h opposition from the Governmental sector and the media, a neutral position from the other stakeholders of the

Table 1. Policy content.

Table 2. Player table.

Figure 2. Current position map.

pharmaceutical supply chain and some medium to high support from its professional bodies and―the most promising―the citizens-patients-customers. A more comprehensive graphical presentation of the key players’ initial position, but also of the homogeneity of their interests and their grouping is being presented in the Coalition Map in Figure 3.

In the Greek community pharmacy environment we discern several opportunities, which should not be unleashed, but also many obstacles that have to cope with (Table 3).

The community pharmacies’ general strategies were therefore analyzed and connected to certain actions, thoroughly specialized and customized to address each key player position and power [Appendix 1].

Figure 3. Coalition map.

Table 3. Opportunities and obstacles.

The expected impact of the pharmacists’ general strategies, analyzed by each certain strategy and key player is presented in [Appendix 2]. The impact is considered as the shift in each player’s initial position and power, assuming that pharmacists’ certain actions as in [Appendix 1], will have a positive impact on key players’ future position and a modification in their power of intervention, so as to develop a more friendly policy environment.

Taking in consideration the stakeholders’ initial position from Table 2, a Future Position Map was constructed, expressing the shifts in the key players’ position (Figure 4).

As it is shown, in this graphical presentation, the pharmacists expected a significant positive shift in the future positions for all key players. More specifically, the Pharmacy sector expected the Government entities to mild their initial high opposite position to medium or low opposition, while non-mobilized positions of other key players to modified to low support and the majority of the pharmaceutical sector players to move to medium or high support. At the same time the pharmacy sector actions were expected to reduce the high power of intervention of the opposition players, while enhancing the power of the supporting players, as presented above in [Appendix 2].

We finally assessed in two given distinct time moments (December31, 2012 and June 30, 2013) the success of the pharmacy sector strategy implementation, concerning the degree in which it succeeded in accomplishing the expected impact. The results are presented in [Appendix 3], from where it is obvious that the initially expected impact proved to be very optimistic in the most of the implemented strategies. It’s worth noting that in the majority of the strategies have worsened or minimized their success ratio throughout the time in study.

4. Discussion

Community pharmacies traditionally have been acting as primary care service points, significantly contributing to the health of citizens not only in Greece, but worldwide [21] - [30] .

With the first stormy clouds over the health (and specially over the pharmaceutical) sector, due to initial austerity measures under the Economic Adjustment Programme for Greece [31] , community pharmacies turn to their National and Regional professional bodies, in order to preserve their scientific, financial and business interests. Though the reforms to modernize the health care sector were rather general in the MoU, its later in the 2010 reviews, unveiled the severe interventions to the pharmaceutical sector, with significant impact to the community pharmacies as well. Along with the Second Economic Adjustment Programme for Greece [2] and the Medium-Term Fiscal Strategy 2013-2016 [7] , the reforms in the Greek health System seem to focus mainly to the pharmaceutical supply chain (from production to community pharmacies) inducing heavy losses to their revenues and profits [6] [8] [32] . Also, the government’s drastic measures due to the obligation of the deregulation in the community pharmacies’ market, worsen the state of tension in the market [33] - [35] . All these, set in question the feasibility of the community pharmacies in Greece, so the formation of a strategic plan for the community pharmacies was therefore required [36] . The strategic goals set under the pressure of reaction to the initial reforms, could be seen as realistic, comprehensive and in accordance to the vision and mission of other

Figure 4. Future position map―all strategies.

European community pharmacists’ professional bodies, scientific publications and the PGEU [9] [24] [25] [37] - [50] .

But, as the research findings show, either the initially set strategies were at the wrong direction or the actions taken to implement them were inappropriate. Moreover, one can suggest that the shifting ability in either the position or the power of the most key players were over-estimated.

Similar misguided and unsuccessfully developed strategic plans, were also implemented before and in many other countries as well, but never with such a deviance from the initial goals and in such a limited time period [50] - [56] .

5. Conclusion

Concluding, on one hand, the community pharmacists proved not to have the ability and the experience to evaluate the current economic and health care environment, while on the other hand, they under-estimated the impact of troika meddling in the pharmaceutical policymaking and in the health sector cost-containment measures imposing.

Competing Interests

The authors declare that they have no competing interests.

Authors’ Contributions

AV: Designed the study, the study questionnaire, supervised the analysis and provided comments on the manuscript.

LS: Analyzed literature and participated in the data analysis.

GP: Made major contributions to the background and discussion section and provided comments on the manuscript.

