Viviendo la experiencia de cuidar a un familiar mayor y ser empleado: roles en conflicto / Living the experience of caring for an elderly relative and being employed: roles in conflict

Objetivo: Develar la experiencia vivida de personas que realizan el doble rol de cuidar a un familiar mayor dependiente y trabajar remuneradamente. Metodología: investigación cualitativa fenomenológica. Participaron 14 personas que asistieron a un programa de apoyo al trabajador-cuidador familiar, y que eran cuidadores de una persona mayor dependiente, de quienes se recogió la experiencia a través de una entrevista semiestructurada. Se entrevistó hasta alcanzar la saturación de significados. El análisis se realizó a través del método propuesto por Streubert. Resultados: el fenómeno se develó en la categoría comprensiva multiplicidad de roles compuesta por las subcategorías angustia/agobio y culpa. Conclusiones: resulta urgente visibilizar las consecuencias de la multiplicidad de roles y desarrollar políticas públicas para la conciliación de ellos (AU)

Objective: To reveal the lived experience of people who perform the double role of caring for a dependent elderly relative and working remuneratively. Methodology: qualitative phenomenological research of 14 people who participated in a family worker-caregiver support program, and were caregivers of a dependent elderly person, from whom the experience was collected through a semi-structured interview. It was interviewed until a saturation of meanings was reached. The analysis was performed through the method proposed by Streubert. Results: the phenomenon was revealed in the comprehensive multiplicity of roles category composed of the subcategories distress/burden and guilt. Conclusions: it is urgent to make visible the consequences of the multiplicity of roles and develop public policies for their reconciliation (AU)

Are professional pharmacy services being offered for free in pharmacies? A feasibility study exploring the use of a time motion study in New Zealand

Background: Pharmacists report to be providing patient-focused clinical services for which they receive no remuneration. Limited literature exists about unfunded services leading to difficulties in ascertaining an appropriate study design for such research. Objective: This study aims to assess the appropriateness of a proposed study design before launching a nationwide study to investigate the provision of unfunded patient care services. Methods: A multi-methods approach was utilised consisting of (1) continuous time motion study in community pharmacies (2) semi structured patient interviews (3) patient follow up (4) semi structured interviews with pharmacy owners/managers. All observations of unfunded patient care services were recorded, numerically coded and descriptively analysed. Semi structured interviews were audio recorded and transcribed verbatim. A semantic thematic analysis was carried out. Appropriateness of study design was dictated by the ability to characterise services and obtain patient perceptions. Results: Ten pharmacies took part in the feasibility study, across the city of Dunedin, New Zealand, representing a range of different practice settings and demographics. Ten patients were interviewed and six responded to follow up. Both pharmacy and patient recruitment proved challenging due to concerns around disruption to workflow and patient privacy. A continuous observation time motion study was found to be appropriate as it minimises disruption to workflow with no additional work required from the pharmacy teams. Conclusions: A continuous observation time motion study proved to be an appropriate method to investigate the provision of unfunded services on a national scale. The findings of the study suggest design changes such as length of observation time, increasing patient recruitment and additional patient questions to enhance the nationwide study (AU)

Why do pharmacists leave the profession? A mixed-method exploratory study

Background: Recent New Zealand policy documents aim for pharmacists to be retained, and promote the provision of extended clinical pharmacy services. However, younger pharmacists have expressed dissatisfaction with the profession on informal social for a. Objectives: To explore the characteristics, and perspectives of pharmacy as a career, of recent Bachelor of Pharmacy (BPharm, four-year degree) graduates who have left, or are seriously considering leaving the New Zealand pharmacy profession in the near future and where they have gone, or plan to go. Methods: We conducted a cross-sectional study with a mixed-method explanatory sequential design. An anonymous online survey among those who completed their pharmacy undergraduate degree (BPharm or equivalent) in 2003 or later and who had left or who were seriously considering leaving the New Zealand pharmacy profession in the next five years, was open from 1st December 2018 to 1st February 2019. Recruitment occurred via University alumni databases, pharmacy professional organisations, pharmaceutical print media, social media and word-of-mouth. Ten semi-structured interviews were then conducted with a purposive sample of survey respondents. Descriptive statistics were generated from the quantitative data and qualitative data were analysed using manifest content analysis. Results: We received 327 analysable surveys of which 40.4% (n=132) were from those who had already left the New Zealand pharmacy sector at the time of the data collection and the rest (59.6% n=195) were those working within the sector, but seriously considering leaving the profession. Reasons most commonly reported for studying pharmacy were having an interest in health and wanting to work with people (AU)

