ORIGINAL ARTICLE

Management of Minor Ailments by

Community Pharmacists in Cebu, Philippines –
An Exploratory Study
Gerard Lee L. See and Florencio V. Arce, Jr.

Department of Pharmacy, School of Health Care Professions, University of San Carlos, Cebu City, Philippines

ABSTRACT

Background. Community pharmacists play a central role in the management of minor ailments and their clinical
knowledge is vital in improving treatment outcomes of these ailments. The provision of minor ailment service
in developed countries has been successful yet the practice in the Philippines has not been documented.

Objectives. The aim of this study was to document the involvement of community pharmacists in the management
of minor ailments, the practices, and the perceived challenges in the provision of pharmacy service.

Methods. This was an exploratory descriptive study. Using qualitative research technique, a guided interview
questionnaire was employed for data gathering. The practices employed and perceived challenges encountered
by pharmacists were interpreted using conventional content analysis.

Results. Colds, cough, skin allergy, diarrhea were the four most common ailments managed by community
pharmacists. Pharmacists had underdeveloped roles in consultation. Community pharmacists were knowledgeable
on the causes of the minor ailments and the medications dispensed were compliant with approved product
indications. The absence of institutional guidelines (66%), lack of ailment-specific training (100%), insufficient
clinical skills (76.7%), and a dominant patient self-selection behavior for OTC medicines (73.3%) were perceived as
challenges in the provision of minor ailment services.

Conclusion. Community pharmacists managed common ailments with non-prescription medicines however
consultation roles were found to be underdeveloped.

Key Words: community pharmacist, minor ailments, nonprescription drugs, Philippines

INTRODUCTION

A community pharmacy is an ideal setting for health

care service delivery because it is an accessible health care
site.1,2 A pharmacist, being one of the most accessible
primary health care professional in the community, can
manage patients with symptoms of minor ailments at an
early stage. A minor ailment is defined as a health complaint
which, by simple action, patients could handle themselves.
These conditions are self-limiting or uncomplicated with
the use of over the counter (OTC) products for relieving
Corresponding author: Gerard Lee L. See, RPh, MSc, PhD symptoms and thus improve the patient’s health condition.3,4
Department of Pharmacy Pharmacy-based management of minor ailments
School of Health Care Professions provides rapid and convenient access to timely care through
University of San Carlos
Cebu City 6000, Philippines,
a pharmacist skilled in providing advice on self-limiting
Telephone: (032) 2300100 loc. 403, conditions and recommending products to alleviate
Email: glsee@usc.edu.ph the symptoms of a condition.4,5 Moreover, community

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Management of Minor Ailments by Pharmacists in Cebu