All authors revised the manuscript critically for important intellectual content and approved the final version.

Funding Source

This work was partly funded by the University of Patras research budget.

Cite this paper

Athanassios Vozikis,Lina Stavropoulou,George P. Patrinos, (2015) Community Pharmacists’ Strategies in Greece: An Assessment of the Policy Environment and the Mapping of Key Players. Health,07,1560-1577. doi: 10.4236/health.2015.711170


  1. 1. Eurostat (2013) EU Unemployment Data. Brussels.

  2. 2. European Commission (EC) (2013) The Second Economic Adjustment Programme for Greece: Third Review. European Economy, Occasional Papers 159, European Commission, Directorate-General for Economic and Financial Affairs. Brussels.

  3. 3. World Health Organization (WHO) (2012) European Health Report. Geneva.

  4. 4. Kanellopoulou, S. (2013) Policies to Contain Public Pharmaceutical Expenditure by Acting Not Only on the Supply-Side but on the Demand Side as Well. Eurobank Economic Research, Greece Macro-Monitor, Focus Notes: Greece, Athens.

  5. 5. Hellenic Association of Pharmaceutical Companies (SFEE) (2012) The Pharmaceutical Market in Greece_Facts and Figures. Athens.

  6. 6. Foundation for Economic and Industrial Research (IOBE) (2013) Annual report for the Pharma-Industry 2012. Athens.

  7. 7. Ministry of Finance (MOF) (2013) Medium-Term Fiscal Strategy 2013-2016. Athens.

  8. 8. Hellenic Association of Pharmaceutical Companies (SFEE) (2013) A Trip without Compass. Athens. (In Greek)

  9. 9. Pharmaceutical Group of European Union (PGEU) (2012) Advancing Community Pharmacy Practice in Challenging Times, Annual Report 2012. Brussels.

  10. 10. Kanellopoulou, S. (2012) Health Sector Reforms and the Memorandum of Understanding. Eurobank Economic Research, Greece Macro-Monitor, Focus Notes: Greece, Eurobank Research, Athens.

  11. 11. Roberts, A., Benrimoj, S.I., Dunphy, D. and Palmer, I. (2007) Community Pharmacy: Strategic Change Management. McGraw-Hill Australia Pty Ltd, Sydney.

  12. 12. Gidman, W. (2010) Exploring the Impact of Evolving Health Policy on Independent Pharmacy Ownership in England. Springer Science & Business Media B.V., Netherlands.

  13. 13. McArthur, D. (2007) European Pharmaceutical Distribution: Key Players, Challenges and Future Strategies. Scrip Reports, Informa UK Ltd., London.

  14. 14. Mossialos, E. and Allin, S. (2005) Interest Groups and Health System Reform in Greece. West European Politics, 28, 420-444.

  15. 15. McMillan, S.S., Wheeler, J.A., Sav, A., King, A.M., Whitty, A.J., Kendall, E. and Kelly, F. (2013) Community Pharmacy in Australia: A Health Hub Destination of the Future. Research in Social and Administrative Pharmacy, 9, 863-875.

  16. 16. Reich, M.R. (1996) Applied Political Analysis for Health Policy Reform. Current Issues in Public Health, 2, 186-191.

  17. 17. Reich, M.R. and Cooper, D.M. (1996) PolicyMaker: Computer-Assisted Political Analysis (Software and Manual). PoliMap, Newton Centre.

  18. 18. Glassman, A., Reich, M.R., Laserson, K. and Rojas, F. (1999) Political Analysis of Health Reform in the Dominican Republic. Health Policy and Planning, 14, 115-126.

  19. 19. Mintzberg, H. (1994) The Rise and Fall of Strategic Planning. Free Press, New York.

  20. 20. Armstrong, M., Lewis, R., Blenkinsopp, A. and Anderson, C. (2005) The Contribution of Community Pharmacy to Improving the Public’s Health. Report 3: An Overview of the Evidence-Base from 1990-2002 with Recommendations for Action. Pharmacy Health Link and the Royal Pharmaceutical Society of Great Britain, London.

  21. 21. Kontozamanis, V., Mantzouneas, E. and Stoforos, C. (2003) An Overview of the Greek Pharmaceutical Market. European Journal of Health Economics, 4, 327-333.

  22. 22. Lluch, Μ.M. and Kanavos, P. (2010) Impact of Regulation of Community Pharmacies on Efficiency, Access and Equity. Evidence from the UK and Spain. Health Policy, 95, 245-254.

