Primary health care policy and vision for community pharmacy and pharmacists in Spain
Main Article Content
Keywords
Pharmacies, Primary Health Care, Delivery of Health Care, Integrated, Ambulatory Care, Community Health Services, Pharmacists, Community Pharmacy Services, Professional Practice, Spain
Abstract
From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.
References
2. Ministerio de Salud. [Healthcare data]. Available at: https://www.mscbs.gob.es/estadEstudios/sanidadDatos/home.htm (accessed May 8, 2020)
3. [Law 16/2003, 28 May, of cohesion and quality of the National Health System]. BOE. 2003;(128):20567-20588.
4. [Royal Decree-Law 16/2012, 20 of April, about urgent measures to guarantee National Health System sustainability and improve the quality and safety of its performance]. BOE. 2012;(98):31278-31312.
5. Ministerio de Salud, Servicios Sociales e Igualdad. National Health System of Spain, 2012. Madrid; 2012. Avalaible at: https://www.mscbs.gob.es/estadEstudios/estadisticas/sisInfSanSNS/tablasEstadisticas/EnglishSNSReport2012.pdf (accessed May 8, 2020).
6. Martínez M, Said I. [Integrated Care. Case study]. In: Martínez M, Said I, Regueiro A. [Integrated Healthcare: an effective improvement]. Madrid: Fundación Gaspar Casal; 2019. ISBN: 978-84-09-10860-2
7. [Community and Primary Care Strategic Framework]. Madrid: MSCBS; 2019. Available at: https://www.mscbs.gob.es/profesionales/proyectosActividades/docs/Marco_Estrategico_APS_25Abril_2019.pdf (accessed May 8, 2020).
8. Ministerio de Salud, Consumo y Bienestar Social. [Resolution from 26 April 2019, of the General Secreatariat of Haealthcare and Consumption to publish the Community and Primary Care Strategic Framework. BOE. 2019;(109):48652-48670.
9. Sistema Nacional de Salud. [General organization of primary care at the autonomous communities]. https://www.mscbs.gob.es/estadEstudios/estadisticas/docs/siap/Organizacion_General_de_la_AP_2010.pdf (accessed May 27, 2020).
10. SEFAP. [Primary care pharmacists Services portfolio]. Madrid: SEFAP;2017 Available at: https://www.sefap.org/wp-content/uploads/2018/01/Cartera-Servicios-FAP-Final.pdf (accessed May 27, 2020).
11. Resolution of 14 September 2015, of the General Doirectorate of University Policy, to publish the Ministerial agreement from September 4, 2015 to establish the correspondence level in the Spanish Framework of Higher Education Qualifications of the university degree of pharmacist. BOE. 2015;(236):89595-89598.
12. Consejo de Colegios Oficiales de Farmacéuticos. [General Council of Province Pharmacists’ Associations]. Available at: https://www.portalfarma.com/Profesionales/organizacionfcolegial/presentacion/Paginas/Presentacion.aspx (accessed May 28, 2020).
13. Consejo General de Colegios Farmacéuticos. [Statistics of members and community pharmacies 2018]. Madrid; 2019 https://www.portalfarma.com/Profesionales/infoestadistica/Documents/Farmacias-Colegiados-2019.pdf (accessed May 15, 2020)
14. OECD. Pharmacists and pharmacies. In: Health at a Glance 2019: OECD Indicators. Paris: OECD Publishing; 2019. Available at: https://doi.org/10.1787/618d7acf-en (accessed May 15, 2020).
15. Gastelurrutia MA, Faus MJ, Fernandez-Llimos F. Providing patient care in community pharmacies in Spain. Ann Pharmacother. 2005;39(12):2105‐2110. https://doi.org/10.1345/aph.1g121
16. Servicio Público de Empleo Estatal (SEPE). [Pharmacy Technicians]. http://www.sepe.es/HomeSepe/Resultados-busqueda.html?queryStr=auxiliares+de+farmacia&origen=DCTM (accessed May 15, 2020)
17. [Aspime Annual Report of community pharmacies 2019]. Madrid: Fundación Farmas; 2019 http://farmas.net/publicaciones.html (accessed May 15, 2020).