pharmacists have the potential to improve patient outcomes, of the four most common ailments and the perceived
reduce the cost of care by promoting health, preventing challenges in the provision of services for minor ailments
illnesses and circumventing adverse events. 6-9 in a community setting.
The practice of a community pharmacist in developing
countries is hindered by factors such as an underdeveloped Selection of Participants
health care system and pharmacists who are educationally The participating chain community pharmacies (N=43)
and professionally less well-equipped.10 In addition, the in Cebu City were grouped into north and south based on
optimal management of minor ailments is compromised their locations. Sample size was calculated using Slovin’s
because majority of patients practice self-selection of over- formula with a confidence level of 90%. As to the choice
the-counter medications, bypassing health care providers.11-13 of the location of pharmacy, a lot was casted. The selected
To effectively contribute to minor ailment management, location of the pharmacy was the basis for inclusion of the
community pharmacists need to have the basic knowledge community pharmacists in this study. Thirty (30) community
foundation on pharmacy. An important factor that pharmacies located in the north (n=15) and in the south
may influence patients to patronize the minor ailment (n=15) served as research sites. The research subjects were
services of a community pharmacy is a well-trained and licensed pharmacists practicing in the community pharmacy
accessible pharmacist.14 belonging to a chain community pharmacy. The community
The clinical knowledge of a community pharmacist pharmacies were visited and the pharmacist on shift was
in the management of minor ailments is vital in the identified as research participant. This allowed exclusive
improvement of healthcare and ailment outcomes. and non-repetitive participation of a community pharmacist.
Insufficient clinical knowledge is one of the main barrier
in providing appropriate interventions.15,16 Research Instrument and Data Collection
The provision of minor ailment services as well as The research instrument used in the first phase was
other expanded pharmacist-roles (e.g., medication therapy a questionnaire with pre-defined categories consisting of
management, immunization) in developed countries has pharmacist demographics, minor ailments encountered,
been successful17,18 yet these practices and the knowledge and their basis for the management of minor ailments.
of Filipino pharmacists on these roles have not been Questions were formulated based on known and published
investigated. The majority (77%) of Filipino pharmacists theme clusters on the management of minor ailments.3,5,9,20
practicing in a community setting,19 their experience The resulting questionnaire was validated among 10% of
and knowledge on the management of minor ailments the respondents. Respondents informed consent was sought
remain undocumented. A basis for the improvement and prior to interview.
development of community pharmacies as a competent and The first phase of the study served as the basis for
accessible health care facility to manage minor ailments the development of the final instrument, focusing on the
need to be established. four most common ailments encountered by community
To the best of our knowledge, this is the first study to pharmacists. The scope of the final instrument included
document the practices of Filipino community pharmacists demographics, questions on how the pharmacists managed
in managing minor ailments. The aim of this study was to the ailments (cough, colds, allergies, diarrhea) in terms
document the involvement of community pharmacists in of their knowledge about the ailment (patient history,
the management of minor ailments, their practices, and disease etiology) and their practices (medications dispensed,
perceived challenges in the provision of pharmacy service. counselling provided, non-pharmacologic interventions
Common minor ailments reported by the community recommended). Open-ended questions to uncover barriers
pharmacists were presented in this study. encountered by the pharmacists and their practices in the
management of minor ailments were also included.
METHODS Data collection was completed on sites visited, using a
guided structured interview instrument with the pharmacist-
Research Design on-shift that lasted for 45 to 60 minutes. Linkage with
This exploratory, descriptive study was conducted from the community pharmacy was established through
June 2015 – November 2015. The study was divided into written communication.
two phases. In the first phase (pre-evaluation), a guided
interview with structured questionnaire was employed to Data and Statistical Analysis
determine minor ailments encountered by community The frequency of responses were tallied and were
pharmacists in Cebu City. expressed as mean standard deviation and percentage (%)
The second phase of the study focused on the four where appropriate, using Microsoft ExcelTM. Conventional
most common ailments reported by the community content analysis was applied to responses for open-
pharmacists from the first phase. The second phase aimed ended questions in the qualitative study. Key thoughts
to establish the practices of pharmacists in the management were gathered from the raw data which were used in the

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derivation of codes. The frequency of the resulting codes by Table 2. Minor ailments encountered by community
category (consultation and medication dispensing practices, pharmacists in Cebu City (Pre-evaluation)
knowledge on ailment and its medication, patient behavior) Ailments Frequency (%)
were used to analyze the qualitative data. Cough 24 (80)
Colds 24 (80)
Ethical considerations Diarrhea 22 (73)
The study was approved by the University of San Carlos Allergy (dermatologic) 20 (66.6)
Institutional Ethics Review Committee (approval number: Constipation 17 (56.7)
001/07-15). Institutional approval from participating Sore throat 17 (56.7)
community chain pharmacy with written consent from Dehydration 15 (50)
the participating pharmacist were obtained prior to Fungal infection 14 (46.7)
commencement of the interview. Nausea & vomiting 14 (46.7)
Sore eyes 13 (43.3)
Limitations Dyspepsia 13 (43.3)
The study initially intended to document pharmacists Minor wounds 11 (36.7)
knowledge and practices in the management of minor
Asthma 10 (33.3)
ailments in several chain community pharmacies operating
Peptic ulcer 10 (33.3)
in Cebu City. However, only one community chain
Musculoskeletal pain 9 (30)
pharmacy agreed to participate in the study while other chain
Sunburn 8 (26.7)
community pharmacies declined for undisclosed reasons.

