EVALUATING THE IMPACT OF PHARMACY HOME DELIVERY SERVICES ON MEDICATION ADHERENCE AND HEALTH OUTCOMES: A COMPARATIVE STUDY OF SPECIALTY PHARMACIES IN URBAN AND RURAL SETTINGS

Abstract

Pharmacy home delivery and telepharmacy expanded markedly during and after the COVID-19 pandemic, coinciding with the growing complexity of specialty pharmacy care. This review synthesized evidence from 12 empirical studies published between January 1, 2020, and June 30, 2025, to evaluate whether home delivery improves medication adherence and health outcomes, and whether these effects differ between urban and rural settings. Searches across PubMed, Scopus, Web of Science, CINAHL, and MEDLINE utilised a predefined Boolean strategy. Eligibility required an empirical focus on speciality pharmacy home delivery or telepharmacy, with adherence and/or clinical outcomes reported, and an interpretable urban-rural context. Findings indicate that home delivery is associated with higher adherence, typically measured by the Proportion of Days Covered or Medication Possession Ratio, and with favourable clinical endpoints, such as better risk-factor control and fewer utilisation events, when delivery is embedded within pharmacist-led services. Patient-reported outcomes, including satisfaction and health-related quality of life, also tended to improve where a reliable supply was paired with structured counseling, reminder systems, and timely problem-solving. However, gains were heterogeneous and sensitive to context: in rural areas, last-mile logistics, cold-chain integrity, and broadband availability were decisive factors; in urban areas, crowded workflows and fragmented follow-up processes diluted counselling opportunities. Across settings, beliefs about medicines and digital literacy moderated the translation of convenience into sustained use. Overall, pharmacy home delivery is a necessary but insufficient component of high-quality specialty care. The most significant and most consistent benefits emerged when delivery was co-designed with telepharmacy consultations and medication reviews. Persistent urban–rural disparities underscore the need for tailored models, equitable digital infrastructure, and reimbursement that recognises pharmacist time for remote clinical care.