Supplementary Material for: Expanding Primary Care to Pharmaceutical Patient Care in Diabetes Mellitus Type 2 through the European Union’s Community Pharmacies, between 2008 and 2018: A Systematic Review

<b><i>Background:</i></b> The analysis of the European Union (EU28) health systems’ intervention for type 2 diabetes mellitus (T2DM) reports an insufficient combination of legal support, prevention, and early diagnosis. This fact compromises the patient’s health outcomes. The inclusion of pharmacy services oriented to T2DM (PS-T2DM) in strategic primary care network’s programs could be a solution. However, the different regulatory frameworks that include good pharmaceutical practices and clinical guidelines for T2DM in each EU28 country may be a limitation. Health systems need to know the evolution of these community services and to analyze their operational and regulatory base, both in time and space. <b><i>Methods:</i></b> A systematic review was carried out on a qualitative and quantitative approach to the expansion and upgrading of PS-T2DM provided in EU28 pharmacies between 2008 and 2018. <b><i>Results:</i></b> The implementation of PS-T2DM in EU28 has increased sharply since 2009 and 2010. Diabetes mellitus (DM) is regulated in 5 countries (Bulgaria, Spain, Italy, Lithuania, and Portugal) and T2DM in 3 (Austria, Latvia, and Romania). Also, in 3 countries (Latvia, Poland, and Spain), pharmacists are involved in implementing guidelines for DM and T2DM, but there is no evidence on the regulation of PS-T2DM. Twenty-two countries showed detailed studies for the PS-T2DM’s provision. The type of PS-T2DM implemented in the highest number of EU28 countries was “promoting the rational use of medicines,” and the specific subtype T2DM-related more commonly reported was the “glucose measurement.” <b><i>Discussion/Conclusion:</i></b> Pharmacy disease-oriented services contributed to improving the accessibility, proximity, and equity of primary care for T2DM provided in community pharmacies across the EU28 in recent decades. This promising strategy for improving health outcome sets may be a call to the action of health systems due to its impact consistent with some objectives of universal health coverage for the eradication of DM and T2DM.

<i>背景：</i> 针对欧盟（EU28）2型糖尿病（type 2 diabetes mellitus, T2DM）卫生系统干预措施的分析显示，其法律支持、疾病预防与早期诊断的整合程度不足，这一现状损害了患者的健康结局。将面向2型糖尿病的药学服务（pharmacy services oriented to T2DM, PS-T2DM）纳入战略性基层医疗网络项目，或可成为破解上述困境的方案。然而，欧盟28国各自包含优质药学实践与2型糖尿病临床指南的差异化监管框架，可能成为该项服务推广的限制因素。卫生系统需掌握这类社区服务的发展动态，并从时间与空间维度分析其运营与监管基础。<i>方法：</i> 本研究采用定性与定量相结合的系统综述方法，对2008—2018年间欧盟28国药房提供的面向2型糖尿病的药学服务的拓展与升级情况进行梳理分析。<i>结果：</i> 自2009、2010年以来，欧盟28国面向2型糖尿病的药学服务实施规模大幅增长。糖尿病（diabetes mellitus, DM）相关监管覆盖5个国家（保加利亚、西班牙、意大利、立陶宛与葡萄牙），2型糖尿病专项监管覆盖3个国家（奥地利、拉脱维亚与罗马尼亚）。另有3个国家（拉脱维亚、波兰与西班牙）的药师参与了糖尿病及2型糖尿病相关指南的落地实施，但尚无证据表明这些国家针对面向2型糖尿病的药学服务出台了专项监管规定。22个国家开展了针对面向2型糖尿病的药学服务提供情况的详细研究。欧盟28国实施最广泛的面向2型糖尿病的药学服务类型为"促进合理用药"，而最常被报道的2型糖尿病相关细分服务则为"血糖检测"。<i>讨论/结论：</i> 近数十年来，面向疾病的药房服务提升了欧盟28国社区药房所提供的2型糖尿病基层医疗服务的可及性、便捷性与公平性。这一可有效改善健康结局的极具潜力的策略，契合全民健康覆盖以根除糖尿病及2型糖尿病的部分目标，或可呼吁卫生系统采取行动推进相关工作。