RESULTS In the management of colds, majority of the

pharmacists did not verify if patients had the ailment. Bed
Demographics of respondents rest (50%), physician visit (50%), along with phenylephrine
The community pharmacists (n=30), each representing + chlorpheniramine + paracetamol tablet preparation
a single community pharmacy situated in Cebu City, (53.3%) were recommended by the pharmacists.
participated in the study. Table 1 describes the profile For cough, majority of the pharmacists asked patients
of the respondents. Majority of the pharmacists were on the prior exposure that possibly led to the ailment.
females with a median age of 26. All of the respondents Community pharmacists recommended physician visit
completed the degree Bachelor of Science in Pharmacy. (66.7%) if the cough persisted for more than two weeks.
In addition, carbocisteine (76.7%) and guaifenesin (56.7%)
Table 1. Demographics of study participants capsules were dispensed to manage the cough.
Age (years) Mean 26.4 (SD=3.9) In the management of dermatologic allergies, 63.3% of
Range 21–40 the pharmacists did not verify if the patient had the ailment.
Gender Male 4 (13.3) Cetirizine (86.7%) and loratadine (73.3%) tablets were
Female 26 (86.7) the non-prescription medicines recommended.
Educational Bachelor of Science in Pharmacy 30 (100.0) For diarrhea, majority of the pharmacists inquired
attainment Advanced pharmacy specialty training 0 (0) patients on the frequency of defecation. Loperamide
Master of Science in Pharmacy 0 (0) capsules (100%) were recommended for management.
or equivalent There were no formularies used in the management
of minor ailments. The pharmacists dispensed non-
Minor ailments encountered by community prescription medicines which were appropriate based on
pharmacists in Cebu City the approved product indications.
Cough (80%), colds (80%), diarrhea (73%), and Consultation and medication dispensing practices
allergy (dermatologic, 66.6%) were the four most common of community pharmacists in Cebu are presented in
minor ailments encountered by community pharmacists Table 4. Half of the respondents dispensed medications
as documented during the first phase of the study. as requested by the patients without any intervention. A
Details are presented in Table 2. The four (4) ailments limited number of pharmacists (3 – 10 %) had the intention
reported by the pharmacists served as the basis for the to counsel patients on their medications and ailments.
common ailments used for the second phase in this study. Table 5 presents the knowledge of community
pharmacists on the four (4) minor ailments and medications
Knowledge and practices in the management of used for treatment.
minor ailments Majority (93%) of the pharmacists knew that “colds”
The practices of community pharmacist on the four is self-limiting and that drowsiness is an adverse effect of
most encountered ailments are presented in Table 3. colds medications.

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Table 3. Minor ailment management practices

Practices Frequency (%)
Colds Questions asked by pharmacist to verify if patients have colds
Asked patient on the duration of symptoms 6 (20)
Asked patient on the prior exposure that possibly led to the disease 2 (6.7)
Asked patient on the prior medications taken 2 (6.7)
None 20 (66.7)
Pharmacists’ advice
Bed rest 15 (50)
Physician visit 15 (50)
Multivitamins intake 2 (6.7)
Increase fluid intake 1 (3.3)
None 1 (3.3)
Non-prescription medicines dispensed by community pharmacist
Phenylephrine + chlorphenamine + paracetamol tablet preparation 16 (53.3)
Phenylephrine + paracetamol tablet preparation 6 (20)
Chlorpheniramine + paracetamol + phenylpropanolamine 3 (10)
Dextromethorphan + phenylpropanolamine + paracetamol 2 (6.7)
Ascorbic acid 2 (6.7)
Cetirizine 1 (3.3)
Cough Questions asked by pharmacist to verify if patients have cough
Asked patient on the duration of symptoms 12 (40)
Asked patient on the prior exposure that possibly led to the disease 26 (86.7)
Asked patient on the descriptive characteristics of phlegm 2 (6.7)
Asked patient on the presence of fever 2 (6.7)
Pharmacists’ advice
Increase fluid intake 4 (13.3)
Bed rest 2 (6.7)
Physician visit or health center visit (for possible referral to Directly Observed Treatment, Short Course – 20 (66.7)
Tuberculosis) if cough persists for more than 2 weeks
None 8 (26.7)
Non-prescription medicines dispensed by community pharmacist
Carbocisteine capsule 23 (76.7)
Guaifenesin capsule 17 (56.7)
Dextromethorphan + phenylephrine + paracetamol capsule 12 (40)
Butamirate tablet 15 (50)
Vitex negundo tablet* 1 (3.3)
Allergy Questions asked by pharmacist to verify if patients have allergy
(dermatologic) Asked patient on the duration of symptoms 2 (6.7)
Asked patient on the prior exposure (food) that possibly led to the disease 7 (23.3)
Asked patient on skin condition (i.e., color, sensation) 2 (6.7)
None 19 (63.3)
Pharmacists’ advice
Physician visit if symptoms persist 2 (6.7)
None 28 (93.3)
Non-prescription medicines dispensed by community pharmacist
Cetirizine tablet 26 (86.7)
Loratadine tablet 22 (73.3)
Hydroxyzine tablet 1 (3.3)
Diphenhydramine capsule 1 (3.3)
Zinc oxide ointment 1 (3.3)
Diarrhea Questions asked by pharmacist to verify if patients have diarrhea
Asked patient on the frequency of defecation 20 (66.7)
Asked patient on the food consumed 4 (13.3)
Asked patient on the duration of symptoms 3 (10)
Asked patient on the characteristics of the stool (i.e. consistency) 3 (10)
Pharmacists’ advice
Physician visit 2 (6.7)
Avoidance of fatty foods 2 (6.7)
None 26 (86.7)
Non-prescription medicines dispensed by community pharmacist
Loperamide capsule 30 (100)
Oral rehydration salts 3 (10)
Rehydration beverages 3 (10
Domperidone tablet 1 (3.3)
Bacillus clausii suspension 1 (3.3)
*standardized and Philippine FDA-approved herbal preparation

