Self-perceived minor ailments might conceal other health conditions if patients are not appropriately assisted by health care professionals. The aim of the study was to evaluate the patient-related outcomes of a community pharmacy Minor Ailment Service (MAS) compared to usual pharmacist care (UC). A cluster randomised controlled trial was conducted over six months in community pharmacy in the province of Valencia (Spain). Patients seeking care or requesting a product for a minor ailments considered in the study (dermatological problems, gastrointestinal disturbance, pain and upper respiratory tract related symptoms) were included. The intervention consisted of a standardised pharmacist-patient consultation guided by a web-based program using co-developed management protocols and patients’ educational material. Patients were followed up by phone ten days later. Primary clinical outcomes were appropriate medical referral and modification of direct product request. Secondary outcomes were symptom resolution and reconsultation rates. A total of 808 patients (323 MAS and 485 UC) were recruited in 27 pharmacies of 21 municipalities. Patients visiting MAS pharmacies had higher odds for being referred to a physician (OR = 2.343, CI95% = [1.146–4.792]) and higher reconsultation rates (OR = 1.833, CI95% = [1.151–2.919]) compared to UC. No significant differences between groups were observed for modification of direct product request and symptom resolution. The use of management protocols through the MAS strengthened the identification of referral criteria such as red flags in patients suffering minor ailments. These patients with symptoms of minor ailments possibly due to more severe illness were to be referred and evaluated by physicians. Results reinforce that MAS increases safety for those patients consulting in community pharmacy for minor ailments. Trial registration number: ISRCTN17235323. Retrospectively registered 07/05/2021, https://www.isrctn.com/ISRCTN17235323.

Background: Autonomous pharmacist prescribing was legally introduced in Switzerland in 2019 with the reclassification from prescription medication to pharmacist prescribing of 105 medications for sixteen indications. Its aim was to limit medical consultations and healthcare costs.Objectives: To evaluate the clinical relevance of the pharmacy prescribing medications compared to the over-the-counter medications (OTCs) and to evaluate its implementation into daily practice.Methods: A comparison was undertaken by clinical pharmacists to evaluate chemical and galenical equivalences between pharmacy prescribing medications and OTCs using compendium. ch and pharmavista. ch. Then, a scoping review was carried out in October 2021 to determine clinical relevance according to clinical guidelines’ recommendations. Clinical relevance was completed by determining if pharmacy prescribing medications were part of a homogeneous therapeutic class (no differences in efficacy and safety considered in clinical guidelines, but rather inter-molecular differences) that included an OTC medication. To identify the most clinically relevant pharmacy prescribing medications, first-line treatments were considered. The implementation into daily practice in Swiss community pharmacies was evaluated through an online questionnaire distributed via e-mail from the national pharmacists’ association and LinkedIn^®. It included 15 questions divided in: pharmacy demographics, experience on pharmacy prescribing, use of prescribing medications and opinion about the them.Results: Of the 105 pharmacy prescribing medications, 20 (19.0%) were first-line treatments without OTC equivalences. Six of them were OTCs reclassified for safety reasons. Ten medications (9.5%) showed a negative clinical relevance (they were not first-line therapeutic options to support pharmacist when managing patients or considered as to be avoided) compared to the OTCs available. For the questionnaire, 283 pharmacists from the German (40.3%), French (37.1%) and Italian-speaking regions (16.9%) answered. In the previous 6 months, 41.7% pharmacies had delivered 10–50 medications and 30.0% between 1 and 10 medications. In situations where patients could be equally treated with a pharmacy prescribing medication or OTC (with an identical OTC, similar OTC or an OTC for the same therapeutic group): 75.6%, 74.9% and 84.8% of pharmacists, respectively, would have chosen OTCs because it required less documentation and it did not require patients’ payment for the service. In addition, pharmacists’ lack of training was also mentioned as barrier for providing the service.Conclusion: Most pharmacist prescribing medications do not present clinical advantages compared to OTCs. In addition, other barriers for implementation were also pharmacists’ training and patient medications costs.

The pharmacist prescribing service was legally permitted in 2019 in Switzerland to face challenges in the health system; however, there has been a lack of implementation. The aims of this study were to identify implementation factors and to evaluate pharmacy association interventions that aim to support implementation. A qualitative study with two methods was carried out: (1) twelve semi-structured interviews with community pharmacists were recorded, transcribed, and a thematic analysis was carried out using the Consolidated Framework of Implementation Research (CFIR); (2) questionnaires were submitted to the six pharmacy associations of French-speaking Switzerland. The main barriers found were non-reimbursement by health insurance companies, medications’ lack of clinical relevance, a negative perception of GPs, and a lack of time. The main facilitators were the availability of service information, pharmacies belonging to chains/groups, a reduction in the medical consultation burden, and the accessibility of pharmacies. Five associations answered, revealing different initiatives supporting implementation, but none of them had strategies at the political level nor communication strategies aimed at patients or GPs. Based on the CFIR, the most frequent implementation factors were highlighted, and this classification facilitates the transposition of the results to other contexts. The results will allow the development of targeted strategies and add the role of the pharmacy associations, which should be considered in future studies.

