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Additional file 2. CHEERS Checklist (Consolidated Health Economic Evaluation Reporting Standards).

Additional file 3. TIDieR checklist

Additional file 1. TIDieR Checklist (Template for Intervention Description and Replication).

Additional file 4. Semi structured interview guide for community pharmacists

Additional file 5. Implementation factors

Additional file 2. Search strategies for the literature review

Additional file 1. Focus group discussion guide

Additional file 6. Example of completed facilitators database

Additional file 7. PRISMA diagrams and the results of the quality assessment process

Additional file 1. Details of the probabilistic sensitivity analysis.

University of Technology Sydney. Graduate School of Health. 𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Governments including the United Kingdom and Canada endeavour to optimise health care systems through investment in primary care reform. Community pharmacists are moving, encouraged by policy, to deliver self-care support in pharmacy. International studies indicate the role and scope of pharmacists in primary care could be expanded with clinical and economic savings. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: Chapter 1 presents a systematic review of randomized controlled trials evaluating self-management support interventions following the Cochrane handbook and PRISMA guidelines. Chapter 4 describes the qualitative research (a focus group with stakeholders, working meetings with general practitioners (GPs) to develop treatment pathways, and semi-structured interviews with community pharmacists) to co-design an Australian model minor ailment service (MAS) applicable to the Australian setting. Chapter 5 presents a protocol for a cluster-randomized controlled trial (cRCT) quantitatively evaluating the clinical, humanistic and economic effectiveness of MAS. MAS pharmacists were trained in treatment pathways pre-agreed with GPs and communication systems with GPs, and received monthly practice facilitator support. Control patients received usual pharmacist care (UC). Chapter 6 details the statistical analysis undertaken using modified Poisson regression. Chapter 7 details the cost utility analysis (CUA) conducted alongside the cRCT. Deterministic and probabilistic sensitivity analysis were performed. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: A theoretical model was developed providing structure to self-management in practice (Chapter 1). Chapter 4 presents the community pharmacy MAS model with the following elements: (1) In-pharmacy consultation, (2) treatment protocols on a technology platform (HealthPathways), (3) communication channels between pharmacy and GPs (HealthLink), (4) educational training, and (5) practice change support. Chapter 6 highlights findings from the cRCT. Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% confidence interval (CI)=1.07-2.11; p=0.018), and were 5 times more likely to adhere to referral, compared with UC patients (RR=5.08; 95%CI=2.02-12.79; p=0.001). MAS pharmacists were 2.6 times more likely to perform a clinical intervention (RR=2.62, 95%CI=1.28-5.38; p=0.009), compared with UC. MAS patients (94%) achieved symptom resolution or relief at follow up, while this was 88% with UC (RR=1.06; 95%CI=1-1.13; p=0.035). MAS patients had a greater mean difference in EQ-VAS at follow up (4.08; 95%CI=1.23-6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95%CI=0.75-1.28; p=0.89). The CUA revealed MAS as cost-effective. MAS patients gained an additional 0.003 QALYs at an incremental cost of AUD $7.14, compared to UC. The resulting ICER was AUD $2,277/ QALY. The probabilistic SA revealed ICERs between AUD -$1,150 and $5,780/ QALY. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Findings suggest MAS should be implemented within the Australian context. A series of recommendations are made including the development of self-care policy in Australia to provide a policy framework for MAS.

Refereed/Peer-reviewed The United Nations Sustainable Development Goal 5 to ‘achieve gender equality and empower all women and girls’ aims to eliminate all forms of discrimination against women and girls and ensure their full and effective participation in all spheres of life. In alignment with this, several key international initiatives are making progress towards gender equality in the pharmacy profession. The pharmacy profession must support women and accelerate the progress of women in leadership positions in pharmacy. International and national pharmacy professional bodies can play a critical role in fostering the change required to improve gender equality in all regions and countries. The ongoing development, evaluation and implementation of policies and initiatives are critical to a profession that is increasingly becoming feminised. Furthermore, there is an imperative to deeply understand the gender-based barriers and develop evidence-based strategies and solutions to support women in pharmacy leadership. There is extensive literature and research on gender inequality and its impact on leadership outside pharmacy which could be used strategically for the profession to develop its own evidence based strategic position. Robust initiatives are needed to ensure that women at all levels including women in pharmacy leadership are empowered and encouraged to participate in their profession. This commentary seeks to generate and contribute to the debate to ensure the profession is proactive and deliberate in tackling the challenges that have traditionally impeded women reaching leadership positions and several critical actions as next steps are proposed. Action is needed to improve gender equality in pharmacy leadership and a profession-wide discussion on ways to progress the above proposed actions is critically needed.