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Table 4. Consultation and medication dispensing practices of community pharmacist in Cebu

Practices Frequency (%)
Asked patient on the intention or use of the (patient) selected medicine 2 (6.7)
Asked patient on the disease and its symptoms 3 (10)
Verified patient knowledge on medication use 1 (3.3)
Provided medication counseling (patient-initiated) 3 (10)
Provided medication counseling (pharmacist-initiated) on instruction for use, dosage, interaction, and precautions 6 (20)
Dispensed patient’s self-selected medication (non-prescription) without intervention 15 (50)

Table 5. Knowledge on minor ailments and its medications

Statements/Questions Frequency (%)
Colds Is colds self-limiting?
Yes 28 (93.3)
No 2 (6.7)
Drug information on adverse effects provided by community pharmacist
Drowsiness and rebound nasal congestion (rhinitis medicamentosa) 28 (93.3)
None 2 (6.7)
Do you advise patients with non-pharmacologic intervention?
Yes 23 (76.7)
No 7 (23.3)
Cough What factors are known to cause cough?
Allergens 12 (40)
“Abrupt changes in weather” 12 (40)
Stress-induced 4 (13.3)
Colds 2 (6.7)
Do you ask patients’ type of cough (dry or productive)?
Yes 30 (100)
No 0
What medications do you recommend for productive cough?
Carbocisteine 23 (76.7)
Guaifenesin 17 (56.7)
What medications do you recommend for dry cough?
Dextromethorphan preparation 15 (50)
Butamirate 15 (50)
Drug information on adverse effects provided by community pharmacist
Dizziness and drowsiness 5 (16.7)
None 25 (83.3)
Do you advise patients with non-pharmacologic intervention?
Yes 25 (83.3)
No 5 (16.7)
Allergy What factors are known to cause allergy?
(dermatologic) Food 18 (60)
Pets 3 (10)
Dust 12 (40)
Medications 1 (3.3)
Drug information on adverse effects provided by community pharmacist
Drowsiness, dizziness 29 (96.7)
Burning sensation at site of application 1 (3.3)
Do you advise patients with non-pharmacologic intervention?
Yes 4 (13.3)
No 26 (86.7)
Diarrhea What factors are known to cause diarrhea?
Unhygienic food preparations 25 (83.3)
Contaminated water 5 (16.7)
Drug information on adverse effects provided by community pharmacist
Constipation 8 (26.7)
Nausea and vomiting 4 (13.3)
None 18 (60)
Do you advise patients with non-pharmacologic intervention?
Yes 18 (60)
No 12 (40)

