Primary health care policy and vision for community pharmacy and pharmacists in Portugal

Keywords: Pharmacies, Primary Health Care, Delivery of Health Care, Integrated, Ambulatory Care, Community Health Services, Pharmacists, Community Pharmacy Services, Professional Practice, Portugal


The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes.


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Author Biography

Filipa A. Costa

Invited Auxiliary Professor


Pordata. [Population density]. Available at: (accessed May 28, 2020).

Organisation for Economic Co-operation and Development. Health at a glance 2019: OECD indicators. Paris: OECD; 2019.

Rosa, MJ. [Ageing of the Portuguese Society]. Lisboa: Fundação Francisco Manuel dos Santos, 2016.

Campos Fernandes A. Uma Perspectiva sobre o Relatório da OCDE “Health at a Glance 2019” [A Perspective on the OECD Report "Health at a Glance 2019"]. Acta Med Port. 2020;33(1):4-6.

Organisation for Economic Co-operation and Development. Country statistical profile: Portugal 2020. Paris: OECD; 2020.

Pordata. [Costs with health care as a percentage of GDP]. Available at:úde+em+percentagem+do+PIB-610 (accessed May 28, 2020).

Kos M. Introduction to healthcare systems. In: van Mil JWF, Alvarez-Risco A, Costa FA, eds. The Pharmacist Guide to Implementing Pharmaceutical Care. Switzerland: Springer; 2019. ISBN: 978-3-319-92575-2.

Tavares AI. Voluntary private health insurance demand determinants and risk preferences: Evidence from SHARE. Int J Health Plann Manage. 2020;35(3):685-703.

Instituto Nacional de Estatística. [Health Statistics 2018]. Available at: (accessed May 28, 2020).

República Portuguesa. [Programme of the XXII Constitutional Government]. Available at: (accessed Jul 3, 2020).

Presidência do Conselho de Ministros. [Proposta de Lei n.º 4/XIV: Main options of the Government Pln for 2020-2023]. Lisboa: República Portuguesa; 2019.

Direção Geral de Saúde. [National Health Plan: Revision and Extension to 2020]. Lisboa: Governo de Portugal, 2015.

Ministério da Saúde. [Despacho n.º 1400-A/2015: National Plan for Patient Safety 2015-2020]. Diário da República. 2015;(28):3882.

Missão para os Cuidados de Saúde Primários. [Resolução do Conselho de Ministros n.º 157/2005, Priority Action Lines for the Development of Primary Health Care]. Diário da República 2005;(196):5981-5982.

Coordenação Nacional para os Cuidados de Saúde Primários. [Strategic and opertational Plan: Reform of the National Health Service]. Lisboa: República Portuguesa, 2016.

USF-AN. [Deliberation on the Standards for Medication Review]. available at: (accessed Mar 14, 2020).

Stewart D, Mair A, Wilson M, Kardas P, Lewek P, Alonso A, McIntosh J, MacLure K; SIMPATHY consortium. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opin Drug Saf. 2017;16(2):203-213.

Administração Regional de Saúde de Lisboa e Vale do Tejo. [Management of polypharmacy in the chronic, complex and fragile patient at ARSLVT]. Lisboa: ARSLVT; 2019.

Ordem dos Farmacêuticos. [Pharmacists in numbers]. Available at: (accessed Mar 14, 2020).

International Pharmaceutical Federation. Pharmacy Workforce Intelligence: Global Trends Report. The Hague: FIP; 2018.

Lebovitz L, Eddington ND. Trends in the pharmacist workforce and pharmacy education. Am J Pharm Educ. 2019;83(1):7051.

Pordata. [Pharmacies: number]. [ (accessed Mar 14, 2020).

Ministério da Saúde. [Decreto-Lei 307/2007: Legal regime for community pharmacies]. Diário da República 2007;(168):6253-6259.

Ministério da Saúde. [Portaria 352/2012: Regulates the process for attributing permission for the establishment of new pharmacies]. Diário da República 2012;(210):6253-6259.

Costa FA, Paulino E, Farinha H. Pharmacy Practice in Portugal. In: Babar ZUD. Encyclopedia of Pharmacy Practice and Clinical Pharmacy. Amsterdam: Elsevier; 2019.

Associação Nacional das Farmácias. [Plan of Activities and Budget for 2020]. Lisboa: Associação Nacional das Farmácias; 2019.

Ministério da Saúde. [Portaria n.º 1429/2007: Defines services provided by pharmacies]. Diário da República 2007;(211):7993.

Ministério da Saúde. [Portaria n.º 97/2018: First modification to the document defining services provided by pharmacies]. Diário da República 2018;(69):1556-1557.

Teixeira I, Guerreiro JP, Costa S. Impact of the recent changes in the pharmacy remuneration system in portugal (2010-2014) – moving from paper to reality. Pharmacoeconomics Open Access. 2018;3:2.

Ministério da Saúde. [Decreto-Lei n.º 112/2011: Approves the regime for price creation for reimbursed medicines]. Diário da República 2011;(229):5104-5108.