  23. 23. Pharmaceutical Group of European Union (PGEU) (2010) Providing Quality Pharmacy Services to Communities in Times of Change, Annual Report 2010. Brussels.

  24. 24. Pharmaceutical Group of European Union (PGEU) (2012) European Community Pharmacy Blueprint for Optimisation of Health Outcomes to Individual Patients and Value for Health Systems across Europe. Brussels.

  25. 25. Pharmacy Voice (2011) Community Pharmacy: A Blueprint for Better Health. London.

  26. 26. Pharmacy Voice (2012) Community Pharmacy: Our Prospectus for Better Health. Pharmacy Voice Limited, London.

  27. 27. Sainsbury’s Pharmacy (2013) The Wells Family Challenge: A Pharmacist First Approach. Collated and Evaluated by 2020 Health, Sainsbury’s Co., UK.

  28. 28. Twigg, J.M., Poland, F., Bhattacharya, D., Desborough, A.J. and Wright, J.D. (2013) The Current and Future Roles of Community Pharmacists: Views and Experiences of Patients with Type 2 Diabetes. Research in Social and Administrative Pharmacy, 9, 777-789.

  29. 29. Moullin, J.C., Sabater-Hernandez, D., Fernandez-Llimos, F. and Benrimoj, S.I. (2013) Defining Professional Pharmacy Services in Community Pharmacy. Research in Social and Administrative Pharmacy, 9, 989-995.

  30. 30. European Commission, EC (2010) The Economic Adjustment Programme for Greece, European Economy. Occasional Papers 61, European Commission, Directorate-General for Economic and Financial Affairs, Brussels.

  31. 31. OECD (2013) OECD Health Data 2013, OECD Health Statistics (Database). Paris.

  32. 32. Von der Schulenburg, G. and Hodek, J.M. (2008) Costs and Benefits of Pharmacy Regulation in Germany. Proceedings of the Workshop on Access to High Quality Pharmacy Services, Brussels, 15 October 2008.

  33. 33. Lluch, M. (2009) Are Regulations of Community Pharmacies in Europe Questioning Our Pro-Competitive Policies? Eurohealth, 15, 26-27.

  34. 34. Vogler, S., Arts, D. and Sandberger, K. (2012) Impact of Pharmacy Deregulation and Regulation in European Countries. Commissioned by Danmarks Apotekerforening (Association of Danish Pharmacies), Gesundheit Osterreich GmbH., Vienna.

  35. 35. Business Concept (2012) Pharmacy Feasibility Study. Business Concept Supply Chain, Athens. (In Greek)

  36. 36. Wiedenmayer, K., Summers, S.R., Mackie, A.C., Gous, G.S.A., Everard, M. and Tromp, D. (2006) Developing Pharmacy Practice: A Focus on Patient Care, Handbook—2006 Edition. World Health Organization, Department of Medicines Policy and Standards, Geneva, Switzerland in Collaboration with International Pharmaceutical Federation, The Hague.

  37. 37. Brown, D., Portlock, J., Rutter, P. and Nazar, Z. (2014) From Community Pharmacy to Healthy Living Pharmacy. Research in Social and Administrative Pharmacy, 10, 72-87.

  38. 38. Deloitte UK, CFHS (2013) Impact of Austerity on European Pharmaceutical Policy and Pricing: Staying Competitive in a Challenging Environment. Deloitte UK Centre for Health Solutions, London.

  39. 39. Department of Health, Social Services and Public Safety (DHSSPSNI) (2013) Making It Better through Pharmacy in the Community. Consultation on Proposals for a Five Year Strategy for Pharmacy in the Community, UK.

  40. 40. Giberson, S., Yoder, S. and Lee, M.P. (2011) Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the US Surgeon General, Office of the Chief Pharmacist, US Public Health Service, Rockville.

  41. 41. Pharmaceutical Group of European Union (PGEU) (2012) Sustainable European Community Pharmacies Part of the Solution. Brussels.

  42. 42. ABDA—Federal Union of German Associations of Pharmacists (2012) German Pharmacies Figures Data Facts. Berlin.

  43. 43. Bush, J., Langley, A.C. and Wilson, A.K. 2009) The Corporatization of Community Pharmacy: Implications for Service Provision, the Public Health Function, and Pharmacy’s Claims to Professional Status in the United Kingdom. Research in Social and Administrative Pharmacy, 5, 305-318.

  44. 44. Harrison, J., Scahill, S. and Sheridan, J. (2012) New Zealand Pharmacists’ Alignment with Their Professional Body’s Vision for the Future. Research in Social and Administrative Pharmacy, 8, 17-35.

