Background and Objective Self‐medication is associated with an important utilization of Over‐The‐Counter (OTC) analgesics. The medical outcome resulting from therapeutic options bypassing the physician prescription is a major issue. In that context, pharmacists are expected to play a crucial role. The main objective of this review was to analyse the state‐of‐the art of pharmacists' role in pain management self‐medication. Databases and Data Treatment An expert multidisciplinary group dedicated to self‐medication in pain was established. Selection of publications was performed from PubMedand EMBASE databases which was based on the use of “pain” and/or “self‐medication” and/or “self‐care” and/or “analgesics” and/or “painkillers” keywords, restricted to the past 10 years. Results A total of 480 papers were identified, 49 of which papers were considered relevant and finally kept for final discussion, on OTC pain management and pharmacist's role. Literature analysis demonstrates that OTC analgesics are generally safe when appropriately used. Risks associated with misuse or inappropriateness depend on patients’ vulnerability (elderly, pregnancy) or behaviour. Social cognitive theory‐based intervention and multimedia applications improve self‐medication but do not replace health care professional advice Pharmacists’ interventions may improve the benefits and safety of OTC analgesic medication, with a better management of pain. Conclusions Considering the heterogeneity of patients’ knowledge and behaviour reported worldwide, inappropriate use of OTC pain medication should not be underestimated. Community pharmacists are ideally placed to guide self‐medication or recommend a medical advice when needed. Embedding pharmacists in primary care pain management is essential and pharmacist‐led medication coupled with an appropriate training of pharmacy staffs should be encouraged. Significance Analgesics are widely used without prescription, all over the world. They represent the largest market of OTC drugs, with an overall benefit/risk ratio favourable when appropriately used. Because of potential individual risks associated to the ailment or to the patient's behaviour, pharmacists’ interventions have proven to optimize analgesic self‐medication, provided that pharmacy staffs are both available and more specifically trained. In the future, in pain management, especially self‐medication, pharmacists should play an increasing role and should be included in educational programmes and pain management guidelines.

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Background Underdiagnosis and undertreatment of chronic heart failure (CHF) are common in older patients, who are usually treated by general practitioners (GPs). In 2007, the French ICAGE study explored GPs’ attitudes to the management of this condition in older patients. Objectives To explore changes over time in GPs’ attitudes towards the management of CHF in patients aged ≥75 and to identify barriers to optimal management. Methods In 2015, we performed a qualitative study of 20 French GPs via semi-structured interviews and a thematic content analysis. The results were compared with the findings of a 2007 study. Results In 2015, the perceived barriers to diagnosis were the same as in 2007. Echocardiography was still the preferred diagnostic method but the GPs relied on the cardiologist to confirm the diagnosis. Many GPs were still unaware of the different types of CHF. In contrast, they reported greater knowledge of decompensation factors and the ultrasound criteria for CHF. They also prescribed a brain natriuretic peptide assay more frequently. Angiotensin-converting enzyme inhibitors and beta blockers were more strongly perceived to be core treatments. Few GPs initiated drug treatments and optimized dosages. Although patient education was never mentioned, the importance of multidisciplinary care was emphasized. Conclusion Our results evidenced a small recent improvement in the management of older patients with CHF. Appropriate guidelines and training for GPs, patient education and multidisciplinary collaboration might further improve the care given to this population.

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