© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 1041 Saudi Journal of Medical and Pharmaceutical Sciences Abbreviated Key Title: Saudi J Med Pharm Sci ISSN 2413-4929 (Print) |ISSN 2413-4910 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: http://scholarsmepub.com/sjmps/ Original Research Article Cross-Sectional Analysis of Current State of Arts and Community Pharmacists' Attitudes toward Value-Added Pharmacy Services in Bulgaria Stefan V. Balkanski 1* , Joana I. Simeonova 2 , Ivan G. Gitev 1 , Ilko N. Getov 3 1 Bulgarian Pharmaceutical Union, 36 Dragan Tsankov blvd., office B 602, floor 6, Sofia 1040 2 Faculty of Public Health, Department of Social Medicine, Мedical University – Sofia, 8 Byalo more str, 1527, Sofia 3 Faculty of Pharmacy, Department of Social Pharmacy, Мedical University – Sofia, 2, Dunav street, Sofia 1000 DOI: 10.36348/SJMPS.2019.v05i12.005 | Received: 02.12.2019 | Accepted: 09.12.2019 | Published: 11.12.2019 *Corresponding author: Stefan Ventzislavov Balkanski Abstract Value-added pharmacy services (VAPS) are not connected with traditional pharmacy activities and do not include services, related to dispensing of medicines and professional consultation. A cross-sectional study that included pharmacists working in the community pharmacies in Bulgaria was carried-out. The pharmacists` attitudes toward VAPS and an implementation of remuneration were studied. The most commonly offered VAPS were blood pressure (BP) measuring with confirmation of 67.4% of the respondents and blood glucose (BG) measuring - 12.9%, but 42.9% of the pharmacists were willing to provide the different VAPS. Most of the respondents (63.5%) did not support the idea of implementation of a fee for BP measuring, but 53.7% considered it is necessary to charge a fee for BG measuring. VAPS are proven to have added value from societal, healthcare and economic point of view, but additional remuneration should be provided. Keywords: Value-added pharmacy services, remuneration, pharmacists, community pharmacy, patient benefits Copyright @ 2019: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited. INTRODUCTION Value-added pharmacy services (VAPS) are additional to the traditional pharmacy activities that do not include dispensing of medicines and professional consultation. It is demonstrated that supplying VAPS can reduce the health system expenses, while inset added value to the pharmacists’ work [1, 2]. According to Porter “The value in healthcare is measured by the outcomes achieved, not the volume of services delivered” [3]. He also determines the value in healthcare as the ratio of the health outcomes achieved for the amount of money spent [4]. According to Moullin, offering value-added pharmacy services correlates to more effective medical treatment, improvement of health outcomes and an opportunity to carry out an overall assessment of the health of the patient [5]. The great administrative pressure that the pharmacist is exposed to is a growing topic of discussion and becomes very important. Pharmacists should be able to carry out much more activities other than dispensing medicinal products and other health goods. Typical examples are monitoring and optimization of the medicinal use, monitoring of the effects of therapy, activities related to additional services in the pharmacy, etc [6]. Pharmacists spend 68% of the working time dispensing medicinal products [7], with a possibility of even bigger percentages in Bulgaria. Roe [23] points out that the big pressure on pharmacists to dispense medicinal products as quickly as possible limits their time to discuss with the patient potential medicinal product interactions, adverse reactions and drug-related problems. Developed countries show a clear trend and practice, in which the pharmacy actually has the functions of a health establishment, facilitating the access of the patient to health professionals. Over the recent years, there has been a rise in the amount of introduced pharmacy services in various countries around the world. Professional advice and additional services provided in pharmacies are becoming increasingly important [8-10]. A major goal of most professional pharmaceutical organizations is to change the attitude