O papel da remuneração na decisão de participar de pesquisa na saúde el papel de / El papel de la remuneración en la decisión de participar en la investigación en salud / The role of remuneration in the decision to participate in health research / El paper de la remuneració en la decisió de participar en la recerca en salut

O processo de consentimento informado para participação de pesquisa com seres humanos visa fornecer as informações adequadas ao indivíduo possibilitando que este tome a decisão de participar de maneira voluntária, livre de pressões externas. A possibilidade de remuneração poderia interferir na voluntariedade deste processo de consentir. O presente estudo objetivou avaliar percepção de influência da remuneração monetária por meio de simulações de pesquisa que variam em nível de risco (Bioequivalência e de Fase I) e tipo de remuneração monetária (com e sem). Participaram do estudo 80 voluntários. Os resultados sugerem que a remuneração não constituiu uma interferência na voluntariedade do processo de consentimento, visto que participantes aceitaram convite para participar da primeira pesquisa para a qual foram convidados e não se sentiram influenciados indebidamente

El proceso de consentimiento informado para la participación de sujetos humanos en investigación tiene por objeto dar la información adecuada al individuo, permitiendo que tome la decisión de participar de manera voluntaria y libre de presiones externas. La posibilidad de remuneración podría interferir en la voluntariedad de este proceso de consentir. El presente estudio evalúa la percepción de la influencia de la remuneración monetaria a través de simulaciones de investigación que varían en nivel de riesgo (Bioequivalencia y de Fase I) y tipo de remuneración monetaria (con y sin). Participaron del estudio 80 voluntarios. Los resultados sugieren que la remuneración no constituyó una interferencia en la voluntariedad del proceso de consentimiento, ya que los participantes aceptaron una invitación para participar en la primera encuesta a la que fueron invitados y no se sintieron influenciados incorrectamente

The process of informed consent for research participation with human beings aims to provide appropriate information to individuals enabling him or her to make the decision to participate voluntarily, free of external pressures. The possibility of remuneration could interfere in the willingness to consent. The present study aims to evaluate the perception of influence of the monetary payment through research simulations that vary in the level of risk (Bioequivalence and Phase I) and type of monetary payment (with and without). Eighty volunteers participated in the study. The results suggest that remuneration did not interfere with the willingness of the consent process, as participants accepted an invitation to participate in the first research option to which they were invited to and did not feel undue influence

El procés de consentiment informat per a la participació de subjectes humans en recerca té per objecte donar la informació adequada a l'individu, permetent que prengui la decisió de participar de manera voluntària I lliure de pressions externes. La possibilitat de remuneració podria interferir en la voluntarietat d'aquest procés de consentir. El present estudi avalua la percepció de la influència de la remuneració monetària a través de simulacions de recerca que varien en nivell de risc (Bioequivalencia I de Fase I) I tipus de remuneració monetària (amb I sense). Van participar de l'estudi 80 voluntaris. Els resultats suggereixen que la remuneració no va constituir una interferència en la voluntarietat del procés de consentiment, ja que els participants van acceptar una invitació per a participar en la primera enquesta a la qual van ser convidats I no es van sentir influenciats incorrectament

Elección de carrera en salud y calidad de la educación superior: efectos en los ingresos de los médicos peruanos / Health career choice and higher education quality: The effects on Peruvian physician salaries

No disponible

Improving nurses' performance through remuneration: a literature review

Background: A remuneration system greatly influences the quality of nursing care and services. Objective: The goal of this study was to identify the effects of a remuneration system on nurses' performance. Design: This research used a literature review design and involved the analysis of 25 articles published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, PsycINFO, and Global Health databases. The literature was limited to articles published in English between August 2006 and August 2015. Results: The results of this study indicate that the improvement of remuneration systems has positive consequences in terms of nurses' performance and subsequent quality of healthcare services. A well-managed remuneration system has the potential to increase nurses' motivation, productivity, satisfaction, and even improve retention. In contrast, poorly managed and low remuneration contributes to a shortage of nurses due to high turnover rates. Conclusions: Adequate remuneration has been shown to improve nurses' performance and, consequently, improve the quality of healthcare. This literature review provides scientific evidence for decision-makers to consider the implementation of remuneration systems that include credentialing, re-credentialing, and career ladders. Future studies are suggested to investigate the development of well-managed remuneration systems for nurses

