Using a conceptualization, it can be said that the service pharmacy is now facing its third season, that of telemedicine. It is a further evolution that arises from a clear need and hinges on the great willingness of pharmacies to take care of the health needs of their communities (as they have been doing since the beginning of the Pandemic), but the fact is that this season still lacks a complete overview. Suffice it to say that in words the word telemedicine is always brought up, but then numbers, conventions, experiments and resolutions always refer to telecardiology and little more: it’s okay that the driving force of the third phase is given by the need to eliminate waiting lists , however, there is no general project in which the pharmacist can move, invest and specialize.
This “void” clearly emerged last week in the module that the executive master’s degree in Pharmacy Management organized in Turin by SAA and Skills Management dedicated to service pharmacy, speakers Bianca Maria Acanfora, pharmacist in Trieste, e Sergio Lai, CEO of CP2 and director of the Italian Heart Foundation: from a political/strategic point of view, it can be said that the service pharmacy project went through three phases, which gave it a progressive connotation.
The first phase can be traced back to law 69/2009, the subsequent approval of legislative decree 153/2009 and the issuing of implementing decrees, which identified new services that can be provided by pharmacies. These are services that enrich the professional heritage of the pharmacist without distorting his role, to be performed in self-monitoring or with the support of a healthcare professional, or even with instrumental devices made available by pharmacies and not at all invasive.
The second phase, however, overturns the traditional role of the pharmacist (not surprisingly it has given rise to numerous problems in the management of pharmacy collaborators) but must be included in an emergency phase linked to the covid-19 pandemic. Once the pandemic emergency occurred, law 178/2020 introduced for the first time the possibility for pharmacists to take capillary blood samples (to detect the presence of IgG and IgM antibodies) and carry out tests for professional use (up to then usable only by healthcare professionals), which involve a diagnosis.
Also during the pandemic, the possibility was then provided – first by law 178/2020, subsequently by Legislative Decree 41/2021 – for the pharmacist to directly administer anti-Sars-CoV-2 and anti-flu vaccines, as well as carry out tests diagnostics which involve the collection of the biological sample at nasal, salivary or oropharyngeal level, without the supervision of medical personnel. As all citizens have understood, the role of the pharmacist has changed and it is no coincidence that recently the Fip (International Pharmaceutical Federation) launched the “Think Health, Think Pharmacy” campaign to remind the public that pharmacies are places of primary healthcare and to promote pharmacists as healthcare professionals.
The third phase, the one we are experiencing now, is no longer an emergency and it is therefore worth analyzing it from a political and strategic point of view, and only subsequently from a regulatory and operational point of view. The evolution, in fact, is part of the crisis of the traditional model of public health service, based on the family doctor and hospitals, and the incomplete restructuring of the local healthcare system as designed by the Pnrr/Mission 6 (Health) and based on the model of community houses.
The Plan envisaged «a new strategy for the NHS» with a «new organizational model projected towards healthcare that is closer to people and overcoming inequalities». This led to Ministerial Decree 77/2022, which defined the models and standards for the development of territorial assistance of the Health Service. However, the implementation of the Plan is proceeding slowly (Agenas, in the latest update, speaks of 187 active community houses out of the 1,430 planned) while the experimentation of a progressive expansion and accreditation of the pharmacy services is progressing at a faster pace.
There is a reason: citizens continue to see the family doctor at the center of the system, but they also report that it is increasingly difficult to see him due to reduced availability. At this point, GPs and pharmacies, whose growing authority is attested by all the most recent research (Iqvia, Doxa Pharma, Ipsos), are candidates to become together the cornerstone of the local healthcare system. Resolution XII/2405 approved the other week by the Lombardy Region clearly expresses this “potential” evolution, which, as other far-sighted administrations have already done, extends the maturation process of the service pharmacy with a timetable that includes pharmacological reconciliation and telecardiology.
And here we are at the point: if all pharmacists have clear ideas about telecardiology (this was also seen during the course) and many are organizing themselves to offer it, the same cannot be said for the other services that fall into the “telemedicine” category. , although they can also be implemented in the pharmacy. As confirmed by contacts and reconnaissances between pharmacists, legal consultants, telemedicine providers (Htn, Cardio on Line, @Clinica Digitale, MeDea), chains and networks, once the perimeter of “cardiorefertations” has been crossed, doubters and skeptics prevail: teledermatology is considered interesting but its diffusion is patchy; spirometry, reported by a pulmonologist, does not seem to arouse interest (the laborious nature of the procedures is the obstacle most often cited by pharmacies); ultrasound is considered by many to be beyond the possibilities of the pharmacy but there are exercises that offer joint, abdominal, neck, thyroid, testicular, and others that offer breast ultrasound on breast cancer prevention days. Regarding televisits (being tested in the Veneto, both with the GP and with the specialist) the uncertainty is even greater.
It then becomes clear that to guide pharmacists, operators and citizens towards a true development of service pharmacy, it will be necessary to work on an even clearer and more structured legal framework. And we will also need decisive and effective communication towards the public, which conveys the concept of a pharmacy formally elected as a territorial garrison of the NHS and therefore a place of prevention and monitoring, with the hospital instead playing the role of place of treatment. When the Simplifications bill has completed its process, expanding the vaccination options in pharmacies and increasing the number of services available (with the possibility of using detached premises and using the banner of “Service Pharmacy”), we should begin to see a effective maturation also of the third phase of the model.
