Background
Community pharmacy appears to have undergone considerable change over the years.

Objectives
The objective of this research is to study the range of community pharmacy services provided in late stages of the COVID-19 pandemic and during the last decades and to identify potential drivers for change.

Methods
Four European countries (Austria, England, Estonia, and Portugal), which represent a balance in terms of income, organization of the health system and pharmacy services, were selected as case studies. For each country, a factsheet on pharmacy services provided in 2023 and recent developments was populated based on a literature review and validated by country experts in community pharmacies. A semi-structured interview was conducted with a community pharmacist in all study countries to gather additional information, in particular on potential drivers for change.

Results
In all case study countries, community pharmacies offer a range of medicines-related and non-medicines-related services, ranging from core activities such as dispensing and counselling to information on general health topics, point-of-care testing, disposal of returned medicines and needle-exchange programs. Certain services are only permitted in some countries (e.g., vaccinations, generic substitution). Developments (e.g., additional tasks) were observed in the last decades, but some changes were only introduced recently in response to the pandemic (e.g., testing for COVID-19, COVID-19 vaccinations). Several, mostly facilitating, factors, such as high accessibility and acceptance of community pharmacies, the growing relevance of the primary health care concept and an appetite of community pharmacists to take over additional tasks, have contributed to changes in the range of services in community pharmacy in recent years and over the decades.
Conclusions
The study confirms changes in community pharmacy, with overall extension of the services offered. The COVID-19 pandemic was reported to have played an important role but was not considered the sole driver for change.