Digital Pharmacy Services and Unequal Access to Medicines: An Integrative Review of Equity Consequences

Digital pharmacy services increasingly mediate how patients obtain medicines, advice, and follow-up. Their expansion may reduce distance and time barriers, but benefits are not distributed uniformly because connectivity, affordability, literacy, language, disability, trust, and organizational capacity shape use. To integrate empirical, theoretical, and policy-relevant evidence on how digital pharmacy services influence unequal access to medicines, who benefits, who encounters barriers, and which contextual conditions reduce or amplify inequity. A transparent integrative review used a protocol-defined search, eligibility criteria, record-level screening, source-type-sensitive appraisal, structured extraction, comparative data reduction, and thematic synthesis. Access was treated as multidimensional rather than equivalent to service availability. Evidence was compared across digital access, affordability, reach, literacy, language, disability, usability, geography, organizational capacity, data representation, and algorithmic processes.

Digital pharmacy can extend service reach, support continuity, and reduce travel or scheduling burdens when infrastructure, accessible design, human assistance, and implementation capacity are adequate. The same services can intensify exclusion when participation requires reliable connectivity, suitable devices, digital or health literacy, dominant-language fluency, accessible interfaces, trust, or institutional support. Evidence concerning algorithmic equity remained less mature than evidence concerning telepharmacy and digital access barriers. Reported benefits were therefore conditional, context-dependent, and not interchangeable with equitable access. Digital pharmacy is neither inherently equity-promoting nor inherently exclusionary. Equity consequences arise from interactions among service design, patient resources, organizational arrangements, and data practices. Evaluation should examine who can enter, use, understand, trust, and meaningfully benefit from the service, while retaining nondigital alternatives and escalation routes.