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Nasal congestion (93%) as adverse effects for colds ailments. Notably, 73.3% of the pharmacists cited a “know-
medications were known to most pharmacists. it-all” behavior of the patients where they have self-selected
Forty percent (40%) of the pharmacists knew that medications prior to pharmacy visit and unconvinced of
allergens and “abrupt changes in weather” were factors pharmacists’ interventions. Moreover, pharmacists (50%)
known to be the cause of cough. All of the pharmacists relayed experiences of dispensing patient’s self-selected
were able to distinguish the type of cough along with the medication without intervention.
recommended medications for each type.
Sixty (60%) percent of the respondents knew that food DISCUSSION
was known to cause an allergic reaction and ninety-six
(96.7%) knew that drowsiness and dizziness were the adverse In health care delivery, the management of minor
effects associated with anti-allergy drugs. ailments and community pharmacists as a source of
Lastly, for diarrhea, unhygienic food preparation was treatment and advice offers numerous benefits to the
the main factor known to pharmacists that caused diarrhea. community. Minor ailments managed by a community
Majority of the pharmacists declared that the use of drugs for pharmacist could minimize physician visits, hospitalization
diarrhea was not associated (60%) with any adverse effects. and hospital readmissions, and emergency department visits
Our study revealed that community pharmacists entail economic, clinical and humanistic consequences.9
were knowledgeable about the causes of the minor The provision of minor ailment services in community
ailments as described in Table 5. Of note, pharmacist had pharmacies has long been established, implemented, and
a distinctive dispensing behavior on cough medications expanded in many countries. In developing countries,
wherein all of them were able to distinguish medicines challenges were reported and mitigation plans set to
intended for dry cough from productive cough. Moreover, implement these services. In Cebu City in the Philippines,
pharmacists were aware of the adverse effects of non- there are no documented reports of the role of the community
prescription medicines for colds, diarrhea, and skin pharmacists in the management of minor ailments.
allergy. Non-pharmacologic interventions, e.g., increase Cough, colds, diarrhea, and dermatologic allergies
fluid intake, bed rest and use of household remedies, were were the four most common ailments encountered by the
described in the management of cough and colds but none pharmacists in this study. They managed these ailments by
were recommended for skin allergy and diarrhea. recommending and dispensing non-prescription medicines
based on the approved product label indications. Our
Perceived challenges in the management of findings suggested that the pharmacists were generally
minor ailments knowledgeable on the medicines used in the management
Table 6 presents the challenges perceived by the of minor ailments.
community pharmacists in the management of minor Community pharmacists in the study intended but
ailments. Of the thirty respondents, twenty (66%) failed to verify patient ailments with questions on the
declared that there were no institutionalized guidelines on symptoms, duration, possible causes, and the intended use
management of minor ailments while ten (33%) attributed of “self-selected” medicines (Tables 3 and 4). Community
the presence of a “guideline” through their week-long pharmacists reported minimal execution of the ideal
in-house training prior to their field assignment. Moreover, dispensing practice.
no ailment-specific trainings were reported at the time of The management of minor ailments revolves around
investigation, to equip the pharmacists in the management three main components: consultation (information
of minor ailments. gathering or provision); counseling (self-care, lifestyle advise;
In terms of the perceived challenges in patient physician referrals); and dispensing (selection of medicine,
counseling, majority (93.3%) of the pharmacists identified quality use of medicines).6,17,21-25
the lack of available drug information tools (e.g., case- In this study, the role of the pharmacist in consultation
specific clinical guidelines, “practice-aid” mnemonics) in was underachieved. Patients displayed “passive-transactional”
the community pharmacy and 76.7% of them felt that behavior when purchasing medicines. This first step in
they had insufficient knowledge to execute the role of the pharmacist-patient encounter is critical on how the
drug information provider in the management of minor counseling step is performed.

