incarcerated Individual*” OR Hostage* OR “Detained Person*” OR “Incarcerated population*” OR “Imprisoned population*” OR Convict OR “Incarcerated Offender*” OR MH:Prisons OR Prison* OR Penitentiar* OR “Correctional facilit*” OR “Correctional institution*” OR Jail* OR “Correctional setting*” OR “Correctional site*” OR “Correctional institution*” OR “Correctional center*” OR “Detention center*” OR Jailhouse* OR “Correctional complex*” OR “Incarceration facility*” OR “Penal institution*” OR Lockup* AND MH:Pharmacists OR Pharmacist* OR “Clinical Pharmacist*” OR “Community Pharmacist*” OR “Hospital Pharmacist*” OR MH:Pharmacies OR Pharmacy OR Pharmacies OR “Community Pharmacy” OR “Community Pharmacies” OR “Pharmacy Distribution*” OR MH: “Pharmacy Service, Hospital” OR “Hospital Pharmacy Service*” OR “Hospital Pharmaceutical Service*” OR “Clinical Pharmacy Service*” OR MH: “Community Pharmacy Services” OR “Community Pharmacy Service*” OR “Community Pharmaceutic Service*” OR “Community Pharmaceutical Service*” OR MH: “Pharmaceutical Services” OR “Pharmaceutic Service*” OR “Pharmaceutical Service*” OR “Pharmacy Service*” OR “Pharmaceutical Care” OR Telepharmacy OR “Telepharmacy Service*” OR “Remote pharmacy” OR “Remote dispensing” OR “Virtual pharmacy” OR “Digital pharmacy” OR “Online pharmacy” OR E-pharmacy OR Telepharmaceutic* OR MH: “Medication Therapy Management” OR “Medication Therapy Management” OR “Drug Therapy Management” OR “Comprehensive Medication Management” OR “Medication Management” OR “Medicines Management” OR “Pharmacotherapeutic follow-up” OR “Medicines Optimisation” OR MH: “Medication Review” OR “Medication Review*” OR “Drug Dispensing” OR MH: “Drug Monitoring” OR “Drug Monitoring” OR “Therapeutic Drug Monitoring” OR MH: “Medication Reconciliation” OR “Medication Reconciliation*” OR MH: “Drug Information Services” OR “Drug Information Service*” OR MH: “Drug Storage” OR “Drug Storage*” OR “Drug Supply” OR “Drug Supplies”
SCOPUSTITLE-ABS-KEY(Prisoner* OR “Imprisoned Individual*” OR Inmate* OR “Incarcerated Individual*” OR Hostage* OR “Detained Person*” OR “Incarcerated population*” OR “Imprisoned population*” OR Convict OR “Incarcerated Offender*” OR Prison* OR Penitentiar* OR “Correctional facilit*” OR “Correctional institution*” OR Jail* OR “Correctional setting*” OR “Correctional site*” OR “Correctional institution*” OR “Correctional center*” OR “Detention center*” OR Jailhouse* OR “Correctional complex*” OR “Incarceration facility*” OR “Penal institution*” OR Lockup*) AND TITLE-ABS-KEY(Pharmacist* OR “Clinical Pharmacist*” OR “Community Pharmacist*” OR “Hospital Pharmacist*” OR Pharmacy OR Pharmacies OR “Community Pharmacy” OR “Community Pharmacies” OR “Pharmacy Distribution*” OR “Hospital Pharmacy Service*” OR “Hospital Pharmaceutical Service*” OR “Clinical Pharmacy Service*” OR “Community Pharmacy Service*” OR “Community Pharmaceutic Service*” OR “Community Pharmaceutical Service*” OR “Pharmaceutic Service*” OR “Pharmaceutical Service*” OR “Pharmacy Service*” OR “Pharmaceutical Care” OR Telepharmacy OR “Telepharmacy Service*” OR “Remote pharmacy” OR “Remote dispensing” OR “Virtual pharmacy” OR “Digital pharmacy” OR “Online pharmacy” OR E-pharmacy OR Telepharmaceutic* OR “Medication Therapy Management” OR “Drug Therapy Management” OR “Comprehensive Medication Management” OR “Medication Management” OR “Medicines Management” OR “Pharmacotherapeutic follow-up” OR “Medicines Optimisation” OR “Medication Review*” OR “Drug Dispensing” OR “Drug Monitoring” OR “Therapeutic Drug Monitoring” OR “Medication Reconciliation*” OR “Drug Information Service*” OR “Drug Storage*” OR “Drug Supply” OR “Drug Supplies”) AND NOT DOCTYPE(“ab” OR “bk” OR “ch” OR “bz” OR “cp” OR “cr” OR “dp” OR “ed” OR “er” OR “le” OR “mm” OR “no” OR “pr” OR “tb” OR “re” OR “sh”) OR SRCTYPE(“b” OR “k” OR “p” OR “m” OR “n” OR “w” OR “l”)
GOOGLE SCHOLAR(Prisoner* OR “Imprisoned Individual*” OR Inmate* OR “Incarcerated Individual*” OR Prison* OR Penitentiar* OR “Correctional institution*” OR Jail*) AND (Pharmacist OR “Hospital Pharmacy” OR “Community Pharmacy” OR “Pharmaceutical Service*” OR “Pharmaceutical Care”)

Appendix B

AuthorsDirect Patient CareMedication Order Review and ReconciliationMedication Counseling, Education and Training
Hadd [21]Conducting patient histories and physical examinations of newly admitted inmates; ordering laboratory tests or X-rays as needed; performing minor surgical procedures and electrocardiograms as requested; and providing evaluation and care in emergency situations.Daily monitoring of drug therapy, including screening for drug interactions and allergies in orders documented in the patient’s medical record.