Spain is a European country with over 47.5 million inhabitants and a public National Health System model (i.e., SNS or “Sistema Nacional de Salud”) that provides universal coverage to residents and non-residents. The system is funded primarily by general taxes, and it is managed by the 17 regions that have responsibility for the provision and management of healthcare services in their respective territories. The health system recognizes self-care as an important element where individuals have an important role to play in maintaining their own health and preventing illness. In addition, there are non-governmental organizations that promote self-care and provide resources and support to individuals and health professionals. Over 55 thousand pharmacists work in 22,198 community pharmacies distributed throughout the Spanish territory. Pharmacies are the only setting that provide non-prescription medications, which is one of the most used tools for self-care. In addition, they provide a range of Primary Care services to improve patient outcomes and the efficiency of the SNS. This paper includes a description and a classification of the community pharmacy services following the seven pillars of self-care established by the International Self-Care Foundation: - Related to pillars 1 to 4 and 6, Spanish community pharmacists provide health promotion, health education, health information and nutritional assessment. - In relation to pillar 5, the services offered are HIV and syphilis screening, colorectal and cervix cancer screening, SARS-CoV-2 screening test and communication, diabetes, high blood pressure and hypercholesterolemia screening. Regarding the programs for avoiding/stopping drug use: methadone supply, syringe exchange and smoking cessation. Another important service is immunization. Spanish community pharmacists are not legally allowed to vaccinate; however, they contribute through education, or vaccines supply, among others. - For the pillar 7, community pharmacists provide services such as a minor ailment service, an adherence service or a network to actively monitor medication safety (sentinel pharmacies). - Many of the pharmacy services related to self-care have been defined and classified at a national level; however, not all community pharmacies provide them while only some services are funded by the regional health systems.

Documentation of pharmacists' activities, such as drug related problems (DRPs) management, is necessary to estimate fair remuneration but is rarely done in community pharmacies. To document and evaluate the evolution of DRPs prevalence and management over six years. Observational study carried out since 2016 in a community pharmacy. Documentation was made yearly for 21 days (depending on seasons, holidays and medical internship rotations) using the ClinPhADoc tool. Pharmacists documented: medication, DRP type, intervention, implied partner and time for DRP management. A subanalysis was made depending on the medical rotation. A total of 171 437 prescriptions were received and 6 844 (4.0%) documented with 1 550 DRPs. Most frequent DRPs were procedural (n = 506, 32.6%), dosage/posology (n = 263, 17.0%) and drug-drug interaction (n = 153, 9.9%). Mean time dedicated to DRP management was 6.9 min, the longest time was for clinical DRPs (11.0 min, SD = 6.6). Most DRPs (n = 726, 44.6%) were managed by the pharmacist alone taking less working time than when involving other stakeholders (p < 0.01). Statistically significant differences were found in DRPs between the beginning and end of medical rotation (p < 0.05). Documentation of DRP management allowed consistent results over the years. Patterns of DRPs can be used to develop inter-professional interventions to prevent DRPs.

Switzerland is a federal country with a liberal health system built on private mandatory health insurance where the government has three different roles (health protector, guarantor of the offered care and regulator). Health is mostly considered as a responsibility that lies with the individual person. Swiss health policies do not include the term "self-care", although, the federal policy strategy established for this decade (Health2030) includes objectives and lines of action, some of which could be classified as self-care.Swiss policies do not specify the role of health professionals; therefore, it is up to each canton (the terminology used to describe a state of the Swiss Confederation), organization or enterprise to stipulate it. Regarding pharmacists, 1844 community pharmacies (CPs) take care of nearly 260,000 patients each day. The CPs play an important role in self-care that includes activities such as improving patients' health literacy, screening for different health problems, self-medication education or recommendation related to non-prescription medication. The government understands and emphasizes the importance of CPs' role in primary health care to overcome some of the health care system challenges, part of these actions related to self-care. However, there is scope for expansion regarding the role of the CPs in self-care. Nowadays the services and activities related are driven by health authorities (i.e., pharmacists' autonomous prescrib-ing, vaccination, strategy for the prevention of non-communicable diseases or digitization of electronic patients' re-cord), professional pharmacy associations (i.e., netCare (R) or screening tests), health foundations (i.e., prevention of addiction) and/or private stakeholders such as chain pharmacies (i.e., screening tests). The possibility of including some of these services related to self-care (even when no medication is supplied) as covered services for the mandatory health insurance is currently politically discussed. Long-term actions that also include remuneration, monitoring and quality assurance, or communication/information to public should be considered to support a broader implementation and the sustainability of CPs' services related to self-care.