Table 6. Perceived challenges in the management of minor ailments

Perceived challenges Frequency (%)
Lack of drug information tools (i.e., case-specific clinical guidelines, practice-aid mnemonics) 28 (93.3)
Lack of knowledge about the ailment and its pharmacotherapy 23 (76.7)
Patients unconvinced of pharmacists’ intervention 22 (73.3)
Lack of institutional guidelines in the management of minor ailments 20 (66%)
Passive dispensing secondary to dominating patient self-selection of medicines 15 (50)

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Pharmacists reported dispensing medicines and guidelines and skill-based trainings, the opportunity to
provided ailment-related advices only when patients sought engage patients and encourage discussion about their
for them. A noticeable gap observed in this study was that ailments and medications may be overlooked by the
pharmacists did not ask for whom the medications were pharmacist. The focus should then be shifted on upskilling
intended for. Community pharmacists were receptive to pharmacists to expand their role competently, by adapting
patient demands rather than initiating a pharmacist-driven institutional, perhaps national practice standards in the
medication choice in managing minor ailments. Patients management of minor ailments.
presented a pre-determined selection of medicines before This paper has its limitations. Not all intended
visiting the pharmacies (Table 4). Our findings suggest pharmacy chain outlets shared interest in this study. Hence,
that patient self-selection behavior dominates in the the findings of this study may not reflect other institutions
management of minor ailments in Cebu. This is clearly not or pharmacists practices in the management of minor
an ideal practice for pharmacist-patient engagement. ailments in Cebu, Philippines. Moreover, the veracity of
Patient self-selection is regarded as suboptimal the responses is beyond the control of the researchers.
with only 15% of them selecting the appropriate non- Appropriateness of the product for a specific case or patient
prescription medicines for their ailments.12,26 Moreover, condition were not evaluated since the data gathered were
patients lack medical knowledge about their condition solely based on the comprehensive experience of community
and its treatment which leads to many misconceptions pharmacists in the management of minor ailments (i.e. self-
about their medications.27 reports). This study serves as an important foundation in
While minor ailments are universally classified as developing guidelines and creating materials for training
uncomplicated and may be managed within a pharmacy aimed to provide clinical skills and knowledge to community
setting, physician referrals continue to be a common advice pharmacists. It is hoped that this study will invoke interest
to patients with cough and colds. These observations among pharmacy leaders, health policy makers, and
reflected two points: First, physician care are still sought for researchers in the academia to consider the opportunity
even for minor ailments; Second, pharmacists may either be to strengthen the role of community pharmacists in the
unaware of or not confident of their role in pharmacy-based management of minor ailments.
management of minor ailments.
Community pharmacists have experienced barriers CONCLUSION
and challenges in the management of minor ailments. In
this paper, pharmacists raised the need for tailored and Colds, cough, skin allergy, and diarrhea were the
accessible tools on drug information. Moreover, they cited four (4) most common ailments managed by community
the lack of confidence in their own clinical ability which pharmacists in one pharmacy chain in Cebu city.
could stifle the provision of these services. Alongside Community pharmacists were knowledgeable in dispensing
with these challenges, pharmacists had varying skill non-prescription medicines for minor ailments but had
levels in consultation. Pharmacists recommendations on underdeveloped consultation roles. The absence of clinical
minor ailments appeared to be non-specific and limited. guidelines, lack of ailment-specific training, insufficient
It is a fact that inconsistent information gathering leads clinical skills, and dominant patient self-selection
to inappropriate recommendations.28 However, with behavior contribute to the challenging pharmacist-patient
the use of appropriate tools and materials, pharmacists relationship in the management of minor ailments.
may obtain sufficient information needed in providing
pharmaceutical care for minor ailments. The implementation Acknowledgements
of training activities for minor ailment services has been The authors are grateful to the participating pharmacy
established as a valuable approach to advancing the quality chain and the pharmacists who contributed in this study.
of pharmaceutical care.29
This study bared important findings on the lack of Statement of Authorship
ailment-specific clinical guidelines, trainings, and several All authors contributed equally in this work. All
components of minor ailment services. authors participated in the data collection and analysis,
At the time of investigation, pharmacy-based minor and approved the final version of the manuscript.
ailment scheme is not yet a part of the national health
services in the Philippines. Likewise, management of minor Author Disclosure
ailments with non-prescription medicines is not a part of All authors declared no conflicts of interest.
most pharmacy curricula in the Philippines. The absence
of standardized tools will not only contribute to practice Funding Source
inconsistencies between pharmacists and other health care This study was fully funded by the University of San
providers, but may lead to variation in clinical practice Carlos – Research Office. The researchers did not receive
and appropriateness of care.25 Without definite practice any external funding.

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