18. [Resolution of 9 April 2014, of General Directorate of Employment, to publish the referee judgement for community pharmacies. XXIV Sectorial Agreement for Community pharmacy]. Available at: https://www.boe.es/boe/dias/2014/05/08/pdfs/BOE-A-2014-4846.pdf (accessed May 8, 2020).
19. [Law 16/1997 of 25 April, about the Regulation of community pharmacy services]. BOE. 1997;(100);13450-13452.
20. Dirección General de Farmacia y Productos Sanitarios. Consensus on Pharmaceutical Care. Ars Pharm 2001;42:221- 41
21. Foro de Atencion Farmacéutica. [Consensus Document]. https://www.portalfarma.com/inicio/serviciosprofesionales/forodeattfarma/Documents/FORO_At_farma.pdf (accessed May 15, 2020).
22. Foro de Atención Farmacéutica-Farmacia Comunitaria (Foro AF-FC). Professional pharmacist care services at community pharmacies. Sixth report of the Foro AF FC. Pan Actual Medic. 2016;40(395):709-711.
23. Foro de Atención Farmacéutica-Farmacia Comunitaria (Foro AF-FC). [Practice guideline for Professional pharmacist care services at community pharmacies]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos; 2019.
24. Martinez-Romero F, Fernandez-Llimos F, Gastelurrutia MA, Parras M, Faus MJ. Pilot phase results of the Dáder program for drug therapy follow up. Ars Pharm. 2001;42:53-65.
25. Fornos JA, Andrés NF, Andrés JC, Guerra MM, Egea B. A pharmacotherapy follow-up program in patients with type-2 diabetes in community pharmacies in Spain. Pharm World Sci. 2006;28(2):65‐72. https://doi.org/10.1007/s11096-006-9003-0
26. Ocampo CC, Garcia-Cardenas V, Martinez-Martinez F, Benrimoj SI, Amariles P, Gastelurrutia MA. Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes. Int J Clin Pharm. 2015;37(5):931‐940. https://doi.org/10.1007/s11096-015-0145-9
27. Jódar-Sánchez F, Malet-Larrea A, Martín JJ, García-Mochón L, López Del Amo MP, Martínez-Martínez F, Gastelurrutia-Garralda MA, García-Cárdenas V, Sabater-Hernández D, Sáez-Benito L, Benrimoj SI. Cost-utility analysis of a medication review with follow-up service for older adults with polypharmacy in community pharmacies in Spain: the conSIGUE program. Pharmacoeconomics. 2015;33(6):599‐610. https://doi.org/10.1007/s40273-015-0270-2
28. Oñatibia-Astibia A, Malet-Larrea A, Larrañaga B, Gastelurrutia MÁ, Calvo B, Ramírez D, Cantero I, Garay Á, Goyenechea E. Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial. Health Serv Res. 2019;54(3):658‐668. https://doi.org/10.1111/1475-6773.13152
29. García-Cárdenas V, Gastelurrutia MA, Malet-Larrea A, Peiró T, Pérez-Escamilla B, Saez-Benito L, Torres-Robles AJ, Valverde MI, Varas R, Zarzuelo MJ, Benrimoj SI, Martínez-Martínez F. [AdherenciaMED Project: Design, impact assessment and implementation of a professional service for therapeutic adherence at the community pharmacy setting]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos ; 2019 ISBN: 978-84-87089-12-1
30. da Costa FA, Mala-Ladova K, Lee V, Tous S, Papastergiou J, Griffiths D, Chaumais MC, Hersberger KE, Viola R, Paulino E, Lobban T, Neubeck L, Freedman B, Antoniou S. Awareness campaigns of atrial fibrillation as an opportunity for early detection by pharmacists: an international cross-sectional study. J Thromb Thrombolysis. 2020;49(4):606‐617. https://doi.org/10.1007/s11239-019-02000-x
31. Amador Fernández N, Baixauli VJ, Climent MT, Colomer V, García-Agudo O, García-Cárdenas V, García-García JI, García-Mochón L, Gastelurrutia MA, Giner J, Gómez JC, Pérez-Vicente S, Benrimoj SI, Martínez-Martínez F. [INDICA+PRO Project: Assessment of the clinical, economic and humanistic impact of the advising to symptoms service at community pharmacy]. Available at: https://www.sefac.org/system/files/2020-01/INDICA%2BPRO_Informe.pdf (accessed May 15, 2020).