No disponible

Modelos de remuneración del servicio de Seguimiento Farmacoterapéutico / Potential remuneration models for medication review with follow-up service in community pharmacy

Introducción: Existen diferentes motivos que justifican la necesidad de remunerar el servicio de seguimiento farmacoterapéutico (SFT). El cálculo de su precio se puede realizar de varias maneras y es importante para que su pago salvaguarde la sostenibilidad de la actividad. Objetivo: Explorar cómo se justifica la necesidad de remunerar la provisión del servicio de SFT, describir las propuestas sobre quién y a quién se debería pagar, así como los modelos de remuneración propuestos. Método: Se realizaron 21 entrevistas semiestructuradas a farmacéuticos Innovadores con experiencia en la realización de SFT y a otros que acababan de comenzar a realizar SFT en el entorno del Programa conSIGUE. Resultados: En ambos grupos, se argumenta que el farmacéutico posee la formación necesaria para proveer el servicio y aventaja la cercanía que tiene con los pacientes. Además, se alude a la asunción de responsabilidad del farmacéutico y al impacto económico y clínico generado por la provisión del servicio. Se sugiere que sea la Administración la que sufrague el servicio y que el pago se efectúe a la farmacia como organización, sin dejar de compensar económica y profesionalmente al proveedor. El precio del servicio debe cubrir, entre otros, los costes de provisión y tener en cuenta el tiempo empleado transcurrido. También se podría valorar la complejidad de los casos, el impacto y eficiencia, el número de pacientes, etc. Conclusión: Es necesario conseguir la remuneración del servicio de SFT con un precio adecuado para que sea sostenible a lo largo del tiempo. Este tipo de servicio debe ser sufragado por la Administración sanitaria aunque no se descarta la participación de los beneficiarios. El pago se debe realizar a la farmacia y el farmacéutico proveedor debe recibir el complemento correspondiente

Introduction: Different reasons justify the need to remunerate the provision of the service of Medication Review with follow-up (MRF). Its price could be obtained through several calculations and its value is essential to sustain the activity. Objective: To explore how is being justified the need to remunerate the MRF’ provision, to describe the proposals on who should pay and to whom, as well as to explore the models of remuneration proposed. Method: 21 semi-structured interviews were conducted with innovative pharmacists experienced in the provision of MRF service and with others that have just been introduced to it within the framework of the conSIGUE program. Results: Pharmacists justified the need to obtain the remuneration of the service for different reasons. In both groups, it is argued that the pharmacist possesses the expertise to provide the service and is surpassed by an easy access to patients. In addition to this, participants referred to the assumption of responsibility and to the economic and clinical impact of the service provision. In both groups the Administration is proposed as the main payer while it is recommended to pay to the pharmacy as an organization as well as, to economically and professionally compensate the provider. The price must cover between others, costs of provision and the spent time. It could be also considered the complexity of the case, the impact and efficiency, the number of patients, etc. Conclusion: It is necessary to obtain the remuneration of MRF’s service with a suitable price in order to sustain the activity. This type of service must be defrayed by the Administration without ruling a patient copayment. The community pharmacy must bill the service provision and the provider must be compensated

Relación entre necesidades básicas y autodeterminación en deportistas de élite / Relationship between basic needs and self-determination in elite athletes / Relação entre as necessidades básicas e autodeterminação em atletas de elite

Este trabajo se centró en algunas de las predicciones hechas desde de la Teoría de la Autodeterminación a nivel contextual en la población de deportistas de élite. El objetivo principal fue estudiar la relación entre la satisfacción de las necesidades básicas y la motivación, comparando ambas en función del género y la modalidad deportiva. Además se exploró la orientación de los deportistas hacia la recompensa económica. Un total de 79 deportistas de élite participaron en el estudio. Generalmente, los resultados mostraron correlaciones positivas entre la satisfacción de las necesidades básicas y los grados más auto-regulados de la motivación, y correlaciones negativas entre la satisfacción de las necesidades básicas y los grados menos auto-regulados. En cuanto a las diferencias en función del género y la modalidad deportiva, pruebas t para datos independientes revelaron que las mujeres sentían una mayor satisfacción de la necesidad básica de relación (t [77] = -2,46; p = .016) y una mayor motivación integrada (t [52.36] = -2,72; p = .009). Además, los hombres tenían una mayor preocupación con el hecho de ganar dinero (t [77] = 2,88; p = .005). En cuanto a la modalidad, los deportistas individuales exhibieron mayores niveles de amotivación que los de equipo (t [77] = 2,73; p =.008) y los deportistas de equipo estaban más preocupados con ganar dinero (t [77] = -2,25; p = .028). Finalmente, se discuten estos resultados teniendo en cuenta resultados de estudios previos. Éste estudio descriptivo encontró diferencias respecto a la necesidad básica de competencia y a las variables de género y modalidad (AU)

