Patients' referral through a Minor Ailment Service in community pharmacy

ABSTRACT

Introduction: Consultation of minor ailments and direct product request are frequent in community pharmacy in Spain, although every pharmacy offers the service following their own criteria. Standard Operational Procedures (SOP) and referral criteria agreed between community pharmacists (CPs) and general practitioners (GPs) are needed to deliver a safer service. Referral criteria set the limits of action for each healthcare professional (CPs and GPs) when managing patients. Following the positive findings of an impact study, a roll out was required to translate the evidence-based approach into usual practice. Objective(s) The aim was to characterise the referrals between CPs and GPs through a Minor Ailment Service (MAS, service offered in community pharmacy following the SOP). Method(s) A 12-month pragmatic study with hybrid effectiveness-implementation design was planned from October 2020 in Spain. The co-designed MAS service had several components agreed SOP with GP scientific organisations, protocols for ailments divided into five groups (dermatological, digestive, related to pain, upper respiratory tract related and others) including referral criteria, information technology (IT) based consultation protocol and training before and during the study. Patients were followed up by pharmacists after ten days of the service. All data were collected through an IT system (SEFAC eXPERT) as a by-product of service delivery and implementation. Outcomes for the first fifteen months (up to December 2021) are shown. Result(s) 1246 pharmacists from 24 provinces in Spain were trained having a reach of 14083 consultations. 1858 (13.2%) patients were referred to the GP. 2193 referral criteria were detected, most patients referred had one single referral criteria (n = 965, 80.8%). Referral criteria detected were red flags such as temperature over 38degreeC, dyspnoea, etc. (n = 846, 39.5%);patients' age (n = 398, 18.6%), symptom duration (n = 361, 16.9%);patients' treatments for other health problems different than the minor ailment consulted (n = 263, 12.3%);other patients' health problems (n = 186, 8.7%) and others (n = 85, 4.0%). Minor ailments more frequently referred were joint pain (n = 190, 10.2%), cough (n = 106, 5.7%), dermatitis (n = 104, 5.6%) and heartburn (n = 63, 3.4%). Conclusion(s) High-risk patients (patients with symptoms/condition that do not appear to be minor ailments) can be assessed by CPs and referred to be evaluated and diagnosed by GPs. The use of co-designed management protocols strengthened the identification of red flags in patients suffering minor ailments to be referred when necessary. Joint pain and cough were two of the minor ailments more frequently referred, which could be a result of the study being undertaken during COVID19 pandemic. CPs can perform clinically, referring patients and acting as a triage point through MAS to increase patients' safety.