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Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system

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RESUMEN

Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.

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OBJECTIVE: Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. METHODS: The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. RESULTS: Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. DISCUSSION: The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.

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Objetivo Conocer las opiniones de los farmacéuticos con relación a los factores que explican la falta de visibilidad de la farmacia comunitaria como establecimiento sanitario y proponer estrategias de desarrollo profesional a fin de lograr mejorar la accesibilidad a los servicios profesionales mediante técnicas de investigación cualitativa. Material y métodos Se utilizó una Técnica de Grupo Nominal (TGN) en 2 rondas sucesivas, respondiendo a 2 consignas guía sobre factores y estrategias. Posteriormente se realizó un Framework analysis. Resultados Se aportaron 34 ideas referidas a factores y 32 a estrategias. Las estrategias fueron agrupadas en 14 temas, destacándose las vinculadas a la priorización de los servicios profesionales orientados a los pacientes, al cumplimiento de la ética y a la formación continua del farmacéutico. Discusión Las técnicas utilizadas permitieron evidenciar situaciones percibidas por los farmacéuticos que no están formalmente descriptas en la literatura. Aumentar la visibilidad de los servicios profesionales en las farmacias comunitarias implica acordar y abordar estrategias que deben sustentarse en la participación conjunta de los propios farmacéuticos, las asociaciones profesionales y las universidades.

Objective Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. Methods The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. Results Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. Discussion The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.

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Objetivo Analizar las evidencias de validez y fiabilidad de un cuestionario de satisfacción de pacientes con el servicio de indicación en las farmacias comunitarias argentinas. Material y Métodos Estudio descriptivo de corte transversal. Participaron todos los pacientes o sus cuidadores que concurrieron a las farmacias durante el período de estudio (marzo y abril de 2006) y que supieran leer y escribir. Resultados Se obtuvieron 289 cuestionarios. El análisis factorial reveló un único componente explicando el 52,2 por ciento de la varianza total. Se obtuvo un coeficiente alfa de Cronbach de 0,89. Los pacientes expresaron comentarios adicionales en 87 cuestionarios (30,1 por ciento) que se relacionaron con la calidad de la atención recibida y con otros aspectos de la asistencia. Discusión El cuestionario mostró evidencias de validez de contenido, validez como estructura interna y fiabilidad para valorar la satisfacción de pacientes con el servicio de indicación en las farmacias comunitarias argentinas.

Objective Analysing the evidence regarding the validity and reliability of a patient-satisfaction questionnaire about professional advice received for minor illness in Argentinean community pharmacies. Methods This was a descriptive, cross-sectional study. All patients or their caregivers who visited the pharmacies during the study period (March and April, 2006) and knew how to read and write were included. Results 289 questionnaires were completed. Factorial analysis revealed one single component explaining 52.2 percent of total variance. A 0.89 Cronbach's alpha coefficient was obtained. Patients made additional comments on 87 questionnaires (30.1 percent) concerning the quality of care received and other aspects. Discussion By presenting evidence of content validity, validity as internal structure and reliability the questionnaire could assess patient-satisfaction with the advice received for minor illness in Argentinean community pharmacies.

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OBJECTIVE: Analysing the evidence regarding the validity and reliability of a patient-satisfaction questionnaire about professional advice received for minor illness in Argentinean community pharmacies. METHODS: This was a descriptive, cross-sectional study. All patients or their caregivers who visited the pharmacies during the study period (March and April, 2006) and knew how to read and write were included. RESULTS: 289 questionnaires were completed. Factorial analysis revealed one single component explaining 52.2 % of total variance. A 0.89 Cronbach's alpha coefficient was obtained. Patients made additional comments on 87 questionnaires (30.1 %) concerning the quality of care received and other aspects. DISCUSSION: By presenting evidence of content validity, validity as internal structure and reliability the questionnaire could assess patient-satisfaction with the advice received for minor illness in Argentinean community pharmacies.

