**5. STARZ-DRP as a tool to attach GPs and CPs in the identical practice**

It is necessary to have a fundamental procedure to follow in advanced prior to execute the other extended services. The procedure should help out CPs to have an initial idea regarding each individual feature acquired via counseling session. In other words, it is crucial for CPs to make an accurate triage action plan as an earlier extended service based on the up-to-date information. For example, the idea to refer the customers to GPs for immediate medical attention should be the first in the sequence of making a triage action plan. Such ethical responsibilities might have potential to save the customers' life from inappropriate medication use. The following sequence is to help out CPs to make a medication therapy plan. It might involve CPs and customers to sit down and start to determine the ideal medication to alleviate the on-going minor ailments or maintain the current health status. Consequently, this sequence is magnifying the role of CPs as an adviser to the customers. The last sequence in a triage action plan is to help out CPs to assist their customers to experience the other extended pharmacy services which are available in community pharmacy settings as illustrated in **Table 2**. The main intention is to help out the customers to enhance their quality of life via CPs' knowledge and skills. Furthermore, the knowledge and skills might have potential to add on more value to an earlier medical treatment or else. As a consequence, it is critical for CPs to start out this triage action mode as a fundamental extended service in advance. Therefore, STARZ-DRP is picked up as the appropriate fundamental procedure to follow via experience in an earlier study [43]. Foremost, STARZ-DRP is helping out CPs to execute the role as the supreme medication protector via determining the drug-related problem (DRP) which might have potential to be the origin of actual or potential medical problem [50]. As a consequence, it is the opportunity for CPs to interact with GPs to discuss in detail about the DRP which might be experienced by the customers.

STARZ-DRP is a simple mnemonic to remember and it is initiated to make it easier for CPs to make an accurate triage action plan and distinguish the origins of DRP [50]. As illustrated in **Table 5**, the mnemonic integrates several words which are entitled to act as an action to

**Letter Description**

operate such extended services. Such working relationship might bring benefits to consumers at all. For example, it is notified in an earlier study which signifies that such relationship can be a service to superintend hypertension patients [47]. Additionally, it is noted that such relationship in managing more chronic diseases have been reflected in an earlier review article [9]. Nevertheless, such working relationship might have potential to summon misconception in the responsibilities of both parties as notified in an earlier study [48]. Therefore, it is necessary to initiate a constructive strategy to fortify such working relationship in the healthcare system [49]. The strategy formula must have a conceptual framework as a general guiding principle to make it easier for CPs to work side-by-side with GPs. For that reason, an instrument is known as STARZ-DRP put into operation as a course of action to enroll both healthcare providers into

GPs, general practitioners; CPs, community pharmacists; Aust, Australia; UK, United Kingdom; UAE, United Arab

CPs are not regarded as the best practitioner to advise GPs about the rationale medication use: Mal [31, 32]

**5. STARZ-DRP as a tool to attach GPs and CPs in the identical** 

It is necessary to have a fundamental procedure to follow in advanced prior to execute the other extended services. The procedure should help out CPs to have an initial idea regarding each individual feature acquired via counseling session. In other words, it is crucial for CPs to make an accurate triage action plan as an earlier extended service based on the up-to-date information. For example, the idea to refer the customers to GPs for immediate medical attention should be the first in the sequence of making a triage action plan. Such ethical responsibilities might have potential to save the customers' life from inappropriate medication use.

a strategy medical team [50].

GPs are favor of CPs to refer customers to them: Mal [31, 32]

CPs are not well trained to perform screening tests: Mal [31] GPs are favor of CPs to treat minor ailments: Mal [31, 32]

CPs' knowledge and skills are underutilized: Mal [32]

Customers appreciate extended services: Mal [33, 35]

CPs should involve in health promotion: Mal [32, 33, 35]

CPs are underestimated by GPs: Mal [31]

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Emirates; Mal, Malaysia; HK, Hong Kong.

GPs should listen to CPs about written prescriptions' issues: Mal [31, 32]

CPs are not well trained in clinical therapeutic knowledge: Mal [31]

CPs are potential to counsel about health screening: Mal [33, 35] CPs are the best practitioner to educate about medications: Mal [31, 32]

**Table 4.** Details of countries which indicate perception of extended pharmacy services.

**practice**


**#** This is not a diagnostic tool, rather it is a format with the purpose of organizing a community pharmacist's knowledge in a manner that allows him/her to begin identifying the actual and potential drug-related problems and subsequently referring triage patients to the appropriate healthcare professionals.

\* The patient's vital signs will be measured when necessary. At times, the patient's blood pressure, pulse rate, and body temperature are measured to aid the pharmacist in assessing the appropriateness of symptoms for self-medication.

**Table 5.** Definition of letters in STARZ #,\* .

**S Symptom presentation** refers to subjective evidence of health problem perceived by the patient


scrutinize customer features. CPs are necessary to act in the same direction while operating the appraisal via the tool and it is prohibited to ignore a single word in STARZ-DRP. For example, there is an inclination toward a particular word in STARZ-DRP such as 'A' since it

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**Figure 4.** Patient referral form.