This article was focused in the study of some variables realized from the Self-Determination Theory at the contextual level in elite athletes. The aim of this article was to study the relationship between satisfaction of basic needs and motivation, comparing both variables in function of modality and gender. Also, the orientation for an economical reward has been explored. A total of 79 elite athletes participated in this study. In general, results showed positive correlations between basic needs satisfaction and more self-regulated degrees, and negative correlations between satisfaction of basic needs and the lower self-regulated degrees. As for difference regarding gender and modality, t for independent values exposed that women felt more satisfaction of the basic need of relationship (t [77] = -2,46; p = .016) and more integrated motivation (t [52.36] = -2,72; p = .009). Further, men were more worried about earning money (t [77] = 2,88; p = .005). Regarding modality, individual athletes exhibited higher amotivation than collective athletes (t [77] = 2,73; p =.008) and collective athletes were more worried about earning money (t [77] = -2,25; p = .028). Finally, results were discussed comparing it with previous literature and limitations of this study. The descriptive study illustrates differences in basic need competence, modality and gender in the variables studied (AU)

Este trabalho centrou-se em estudar algumas variáveis dadas pela Teoría da Autodeterminação no nível contextual da poblação de desportistas de élite. O objectivo principal foi avaliar a relação entre a satisfação das necessidades básicas e a motivação, comparando as duas em função do género e da modalidade desportiva. E explorar a orientação para remuneração económica. Um total de 79 desportistas de élite participaram no estudo. Geralmente os resultados mostraram uma correlação positiva entre a satisfação das necesidades básicas e os graus mais auto-regulados da motivação, e correlações negativas entre a satisfação das necessidades básicas e os graus menos auto-regulados. Nas comparações realizadas em função do género e a modalidade desportiva as provas t para dados independientes exposto que as mulheres sentem uma maior satisfação da necessidade básica de relação (t [77] = -2,46; p = .016) e uma maior motivação integrada (t [52.36] = -2,72; p = .009). Também, os homens estavam mais preocupados em ganhar dinheiro (t [77] = 2,88; p = .005). Relativamenta a modalidade, os desportistas indivudais exibiram maiores níveis de desmotivação do que as equipas (t [77] = 2,73; p =.008) y os desportistas de equipa estavam mais preocupados em ganhar dinheiro (t [77] = -2,25; p = .028). Finalmente são discutidos estos resultados tendo em conta resultados de estudos previos e as limitações deste trabalho. En este estudo descritivo se encontraram diferenças na necessidade básica para as variáveis de competência e de gênero e modalidade (AU)

Do family physicians need more payment for working better? Financial incentives in primary care / ¿Son necesarios los incentivos para trabajar mejor? Incentivos económicos en atención primaria

INTRODUCTION: Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. OBJECTIVE: Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. METHODS: Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. RESULTS: Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. CONCLUSIONS: The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well

INTRODUCCIÓN: En muchos países europeos se aplican en atención primaria diferentes programas de pago de incentivos en función de objetivos alcanzados. OBJETIVO: El objetivo de nuestro estudio es describir y comparar los indicadores más recientes utilizados en estos programas. MÉTODOS: Se realiza una revisión bibliográfica sistemática recogiendo las principales publicaciones sobre el tema. De forma complementaria se remite un cuestionario a diferentes expertos en atención primaria de diferentes países de la red European General Practice Research Network'. RESULTADOS: Diez países tienen publicados sus indicadores de calidad (IDC) asociados a los incentives económicos. El número de indicadores varía entre 1 y 134. En 8 países los IDC y los incentivos están incluidos en el salario mensual del médico, suponiendo entre el 1 y el 25% del mismo. CONCLUSIONES: Los IDC se basan fundamentalmente en el registro de determinadas variables tanto por el médico como por el equipo directivo, aunque la validez de los mismos puede variar según la fuente de datos utilizada. Los programas se monitorizan de forma continua a nivel nacional o regional, de acuerdo con cada sistema de atención sanitaria y los recursos disponibles