Costa FA, Kos M. Payment methods and Pharmaceutical Care. In: van Mil JWF, Alvarez-Risco A, Costa FA, eds. The Pharmacist Guide to Implementing Pharmaceutical Care. Switzerland: Springer, 2019. ISBN: 978-3-319-92575-2.

Administração Central do Sistema de Saúde.[National Database for Homogeneous Daignostic Groups]. (accessed May 28, 2020).

Ministério da Saúde. [Decreto-Lei n.º 62/2016: Establishes conditions for pulic health services provided by community pharmacies]. Diário da República 2016;(175):3154-3155.

Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, Costa S, Costa J, Carneiro AV. Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews. BMC Public Health. 2017;17(1):309. Published 2017 Apr 11.

CEMBE. [Economic evaluation of the needle exchange programme in pharmacies]. Lisboa: CEMBE; 2016.

Ministério da Saúde. [Portaria 301-A/2016: Establishes terms and conditions for contracting community pharmacies to provide Needle Exchange Program]. Diário da República 2016;(230 Suppl 1):4270-4272.

Sistemas Partilhados do Ministério da Saúde. [Program "Say no to a second-hand needle". Data from January to June 2018/2019]. Available at: (accessed May 2, 2020).

Ministério da Saúde. [Portaria 188/2018. Regulates remuneration to pharmacies by dispensing reimbursed medication as a function of the reduction of reference pricing]. Diário da República 2018;(124):2823.

Ministério da Saúde. Acesso a cuidados de saúde nos estabelecimentos do SNS e entidades convencionadas. Relatório anual. Lisboa: Ministério da Saúde; 2018.

da Costa FA, da Costa Miranda A. Using cancer registries to supplement clinical trial data and inform regulatory decision. Pharmacoepidemiol Drug Saf. 2019. [Ahead of Print]

Félix J, Ferreira D, Afonso-Silva M, Gomes MV, Ferreira C, Vandewalle B, Marques S, Mota M, Costa S, Cary M, Teixeira I, Paulino E, Macedo B, Barbosa CM. Social and economic value of Portuguese community pharmacies in health care. BMC Health Serv Res. 2017;17(1):606.

Rosado H. Bates I. An overview of current pharmacy impact on immunisation: a global report. The Hague; FIP; 2016.

Imfeld-Isenegger TL, Soares IB, Makovec UN, Horvat N, Kos M, van Mil F, Costa FA, Hersberger KE. Community pharmacist-led medication review procedures across Europe: Characterization, implementation and remuneration. Res Social Adm Pharm. 2020;16(8):1057-1066.

Soares IB, Imfeld-Isenegger TL, Makovec UN, Horvat N, Kos M, Arnet I, Hersberger KE, Costa FA. A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Res Social Adm Pharm. 2020;16(1):41-47.

Associação Nacional das Farmácias. [Renewal of the pilot project reservationof 10,000 free vaccines to Loures pharmacies]. available at: (accessed May 2, 2020).

Gregório J, Cavaco A. The pharmacists' guide to the future: Are we there yet? [published online ahead of print, 2020. Res Social Adm Pharm. 2020 [Ahead of Print].

Ministério da Saúde. [Portaria n.º 390/2019: fourth modiffication of the Portaria n.º 224/2015, Legal regime for the prescription and dispensing of medicines and health-related products]. Diário da República 2019;(208):6-7.

Félix IB, Guerreiro MP, Cavaco A, Cláudio AP, Mendes A, Balsa J, Carmo MB, Pimenta N, Henriques A. Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software. Front Pharmacol. 2019;10:680.

Alves da Costa F, Lee V, Leite SN, Murillo MD, Menge T, Antoniou S. Pharmacists reinventing their roles to effectively respond to COVID-19: a global report from the international pharmacists for anticoagulation care taskforce (iPACT). J Pharm Policy Pract. 2020;13:12.

INFARMED. [Circular Normativa nº005/CD/550.20.001: Guidance on proximity access to hospital only medication in the context of COVID-19 pandemic]. (accessed Apr 04, 2020).

Ministério da Saúde. [Portaria nº 90-A/2020. Issued 09/04/2020: Exceptional and temporary measures for electronic prescribing of medicines during COVID-19 pandemic]. (accessed Jul 05, 2020).

United Nations. Transforming our world: The 2030 agenda for sustainable development. Available at: (accessed Jul 05, 2020).

Cabelguenne D, Picard C, Lalande L, Jonker J, Sautereau M, Meunier F, Zimmer L. Benzodiazepine dose reduction in prisoner patients: 15 years' teamwork between psychiatrists and pharmacists. J Clin Pharm Ther. 2018;43(6):807-812.

How to Cite
Ribeiro N, Mota-Filipe H, Guerreiro MP, Costa FA. Primary health care policy and vision for community pharmacy and pharmacists in Portugal. Pharm Pract (Granada) [Internet]. 2020Jul.17 [cited 2020Aug.15];18(3):2043. Available from:
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