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Background and Importance Hospital pharmacists are increasingly taking on advanced and specialist roles in outpatient settings, yet the scope and impact of these roles remain unclear. Understanding these roles is essential for workforce planning, service optimisation, and improving patient outcomes.Aim and Objectives To systematically map the global evidence regarding advanced or specialist pharmacist roles in hospital outpatient settings.Material and Methods Guided by JBI methodology and a pre-registered protocol (https://osf.io/t6d3w), five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Google Scholar) were searched from inception to February 2025. English language articles describing advanced or specialist pharmacist roles in hospital outpatient settings were included. Two reviewers independently screened all articles. Data extraction was undertaken by one reviewer using a structured tool, with 10% dual-extracted to ensure consistency. Extraction included study characteristics and information on scope of practice and service delivery. Descriptive statistics were performed, and findings were narratively synthesized.Results From 8064 studies screened, 126 were included. Most studies originated from the United States ( n=93), the United Kingdom (n=12), and Canada (n=10). Almost two-thirds were descriptive case studies/practice reports (n=81), with only three randomised controlled trials (RCTs). Common practice areas included haematology and/or oncology (n=30), cardiology (n=26), endocrinology (n=12), and infectious diseases (n=11). Pharmacists had prescriptive authority in 69% of studies. Frequently reported tasks included initiating, modifying, discontinuing, or administering a medicine (88.1%), monitoring safety of drug therapy (84.9%), and patient/caregiver education (80.2%). Pharmacist education and/or training was reported in 51% of studies. Reported outcomes demonstrated broad impact across pharmacist productivity (n=84), patient measures (n=61), costs and resources (n=56), medication (n=46), and healthcare staff (n=6).Conclusion and Relevance This review has uniquely mapped the diverse tasks undertaken by advanced or specialist hospital pharmacists in outpatient settings and identifies key practice areas in which these roles exist. Reported outcomes demonstrate a wide spectrum of person-centred, clinical, and economic impact. These findings establish a benchmark for service development and highlight the need for further research, particularly in underrepresented regions beyond North America and the United Kingdom. Key recommendations for future research include providing more detailed accounts of pharmacist education and training and further RCT evidence to support role expansion.Conflict of Interest No conflict of interest