Delphi study on barriers to the implementation of a national clinical pharmacy practice guideline – results from Bulgaria

Although postgraduate training in clinical pharmacy has been established in Bulgaria since 1986, the practical implementation and standardization of clinical pharmacy practice remain insufficiently studied and documented. This Delphi study explored barriers to introducing a national clinical pharmacy practice guideline. Eight clinical pharmacists from six university hospitals identified, ranked, and prioritized barriers. A total of 12 barriers were categorized into educational, regulatory, logistical, organizational, and financial groups. The most frequently cited barrier was the insufficient number of clinical pharmacists in hospital settings (87.5%). The most meaningful barriers were insufficient practical training during specialty education and the lack of a comprehensive regulatory framework. A moderate and statistically significant degree of concordance between the pharmacists was observed (Kendall’s W = 0.320; p = 0.003). The findings highlight the need for targeted educational, regulatory, and workforce-related measures to ensure consistent and high-quality clinical pharmacy practice.