Pharmacists in France are expanding their role in first-line care, using protocols like Osys to assess and treat conditions like allergic rhinoconjunctivitis, reducing the need for doctor referrals.
Pharmacist-led care protocols introduced
In 2021, the Osys program was launched to allow pharmacists to assess symptoms using a validated decision tree before deciding on care, referral, or emergency services. This initiative aimed to streamline the management of minor health issues and reduce unnecessary visits to doctors or emergency rooms.Local cooperation expands pharmacist roles
In areas like Antony, Bourg-la-Reine, and Sceaux in the Hauts-de-Seine department, pharmacists can work under local cooperation protocols with a delegating physician to assess and treat certain conditions that previously required a medical prescription. This collaboration allows pharmacists to provide care that aligns with local health needs.Experiment with first-line care
An experiment initiated by NèreS, an association of first-line health product manufacturers, in partnership with the Leem and USPO, tested pharmacist-led care in seven pharmacies in Gironde. The results showed that pharmacists could correctly refer patients and dispense health products without a doctor's prescription, following a validated protocol.Pharmaceutical advocacy for first-line care
NèreS represents pharmaceutical companies that produce first-line health products available without a prescription in many European countries. However, in France, these products are still subject to medical prescription. NèreS advocates for removing these restrictions without affecting reimbursement, while the ANSM reviews each molecule individually for safety.Pharmacists' ability to distinguish care options
Pharmacists are trained to assess risk and determine the appropriate care based on symptoms. While some protocols, like those for managing headaches, are available, they are rarely used. Pharmacists often rely on their judgment to provide advice or dispense over-the-counter medication like paracetamol when they assess no serious risk.Multiple systems coexist for pharmacist care
Several systems, including Osys, cooperation protocols, and official advice, can be used by pharmacists depending on the situation. These systems complement each other, allowing pharmacists to choose the most appropriate approach. Some systems apply only to specific patient groups or conditions.Triage model supported by trade unions
The Osys triage model, which involves pharmacist-led assessments, is supported by trade unions. They advocate for its inclusion in collective agreements and for the proper remuneration of pharmacists for their role in first-line care. They also emphasize the need for data collection tools to be integrated into pharmacy management systems.Financial and operational aspects of pharmacist care
The Osys model includes a fixed remuneration for pharmacists based on their triage work, regardless of medication dispensed or test results. This model has shown operational success, with pharmacists using it to manage conditions like cystitis and angina, which have led to increased sales of related products.Pharmacist autonomy and doctor collaboration
Pharmacists in coordinated practice structures, such as CPTS, can work independently or with a delegating doctor. While some pharmacists advocate for greater autonomy, others emphasize the need for doctors to remain a central part of the healthcare system, especially for more complex cases.Pharmacists' role in unplanned care
A study by the regional union of health professionals in the Grand Est showed that pharmacists can handle a high volume of unplanned care requests efficiently. However, many pharmacists lack specific training in this area, and there is a strong desire for recognition and proper compensation for their role.Future of pharmacist-led first-line care
The goal is to generalize first-line care in all pharmacies, following the model used for conditions like cystitis and angina. This would allow pharmacists to operate independently, provide necessary care, and receive reimbursement for medications dispensed, reducing the need for doctor referrals in many cases.Local protocols for specific conditions
In some areas, such as the island of Oléron, local cooperation protocols allow podiatrists to manage specific conditions like ingrown toenails. These protocols involve specific training, validation by a delegating doctor, and follow-up by other healthcare professionals, ensuring safe and effective care for patients.