**Figure 3.** Pharmacy self-care advice form.

scrutinize customer features. CPs are necessary to act in the same direction while operating the appraisal via the tool and it is prohibited to ignore a single word in STARZ-DRP. For example, there is an inclination toward a particular word in STARZ-DRP such as 'A' since it


**Figure 4.** Patient referral form.

**Figure 3.** Pharmacy self-care advice form.

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is not a conventional practice to assess such features. However, it is notified that such precise word might help CPs to determine critical signs and symptoms that require instant medical attention [51]. On top of that, CPs shall not fail to hit the single word is known as 'Z' in STARZ-DRP. Such a single word is the paramount importance to determine the origins of actual and potential drug-related problems. It has been notified in an earlier study regarding the potential of CPs to determine, counteract, and rectify drug-related problems [52]. In the authentic practice, the role to determine the origins of drug-related problems is the rightful possession of CPs. Furthermore, CPs are the supreme medication protector who are trained in superintending medication affairs in the healthcare system.

Additionally, STARZ-DRP acquires CPs to retain possession of customer features in a printed paper as illustrated in **Figure 3**. Subsequently, there is a potential to experience some issues like unable to track down the printed paper because it is not in its expected place or absence of a proper cabinet to put aside all printed papers. Therefore, in the near future, STARZ-DRP might have potential to be exercised via a softcopy version. Such a legible version might eliminate the issues as noted in advanced. As a consequence, STARZ-DRP is eligible for CPs who

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Foremost, STARZ-DRP acquires CPs to allocate a few moments in their life to interact with the customers in order to understand about their features. Failure to execute the moments might have potential to put an end to other extended services. Therefore, it is crucial for CPs to have motivating force to perform STARZ-DRP as a mode of action. In the scenario, the pharmaceutical association should take the responsibilities to convince the policymakers to enforce a regulation for CPs to make an accurate triage action plan for each customer. The policymakers should have absolute understanding that STARZ-DRP might have potential to benefit the customers at all.

Aftermost, CPs must allocate a space for a private conversation with their customers. It is necessary to have the private room in order to protect the information obtained via the conversation to be heard by other customers. Subsequently, it might have potential to ease the customers to voice out their features to CPs. As a consequence, CPs might have the opportu-

STARZ-DRP is a conceptual framework for CPs and it emerges from the concept of PC which acquires CPs to determine DRP among the customers who are on short- or long-term treatment. STARZ-DRP had been incorporated into an earlier study in order to look into its feasibility to be put into practice in non-hospital independent facilities [50]. Interestingly, the model is able to coach CPs to determine a wide range of DRP as well as help out CPs to initiate an accurate triage action plan. Consequently, the end result is bringing to the public attention about the competence of the model to be the course of actions for CPs in their on-going practice. Subsequently, the model is on the right track to reject the idea as a theoretical work. In general, STARZ-DRP is actually helping out CPs to market their critical accountability as a supreme medication protector in the healthcare system. In other words, CPs must make sure that each customer is accessible to a wide range of medications which its safety, effectiveness, quality, and cost-effective are protected. It might involve the customers who are on short- or long-term treatment. Consequently, the role might have potential to magnify the image of CPs in the healthcare system. Moreover, the model acquires CPs to be more responsible with each decision made. Therefore, the model is practical to be put into the on-going practice

Moreover, STARZ-DRP might have potential to help out CPs in Malaysia to market their position as a healthcare provider after CPs are taken into account as an entrepreneur for such a long time [3]. STARZ-DRP might show the way for CPs to determine the basic extended service

despite different languages, culture, and healthcare modus operandi.

might have an interest to sustain their authentic practice in up-to-date scenario.

nity to determine an appropriate triage action plan.

**7. Benefits via STARZ-DRP model**

STARZ-DRP has been initiated in a printed paper as illustrated in **Figure 3**. The main objective is to make easier for CPs to transcript the verbal data of customer features into a written version. Such a proceeding is to facilitate CPs to reminisce about earlier events when CPs counsel their customers during a follow-up session. Consequently, the proceeding might precipitate CPs to determine the successful result of the previous triage action plan. In other words, CPs might have to initiate another alternative triage action plan if the earlier blueprint disappoints to wipe out the origins of the medical and medication affair. In such authentic practice, a referral to GPs must be carried out using the form as illustrated in **Figure 4** in order to request for advanced medical examination or advice. Interestingly, CPs can put in writing about their earlier observation so that GPs will have some ideas about the customers.

An earlier study has pointed out that CPs' knowledge and skills to make a triage action plan are ameliorated after CPs emerged in a STARZ-DRP training [53]. Additionally, significant differences are noted in some of the knowledge and skills after weighing up the mean scores of preand post-training. Among the significant differences, the self-confidence to assess and determine individual features that acquire immediate medical attention or non-prescription medications are noted. As a consequence, it is an aspiration if CPs can determine STARZ-DRP as a potential mode of action to execute the initial extended service in community pharmacy settings.

Sincerely, such proceeding should be reimbursed with appropriate dollars as it takes CPs to perform their knowledge and skills to determine the triage action plan and origins of drugrelated problems. In addition, CPs have to spend their time to interact with their customers via the proceeding. Foremost, CPs should be adjudged as a supreme healthcare practitioner in determining all medication affairs in the healthcare system.