  45. 45. Lindberg, K., Nicolini, D., Adolfsson, P., Bergamaschi, M., Delmestri, G., Goodrick, E. and Reay, T. (2008) Exploring the Globalized Face of Pharmacy. In: Academy of Management “The Questions We Ask”, Anaheim.

  46. 46. Perepelkin, J. and Manfrin, A. (2012) Pharmacist Service Provision and the Environment of the Community Pharmacy in Canada. Research in Social and Administrative Pharmacy, 8, e53-e54.

  47. 47. Doucette, R.W., Nevins, C.J., Gaither, C., Kreling, H.D., Mott, A.D., Pedersen, A.C. and Schommer, C.J. (2012) Organizational Factors Influencing Pharmacy Practice Change. Research in Social and Administrative Pharmacy, 8, 274-284.

  48. 48. NHS Lothian (2013) Pharmacy Strategy 2013-2016. Scotland.

  49. 49. Center for Health Services Management and Evaluation (CHESME) (2001) Expenditure on Pharmaceuticals and the Organizational and Operational Framework of Pharmacies in Greece and the EU. National and Kapodistrian University, Athens.

  50. 50. Co-Operatives Europe (2009) Mapping Exercise: Co-Operatives Working in the Pharmacy Sector in Europe, European Seminar: Cooperative Enterprises in the Pharmacy Sector, Opportunities & Challenges. European House of Co-Operatives, Brussels.

  51. 51. Eyeforpharma (2012) Austerity Agenda Increases Pressure on Pharma Companies to Adopt KAM for Managing Burgeoning Stakeholder Challenges. Eyeforpharma KAM Report 2011/2012, Eyeforpharma, FC Business Intelligence Ltd., London.

  52. 52. Kanavos, P., Vandoros, S., Irwin, R., Nicod, E. and Casson, M. (2011) Differences in Costs of and Access to Pharmaceutical Products in the EU. European Parliament’s Committee on Environment, Public Health and Food Safety, D.G. for Internal Policies, Policy Department, Economic and Social Policy, Brussels.

  53. 53. Manhattan Research (2012) Taking the Pulse? Pharmacists 2012: Pharmacist Market Trends. Manhattan Research, New York.

  54. 54. National Pharmacy Association (2012) Community Pharmacy Statistics 2012.

  55. 55. Sheppard, A. (2010) Generic Medicines: Essential Contributors to the Long-Term Health of Society, Sector Sustainability Challenges in Europe. IMS Health, London.

  56. 56. Schommer, C.J., Yusuf, A.A. and Hadsall, S.R. (2013) Market Dynamics of Community Pharmacies in Minnesota, US from 1992 through 2012. Research in Social and Administrative Pharmacy, 10, 217-231.


MoU: Memorandum of Understanding; SSFs: Social Security Funds; HPA: Hellenic Pharmaceutical Association; OMB: Pharmaceutical Industries; MHSS: Ministry of Health and Social Solidarity; MESP: Ministry of Employ- ment and Social Protection; MPDC: Ministry of Development & Competitiveness; MOF: Ministry of Finance.

Appendix 1. Strategy Table

Appendix 2. Strategy Impacts

Appendix 3. Strategy Impacts

Appendix 4. Research Questionnaire

1) To your opinion, what are the main goals associated with the community pharmacists’ implementation policy and define the priority for each of them (check the appropriate cell).

2) What are the mechanisms that the community pharmacists’ implementation policy (must) use to achieve the above mentioned goals? (Note, each mechanism must refer to a certain goal).

3) Please, identify all the players that might be affected by or might affect the community pharmacists’ implementation policy, and assess their position on the policy (check the appropriate cell).

4) Please, estimate how much power each particular player has over the outcome of the community pharmacists’ implementation policy debate (check the appropriate cell).

5) Please, fill in the Interests Table below by estimating each player’s level of interest in certain types of interest fields, concerning the community pharmacists’ implementation policy debate (use L (Low), M (Medium) or H (High)).

6) Please, identify the Strengths of the community pharmacists’ Sector (up to 5 Strengths).

7) Please, identify the Weaknesses of the community pharmacists’ Sector (up to 5 Weaknesses).

8) Please, identify and assess transitions that may present opportunities (Opportunities) to enhance the political feasibility of the community pharmacists’ implementation policy (up to 5 Opportunities).

9) Please, identify and assess transitions that may create significant obstacles (Threats) to enhance the political feasibility of the community pharmacists’ implementation policy (up to 5 Threats).


*Corresponding author.

Journal Menu>>