Transformaciones de datos en la elaboración de estudios salariales / Data transformations in salary surveys

El presente trabajo pretende mostrar algunos aspectos de la preparación y el tratamiento de los datos procedentes de encuestas salariales con vistas a la elaboración de informes retributivos. Veremos cómo, tras probar diferentes transformaciones alternativas, se puede comprobar que mediante una transformación logarítmica es posible mejorar la asimetría y la curtosis de las variables del modelo (facturación y salario), así como convertir en lineal una relación entre dos variables que con los datos originales no lo es, lo que facilita el análisis de los datos al permitir utilizar el modelo de regresión. Estudiaremos la relación entre el salario y el tamaño de la empresa, ya que esta relación es la que mejor predice el salario de mercado que debe obtener un empleado en un puesto determinado. Presentamos un ejemplo de la aplicación del modelo de regresión para el estudio de esta relación (AU)

This article intends to show some of the aspects involved when elaborating and processing data coming from salary surveys to produce retribution reports. We will see how after trying different alternative transformations it is possible to verify that, through a logarithmic transformation, the asymmetry and kurtosis of a model’s variables can be improved (revenues and salary) as well as a relation between two variables converted in lineal –something that would have been impossible to achieve with the original data. This would make data analysis easier, because it allows the use of the regression model. We will study the relation between salary and company size, because this relationship is the best to predict the market salary that is earned by a specific jobholder. We give an example of application of a regression model for studying this relationship (AU)

La atención farmacéutica está inexorablemente unida al desarrollo y la aplicación de un sistema mixto de remuneración en España / Pharmaceutical care is inextricably linked to the development and implementation of a mixed remuneration system in Spain

No disponible

How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing? / ¿Cómo pueden contribuir los sistemas de remuneración farmacéutica a la dispensación de medicamentos genéricos?

Generic medicines can generate larger savings to health care budgets when their use is supported by incentives on both the supply-side and the demand-side. Pharmacists’ remuneration is one factor influencing the dispensing of generic medicines. Objective: The aim of this article is to provide an overview of different pharmacist remuneration systems for generic medicines in Europe, with a view to exploring how pharmacist remuneration systems can contribute to generic medicine dispensing. Methods: Data were obtained from a literature review, a Master thesis in Pharmaceutical Care at the Catholic University of Leuven and a mailing sent to all members of the Pharmaceutical Group of the European Union with a request for information about the local remuneration systems of community pharmacists and the possible existence of reports on discounting practices. Results: Pharmacists remuneration in most European countries consists of the combination of a fixed fee per item and a certain percentage of the acquisition cost or the delivery price of the medicines. This percentage component can be fixed, regressive or capped for very high-cost medicines and acts as a disincentive for dispensing generic medicines. Discounting for generic medicines is common practice in several European countries but information on this practice tends to be confidential. Nevertheless, data for Belgium, France, the Netherlands and United Kingdom indicated that discounting percentages varied from 10% to 70% of the wholesale selling price. Conclusion: Pharmacists can play an important role in the development of a generic medicines market. Pharmacists should not be financially penalized for dispensing generic medicines. Therefore, their remuneration should move towards a fee-for-performance remuneration instead of a price-dependent reimbursement which is currently used in many European countries. Such a fee-for-performance remuneration system provides a stimulus for generic medicines dispensing as pharmacists are not penalized for dispensing them but also needs to account for the loss of income to pharmacists from prohibiting discounting practices (AU)