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OBJECTIVES: The aim of this study is to determine the influence that different risk factors (age, gender, obesity, smoking, inactivity, diabetes mellitus and previous diagnosis of arterial hypertension) have on arterial pressure, and to determine the prevalence of patients that have high blood pressure and hypertension but have not received drug-treatment for arterial hypertension. SETTING: 42 Spanish community pharmacies. METHOD: Observational and descriptive study. Patients included in the study were over 18 years of age, not receiving pharmacological treatment for arterial hypertension and not pregnant. Two measurements of arterial pressure were taken from each patient on the first day of the study and two other measurements on a later day. The average of these four measurements was taken as the arterial pressure value for the patient. All measurements were taken in the participating community pharmacies, always by the pharmacist and following the same protocols. The measurements were noted in the patients' records along with data about the seven risk factors being studied, allowing them to be related with the patient's arterial pressure value. RESULTS: The number of patients invited to join the study was 3,760, of whom 2,574 agreed to participate, with 2,094 completing the study. It was found that an increase in the number of risk factors led to a corresponding rise in the percentage of patients with high blood pressure and arterial hypertension. The risk of having arterial hypertension was 4.23 times higher in patients aged 65 years and over. It was also 2.88 times greater in those who had been previously diagnosed with arterial hypertension, 2.79 times higher in overweight or obese patients, 2.69 times more in diabetics and 2.22 times higher in men compared with in women. Prevalence of high blood pressure in patients not receiving pharmacological treatment for arterial hypertension was 33.6%, and prevalence of arterial hypertension was 22.8%. CONCLUSIONS: Of the people studied, 22.8% had arterial hypertension. For the risk factors identified, those most related to the presence of arterial hypertension were, in descending order: being 65 years old or over, previous diagnosis of arterial hypertension, being overweight or obese, being diabetic and being male.

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OBJECTIVE: To develop and validate a specific questionnaire about patient satisfaction with drug dispensing at Spanish community pharmacies. METHOD: A self-administered semi-structured questionnaire was designed centered on the perception of the patients with the dispensing service. To validate this questionnaire, it was administered at Spanish community pharmacies, which voluntarily agreed to participate in the study for a period of 2 months (March and April 2006). Patients or caregivers who were able to read and write were included in the study. MAIN OUTCOME MEASURE: Scores of the items related to satisfaction with the dispensing service. RESULTS: The questionnaire consisted of: an introduction, 10 closed questions in an interval scale of five points, an open section to express comments, and finally demographic data of the patients. Twenty-seven community pharmacies participated in the validation, and 561 questionnaires were obtained with a response percentage of 56.5%. A Cronbach's alpha coefficient of 0.91 was obtained. The Kaiser-Meyer-Olkin coefficient was 0.92, and the extraction of the principal components revealed a unique component explaining 55.2% of the total variance. About 15.5% of patients made additional comments that praised the quality of attention received and other aspects of the service such as the amiability and friendliness shown by pharmacy staff. CONCLUSION: The questionnaire developed shows evidence of validity and reliability for evaluating patient satisfaction with the dispensing service in community Pharmacies in Spain.

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OBJECTIVE: To identify the perceived barriers to implementing pharmaceutical care in Argentina. METHOD: A semi-structured questionnaire was designed to carry out a cross-sectional descriptive study. The questionnaires were distributed in different continuing professional development events for pharmacists during November-December 2005. RESULTS: Ninety completed questionnaires were collected with the following distribution: 16.7% at the national congress of hospital pharmacy, 18.9% after a conference, 64.4% during two courses related to pharmaceutical care. The surveyed pharmacists work for community pharmacies (76.7%), hospital/institutional pharmacies (20.0%) and primary care centers (2.2%). The most important barriers mentioned were lack of time, lack of specific training and lack of communication skills. CONCLUSION: The opinions of Argentinian pharmacists from different places and professional practice settings were obtained. In all work settings, "lack of time" is the main barrier to overcome for implementing pharmaceutical care.

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Con el objeto de evitar que se presenten los Problemas Relacionados con Medicamentos (PRM) se hace necesario implementar medidas de tipo preventivas en el ámbito dela salud pública. Es importante el papel que el farmacéutico puede desarrollar en esta área, para actuar antes de que los PRM se manifiesten y provoquen la morbimortalidad relacionada con medicamentos. Por ello, los PRM potenciales, no manifestados o riesgo de PRM deben ser considerados en las actividades cotidianas del farmacéutico. Se analiza el artículo sobre el Segundo Consenso de Granada, considerando los alcances teóricos del concepto de PRM, la utilidad práctica de los mismos y su clasificación. Se aconseja que, conjuntamente con la definición de PRM, se contemple el concepto de los PRM potenciales, no manifestados o riesgo de PRM como aquellos que «pueden conducir a la no consecución del objetivo terapéutico o a la aparición de efectos no deseados». Además, y dada su importancia, se debería presentar a cada uno de los PRM en forma potencial (AU)

Avoiding the appearance of Drug Related Problems (DRP) to implement preventive measures in the field of public health is necessary. The role of pharmacist acting beforethe DRP arise provoking drug related morbidity is important. Therefore the risk of DRP, also known as potential or not manifested DRP, should be considered between the daily activities of the pharmacist. The article about the Second Consensus of Granada is analyzed taking into account the theoretical scope of the concept of DRP as well as their practical usefulness and classification. The potential or not manifested DRP or the risk of DRP should be contemplated as those that «can conduct not to reach the therapeutic aim or to the appearance of undesirable effects». In addition and because of their importance, each one of the DRP should be introduced in the potential way too (AU)

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