The Spanish Society of Clinical, Family and Community Pharmacy (SEFAC) proposed the integration of community pharmacies into the systematic care of patients with mild to moderate symptoms of acute respiratory infection (ARI) during the winter season as a solution to the problem of morbidity peaks. high incidence of respiratory diseases.
SEFAC explains that “this situation is generating high demand for health care, both in primary care and in hospitals, reaching certain peaks to saturate the response capacity of the health system and delay consultations and visits of citizens who request them.” Community pharmacists see approximately “2.3 million patients daily, often meeting demand for solutions to treat minor symptoms, including those associated with ARI.”
In various countries, such as the UK, Canada and other developed countries, community pharmacies are integrated into the treatment of mild and moderate ARIs, providing the healthcare system with its healthcare network to jointly manage these infections.
SEFAC believes that protocolized and routine care for these mild to moderate symptoms, which are self-limiting and do not require medical attention, will redistribute some of the burden of care concentrated in health centers, allowing them to more effectively manage patients with severe AKI symptoms or cases with more serious complications, avoiding unnecessary saturation.
Although community pharmacists routinely provide this type of advice, such care for patients with mild to moderate ARI symptoms within the care pathway will require the following requirements, as detailed by the Society:
1. Use standardized protocols to manage these minor symptoms. For many years, protocols have been agreed between scientific medical and public pharmacy societies that provide excellent guidance for this. According to the guidance, specific to and applicable to IRAs, the following protocols exist: Protocols for pharmaceutical indications and referral criteria for minor symptoms: cough, nasal congestion, cold and flu syndrome, sore throat and fever.
2. Availability of a communication system between the community pharmacy and the medical center, direct and two-way.included in an electronic prescription system or a similar system, as proposed by SEFAC and SEMERGEN in the decalogue of the Zaragoza Manifesto on Medico-Pharmaceutical Communication.
3. Selective financing of these drugs. in the treatment of these symptoms in those patients treated in a community pharmacy.
4. Establish a community pharmacy/health center/emergency referral system. in case of detection of anxiety and/or serious symptoms of ARVI.
SEFAC has prepared a report detailing the possible implementation of this proposal.
Advantages
Incorporating a community pharmacy into SNS care for the treatment of mild to moderate winter ARI symptoms could, as outlined by SEFAC:
- The work of medical centers is complemented by assistance in emergency hospitals.
- Reduce the burden on healthcare and the risk of overcrowding of medical centers during seasonal peaks.
- Avoid unnecessary delays in treating these symptoms.
- Improve detection of circulating respiratory viruses (influenza, influenza A, RSV and SARS-CoV-2).
About the IRA
For the 2020–2021 season. In Spain, a sentinel surveillance system for acute respiratory infections (SiVIRA) was established for both ARI in primary care (PHC) and severe acute respiratory infections (SARI) in hospital settings, in accordance with the international recommendations of the European Center for Prevention and Prevention Disease Control (ECDC) and the World Health Organization (WHO) in the context of the COVID-19 pandemic.
AP IRA positivity rate for the entire 2022-2023 season. in all autonomous communities for coronavirus type 2 (SARS-CoV-2), which causes severe acute respiratory syndrome, influenza and respiratory syncytial virus (RSV), was 13.7%, 16.6. % and 5.3% respectively. The incidence of ARI was highest at weeks 48 and 50, with weekly incidence rates of 1165 and 1163 ARI cases per 100,000 inhabitants, respectively, and was higher in women than men. In the 2023–2024 season. ARI incidence rates were highest in the final weeks of 2023 and the first week of 2024 (last recorded at the time of this report), highlighting the greater influenza positivity for RSV and SARS-CoV-2.
Thus, SEFAC states that “this situation is complex and recurring, especially when several viruses coincide, medical personnel are on vacation, frequent crowds, etc. It therefore requires the efforts and participation of various sustainable and effective solutions”:
- IRA spikes are a problem. seasonal, recurring and therefore predictablewhich needs to be addressed multifactorially, both from the side of prevention (medical education, vaccination…) and medical care (primary and hospital), and from public health.
- The saturation of PCs and hospitals at these peaks requires strengthening these structures and providing them with adequate human and material resources, as well as the inclusion of new assets such as community pharmacies. The situation will not be changed in the coming years by introducing small temporary reinforcements.
- A patient who exhibits symptoms of any disease, including respiratory symptoms, has the right to medical care during these winter periods, when its prevalence is very high. In such situations, messages such as “the patient must remain at home” should not be disseminated without accompanying the ability to effectively provide medical care.