Letter to the Editor Legal cognitive requirements impact on pharmacy practice and patient outcomes Karin Svensberg, M.Sc.Pharm. a, * , Ingunn Bjo¨rnsdottir, M.Sc.Pharm., Ph.D. a , Sofia Ka¨lvemark Sporrong, Ph.D. b a School of Pharmacy, Section of Social Pharmacy, Research Group Pharma-Safe, University of Oslo, P.O. 1068, Blindern, 0316 Oslo, Norway b Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark To the Editor: Dispensing medications is among the core and most time consuming tasks of community pharmacists. Dispensing can be defined as the distribution of medications according to a pre- scription. 1 Some aspects of the dispensing process, such as finding the right product to dispense or label, can be done by a robot. Nevertheless, the dispensing can also include important clinical and cognitive elements, i.e. identifying clinical errors and undertaking interventions to optimize patient outcomes. In those situations a pharmacist’s pro- fessional competence and judgment is needed to ensure optimal outcome and patient safety. We also know that pharmacists’ individual dispensing practice varies regarding i.e. kinds and amount of prescription interventions undertaken. 2,3 Irrespec- tively of pharmacy system, the legislation consti- tutes a basis for the pharmacy professional’s work and autonomy. This subsequently impacts the comprehensiveness, content and the quality of the dispensing process. Exploring the regulatory frameworks’ requirements increases our under- standing of policymakers’ intentions with regard to the clinical role of the community pharmacists and their autonomy during dispensing. Various countries throughout the world differ in their requirements of the prescription review process for pharmacy staff during dispensing. We conducted a comparison of the Nordic countries’ (Denmark, Finland, Iceland, Norway and Swe- den) legal demands of the dispensing process (except for counseling, which is described else- where 4 ). The results showed that the countries legal cognitive requirements of the prescription re- view process and handling of interventions are diffuse and few. At least when compared to re- quirements regarding control of prescriptions for completeness; i.e. technical issues such as standard information on the prescriber and patient, and verification of the authenticity. Some cognitive areas mentioned for control are dosage accuracy and checking for interactions. Otherwise the phar- macist should judge and approve each prescrip- tion professionally, with no further definitions or guidelines. As a general rule in these countries, all identified clinical and technical problems should be discussed with the prescriber before a change takes place. Whereas for example Cana- dian pharmacists, in some situations, can indepen- dently change the dose or regime of a suboptimal prescribed medication to improve patient out- comes. 5 The Nordic dispensing legislations, on the other hand, appear to limit the benefits the pa- tients enjoy from the pharmacists’ medication expertise. * Corresponding author. Tel.: þ47 22845549. E-mail address: karin.svensberg@farmasi.uio.no (K. Svensberg). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.01.003 Research in Social and Administrative Pharmacy 11 (2015) 590–591