Cassidy et al. [22]The pharmacist operated chronic care refill clinics, conducting both patient interviews and chart reviews. The pharmacist assumed the role of primary care provider; physicians or physician assistants only interviewed patients when requested by the patient or pharmacist. The pharmacist adjusted pharmacotherapy, ordered laboratory tests (e.g., serum drug concentrations), and referred patients to physicians for new diagnoses.In another pharmacist-operated chronic care refill clinic, the pharmacist performed chart reviews only and did not see patients directly. Patient interviews were conducted by physicians after the pharmacist completed the chart review. The pharmacist adjusted pharmacotherapy, ordered laboratory tests (e.g., serum drug concentrations), and referred patients to physicians for new diagnoses.Patient counseling focused on disease states, treatment goals, and appropriate medication use.
Seals and Keith [23]Operates chronic care clinics and assesses and determines the patients’ therapeutic and laboratory needs; schedules follow-up visits; performs medication dispensing; maintains medication records; monitors medication orders and patient compliance. Patient counseling and distribution of information leaflets on anticonvulsant treatment, covering the medication’s primary indications, proper administration, the importance of communicating with the prescriber, the role of blood or serum drug concentrations as therapeutic indicators, and common adverse effects.
Mathis and O’Reilly [24]Leads the anticoagulation point-of-care service, evaluates drug interactions and metabolic changes that may influence warfarin levels, monitors and tests patients’ INR, and prescribes or adjusts warfarin doses. Patient education to enhance compliance with testing and appointments, medication adherence, and communication with the healthcare team.
Badowski and Nyberg [25]Addressing medication adherence, documenting the patient’s medication history and allergy information, managing drug interactions, identifying and managing medication adverse effects, and recommending alternative antiretroviral therapy when necessary. Providing drug information to patients, educating patients about their medication.
Bingham [26]Conducting consultations for patients with HIV, including activities such as modifying medication regimens, ordering follow-up laboratory tests, adjusting dosages, initiating or managing antiretroviral therapy, reducing pill burden, and treating adverse events.
Barnes et al. [27] Conducting an 8 weeks education group focused on information about diabetes, interpretation of disease values and parameters, signs, symptoms, and behaviors associated with hypoglycemia or hyperglycemia, long-term complications of diabetes, nutrition, antidiabetic medication, etc.
Bingham and Mallette [28]Collaborate with physicians to achieve better diabetes outcomes for patients by monitoring parameters, ordering and interpreting laboratory tests, prescribing medications, and implementing changes to drug treatment. Patient education and individualized counseling.
Dong et al. [29]Prison pharmacists select cases with specific questions focused on the management of complex HIV/HBV/HCV patients whose optimal outcomes have not yet been achieved. They discuss the cases via teleconference with a specialized multidisciplinary team. This team provides personalized recommendations and therapeutic strategies. The prison pharmacists are responsible for discussing the treatment plan with primary care providers and ensuring its final implementation.
Long, LaPlant, and McCormick [30] Leading the antimicrobial stewardship program alongside the clinical director; reviewing all antibiotic prescriptions prior to dispensing using the electronic medical record system; and, in cases of guideline divergence or when the condition appears to be viral in nature, suggesting alternative treatments or seeking clarification from the prescriber. Additional interventions include identifying potential medication interactions.In cases where no antibiotics are prescribed and the patient perceives they are “not being treated,” pharmacists provide counseling. This includes acknowledging the patient’s illness, using the term “viral illness,” and recommending over-the-counter therapies for symptom management.
Leung, Colyer, and Zehireva [31] Patient education on the proper use of the naloxone nasal spray kit.
Lin et al. [32]Pharmacists conducted an initial face-to-face evaluation with each diabetic patient, followed by at least one follow-up visit during which adherence was assessed and the medication regimen was adjusted—including initiation, modification, or discontinuation of oral antidiabetic and cholesterol-lowering medications—under a collaborative practice agreement with physicians. Pharmacists also ordered and interpreted laboratory tests and initiated referrals to medical providers. Patient education on the importance of medication adherence and the complications of diabetes.
