Background: Self-medication is an important component of health care. To optimise pharmacists' over-the-counter counselling, there are several guidelines and protocols used in practice. In a self-care environment, protocols should comprise items related to patients' autonomy. The structure of self-medication protocols, among other elements, should present steps to facilitate patients' participation.
Objective: To analyse structural differences between existing community pharmacy minor ailment protocols, including those related to patient autonomy and empowerment in self-medication conditions.
Methods: The study design followed a cross-sectional descriptive approach. Self-medication protocols were systematically collected from three different professional sources in Portugal (Pharmaceutical Society (OF), National Pharmacies Association (ANF) and Grupo Holon (GH)). A structural-based analysis, by comparison with the general self-medication OF standard protocol, produced outcome measures such as frequencies of flowchart critical steps, active pharmaceutical substances, dosage forms, and posologies. Simple scores were computed to assess the structural quality of the protocols, as well as differences between the protocols produced by each professional organisation.
Results: 44 protocols presented on average 8 counselling steps toward 10 different active substances, 7 dosage forms, and 14 posologic schemes. From a maximum of 30 critical items, 1 protocol scored 24, 7 scored 23 and 5 scored less than 15 items. Significant differences were found between the structural components of protocols from different sources, particularly between the GH protocols compared with those produced by OF and ANF.
Conclusions: In general, all protocols matched the OF standard for ailment characterisation but fell short on steps related to medicine information and selection. Steps for patient participation and agreement were absent, as was the pharmacist's expected role of outcomes monitoring. It might be appropriate to redesign self-medication protocols, preferably through a consensus process that includes not only the preferences of professionals but also those of patients, starting from the prevalent conditions in Portuguese pharmacy practice.