The Service Pharmacy

In our review of articles dedicated to the counselling by the pharmacist cannot miss an update on an important novelty, destined to be fully developed in the coming years: the Service pharmacy.
This is an ambitious project, which saw the light of day about 10 years ago and of which the first experimental phase was launched in a group of 9 regions and which, with the 2020 budget, could be extended to pharmacies in the other Italian regions.

Regulatory Sources
The Service Pharmacy finds its first regulatory source in the Law No. 69 of 18 June 2009which was followed by the issuance of the Legislative Decree 153 of 2009in which the Government specified the 'new tasks and welfare functions of pharmacies'. Three implementing decrees were then adopted and converted into law at the beginning of 2011:
– Decree 16 December 2010OJ No. 57 of 10 March 2011
– Decree of 16 December 2010, OJ No. 90 of 19 April 2011'
– Decree of 8 July 2011OJ No. 229 of 1 October 2011

Let us try to draw a brief picture of the planned services and the current state of the art.

Objectives
The objectives of the Service Pharmacy include:

a) the collaboration of pharmacies in initiatives aimed at ensuring the correct use medicines prescribed and its monitoring, in order to facilitate thepatient adherence to medical treatment, including through participation in specific pharmacovigilance.

b) the involvement of pharmacies, through the provision of first-level services, in the implementation of health education and of prevention campaigns of major diseases with a high social impact. These initiatives may be aimed at the general population or specific risk groups and be implemented at national or regional level, using information methods appropriate to the type of facility and, where necessary, after training the pharmacists involved.

c) the support of pharmacies in the implementation of Guidelines e Diagnostic-Therapeutic Pathways provided for specific pathologies, through the provision of second level services addressed to individual patients, on the prescription of general practitioners and paediatricians of free choice, also using nursing staff.

The 'services'
An articulated and differentiated series of performance:

- Reservation of specialist services through a dedicated workstation.
Pharmacies will therefore be able to act as access channels to the CUP System for:
- booking specialist outpatient services at accredited public and private healthcare facilities
- provide for the payment of co-payments by citizens
- collect the relevant reports.

- Execute first instance analytical servicesconsisting of self-diagnosis test, which can be carried out directly by patients, as a self-monitoring function, at home, but which, in the case of particular conditions of frailty or incomplete self-sufficiency, can be used with the support of a health professional, at public and private territorial pharmacies.
The first-instance analytical services that can be performed in pharmacies are:
- testing for blood glucose, cholesterol and triglycerides
- test for real-time measurement of haemoglobin, glycated haemoglobin, creatinine, transaminase, haematocrit
- tests for measuring urine components such as ascorbic acid, ketones, urobilinogen and bilirubin, leucocytes, nitrites, ph, blood, protein and leucocyte esterase
- ovulation test, pregnancy test and menopause test for measuring FSA hormone levels in urine
- colorectal test for the detection of occult blood in faeces.

- Home delivery medicines and medical devicesas well as preparing and dispensing at home mixtures for artificial nutrition and pain-relieving medicinessubject to the rules of good preparation and good distribution practice for medicinal products.

- Dispensing direct distribution drugs on behalf of healthcare facilities.

- Making health and social workers available to the public, nurses e physiotherapistsfor the provision at home of specific professional services requested by the family doctor or freely chosen paediatrician.

Services, including screening, by other professionals, such as ophthalmologists or diabetologists, remain precluded.

The state of the art
The experimental phase of the Service Pharmacy was launched in 2018 in nine regions, with an allocation of EUR 36 million, according to a timetable that includes three regions for the year 2018 (Piedmont, Latium and Apulia), a further three for the year 2019 (Lombardy, Emilia-Romagna and Sicily) and a further three for the year 2020 (Veneto, Umbria and Campania).
On 17 October 2019, the State-Regions Conference approved the agreement between the Government, the Regions and the Autonomous Provinces of Trento and Bolzano on the document on 'Guidelines for the experimentation of new services in community pharmacy'.. The first nine Regions involved in the experimentation, therefore, will implement the agreement by issuing the implementation directives on the basis of what has been decided. Subsequently, a first tranche of the 20% of the amounts provided for will be disbursed, and the subsequent tranches of the 80%.
The funding is intended to support cognitive services, front-office services, telemedicine services and colorectal cancer screening services in the territory on an experimental basis.
The 2020 Budget Law, barring any last-minute cuts, could mark an important step, as the Senate Budget Committee approved an amendment to extend the trial of the Pharmacy of Services, for the two-year period 2021-22, to all regions of the country, with an expenditure of EUR 25.3 million for each of the two years.

Dr. Carmelo Chines
Direttore responsabile