Muradian et al. [33]Conducting withdrawal assessments and medication history, as well as initiating, modifying, and discontinuing withdrawal medication therapy under a collaborative practice agreement with a physician. Additionally, the pharmacist was responsible for initiating referrals to a substance use disorder counselor and other healthcare providers.
Tran et al. [34]Working under a collaborative practice agreement, the pharmacist was authorized to initiate, adjust, or discontinue anticoagulation therapy and to order relevant laboratory tests. The pharmacist reviewed medication compliance and assessed potential drug–drug and food–drug interactions through both patient interviews and chart reviews. Patient education to enhance compliance with laboratory testing, clinic appointments, diet, and medication. The pharmacist discussed indication, mechanism of action, dosing regimen, treatment duration, target INR range, and food–drug interactions with each patient. Other topics discussed include recognition of the signs and symptoms of bleeding or thrombotic events, the appropriate action to follow if bleeding occurred, and the importance of informing other healthcare providers of warfarin use prior to any medical or dental procedures.
Masuda et al. [35]Led a telemedicine clinic specializing in HCV treatment, responsible for conducting remote consultations to gather patient social and medical histories; managing medication regimens, including making necessary adjustments; screening for potential drug interactions; providing follow-up care throughout the treatment course to ensure its success; and collaborating with other healthcare providers for case discussions. Patient education covered their HCV infection status, test results, health implications, medication regimen, treatment monitoring plan, potential side effects, medications to avoid during treatment, and strategies to prevent reinfection after cure.
Patel [36]A pharmacist, under a collaborative practice agreement, conducted mental health clinical visits, monitored narrow therapeutic index medication laboratory test results, performed movement disorder testing. Three additional pharmacists also conducted metabolic monitoring to minimize cardiovascular risk in patients prescribed antipsychotics. Execution antipsychotic psychoeducation meetings with other healthcare professionals and inmate patients.
Cabelguenne et al. [37] Organization and participation in medical-pharmaceutical meetings, where patient records are discussed between pharmacists, general practitioners and psychiatrists with the aim of solving prescription problems and developing good prescribing practices. Pharmaceutical analysis of prescriptions (validation of indications for use, search for redundancies, validation of doses/dosage regimens, search for drug interactions, proposal for cessation or substitution of treatment).
Harcouët [38]Participation in initiatives aimed at pain management, vaccination, smoking cessation, and cardiovascular risk prevention. Pharmaceutical analysis of prescriptions and guidance on the appropriate use of medications; organization of continuity of care following inmate release; reconciliation of treatment regimens during inmate transfers between facilities.
Lerat et al. [39] Through collaboration between psychiatrists and pharmacists, BZD prescribing guidelines were developed. The pharmacist then participated in monthly staff meetings with psychiatrists to evaluate psychotropic drug prescriptions, ensuring appropriate drug regimens, treatment duration, and the detection of drug–drug interactions.
Davoust et al. [40] Leading workshops on diabetes education, emphasizing the understanding and management of antidiabetic medications.
Lalande et al. [41] Systematic pharmaceutical analysis of prescriptions; pharmacotherapy adjustment (dose modification or discontinuation, regimen optimization, and intake supervision); monitoring of treatment and detection of patients with low adherence; real-time prescribing support during medical consultations; organization of medical-pharmaceutical meetings and promotion of the rational use of medicines; coordination of pharmacovigilance activities; identification and reporting of prescription-related and drug management anomalies.
Cabelguenne et al. [42] Collaboration with psychiatrists to review BZD prescriptions after they are made and before administration, along with meetings to develop common guidelines.
Picard et al. [43] The pharmacist worked collaboratively with physician, performing the following activities: systematic analysis of medical prescriptions; identification of therapeutic follow-up needs, issuing pharmaceutical interventions requesting monitoring tests; participation in monthly physician-pharmacist consultation meetings, contributing to the development of protocols and patient monitoring strategies for antipsychotic use; development and implementation of a standardized follow-up form, included in the patient’s medical record, with clinical and paraclinical parameters to be monitored; raising awareness among the clinical team about the importance of monitoring adverse effects of antipsychotics, with emphasis on metabolic, cardiovascular, and hepatic toxicities.
Denning [44]Providing pharmaceutical care to inmates with complex medical conditions, monitoring the charts of inmates undergoing methadone treatment, and identifying potential medication interactions, recommending changes in pharmacotherapy as necessary.
Bhat et al. [45]Order monitoring parameters (laboratory tests and/or vital signs), intervene in drug therapy, and refer the patient to one or more healthcare professionals.
Dawson et al. [46]Appointments with patients to conduct medication review, identify drug-related problems, and deprescribe pain medications. Patient education.
Cronin, Ryan, and Lyons [47]While dispensing methadone, pharmacists served as supervisors and managers for the patients in SSD.
Abbreviations: Benzodiazepines (BZD), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), International Normalized Ratio (INR), Self-directed Detoxification (SSD).

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