32. Arrillaga A, Martínez ML, Oñatibia A, Sanz S, Sanz I, Lajo N, Arraiza A. [Implication of Basque community pharmacy in prevention and diagnose of HIV]. XIX National Congress on AIDS and STDs. Alicante, May 2019.
33. Consell de Col.legis Farmacèutics de Catalunya. [2018 Annual Report]. Available at: http://www.ccfc.cat/wp-content/uploads/memories/2018/Memoria-2018-CCFC.pdf (accessed May 15, 2020).
34. [Annual report from the Gipuzkoa Pharmacist Association 2018]. http://www.cofgipuzkoa.com/Sec_PB/wf_publicacioneslst.aspx?IdMenu=1005 (accessed May 15, 2020).
35. [San Bartolome municipality will fund a personalized dose system]. https://www.diariodehuelva.es/2016/04/25/el-ayuntamiento-de-san-bartolome-financiara-un-servicio-personalizado-de-dosificacion-de-medicamentos/ (accessed May 15, 2020).
36. Gastelurrutia MA, Larrañaga B, Garay A, Echeveste FA. [Intervention from community pharmacies on patients assisted at municipal domiciliary support]. Farmacéuticos Comunitarios. 2010 Mar 30; 2 (1): 15-20
37. Ruiz González D, Baixauli Fernández VJ, Colomer Molina V, Sendra Lillo J, Sanfeliu Vela M, Gil Peinado M, García Agudo Ó, Hortigüela Español C. [Results of an directly observed treatment (TOD) in community pharmacy on a patient treated with anti-retrovirals]. Pharm Care Esp. 2017;19(5):237-431.
38. SIGRE. [Medicines and environment]. Available at: https://www.sigre.es/#nav-primary-cat04 (accessed May 25, 2020).
39. SIGRE. [The system in figures]. Available at: https://www.sigre.es/sigre/cifras/el-sistema-en-cifras/ (accessed May 25, 2020).
40. Gastelurrutia MA, Fernández-Llimos F, Benrimoj SI, Castrillon CC, Faus MJ. [Barriers for the implementation of cognitive services in Spanish community pharmacies]. Aten Primaria. 2007;39(9):465‐470. https://doi.org/10.1157/13109494
41. Martinez-Martinez F, Farragher T, Faus M, Garcia-Cardenas V, Gastelurrutia MA, Jodar F, Martín Martín JJ, Noain MA, Sabater-Hernández D, Sáez-Benito L, Varas R, Benrimoj SI. [conSIGUE Impacto: measuring clinical, economic and humanistic impact of medication review with follow-up in polypharmacy elderly at Spanish community pharmacy]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos; 2014. ISBN: 9788487276835
42. Martínez-Martínez F, Faus MJ, Fikri-Benbrahim N, García-Cárdenas V, Gastelurrutia MA, Malet-Larrea A, Moullin J, Pérez-Escamilla B, Sabater- Hernández D, Sáez-Benito L, Sánchez AI, Varas R, Benrimoj SI. Informe 2014- 2016 [conSIGUE report 2014-2016: Program to implementation and future sustainability of the medication review with follow-up service in Spanish community pharmacy]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos; 2016. ISBN: 978-84-87276-99-6
43. Gastelurrutia MA, Fernández M, García-Cárdenas V, Megía C, Pérez-Escamilla B, Varas-Doval R, Zarzuelo MJ, Benrimoj SI, Martínez-Martínez F. [ConSIGUE generalization of the implementation of medication review with follow-up service in]. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos; 2019. ISBN: 978-84-87089-13-8
44. [Physician and pharmacist: solution in health]. 2º Congreso Nacional Médico-Farmacéutico SEFAC-SEMERGEN. Available at: https://congresosemergen-sefac.com/ (accessed May 27, 2020).
45. Aliaga L, Baixauli VJ, Murillo MD, Sáez FJ. COVID-19. [Problems and solutions in Primary Care and Community Pharmacy]. Madrid: SEFAC-SEMERGEN-SEMG. ISBN: 978-84-09-20476-2
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.