Los medicamentos genéricos pueden producir mayores ahorros a los presupuestos sanitarios cuando se apoyan con incentivos tanto a la oferta como a la demanda. La remuneración de los farmacéuticos es un factor que influye en la dispensación de medicamentos genéricos. Objetivos: El objetivo de este artículo es proporcionar una revisión de diferentes sistemas remunerativos de medicamentos genéricos en Europa, con idea de explorar con la remuneración de los farmacéuticos puede contribuir a la dispensación de genéricos. Métodos: Se obtuvieron datos de una revisión de la literatura, de una tesis de Master en Atención Farmacéutica en la Universidad Católica de Lovaina, y de un correo enviado a todos los miembros del Grupo Farmacéutico de la Unión Europea solicitando información sobre los sistemas locales de remuneración de farmacéuticos comunitarios y la posible existencia de informes sobre las prácticas de descuentos. Resultados: La remuneración de los farmacéuticos en la mayoría de los países europeos consiste en la combinación de una tasa fija por artículo y un cierto porcentaje del precio de compra o del precio de venta del medicamento. Este componente porcentual puede ser fijo, regresivo o con topes para los medicamentos de muy alto coste, y actúa como un desincentivo para dispensar medicamentos genéricos. Los descuentos para medicamentos genéricos son practica común en varios países Europeos, pero la información sobre esta práctica tiende s ser confidencial. Sin embargo, los datos de Bélgica, Francia, Holanda y Reino Unido indican que los porcentajes de descuento varían del 10% al 70% del precio del mayorista. Conclusión: Los farmacéuticos pueden jugar un papel importante en el desarrollo del mercado de genéricos. No se debería penalizar financieramente a los farmacéuticos por dispensar genéricos. Por tanto, su remuneración debería moverse hacia una tasa-por-acto en lugar de un rembolso precio-dependiente, que es lo que ocurre en la mayoría de los países Europeos. Este sistema de remuneración en tasa-por-acto produce estímulos para la dispensación de genéricos, ya que los farmacéuticos no son penalizados por dispensarlos, pero también necesita tener en cuenta las pérdidas de ingresos al prohibir las prácticas de descuentos (AU)

Alternativas a la distribución de medicamentos y su retribución / Alternatives to pharmaceutical distribution and reimbursement

La distribución de medicamentos en España se articula mayoritariamente alrededor de las 20.000 oficinas de farmacia (OOFF) independientes radicadas en el territorio. Esta situación contrasta con la de otros países en que otros proveedores sanitarios desempeñan un papel primordial en la dispensación de fármacos, o con la de aquellos cuyas farmacias forman parte de conglomerados industriales o cadenas empresariales. Se presenta una descripción de la cadena de distribución del medicamento española –mayoristas y OOFF–, destacando 5 aspectos relevantes para la consideración de alternativas: titularidad de la farmacia y actuación profesional, criterios de radicación, monopolio de dispensación, concierto automático con el Sistema Nacional de la Salud (SNS) y sistema de retribución. Se consideran algunas alternativas existentes en países de nuestro entorno: distribución a distancia, venta de especialidades farmacéuticas publicitarias en establecimientos distintos de las OOFF, constitución de cadenas farmacéuticas, dispensación por proveedores, repercusiones de la prescripción electrónica y las posibilidades de la aún emergente atención farmacéutica. Asimismo se revisan las características de los sistemas de retribución de las farmacias. Se proponen la modificación de las limitaciones a la propiedad de las OOFF, el establecimiento de convenios de libre aceptación entre éstas y el SNS, y la autorización de canales alternativos o complementarios para la distribución de algunos productos. En (..) (AU)

In Spain pharmaceutical distribution is carried out mainly thorugh the 20,000 independent pharmacies located throughout the country. This situation contrasts with that in other countries where other health care providers play a major role in drug dispensation or where pharmacies form part of industrial conglomerates or commercial chains. We describe the pharmaceutical distribution chain in Spain –wholesale and through the pharmacies– and place particular emphasis on five aspects of relevance when considering alternatives: ownership of the pharmacy and norms of professional service, criteria for setting up a pharmacy, monopoly on dispensing, automatic ageement with the Spanish national health system and reimbursement system. Several alternatives found in comparable countries are described: mail order and on-line distribution, sale of over-the counter pharmaceutical products in establishments other than pharmacies, the estabilishment of pharmaceutical chains, dispensing by providers, the repercussions of electronic prescribing and the possibilities of the still-emerging «Pharmacuetical Care». The characteristics of pharmacy reimbursement systems are also reviewed. We recommend modification of limitations on ownership of pharmacies, the establishment of optional agreements between pharmacies and the Spanish national health system and the authorization of alternative or complementary channels of distribution for some products. We propose a mixed model of reimbursement that would include: a) a ficed price for dispensing; b) almost total (..) (AU)